Average Monthly Cost Research Articles

Energy Management System for an Industrial Microgrid Using Optimization Algorithms-Based Reinforcement Learning Technique

The climate crisis necessitates a global shift to achieve a secure, sustainable, and affordable energy system toward a green energy transition reaching climate neutrality by 2050. Because of this, renewable energy sources have come to the forefront, and the research interest in microgrids that rely on distributed generation and storage systems has exploded. Furthermore, many new markets for energy trading, ancillary services, and frequency reserve markets have provided attractive investment opportunities in exchange for balancing the supply and demand of electricity. Artificial intelligence can be utilized to locally optimize energy consumption, trade energy with the main grid, and participate in these markets. Reinforcement learning (RL) is one of the most promising approaches to achieve this goal because it enables an agent to learn optimal behavior in a microgrid by executing specific actions that maximize the long-term reward signal/function. The study focuses on testing two optimization algorithms: logic-based optimization and reinforcement learning. This paper builds on the existing research framework by combining PPO with machine learning-based load forecasting to produce an optimal solution for an industrial microgrid in Norway under different pricing schemes, including day-ahead pricing and peak pricing. It addresses the peak shaving and price arbitrage challenges by taking the historical data into the algorithm and making the decisions according to the energy consumption pattern, battery characteristics, PV production, and energy price. The RL-based approach is implemented in Python based on real data from the site and in combination with MATLAB-Simulink to validate its results. The application of the RL algorithm achieved an average monthly cost saving of 20% compared with logic-based optimization. These findings contribute to digitalization and decarbonization of energy technology, and support the fundamental goals and policies of the European Green Deal.

Disparity in Guideline-Based Antidiabetic Drugs Prescribing for Type 2 Diabetes Patients in Primary Healthcare Facilities Across China, 2017-2019.

The purpose of this study is to evaluate the pattern, appropriateness, and cost of antidiabetic drugs prescribed for patients with Type 2 diabetes at primary healthcare facilities (PHFs) in China. We collected outpatient-visit prescriptions from 363 PHFs in 31 cities covering eastern, central, and western regions of China. The visits of adult patients with Type 2 diabetes diagnosis were collected and classified the antidiabetic medication pattern of each patient use as recommended or non-recommended according to Chinese guidelines. We then calculated the proportion of guideline-recommended patterns and the average monthly cost for each pattern, overall and by region. Of 33 519 prescriptions for Type 2 diabetes, most (73.9%) were for guideline-recommended antidiabetic treatments. The proportion of guideline-recommended prescriptions varied by region (eastern [75.9%], central [87.5%], and western [59.7%]). Metformin monotherapy was the most common guideline-recommended treatment in all three regions (eastern [20.1%], central [28.0%], and western [24.6%]). The most common non-guideline-recommended treatments were monotherapy of insulin (eastern [16.5%], central [5.1%], and western [25.7%]) and traditional Chinese antidiabetic medicines (eastern [5.6%], central [5.7%], and western [11.1%]). The average monthly costs were lower for guideline-recommended treatments compared to non-recommended treatments in all regions (eastern [13.6 ± 15.4 USD vs. 28.1 ± 22.0 USD], central [9.8 ± 10.9 USD vs. 28.7 ± 19.4 USD], and western [17.9 ± 21.4 USD vs. 30.3 ± 23.6 USD]). The majority of patients with Type 2 diabetes received guideline-recommended antidiabetic medications at PHFs in China, with only half of the prescriptions containing guideline-recommended metformin. Utilization of guideline-recommended therapies differed across regions. Tailored interventions to promote evidence-based antidiabetic prescribing are urgently needed, especially in the undeveloped western region.

Adherence to oral anticoagulants in patients with non-valvular atrial fibrillation: the role of patients’ characteristics and out-of-pocket payments

ABSTRACT Background Recent practice guidelines favor direct oral anticoagulants (DOACs) over warfarin for primary stroke prevention in patients with non-valvular atrial fibrillation (NVAF). However, challenges persist in Iraq’s private pharmaceutical sector. DOACs have been sold at high and inconsistent retail prices and lack insurance coverage, leading to significant out-of-pocket (OOP) costs. The objective of this study is to investigate the impact of OOP costs on oral anticoagulants (OAC) adherence among NVAF patients. Research design and methods This multicenter cross-sectional study interviewed 359 eligible patients attending three private cardiology clinics within Iraq’s southern region from December 2022 to February 2023. The 8-item Morisky Adherence Scale evaluated patient adherence. Statistical analyses, including descriptive analysis, ANOVA, and chi-square. p < 0.05 was considered statistically significant. Results The most frequently prescribed OAC were DOACs (62.8%). Patient adherence level to OAC was chiefly medium (54.6%) with no significant difference in adherence based on OAC type. Patient adherence was significantly associated with monthly income (p = 0.001), number of daily pills (p = 0.006), and OACs’ average monthly cost (p = 0.011). Conclusion Addressing the issue of cost-related non-adherence to OACs requires multiple actions. These include ensuring comprehensive health insurance coverage for OACs, increasing the use of affordable generic alternatives, and establishing effective cost-related discussions between healthcare providers and patients.

Cost of Care for Non-communicable Diseases: Which Types of Healthcare Providers are the Most Economical in India's Chhattisgarh State?

Non-communicable diseases (NCDs) affect a large number of people globally and their burden has been growing. Healthcare for NCDs often involves high out-of-pocket expenditure and rising costs of providing services. Financing and providing care for NCDs have become a major challenge for health systems. Despite the high burden of NCDs in India, there is little information available on the costs involved in NCD care. The study was aimed at finding out the average monthly cost of outpatient care per NCD patient. The average cost was defined as all resources spent directly by government and citizens to get a month of care for a NCD patient. The cost borne by the government on public facilities was taken into account and activity-based costing was used to apportion it to the function of providing outpatient NCD care. For robustness, time-driven activity-based costing and sensitivity analyses were also performed. The study was conducted in Chhattisgarh State and involved a household survey and a facility survey, conducted simultaneously at the end of 2022. The surveys had a sample representative of the state, covering 3500 individuals above age of 30 years and 108 health facilities. The average monthly cost per NCD patient was Indian Rupees (INR) 688 for public providers, INR 1389 for formal for-profit providers and INR 408 for informal private providers and they managed 53.5, 34.3 and 12.0% of NCD patients respectively. The disease profile of patients handled by different types of providers was similar. The average cost per patient was lowest for the primary care facilities in the public sector. The average direct cost of NCD care for government and citizens put together was substantially higher in case of formal for-profit providers compared with public facilities, even after taking into account the government subsidies to public sector. This has implications for allocative efficiency and the desired public-private provider mix in health systems.

Evaluation of the management of hypertension among stroke patients in a neurology department of Côte d'Ivoire

Reducing blood pressure after stroke is important to prevent recurrent stroke, but we have no data about the control of blood pressure in our context. The purpose of this study was to assess management of hypertension among post-stroke patients in a neurology department. It was a retrospective study involving hypertensive stroke patients. They were followed up at 1, 3, 6 and 12 months after discharge. 141 patients fulfilled the inclusion criteria. The mean age was 61 years. Almost all patients (94.3%) received a dual antihypertensive therapy combining mainly an ACE inhibitor and a diuretic (70.2%). During follow-up, only 76 patients were assessed at M1, 50 at M3, 44 at M6 and 42 at M12. The average monthly cost of antihypertensive treatment was 13,771 CFA francs (21 euros). Non-adherence to antihypertensive medication were mostly noted in widows, patients without occupation, those with low education and no health insurance. At one year, blood pressure was controlled in 80% of the 42 patients still present. Non-control of blood pressure was related to poor therapeutic compliance (p<0.05). This study highlights follow-up issues in hypertensive post-stroke patients with a high number of lost to follow-up. Blood pressure was controlled in patients who were regularly followed and adherent to antihypertensive treatment.

A GIS-Based Top-Down Approach to Support Energy Retrofitting for Smart Urban Neighborhoods

Energy and environmental challenges are a major concern across the world and the urban residential building sector, being one of the main stakeholders in energy consumption and greenhouse gas emissions, needs to be more energy efficient and reduce carbon emissions. While it is easier to design net zero energy homes, existing home stocks are a major challenge for energy retrofitting. Two key challenges are determining the extent of retrofitting required, and developing knowledge-based effective policies that can be applied en-masse to housing stocks and neighborhoods. To overcome these challenges, it is essential to gather critical data about qualities of existing buildings including their age, geo-location, construction type, as well as electro-mechanical and occupancy parameters of each dwelling. The objective of this study was to develop a GIS-based model embedded with critical data of residential buildings to facilitate evidence-based retrofit programs for urban neighborhoods. A model based on a bottom-up approach was proposed in which information gathered from all stakeholders was inputted into one database that can be used for decision-making. A geo-located case study to validate a proposed GIS-based residential retrofitting model sample size of 74 residential buildings in the city of Riyadh was statistically analyzed and used. The results indicate behavior-based patterns, with a strong positive correlation (r = 0.606) between the number of occupants and number of household appliances, while regression analysis showed high occupancy rates do not necessarily result in high utility costs at the end of the month, and there is no statistical difference in the average monthly cost of gas between partial and fully occupied houses. Furthermore, neither the type of building, height, age, nor occupancy status play a significant role in the average energy consumed. Additionally, the GIS-based model was validated and found to be effective for energy-use mapping and gathering critical data for analyzing energy consumption patterns at neighborhood scale, making it useful for municipalities to develop effective policies aimed at energy efficient and smart neighborhoods, based on a recommended list of most effective energy-saving retrofit measures.

Direct treatment cost of patients with psoriatic arthritis disease covered by the social health insurance at the National Hospital of Dermatology and Venereology from 2021 to 2022

Objective: Estimate the direct medical costs of treating psoriatic arthritis (PsA), including in-patient and out-patient treatment costs. Methods: The retrospective study follows a prevalence-based approach, collecting all patients with PsA undergoing treatment at the National Hospital of Dermatology and Venereology from July 1, 2021 to December 31, 2022. Data collected included demographic characteristics and costs covered by the social health insurance (SHI). Results: Among the 74 patients included in the study, 64 patients received outpatient treatment, eight patients received both outpatient and inpatient treatment, and two patients received inpatient treatment only. The average monthly cost of outpatient treatment was 1.7 ± 2.2 million VND, with an average of 0.7 ± 0.3 outpatient visits per month. The average cost for an inpatient treatment session was 6.8 ± 6.2 million VND, with an average duration of 16.2 ± 20.9 days. Conclusions: We have analyzed the economic burden of PsA from SHI perspective and shown medication costs accounted for the highest proportion of expenses in all cost categories. Keywords: Direct medical costs, Health insurance, Psoriatic arthritis

P1190 Inflammatory Bowel Disease Treatment Economics: Assessing the Financial Ramifications and Striving for Healthcare Equity

Abstract Background Inflammatory Bowel Disease (IBD) has emerged as a public health challenge. In addition to the health effects on patients, IBD also carries a significant economic impact. The diagnosis, treatment, and follow-up of IBD entail considerable costs for both patients and the healthcare system. Therefore, understanding the economic impact of this disease is crucial for making informed decisions about its management and resource allocation. The aim of this study was to determine the short-term (one month) and long-term (twelve months) economic impact of medical care and surgical treatment in patients diagnosed with IBD at a tertiary-level hospital in Mexico. Methods A retrospective study was conducted, which included 118 patients diagnosed with IBD and treated at the IBD Clinic of the "Dr. Eduardo Liceaga" General Hospital in Mexico over the past 12 months. The economic impact of both medical treatment (conventional and biological) and surgical treatment in managing IBD was evaluated. For the calculation of medical treatment costs, the unit costs of medications were based on maximum retail prices at a conventional pharmacy. Surgical treatment costs were based on the hospital's provided costs. Individual costs for each patient were recorded and tabulated, and the total cost for each treatment regimen was calculated at one and twelve months. Descriptive statistical methods were used to analyze the data to obtain measures of central tendency and dispersion. Results The average monthly cost of medical treatment for a patient with IBD is estimated to be $11,612.45 Mexican pesos (MXN), resulting in a total cost of $139,349.40 MXN over 12 months. Considering all our patients, the total cost of medical care reaches $16,443,229.20 MXN in 12 months. Regarding surgical treatment, there is an average cost of $626,847.45 MXN per surgical event in patients with IBD. The total cost of surgical treatment for our IBD patients, encompassing a total of 24 patients, amounts to $15,043,379 MXN. Therefore, medical treatment appears to be more cost-effective compared to surgical treatment (the total cost of medical treatment for the 121 patients over one year is $16,443,229.20 MXN, while the total cost of surgical treatment for the 24 patients is $15,043,379 MXN). In our institution, 95% of the IBD Clinic patients receive free medical care. This represents significant cost savings for patients. Conclusion This study provides evidence regarding the economic impact of medical and surgical treatment in patients with IBD. The results support the consideration of medical treatment as the more cost-effective option while emphasizing the significance of free medical care in improving equitable access and alleviating the financial burden on patients and their families.

Potable Water Purification Costs of Urban People: A Cross-Income Group Analysis in Greater Mirpur, Dhaka

This research examines the economic implications of water purification in urban areas of Dhaka, where foul odors and potential pathogens, have led many residents to use various water purification methods. The study aims to investigate the additional costs incurred by households for water purification and how these costs vary across income groups. Data was collected from households of different thanas in the Greater Mirpur area through structured and semi-structured questionnaires. The findings show that although 89% of households rely on water delivered by the Water Supply and Sewerage Authority (WASA), only 28% have access to clean water. Water purifiers, especially manual ones, are popular choices for water purification. The average monthly cost of water purification was found to be 331 BDT, with considerable variation based on income. Unilever was the most popular brand of water purifier, although a significant proportion of respondents selected their purifier randomly. The study highlights the urgent need for improved water quality management and treatment, particularly for low-income residents, and the importance of raising awareness about different water purification brands and their efficacy. While the research gives helpful information into the water purification practices of city’s households, certain limitations, such as its limited geographic scope and sample size, should be considered. Nevertheless, this research provides a foundation for understanding the economic challenges of water purification and encourages further research into these pressing issues.

Healthcare judicialization: an analysis of indicators and official data on medications.

to analyze judicial demands for medications in Campo Grande, Brazil, between July 2018 and June 2020. the four dimensions of the Manual of Indicators for Evaluation and Monitoring of Judicial Demands for Medications were examined. 676 judicial processes were identified, corresponding to 1006 requests for 284 different medications. In 92.74% of the processes, access to medications was granted, with 88.80% granted on an urgent basis. The median time between the decision and delivery of the medication was 146 days. The average monthly cost of acquiring medications was R$ 2,183.68 Brazilian reais. Among the identified medications, 90.22% had at least one therapeutic alternative available in the public healthcare system. characterizing and analyzing judicial demands related to medications can support discussions on updating medication lists and clinical protocols, organizing healthcare services, allocating resources, and implementing actions to reduce judicialization.

Development and Pilot Implementation of Neotree, a Digital Quality Improvement Tool Designed to Improve Newborn Care and Survival in 3 Hospitals in Malawi and Zimbabwe: Cost Analysis Study.

Two-thirds of the 2.4 million newborn deaths that occurred in 2020 within the first 28 days of life might have been avoided by implementing existing low-cost evidence-based interventions for all sick and small newborns. An open-source digital quality improvement tool (Neotree) combining data capture with education and clinical decision support is a promising solution for this implementation gap. We present results from a cost analysis of a pilot implementation of Neotree in 3 hospitals in Malawi and Zimbabwe. We combined activity-based costing and expenditure approaches to estimate the development and implementation cost of a Neotree pilot in 1 hospital in Malawi, Kamuzu Central Hospital (KCH), and 2 hospitals in Zimbabwe, Sally Mugabe Central Hospital (SMCH) and Chinhoyi Provincial Hospital (CPH). We estimated the costs from a provider perspective over 12 months. Data were collected through expenditure reports, monthly staff time-use surveys, and project staff interviews. Sensitivity and scenario analyses were conducted to assess the impact of uncertainties on the results or estimate potential costs at scale. A pilot time-motion survey was conducted at KCH and a comparable hospital where Neotree was not implemented. Total cost of pilot implementation of Neotree at KCH, SMCH, and CPH was US $37,748, US $52,331, and US $41,764, respectively. Average monthly cost per admitted child was US $15, US $15, and US $58, respectively. Staff costs were the main cost component (average 73% of total costs, ranging from 63% to 79%). The results from the sensitivity analysis showed that uncertainty around the number of admissions had a significant impact on the costs in all hospitals. In Malawi, replacing monthly web hosting with a server also had a significant impact on the costs. Under routine (nonresearch) conditions and at scale, total costs are estimated to fall substantially, up to 76%, reducing cost per admitted child to as low as US $5 in KCH, US $4 in SMCH, and US $14 in CPH. Median time to admit a baby was 27 (IQR 20-40) minutes using Neotree (n=250) compared to 26 (IQR 21-30) minutes using paper-based systems (n=34), and the median time to discharge a baby was 9 (IQR 7-13) minutes for Neotree (n=246) compared to 3 (IQR 2-4) minutes for paper-based systems (n=50). Neotree is a time- and cost-efficient tool, comparable with the results from limited similar mHealth decision-support tools in low- and middle-income countries. Implementation costs of Neotree varied substantially between the hospitals, mainly due to hospital size. The implementation costs could be substantially reduced at scale due to economies of scale because of integration to the health systems and reductions in cost items such as staff and overhead. More studies assessing the impact and cost-effectiveness of large-scale mHealth decision-support tools are needed.

Pre- and post-surgical evaluation of the impact on Hansen disease sequealae patients’ quality of life submitted to orthopedic surgery for closure of chronic plantar ulcers

IntroductionLeprosy is a chronic infectious disease that still persists as a public health problem in Brazil. Plantar ulcers are serious complications due to leprosy neuropathy and intensify the isolation and stigma of these individuals. The difficulty in closing these lesions associated with the fetid odor negatively impact the quality of life of people with these lesions. Objective: To evaluate the clinical, socioeconomic conditions, degree of satisfaction and quality of life (QoL) of patients after healing of chronic ulcers on feet submitted to orthopedic surgery. MethodologyThis is a qualitative, exploratory, descriptive and observational study carried out with 92 people after surgical treatment of chronic leprosy plantar ulcers. These patients were submitted to a semi-structured questionnaire raising questions of an epidemiological, socioeconomic and perception of quality-of-life order, comparing before and after the surgical procedure. ResultsDecrease in indicators - alcohol consumption, tobacco consumption, average monthly cost of analgesic medications, fetid wound odor, foot pain and number of dressings performed weekly; Recurrence of lesions in 55.4 % of cases, related to irregular use or lack of shoes and insoles; Improvement in self-perception of Quality of Life (QoL) in 89.1 % of patients after surgery. ConclusionOrthopedic surgical treatment with resection of plantar bony prominences and skin grafting is an effective therapeutic method for closing chronic plantar ulcers in leprosy, resulting in a decrease in the financial costs employed and in an important improvement in the Quality-of-Life parameters of the individuals undergoing to this procedure. The availability and regular use of shoes and insoles is crucial to prevent recurrence of these injuries.

Estimation of life expectancy and healthcare cost in rheumatoid arthritis patients with and without depression: a population-based retrospective cohort study.

This study aimed to estimate the lifetime healthcare costs and loss of life expectancy (loss-of-LE) among patients with incident rheumatoid arthritis (RA) with and without depression. This 18 years longitudinal cohort study used data from Taiwan's National Health Insurance Research Database. In total, 43,311 patients with RA were included. Among them, 1,663 patients had depressive disorders in the year preceding the RA diagnosis. The survival function for patients with RA with or without depression was estimated and extrapolated over a lifetime using the rolling extrapolation algorithm. The loss-of-LE was calculated by comparing the sex, age, and calendar year-matched referents from vital statistics. The average monthly cost was calculated as the sum of the monthly costs for all patients divided by the number of surviving patients. Lifetime healthcare costs were estimated by multiplying the monthly average cost by the monthly survival probability. The loss-of-LE for RA patients with and without depression was 5.60 years and 4.76 years, respectively. The lifetime costs of RA patients with and without depression were USD$ 90,346 and USD$ 92,239, respectively. However, the annual healthcare costs were USD$ 4,123 for RA patients with depression and USD$ 3,812 for RA patients without depression. Regardless of sex or age, RA patients with depression had higher annual healthcare costs than those without depression. Patients with RA and depression have a high loss-of-LE and high annual healthcare costs. Whether treating depression prolongs life expectancy and reduces healthcare costs warrants further investigation.

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.

The Financial Cost of Managing Menstrual Hygiene in Schools in the Health District of Bla in Mali

Introduction: Many women and girls face financial challenges in meeting their menstrual hygiene management needs. The main objective of this study is to estimate the financial cost of menstrual hygiene management among school-going girls. Methodology: This is a prospective study carried out in a semi-urban school environment at the Public High School in the health district of Bla in 2020. Results: This study was conducted among 125 high school girls with no income. The average age was 18 years old. Parents lived in rural areas with no fixed monthly income in 52% of cases. Multipurpose pieces of cloth were the protective material used in 67% of cases. The girls explained this choice in 100% of cases by the high cost of single pads and tampons. The average monthly cost of menstrual hygiene management was 0, 56 $ or 6, 67 $ per year with extremes of 0, 16 and 2, 45 $ per month. This amount was used to buy either single-use pads or soap for body care and multiple-use pads. This financial cost was covered at 92% by female support (mother, aunt, sister); male support (father, spouse) accounted for only 8%. Conclusion: This study made it possible to estimate the average annual financial cost of menstrual hygiene management among young school girls in Bla. These findings call for further studies to better understand the financial implications of menstrual hygiene management in low-resource settings.

Genitourinary Radiation Injury Following Prostate Cancer Treatment: Assessment of Cost and Health Care System Burden

To evaluate the healthcare resource impact of radiation injury following prostate cancer treatment. Using IBM MarketScan, we performed a retrospective study of men with prostate cancer who were treated with radiotherapy and subsequently developed low-grade (LGRI) and high-grade radiation injury (HGRI). Radiation injury diagnoses includedbladder neck stenosis, hematuria/cystitis, fistula, ureteral stricture, and incontinence. LGRI and HGRI included injury diagnosis without intervention and with intervention, respectively. Health care visits and costs were measured over 5 time periods including2 years before radiation, 1 year before radiation, radiation to injury diagnosis, injury diagnosis to first intervention (LGRI), and following first intervention (HGRI). Negative binomial regression modeling was used to assess the effect of radiation injury on average cost adjusting for demographics and comorbidities. Between 2008 and 2017, we identified 121,027 men who received radiotherapy following prostate cancer diagnosis of which 10,057 (8.3%) experienced aHGRI. The frequency of urologic visits and average costs were similar in those without injury and LGRI. However, men with HGRI experienced higher visit frequency and monthly costs. Amongst high-grade injuries, urinary fistula had the highest frequency of visit utilization at 378 visits before first intervention and 245 visits after first intervention. Following radiation injury diagnosis, the average monthly cost was twice as high in those with HGRI ($85.78) compared to LGRI ($38.66). HGRI was associated with increased urologic health care use and average monthly cost when compared to those who experienced LGRI or no injury. Urinary fistula was associated with the largest resource burden.

Betahistine Prescribing Practices in England: An Analysis of Prescribing and National Spending Pre- and Post-BEMED Trial.

Betahistine has not been proven to be superior to placebo in the BEMED study, a multicenter, double-blind, randomized, placebo controlled trial. Our study aimed to establish the prescribing practices of clinicians in England in relation to betahistine and to assess if there has been any change in prescribing practices since the publication of the BEMED trial. Retrospective study and clinician survey. All patients who were prescribed betahistine from primary care. Total quantity of betahistine prescribed and total actual cost. The average total monthly quantity prescribed was 11,143,253 tablets (range, 10,056,516-12,276,423). Prescribing did not decrease from the period before (January 2014-February 2016) to after (February 2016-February 2021) the publication of the BEMED trial, with the average monthly prescribing before publication being 11,294,848 tablets (range, 10,280,942- 12,276,423) and the average monthly prescribing after publication being 11,081,123 tablets (range, 10,056,516-11,915,707). The average actual monthly cost increased from the period before publication to after publication from a sum of £279,264.82 to a sum of £428,846.22. Most (90.5%) of the survey respondents prescribed betahistine for Menière's disease. Less than half (38.09%) prescribed betahistine for indications other than Menière's disease. Only 45.24% of the clinicians were aware of the results of the BEMED trial. Knowledge of the BEMED trial among otology and neurotology subspecialists is lacking. The results of the BEMED have made no difference to prescribing practice, and in fact, the cost of the medication to the health bill has increased.

161 Texas 4-H program initiates a tangible opportunity to help at-risk horses

Texas continues to have the highest number of horses at approximately 767,100, according to the American Horse Council (2017). This coupled with the ever-growing population of at-risk horses, sometimes referred to as “unwanted” horses, puts Texas in a unique position to develop initiatives to mitigate the abuse, neglect, and abandonment of horses. The grant-funded, Texas 4-H Homes for Horses program launched in 2021 to provide Texas 4-H youth the opportunity to actively help reduce the number of horses at-risk in Texas. 4-H youth were competitively selected to participate with an at-risk horse provided by a select group of Texas adoption partners with guidance of American Society for the Prevention of Cruelty to Animals (ASPCA) Right Horse Initiative. Before program start, participants completed a pre-survey and data was analyzed for 2021 and 2022 (n = 24) for descriptive statistics using the means and frequency procedures in SAS 9.4 (Cary, NC). Participants reported that 91% currently owned horses with an average ownership of 4.57 horses and average monthly cost of $276.25 per horse. Program participants were allotted a stipend of $1,000 from the grant to help cover project horse expenses for the duration of the program. Participants reported that the horse expense stipend had little to no influence on their decision to participate in the program (49.5%), whereas 12.5% reported it influenced them a great deal.Overall, 79.5% of the participants reported that they were somewhat to very likely to permanently adopt their project horse following the conclusion of the program, whereas 18.8% actually did adopt their horse at the conclusion of the program in 2021. Four horses were permanently adopted by their 4-H youth and 5 horses were adopted to new homes at the Texas State 4-H Horse Show program finale. Seven horses were returned to adoption partners where on average it took 22.8 d for them to be adopted into a new home, whereas according to the Equine Welfare Data Collective (2022), the average length of stay for horses at adoption facilities across the United States is significantly longer at 210 d. The Humane Society of North Texas (HSNT) reported the initial intake of a horse costs $426 and subsequent care costs $250–400 per horse per month. An annual savings of $44,000–70,400 was perceived by adoption partners by supplying horses for the program. The initiation of this program successfully connected 4-H youth with at-risk horses to demonstrate how youth can be actively involved in helping at-risk horses in Texas while simultaneously helping adoption agencies with the financial burden of intake and care of this population of horses.

Analysis of the Causes of Outages in the Distribution System of Lagos State, Nigeria

The distribution system is essential in the provision of electricity for all consumers. However, outages occasioned by faults are a major setback in ensuring a regular supply of electricity to consumers in a populous state like Lagos. This study analyses the outage causes, their cost, energy loss, and duration of outages experienced by electricity consumers in the distribution systems of Lagos State. The fault reports of Eko Electricity Distribution Company (EKEDC) and Ikeja Electricity Distribution Company (IKEDC) were used for the analysis. The analysis revealed that the main causes of outages on the network are transient faults (356.78 occurrences per month) and jumper cuts (352.83 occurrences per month). The average monthly cost impacts of the outages on the network are estimated to be between ₦631m &amp; ₦837m and ₦837m &amp; ₦1.66b for the 11kV and 33kV networks of the State respectively. The average monthly energy lost due to outages on the network for the period under review is significant (100,415.34 MWh in total) while the average monthly duration of the outages is notably high (28,463.34 hours in total). To minimise outages and their impacts, faults should be cleared on time while the lines are patrolled and maintained regularly. The jumpers should be replaced with metal line taps or bi-metal line taps while intermediate poles are introduced in over-spanned lines to minimise transient fault on the network of the State.

Comparison of simplicity, convenience, safety, and cost-effectiveness between use of insulin pen devices and disposable plastic syringes by patients with type 2 diabetes mellitus: a cross-sectional study from Bangladesh

Introduction:Insulin pen devices and disposable plastic insulin syringes are two common tools for insulin administration. This study aims to compare the simplicity, convenience, safety, and cost-effectiveness of insulin pens versus syringe devices in patients with type 2 diabetes mellitus (T2DM).Methods:A cross-sectional study was conducted at 14 diabetes clinics throughout Bangladesh from November 2021 to April 2022 among adults with T2DM injecting insulin by pen devices or disposable insulin syringes at least once a day for at least one year by purposive sampling. The simplicity, convenience, and safety of insulin devices were assessed using a structured questionnaire, and the study subjects were scored based on their answers; higher scores indicated a poorer response. Total scores for simplicity, convenience, and safety were obtained by adding the scores for relevant components. Their average monthly medical expense and cost of insulin therapy were recorded. The median values of the total scores and monthly expenses were compared between pen devices and disposable syringe users.Results:737 subjects were evaluated; 406 were pen users, and 331 were vial syringe users. The pen users had lower median scores for simplicity [6.0 (5.0–8.0) vs. 7.0 (5.0–9.0), p = 0.002], convenience [4.0 (3.0–6.0) vs. 5.0 (4.0–6.0), p < 0.001], and safety [7.0 (6.0–8.0) vs. 7.0 (6.0–9.0), p = 0.008] than vial syringe users. Pen devices were more expensive than vial syringes in terms of average medical expense per month [BDT 5000 (3500–7000) vs. 3000 (2000–5000), p < 0.001], the total cost of insulin therapy per month [BDT 2000 (1500–3000) vs. 1200 (800–1700), p < 0.001] and cost per unit of insulin used [BDT 2.08 (1.39–2.78) vs. 0.96 (0.64–1.39), p < 0.001]. Non-significant differences in favor of pens were observed in HbA1c levels [8.7 (7.8–10) vs. 8.9 (7.9–10)%, p = 0.607] and proportions of subjects having HbA1c < 7% (6.9 vs. 6.3%, p = 0.991).Conclusion:Insulin pens are simpler, more convenient, and safe but more expensive than vial syringes. Glycemic control is comparable between pen and syringe users. Long-term follow-up studies are needed to determine the clinical and economic impacts of such benefits of insulin pens.