Average Total Cost Research Articles

Predatory pricing in platform markets: a modified test for firms within the scope of Article 3 of the DMA and super-dominant platform firms under Article 102 TFEU

ABSTRACT The paper examines predatory pricing in the context of two-sided digital platforms, arguing that traditional tests based on Average Variable Cost (AVC) may be inadequate for these markets. While predatory pricing by dominant firms is prohibited in both EU and US competition law, the current standards may not effectively capture predatory behavior in platform markets characterized by strong network effects and low marginal costs. The paper analyses cases where cross-subsidization between platform sides had predatory elements and resulted in findings of abuse of dominant position. Given platforms' unique characteristics, it proposes a modified test under Article 102 TFEU for super-dominant platforms and those within the scope of Article 3 of Digital Markets Act's scope. The proposal extends the Akzo test by presuming prices below Average Total Cost (ATC) to be abusive, rather than using AVC, with LRAIC as a proxy for ATC. This addresses the current test's limitations for low marginal cost businesses while allowing for objective justification.

Effectiveness study of learning algorithms in supply chains of a dairy business

Objective: To develop a control system to prevent over-response of the supply chain of a dairy business. Methodology: The following methods were used: DQN, Double DQN, Dueling DQN, and Dueling Double DQN to determine the distribution of demand: normal and uniform. Results: Results were calculated based on stability in learning (the last 10,000 episodes). It was observed that the means of DQN and DDQN were very similar. To validate whether the performance of the Dueling DQN algorithm is better than that of the DQN algorithm, a non-parametric test was performed to compare the mean rank of two related samples and to determine if there are differences between them. The p values ​​were 5.83e−38 and 0.000 for the Normal and Uniform distributions, respectively. Conclusions: The algorithm with the best results is Dueling DQN, with an average total cost of 151.27 units for the demand with a normal distribution and an average of 155.3 units for the demand with a uniform distribution. This method has less variability once convergence is achieved

Estimation of the girls cost vaccination against human papillomavirus in the Siberian Federal District

Background. The non-declining cervical cancer incidence in the Siberian Federal District 16.30/0000 (in Russia - 13.80 /0000) necessitate preventive vaccination against the human papillomavirus (HPV).Aim. To evaluate the cost-effectiveness of HPV vaccination in girls aged 9-14 years in the Siberian Federal District as a whole and in the context of subjects with a 60, 80, 90 percent target cohort.Materials and methods. We studied the size of the female population aged 9-14 years in the constituent entities of the Siberian Federal District for 2022, the average total cost of the vaccine, information on the gross regional product per capita, form C51 “Distribution of deaths by gender, age groups and causes of death” of Tomsk region, 2022. Age-standardized rate per 100,000 population of morbidity and detection (in percentages) of pre-invasive cervix cancer (carcinoma in situ) in the Siberian Federal District were calculated per 100 newly diagnosed malignant cervix neoplasms in 2022.Results. In the Irkutsk, Tomsk regions, Altai and Krasnoyarsk territories age-standardized rate (16.6; 17.8; 16.3; 18.90 /0000, respectively), the detection rate of pre-invasive cancer was 48.0-82.4 %, which indicates on the effectiveness of measures for early cervical cancer diagnosis. In the Republics of Tyva, Altai, Khakassia, age-standardized rate (26.4; 20.1; 19.30 /0000, respectively), cancer in situ was diagnosed in 8.2-23.6 % of cases, which indicates an insufficient level and defects in the organization preventive examinations in medical institutions. In the first year of vaccination against HPV with 60 % coverage of a girls cohort 9-14 years old (n = 404,943), 9.3 billion rubles will be required, with 80 % coverage (539,924 girls) - more than 12.4 billion rubles, with 90 % coverage (607,415 girls) - more than 13.9 billion rubles for primary vaccination against HPV. In subsequent years, more than 2.5-2.8 billion rubles will be required annually. Over 5 years, with 90 % coverage of the population, the financial costs of vaccination will be (817.8 million rubles), and the subsequent 4 annual investments (163.6 million rubles per year). The economic damage caused by mortality from cervical cancer in the Tomsk region over five years (2018-2022) amounted to 3,166.4 million rubles.Conclusion. Using the example of the Tomsk region, it was noted that when comparing financial resources, the costs of vaccinating girls against HPV are 2.2 times less than the economic damage from cervical cancer mortality. Regional budget funding for girls vaccination in administrative territories is relevant before its integration into the national calendar of preventive vaccinations.

Generic Volar Locking Plate Use in Distal Radius Fractures: A Prospective Randomized Study to Evaluate Clinical Outcomes and Cost Reduction.

The purpose of this study was to evaluate differences in 90-day clinical outcomes between patients treated with generic volar locking plates (VLPs) and conventional VLPs in distal radius fractures. Secondary aims included assessing for differences in surgical characteristics and cost between the groups. From November 2022 to April 2023, a prospective block-randomized study was undertaken in which surgeons alternated between using a generic VLP and a conventional VLP each month. The institution's chargemaster database was cross-referenced for implant cost. Primary outcomes were 90-day readmission, reoperation, and mortality rates. Secondary outcomes included estimated blood loss, tourniquet time, and implant cost. A total of 66 patients were included. Most were women (n = 61, 92.4%), with an average age of 61.0 ± 11.5 years. There were no significant differences in age, sex, smoking status, AO Foundation/Orthopaedic Trauma Association classification, or tourniquet time between patients who received generic and conventional implants. The average total cost was higher with conventional implants than generic implants($1348.61 ± 100.77 and $702.38 ± 47.83, respectively; P < .001). The largest difference in cost came from pegs and screws that were used ($640.77 ± 90.93 vs $268.47 ± 45.93, P < .001). No patients experienced complications such as readmission, reoperation, or death within 90 days. Total implant cost was lower for procedures where generic VLPs were used. Cost differences between generic and conventional implants are driven by the variable selection of pegs and screws. With no differences in 90-day outcomes, surgeons may consider using generic implants as a way of increasing the value of care delivery.

Economic Comparison of Stocker Cattle Performance on Winter Wheat vs Summer-Dormant Tall Fescue with Nitrogen or Interseeded Alfalfa in the Southern Great Plains

Abstract Winter wheat (Triticum aestivum L.) is a significant forage source for livestock grazing in the Southern Great Plains (SGP). However, increasing input costs and changing climate conditions compel producers and researchers to search for alternative forage systems, such as cool-season perennials. Specifically, cool-season perennials with summer dormancy traits can survive droughts in the SGP. This paper aimed to determine the net returns of three different types of cool-season perennial summer-dormant tall fescue [Schedonorus arundinaceus (Schreb.) Dumort., nom. cons.] systems either with N fertilizer or interseeded with alfalfa (Medicago sativa L.) and the traditional graze-out annual winter wheat forage system. The data were from a 5-year experiment conducted in south-central Oklahoma. Animal performance results indicated that the traditional graze-out winter annual wheat forage system provided more total gains at 434 kg ha-1 than the three tall fescue variety systems at 326 kg ha-1 (p = 0.006) due to more grazing days. Thus, the gross revenue estimated at a cost of gain of $1.60 kg-1 gain for wheat at $694 ha-1 was greater than the average gross revenue of $521 ha-1 for the tall fescue systems. However, the average total cost for the perennial tall fescue systems ($374 ha-1) was lesser than the total cost ($594 ha-1) of the wheat system. Overall, the average net returns were similar for all grazing systems at about $145 ha-1.

Unveiling the chasm of economic burden from metastatic prostate cancer through a nationwide retrospective cohort study

Objective To analyze the clinical and economic consequences of the progression to castration-resistant status for patients with metastatic hormone-sensitive prostate cancer (mHSPC) and metastatic castration-resistant prostate cancer (mCRPC) in South Korea. Methods This retrospective cohort study was conducted using National Health Insurance claims data from 2013 to 2021. Patients defined as newly diagnosed with mHSPC had an index date of first claim for metastatic PC between 2015 and 2016 and no exposure to CRPC medicines during the washout period. All-cause monthly medical and end-of-life costs were described for mHSPC and mCRPC. Descriptive statistics were used to analyze medical costs, and generalized estimating equations were used to evaluate the correlation between medical costs and significant variables, including disease progression, death, and clinical characteristics. Results Of the 3,739 patients with mHSPC included (mean 72.9 years), 779 progressed to mCRPC. The overall study population underwent a median 60.48-months follow-up period. The average monthly medical cost depending on CRPC progression was 1.5 times in the mCRPC than in the mHSPC group ($1,734.2 vs. $1,185.4). Monthly medical costs for those who progressed to mCRPC were 2.4 times one year after progression than one year before. In all groups, the average total medical costs gradually increased near mortality. Disease progression and death had a significant correlation with medical costs, by 1.7 times and 2.46 times, respectively. Conclusion This study highlights the economic and health benefits of preventing progression to castration resistance in patients with mHSPC based on real-world data.

Analisis Minimalisasi Biaya Terapi Antibiotik Ceftriaxone dan Cefotaxime Pada Pasien Pneumonia di Instalasi Rawat Inap RSUD Kabupaten Kediri

Pneumonia is an infection caused by pathogenic microorganisms such as microbes, bacteria, fungi and viruses that cause inflammation of the lung tissue. The prevalence of pneumonia has increased every year. The first-line therapy used at the Kediri District Hospital is the use of ceftriaxone and cefotaxime antibiotics. Decision making on antibiotic use has an influence on the amount of medical costs incurred by patients. This study aims to determine which antibiotics are more cost-minimal and whether there is a significant difference between the use of ceftriaxone and cefotaxime antibiotic therapy at Kediri District Hospital. The design of this study was cross sectional, data collection was done retrospectively. The analysis method used independent t-test statistical test. The perspective in this study was seen through the provider, namely the hospital, a total of 215 pneumonia patients and the sample for this study was 63 patients. With 32 patients receiving ceftriaxone antibiotic therapy and 31 patients receiving cefotaxime antibiotic therapy. Total direct medical costs were categorized into four types of costs, namely treatment costs, antibiotic costs, other drug costs, laboratory and radiology costs. The average total direct medical costs of patients who received ceftriaxone antibiotic therapy were more cost minimal than patients who received cefotaxime antibiotics, namely Rp.2,296,449 and Rp.2,464,470. The results of the difference test using independent t-test statistics show a p-value of 0.219 so that it can be interpreted that there is no significant difference.

What is the True Cost of Motion Preservation? A Time-Driven Activity-Based Cost Analysis of Anterior Cervical Discectomy and Fusion versus Disc Replacement

Total disc replacement (TDR) has become a viable alternative to anterior cervical discectomy and fusion (ACDF) for select patients. Although most comparative studies have assessed outcomes, cost differences remain largely uninvestigated. This information is critical as we move towards value-based reimbursement. To address this knowledge gap, we used time-driven activity-based costing (TDABC) to compare total intraoperative costs between the two procedures. Total cost was divided into direct (personnel and supply cost) and indirect costs (administrative and overhead costs). Individual costs were determined through direct observation, electronic medical records, and through querying multiple departments (including business operations, sterile processing, plant operations, and pharmacy). Timestamps for all involved personnel and material resources were documented, in conjunction with process mapping of the intraoperative period. Total intraoperative costs were estimated for all ACDFs (n=810) and TDRs (n=54) from 2017 to 2022. Regression analyses were performed to identify factors associated with total cost. A total of 810 and 54 patients underwent one- and two-level ACDFs and TDRs, respectively. The average total intraoperative cost for an ACDF was $6,776 +/- $2,808, compared to $12,026 +/- $4,235 for TDR. Supply cost accounted for the majority of total cost for both procedures ($4,173 +/- $2,225 for ACDF and $9,532 +/- $4,010 for TDR). On multivariable linear regression analysis, TDR was associated with roughly $3,885 of additional cost compared to ACDF (p<0.001), as well as $4,072 in additional supply cost (p<0.001), most of which was driven by the higher cost of implants (p<0.001). TDABC is a highly useful methodology for estimating differences in true costs between procedures and determining cost drivers. TDRs were associated with an additional $3,885 of total intraoperative cost as compared to ACDFs, the majority of which was driven by the cost of implants.

Joint optimization of recyclable inventory routing problem under uncertainties in an incentive-based recycling system

Due to the value of resource recovery and the development of a circular economy, waste recycling has gathered global attention. Recently, many emerging cities designed new systems like an incentive-based recycling system (IBRS). In such systems, recyclables are collected through community recycling nodes by offering incentives, then transported to street recycling stations and sorted before being finally recycled. The increased recycling nodes and the incentives enhance the convenience and residents’ enthusiasm for waste recycling, but also intensify the uncertainty of recycling quantities and the complexity of the recycling operation management. Poor recycling operation management may result in increased recycling costs or greater loss of recyclables, which discourages residents from participating in recycling. Based on an existing IBRS, this study investigates the joint optimization problem of the recyclable inventory management at each community recycling node and the vehicle routing from the recycling nodes to the recycling station. A two-stage dual-objective multi-period stochastic programming model is established to minimize the loss of recyclables and logistics costs, which is further reformulated using the weighting method and transportation cost approximation parameters. To solve the reformulated model, a three-phase iterative algorithm is designed by combining the progressive hedging algorithm and route splitting algorithm based on the Lin-Kernighan heuristic. A case study is conducted using data from Shanghai’s IBRS. The proposed joint decision model is superior to separate decisions and the three-phase iterative algorithm can reduce the average total cost by up to 42.12% compared to the genetic algorithm and the Iteration-Move-Search method in the literature. Additionally, a sensitivity analysis is conducted to provide managerial insights.

The administration of immune checkpoint inhibitors via an elastomeric pump versus conventional intravenous infusion: an economic perspective

BackgroundRecent studies have underscored the potential of innovative administration methods to mitigate the capacity burden on healthcare systems, without compromising the quality of care. This study assessed and compared the resource utilization and associated costs of two distinct administration modes of immune checkpoint inhibitors: the innovative elastomeric pump and conventional intravenous infusion. This comparison can inform sustainable healthcare practices and healthcare decision-making to optimize treatment efficiency in an era of escalating healthcare demands.MethodsIn this micro-costing study, data on resource use and time allocation for drug preparation and administration were collected using an observational, non-interventional study design. Data were registered at the oncology daycare unit and hospital pharmacy. Cost categories included drug acquisition, disposable materials, healthcare professional time for drug administration, drug preparation, and patient time spent at the oncology day care unit.ResultsDrug administration through the elastomeric pump resulted in substantially lower healthcare costs when compared to conventional infusion, particularly due to reduced labor and chair time. The elastomeric pump reduced the total chair time by 78% and nurse time by 55%. Total average costs (excluding drug costs) were €103,47 and €77.99 for conventional infusion and the elastomeric pump, respectively, showcasing potential savings of €25.48 (P < 0.001) per administration.ConclusionsThis study demonstrated that the elastomeric pump not only offers substantial cost savings but also enhances the treatment capacity of the oncology day care unit. These findings support the adoption of the elastomeric pump in clinical settings as a cost-saving and efficient alternative to conventional infusion.Trial registrationThis study has been registered in the National Trial Register (NTR), with the reference number NTR NL9473. Registration date: 05-05-2021.

Cost-consequence analysis of the enhanced recovery after surgery protocol in major lung resection with minimally invasive technique (VATS).

ERAS is an evidence-based multimodal perioperative protocol focused on stress reduction and promoting a return to function. The aim of this work is to perform a cost-consequence analysis for the implementation of ERAS in major lung resection by means of minimally invasive surgery (VATS) from the public health service perspective, evaluating resource consumption and clinical outcomes with respect to a control group of past patients, which did not adopt an ERAS protocol. Outcome differences (re-intervention rates, major and minor intraoperative and postoperative complications, readmissions, and mortality) as well as the costs of preoperative, operative, and postoperative care were estimated. The sample consisted of 64 consecutive patients enrolled in the ERAS programme between April 2021 and August 2022, compared to a control group (historical cohort) comprising 31 patients treated from April 2020 to December 2020, prior to the implementation of the ERAS programme. The study sample comprises patients who fulfil the established ERAS protocol inclusion criteria, including general criteria (acceptance of the protocol, proximity of residence, absence of contraindications to physiotherapy and early mobilisation), surgical criteria (anatomical lung resection up to lobectomy, absence of extensive resection, good possibility of conducting the operation in VATS) and anaesthesiologic criteria (ASA ≤2). Costs were quantified using the national health system perspective. The average length-of-stay was at least one day shorter in the ERAS group [<0.001. Average total costs including entire pathway healthcare costs were substantially reduced for ERAS-VATS patients (mean: € 5,955.71 vs. €6,529.41 Δ = -573.70 p = 0.018)]. Specifically, the median costs of the admission phase were significantly different between the two groups (median: €4,648.82 vs. €5,596.58, p = 0.008), with a reduction in hospital stay expenditure in the ERAS-VATS group (median: €1,599.62 vs. €2,399.43, p = 0.025). No significant differences were found regarding major clinical outcomes. The implementation of an ERAS programme is a dominant strategy, representing an intervention capable of reducing overall costs in the context of elective anatomical lung resection with VATS without any significant differences in major complications and re-intervention rates.

Economic evaluation of fractional flow reserve-guided versus intravascular ultrasound-guided percutaneous coronary intervention

Abstract Background The randomized, controlled FLAVOUR trial demonstrated that the clinical outcomes of the fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) strategy were non-inferior to the intracoronary ultrasound (IVUS)-guided PCI strategy. Purpose This study aimed to compare the difference in economic implications and health-related quality of life between the two strategies. Methods A total of 890 patients with intermediate stenosis in 9 sites in China from the FLAVOUR trial were included. Direct medical costs were calculated using a combination of resource-based and event-based methods. Health utility was defined as quality-adjusted life years and assessed based on the 19-item Seattle Angina Questionnaire. The primary analysis was a cost-utility analysis. Probabilistic sensitivity, one-way sensitivity, and subgroup analyses were performed. Results At two years, the average total cost per patient was Chinese yuan (CNY) 36,287±19,531 in the IVUS-guided group and CNY 29,237±19,239 in the FFR-guided group (ΔIVUS-FFR=CNY 7,050, p&amp;lt;0.001). The difference was driven primarily by the cost of initial admission (ΔIVUS-FFR=CNY 6,284, p&amp;lt;0.001). Quality-adjusted life years gained showed no significant differences between the two groups (FFR vs. IVUS: 1.639±0.086 years vs. 1.638±0.128 years, p=0.872). The probabilistic sensitivity and one-way sensitivity analyses revealed robust results. The subgroup analysis found that the cost reductions attributed to FFR guidance decreased in several subgroups, including patients with diabetes and those with high anatomical complexity. Conclusions In patients with intermediate stenosis, FFR-guided PCI is associated with significant cost savings compared with IVUS-guided PCI at two years and shows no differences in health-related quality of life outcomes.Central Illustration

Ferric derisomaltose versus usual care in patients with heart failure, reduced ejection fraction, and iron deficiency: a short-term UK cost-utility analysis based on the IRONMAN RCT

Abstract Background In the IRONMAN trial, patients with heart failure (HF), a reduced ejection fraction and iron deficiency who were randomly assigned to ferric derisomaltose (FDI), rather than usual care, had a lower rate of the composite of hospitalization for heart failure (HHF) and cardiovascular (CV) death (rate ratio, RR, 0.82; 95% CI 0.66 to 1.02; p=0.07). A COVID-19 sensitivity analysis, censoring data at 1 year of follow-up showed a greater magnitude of treatment effect (RR 0.66; 95% CI 0.48 to 0.91; p=0.011). Purpose Patient-level data from IRONMAN were used to evaluate the effectiveness and cost-utility of FDI compared to usual care for patients with a current or recent HHF, or raised plasma natriuretic peptide concentrations, from a UK National Health Service (NHS) perspective. Methods A cost-utility analysis (CUA) was conducted covering the first year after randomization. Numbers-needed-to-treat (NNTs) were calculated for the primary endpoint censored at 1 year. In the CUA model, patient survival and rates of (re)hospitalization due to HF, other CV events, infections, respiratory conditions, and other non-CV events were modeled based directly on data from the IRONMAN RCT. UK-specific costs were obtained from the national schedule of NHS costs. Quality of life was estimated based on EQ-5D-5L data collected from patients included in the IRONMAN RCT. Results were undiscounted and reported as absolute and incremental costs in 2023 pounds sterling, and quality-adjusted life expectancy in quality-adjusted life years (QALYs). A willingness-to-pay threshold of £20,000 per QALY was adopted to allow calculation of a net monetary benefit (NMB), a summary measure of the overall value of FDI in monetary terms, capturing changes in both cost and QALY outcomes. Results The NNT analysis showed that 9 patients would need to be treated with FDI to avoid one composite primary endpoint event (CV death and HHF) over 1 year. Relative to usual care, FDI was associated with an improvement of 0.01 QALYs per patient over 1 year (0.58 versus 0.57 QALYs). Total average costs per-patient were £1,672 for FDI, versus £1,975 for usual care, leading to a saving of £302 per patient with FDI. The cost of iron procurement was more than offset by reductions in costs of (re)hospitalizations (Figure). FDI was therefore dominant over usual care, yielding an NMB of £483 over 1 year. Conclusions This short-term, within-trial CUA suggests that FDI both improves QALYs and reduces healthcare expenditure versus usual care when administered to patients with HF and iron deficiency in the UK. Iron repletion with FDI may be a prudent allocation of healthcare resources in this patient population.Breakdown of costs

Cemented Hemiarthroplasty Results in Substantial Cost Savings Over Uncemented Hemiarthroplasty for the Treatment of Femoral Neck Fractures in Patients Over 60 Years Old: A Markov Analysis

BackgroundWhile there is growing scientific evidence supporting superior outcomes following cemented versus uncemented hip hemiarthroplasty (HHA) in elderly femoral neck fractures (FNFs), the relative cost-effectiveness of this in the United States is unknown. Thus, the purpose of this study was to compare the cost-effectiveness of cemented versus uncemented HHA for the treatment of FNFs in patients > 60 years old in the United States, accounting for postoperative outcomes including periprosthetic fractures. MethodsA Markov model utilizing Monte Carlo microsimulation was developed to evaluate the outcomes and costs of patients at least 60 years of age (mean ± standard deviation, 84 ± 8 years) undergoing cemented versus uncemented HHA for the treatment of FNFs. Health utility values, transition probabilities, and upfront costs were derived from the published literature. Outcome measures included average total costs associated with each treatment (including those from patients who sustained a periprosthetic fracture), quality-adjusted life-years (QALYs), and the incremental cost-effectiveness ratio (ICER). ResultsMean total costs resulting from cemented and uncemented HHA were $19,462 ± 3,581 and $21,997 ± 3,574, respectively (upfront costs from the published literature were $18,267 for cemented HHA and $16,803 for uncemented HHA). Average QALYs resulting from cemented and uncemented HHA were 4.0 ± 0.7 and 3.1 ± 0.6. The resulting ICER was -$2,688.9/QALY. Cemented HHA was found to be the most cost-effective treatment strategy in 89% of the patients in the Monte Carlo microsimulation model. ConclusionDespite documented higher upfront costs for cemented HHA, the averaged total costs over a 10-year time horizon were $2,534 less for cemented HHA than for uncemented HHA. In addition, cemented HHA resulted in an additional 0.9 QALYs relative to uncemented HHA. The findings of this United States-based study replicate the financial and quality-of-life benefits of cemented HHA for elderly FNFs seen in other health systems.

Cardiodiabesity: Epidemiology, resource and economic impact

ObjectiveTo assess i) the epidemiology of cardiodiabesity, ii) its association with healthcare resource utilization and cost of care, as well as iii) provide recommendations for its management. MethodsA cohort study of insured adults with early-stage and/or active cardiodiabesity from January 2019 to December 2021 identified through a longitudinal, and de-identified medical and pharmacy claims database was conducted. All patients were followed for one year through December 2022. Conditions include cardiovascular disease, prediabetes, Type 2 diabetes (T2D), chronic kidney disease (CKD), overweight and/or obesity. Rates of progression from early-stage cardiodiabesity to active cardiodiabesity and/or advanced cardiodiabesity with complications; frequency of emergency department, inpatient and outpatient visits; as well as total cost of care over one year were analyzed. ResultsA total of 3,273,813 and 1,628,407 patients had at least one of the comorbid conditions for early-stage and active cardiodiabesity, respectively. Among those with all early-stage cardiodiabesity conditions, 27.4 % progressed to active cardiodiabesity, while 88.4 % of those with all active cardiodiabesity conditions progressed to complications within one year. Predictors of progression from early-stage to active cardiodiabesity were hypertension (OR: 2.31, 95 % CI: 2.29–2.33, p < 0.001), hyperlipidemia (OR: 1.77, 95 % CI: 1.76–1.79, p < 0.001), CKD stages 1 and 2 (OR: 1.74, 95 % CI: 1.69–1.79, p < 0.001), prediabetes (OR: 1.64, 95 % CI: 1.63–1.66, p < 0.001) and living in areas with very high social needs (OR: 1.25, 95 % CI: 1.23–1.26, p < 0.001). Significant predictors of progression from active cardiodiabesity to complications were T2D (OR: 1.88, 95 % CI: 1.81–1.96, p < 0.001), CVD (OR: 1.47, 95 % CI: 1.44–1.51, p < 0.001), CKD stages 3 and 4 (OR: 1.37, 95 % CI: 1.34–1.41, p < 0.001) and obesity (OR: 1.29, 95 % CI: 1.26–1.32, p < 0.001). Average total cost of care increased significantly among those who progressed from one disease phase to the next (p < 0.05). ConclusionsCardiodiabesity is deadly and rapidly progressive with substantial economic burden on the healthcare system. However, it is preventable. Innovative approaches to better understand the holistic impact of cardiodiabesity on total cost of care, early intervention or management to halt disease progression and promote equity, as well as decrease resource utilization are needed.

Determination of Direct and Indirect Costs Incurred by Tuberculosis Patients During Diagnosis and Treatment in Urban Areas of South Gujarat: A Mixed Method Approach

Though many initiatives and monetary benefits are incorporated under RNTCP/NTEP, many patients might incur some out-of-pocket expenditure (OOP) related to diagnosis, treatment, and hospitalization. Such costs lead to further poverty and default. This study estimated OOP costs. A cross-sectional mixed method study was conducted in 2020. Data were collected from two selected UHCs (both public and private sectors) from all eight administrative zones. A total of 278 newly registered drug-sensitive tuberculosis patients at different stages of treatment were enrolled, and 18 IDIs were done after obtaining the consent. Among 278, 231 (83%) were seeking the treatment from the public sector and 47 (17%) from the private sector. The average direct, indirect, and total costs were Rs. 8812, Rs. 4825, and Rs. 13,637, respectively. Extra food and supplements are the major field of expenditure for those enrolled in the public sector. Higher costs were incurred by the private sector patients. Longer distances, a long waiting time, belief systems, and unavailability of facilities or drugs were the common reasons for not visiting the public sector. IDI results also supported the cost heads. The majority of the expenses occurred at the private settings before diagnosis. IDIs suggested to changes in the programmatic approach toward migrants, industrial workers, and women.

Optimization of Fuzzy Economic Order Quantity using Machine Learning and Weka

Inventory management is a crucial need for businesses because it requires a significant financial and human resource investment. Machine Learning models are used by e-commerce huge companies to manage their inventory to the demand for specific products. Businesses can benefit from inventory management as a service to increase sales and forecast product demand. Inventory Management might be revolutionised by AI and ML technologies, which would allow businesses to automate repetitive processes, make data-driven choices, and instantly optimise inventory levels. By analysing vast amounts of both historical and current data, these technologies can spot inclination, forecast, and recommend, all of which increase inventory accuracy and lower the chance of stockouts or overstocking. The most efficient solution is determined using the Kuhn-Tucker Method for Nonlinear Programming, which has an impact on the monthly cost. The proposed model employs the Signed distance approach for defuzzification and the Pentagonal fuzzy number to find the lowest cost and met the demand. To evaluate the inventory concept, purchased a dataset and calculated the profit and non profit using apriori algorithm and use the Weka software to analyse the average order quantity and total cost.

Healthcare resource utilisation and costs in infants with confirmed respiratory syncytial virus infections: a national population cohort study

BackgroundRespiratory syncytial virus (RSV) is the leading cause of severe respiratory infections in infants worldwide, significantly affecting their health and contributing to the global healthcare burden. We aimed to examine healthcare resource utilisation patterns and costs for infants under one year old with confirmed RSV infection across subgroups of different gestational ages and health conditions and the cost implications of RSV infections over time, thereby demonstrating the economic burden of the disease.MethodsThis retrospective cohort study utilised nationwide claims data from the Korea Health Insurance Review and Assessment Service for infants under one year of age with confirmed RSV infection in the first year of life from January 2017 to April 2022. The infants were stratified into three subgroups based on their gestational age and health status: unhealthy preterm, healthy preterm, and full-term infants. A descriptive analysis was conducted to estimate healthcare utilization by type of resource and costs related to the treatment of RSV.ResultsOut of 93,585 RSV infections identified, 31,206 patients met the inclusion criteria; these included 963 unhealthy preterm, 1,768 healthy preterm and 28,475 full-term infants. In our study, 76.3% of the infants with confirmed RSV infection required intensive care, including hospitalisation and more critical interventions such as intensive care unit (ICU) or mechanical ventilation (MV). The total average cost of RSV management was notably higher for unhealthy preterm infants ($ 6,325; 95% confidence interval (CI): $ 5,484-7,165) than for healthy preterm ($ 1,134; 95% CI: $ 1,006 − 1,261) and full-term infants ($ 606; 95% CI: 583–630). Our findings confirmed a significant epidemiological and economic burden, with infants at greater risk–shorter gestational age and poorer health conditions. Furthermore, we observed a marked increase in the total average cost of RSV management during COVID-19, reflecting the complex interplay between RSV and pandemic-related healthcare dynamics.ConclusionOur findings provide evidence for the significant economic burden of RSV infection among infants, with considerable disparities based on gestational age and health status subgroups. However, RSV prevention policies should also recognise that healthy preterm or full-term infants who receive intensive care face a significant disease burden.

Time is money: An analysis of cost drivers in ambulatory sinus surgery.

Functional endoscopic sinus surgery (FESS) is one of the most commonly performed otolaryngologic procedures and is associated with significant cost variability. We performed a retrospective analysis of all inflammatory sinus surgeries at a single tertiary care medical center from July 2021 to July 2023. The electronic medical record was reviewed for patient factors and cost variables for each procedure, and multivariable analysis was performed. A total of 221 patients were included in analysis with a mean age of 48.2 years. There was a 44.8% incidence (n=99) of nasal polyps and 31.2% (n=69) of cases were revision surgeries. The average total cost for the surgical encounter was $8960.31 (standard deviation $1967.97). Operating room time represented $4912.46 (54.8% of all costs), while average operating room supply costs were $1296.06 (14.5%) and recovery room costs were $919.48 (10.3%). Total costs were significantly associated with length of surgery ($7.83/min, p=0.04), in addition to presence of nasal polyps ($531.96, p=0.04). There was no significant association between total costs and the remaining clinical and demographic factors. Costs associated with ambulatory FESS for inflammatory sinus disease vary across patients and this cost variability is predominantly driven by time efficiency within the operating room, as well as supply utilization and nasal polyposis to a lesser degree. As a result, operating room efficiency represents a primary target for cost-related interventions. Additionally, our data provide a framework for surgeons and hospitals to make evidence-based decisions on intraoperative equipment in a tradeoff between efficiency and supply costs. Our findings indicate that an approach focused on streamlining efficiency across the entire ambulatory surgery encounter will have the greatest impact on reducing healthcare expenses for both the patient and the health system.

Economic burden of pelvic sepsis after anastomotic leakage following rectal cancer surgery: A retrospective cost-of-illness analysis.

Anastomotic leakage following rectal cancer surgery remains a challenging complication, with a nonhealing rate of approximately 50% at 1 year. Pelvic sepsis may require tertiary treatment that encompasses additional admissions, extensive surgery and other types of interventions. The aim of this study is to analyse the financial burden of pelvic sepsis in a tertiary hospital. From 2010 until 2020, all patients referred to a tertiary centre for pelvic sepsis after low anterior resection for rectal cancer were prospectively registered and retrospectively reviewed. The cost analysis adhered to Dutch National Healthcare Institute guidelines and covered hospital-imposed medical costs from salvage surgery to the last registered intervention, adjusted for inflation and priced in euros. This analysis included 126 patients, with an average total cost per patient of €31 131. Salvage surgery accounted for €21 326, with an additional €9805 for reinterventions and readmissions. Salvage surgery comprised nonrestorative surgery in 48% and restorative salvage surgery in the remaining cases. Length of hospital stay averaged 9.6 days on the general ward and 0.8 days in the intensive care unit. Common reinterventions included endoscopic vacuum sponge changes (n = 153), stoma closures (n = 59) and radiological abscess drainages (n = 51). Total costs did not differ significantly between nonrestorative surgery and restorative surgery (mean = €31 950 vs. €30 362, respectively; p = 0.893). Treating pelvic sepsis after rectal cancer resection in a tertiary hospital carries a substantial economic burden, averaging €31 131 per patient, and this work helps to quantify the potential economic impact of innovative care to reduce anastomotic leakage.