Billion In Savings Research Articles

Sustaining competition for biosimilars on the pharmacy benefit: Use it or lose it.

Congress passed the Biologic Price Competition and Innovation Act of 2009, specifically to offer market competition as a counterweight to the rising costs of biologic medicines. As of April 15, 2024, 49 biosimilars have been approved by the US Food and Drug Administration in 15 biologic categories. Biosimilar competition has been undeniably successful: Through 2022, biosimilars have saved the US health system $23.6 billion, without significant care disruption or reduced quality. Through 2023, adalimumab biosimilar competition has added an additional $6.5 billion to this total, primarily through greater rebates from the reference manufacturer. Despite launching at discounts as great as 85%, adalimumab biosimilars have not been given preferred formulary positioning in the vast majority of cases and have thus gained only 3% of market share through 2023, largely because of payers' and pharmacy benefit managers' preference for rebates over discounts. This situation may negatively influence future biosimilar development, posing a threat to a biosimilar pipeline that represents hundreds of billions in savings over the next 10 years.

(164) Potential Savings with Use of Cost Plus Pharmacy for Medical Treatment of Erectile Dysfunction

Abstract Introduction With its stated goal “to end ridiculous drug prices,” the Mark Cuban Cost Plus Drug Company (MCCPDC) launched in January 2022 with over 100 generic prescription drugs available to be mailed directly to patients without the involvement of health insurance. To promote drug cost transparency, all drugs are priced at the cost to manufacture the drug with a 15% administrative markup, a $3 pharmacist fee, and a $5 shipping fee. Prior research has focused on the theoretical savings MCCPDC could offer if Medicare purchased drugs at MCCPDC prices with studies reporting a potential $3.3 billion in savings for Medicare. Prescription drug spending is continuing to rise in the United States and providers are increasingly considering patient’s out-of-pocket costs. MCCPDC touts a transparent, consistent pricing model, but it is unclear if this pricing model will actually translate to cost savings for patients. Objective We sought to analyze if Mark Cuban Cost Plus Drug Company (MCCPDC) can offer savings directly to patients compared with other mail-order pharmacies, local pharmacies (based on zip code of our urology clinic) and with patients using health insurance to fill prescriptions for their sildenafil, vardenafil and tadalafil. Methods Out of the approximately 100 generic drugs available on MCCPDC website, we analyzed the 3 drugs that are prescribed to treat erectile dysfunction. We analyzed drug prices of 30 and 90-day prescriptions at the same dose of each medication. Using Good Rx prescription drug search engine, we compared the drug prices of the cheapest mail order and local in person pharmacies near our zip code. We also included prices for the recently started telemedicine company Roman. To compare if MCCPDC could offer savings to patients using health insurance to fill their prescriptions, we extracted the out-of-pocket drug costs for patients from the 2020 Medical Expenditure Panel Survey (MEPS; a national survey that compiles data from both the pharmacy and the survey respondent to determine the exact cost of each prescription filled during that year) and the 2020 Medicare Part D spending data. Medicare Part D spending data was used to estimate the out-of-pocket cost for each medication, which is approximately a 25% copayment for Medicare prescriptions. Results MCCPDC offered the lowest direct-to-consumer price on sildenafil and tadalafil 90-day prescriptions (Table 1). MCCPDC saved patients approximately $10 per sildenafil and tadalafil prescription compared with the next cheapest option. We found additional, although smaller, savings at 30-day prescriptions for sildenafil and tadalafil. MCCPDC was not the cheapest option for vardenafil. Compared with Roman, MCCPDC offered cheaper prescriptions for sildenafil and tadalafil by over $300 and $900, respectively. Conclusions MCCPDC can offer significant cost savings to patients, especially considering the high number of sildenafil and tadalafil prescriptions each year. The transparency and consistency in pricing with MCCPDC can be utilized by providers when counseling patients on medical therapy options for erectile dysfunction. Disclosure No.

How state surprise billing protections increased ED visits, 2007-2018: potential implications for the No Surprises Act.

The No Surprises Act took effect in 2022 and prevents patients from receiving unexpected emergency department (ED) out-of-network physician bills from in-network hospitals and restricts out-of-network co-payments to in-network co-payment levels. By studying similar state bans, we examine whether the large reduction in out-of-pocket payments under bans will have an unintended consequence of an increase in ED visits and spending. We examine 16 million nonelderly, fully funded, privately insured health maintenance organization (HMO) enrollees between 2007 and 2018 from 15 states with balance billing bans for HMO ED visits and 16 states without bans as the control group. Using MarketScan data, we conduct an event study analysis and a difference-in-difference analysis of the impact of state balance billing bans on the probability of an ED visit. We use a 2-part expenditure model to estimate the impact on spending. By analyzing 15 state-level bans, we find that the bans reduced spending per visit by 14% but spurred a demand response, an increase of 3 percentage points in ED visits, which wiped away the cost savings. Based on an ED severity index, these extra ED visits were 9% less urgent than prior to the bans. We predict that the federal ban will result in $5.1 billion in savings but 3.5 million more ED visits at $4.2 billion in extra spending per year, largely negating expected savings. Health plans must be prepared to manage this spike in ED visits as the No Surprises Act takes effect.

Projected US savings from biosimilars, 2021-2025.

Biologics account for an increasing share of US prescription drug spending. Biosimilars could lower biologic prices through competition, but barriers to increasing both supply and uptake remain. We projected US biosimilar savings from 2021 to 2025 under different scenarios. We projected US spending on biologics over a 5-year period under 3 scenarios: (1) a baseline scenario holding quarter 4 (Q4) of 2020 market conditions constant; (2) under main assumptions allowing for biosimilar market growth and entry; and (3) an upper-bound scenario assuming greater biosimilar uptake, more robust price competition, and quicker biosimilar entry. We first analyzed 2014-2020 US volume and price data from IQVIA's MIDAS database for biologics already facing biosimilar competition to inform model parameter values. We used these inputs to project biosimilar entry, biosimilar volume shares, biosimilar prices, and reference biologic prices. We calculated 2021-2025 new savings from biosimilar competition vs the Q4 2020 baseline. Estimated biosimilar savings from 2021 to 2025 under our main approach were $38.4 billion, or 5.9% of projected spending on biologics over the same period. Biologics first facing biosimilar competition from 2021 to 2025 accounted for $26.1 billion of savings, with $12.2 billion from evolving market conditions for already-marketed biosimilars. Furthermore, $24.6 billion of savings under our main approach were from downward pressure on reference biologic prices rather than lower biosimilar prices. Savings were substantially higher ($124.5 billion) under the upper-bound scenario. Biosimilar savings from 2021 to 2025 were $38.4 billion under our main assumptions. Greater savings may be feasible if managed care and other settings increase biosimilar utilization and promote competition.

Variability in the Use of Disposable Surgical Supplies: A Surgeon Survey and Life Cycle Analysis

A substantial amount of waste is generated during surgery, yet few studies have investigated this problem. Therefore, we conducted a multicenter survey to investigate how the variation in the use of disposable supplies contributes to the environmental and financial burdens of health care. We created a questionnaire to identify differences in supply use and practice characteristics among hand surgeons who participated in the Wrist and Radius Injury Surgical Trial. We determined the average cumulative cost of 10 key surgical items based on the responses. Subsequently, we estimated the kilograms of carbon dioxide emitted during the life cycle of supplies, from raw material extraction to production and disposal, using economic input-output life cycle analysis. Thirty-five surgeons from 19 institutions responded to the survey (65% response rate). Based on the difference in costs between surgeons who used the fewest and the most supplies, we determined that expenditures and carbon dioxide emissions could decrease by $22.47 and 10.9 kg per procedure, respectively, with leaner use of 10 key items. Furthermore, assuming that surgeon variation in supply use is present in other surgical subspecialties, we estimated that $2.4 billion in savings and an 800.6 thousand metric ton reduction in carbon emissions could be achieved if all US surgeons reduced their supply use by this amount. This study revealed considerable variations in the use of disposable supplies among hand surgeons, highlighting the need for evidence-based tools, policies, and education campaigns to reduce hospital waste across health care systems. Optimal use of disposable supplies is necessary to reduce the cost and environmental burden of hand surgery care.

Estimating public health and economic benefits along 10 years of Fluzone® High Dose in the United States

ObjectiveThe objective of this study was to estimate the public health and economic benefits (from a Medicare perspective) of Fluzone High-Dose® in the US elderly population, since its introduction in 2010. MethodsA budget impact model was developed using a decision tree framework and applied over 9 influenza seasons (2010/11 to 2018/19). The decision tree model was designed to capture influenza cases, hospitalizations possibly related to influenza or laboratory confirmed influenza, and influenza-related deaths. The analysis included influenza vaccines recommended by ACIP since 2010: SD TIV (trivalent), SD QIV (quadrivalent), HD TIV, aTIV (adjuvanted), ccQIV (cell-cultured). Two strategies were compared to evaluate the impact of HD TIV: a ‘with HD TIV’ strategy representative of the US vaccine landscape, and a ‘without HD TIV’ where the absence of HD TIV was modelled. Clinical and economic inputs were based on public US data from the CDC and national databases, while data on vaccine effectiveness were extracted from published literature and clinical trials. The impact of HD TIV was further explored in five scenario analyses and deterministic sensitivity analyses (DSA). ResultsOver 10 years, it is estimated that HD TIV resulted in an averted 1,333,479 influenza cases, 769,476 medical visits, 40,004 ED presentations, 520,342 cardiorespiratory hospitalizations and 73,689 deaths and generated an absolute $4.6 billion in savings, translating into a return on investment of 214.4%. Hospitalizations costs represented 98.4% and 98.3% of the management costs in the ‘with HD TIV’ strategy and ‘without HD TIV’ strategy respectively. Hospitalizations and HD TIV relative vaccine efficacy vs SD TIV as a major cost driver were further confirmed in scenario analysis and DSA. HD TIV remained cost saving under all the scenarios. ConclusionThe model showed that HD TIV higher efficacy translated into increased averted health and economic outcomes. HD TIV represented a cost saving intervention from a payer perspective since its introduction.

S0413 The Cost-Effectiveness of Implementing an Exercise Program for Fall and Fracture Prevention in Adults Aged 65 and Older on Proton Pump Inhibitor Therapy

INTRODUCTION: National guidelines recommend implementing an exercise program in community-dwelling adults ≥ 65 years old to decrease risk of falling. Proton pump inhibitors (PPI) are not currently recognized as contributing risk factors for falls in these guidelines. However, observational studies have linked PPI use with increased falls and fractures. In 2013, 7,000,000 people over the age of 65 were using PPIs. We studied the economic effects of fall prevention programs in PPI users over 65 and hypothesize that these programs will produce significant healthcare savings. METHODS: Using previously published data, we developed a cost-benefit model to predict various outcomes associated with a fall and fracture in the elderly (Figure 1). We incorporated three exercise programs: Tai Chi, Stepping On, and the Otago. We conducted sensitivity analysis using different Odds Ratios (OR)s for falls in PPI users to determine the threshold of effectiveness of the interventions. We then compared the average cost of each program to the relative reduction in cost associated with a fall and fracture to determine the financial benefit to elderly patients taking PPI therapy. RESULTS: Based on prior studies, adults over 65 have a 30% chance of falling annually with a 33.4% likelihood of seeking medical care. Sensitivity analysis was performed for OR for PPI use and falling ranging from 1.2 to 3.77 (P-value = 0.05). The annual expected cost of falls and fractures in adults over 65 on PPI therapy ranged from $10,317.35 to $18,766.28. Cost of the exercise programs ranged from $112.70 to $336.82 annually, with an anticipated fall reduction ranging from 31-55% based on the literature. Using a range of ORs for PPI use and fall/fracture rate, the model suggests a net financial benefit when reduction of falls is greater than 5% (Figure 3). Individual benefits achieved from exercise programs ranged from $3,198.38 to $10,208.76 (Figure 2). The annual net financial benefit of these programs in the US population of PPI users over age 65 ranges from $18 to $85 billion in savings (Figure 3). CONCLUSION: With modest fall reduction returns above 5%, implementing a fall prevention exercise program in patients over 65 on PPI therapy offers an effective means of reducing the overall financial impact of falls and fractures both individually and on a national level. Formal exercise programs including Tai Chi, Stepping On, and the Otago are highly recommended for these patients.Figure 1.: This figure illustrates our financial model of the costs attributable to falling in a population of PPI users over age 65.Figure 2.: This figure represents the average annual financial benefit of implementing one of three exercise programs to reduce fall and fracture risk in elderly patients over the age of 65 in comparison between PPI and non-PPI users.Figure 3.: This figure represents sensitivity analysis conducted on different odds ratios (OR) between PPI and falling rate. For all OR’s, there was an expected annual benefit when the exercise program implemented conferred a fall reduction greater than 5%.

Inequality During the COVID-19 Pandemic: The Case of Savings from Mortgage Refinancing

We study the distribution of savings from mortgage refinancing across income groups during the COVID-19 pandemic. Between February and June 2020, the difference in savings from refinancing between high- and low-income borrowers was ten times higher than before the pandemic. This was the result of two factors: individuals in the top quintile of the income distribution increased their refinancing activity more than comparable borrowers in the bottom quintile and, conditional on refinancing, they captured slightly larger improvements in interest rates. Exploiting idiosyncratic variation in COVID-19 case rates within zip codes over time, we find that changes in local economic conditions explain up to 74 percent of the increase in refinancing inequality tied to the pandemic. Using data on refinancing applications and funding rates we find that, conditional on applying, the funding rates and processing times for low-income borrowers were not differentially affected by the pandemic. Instead, low-income borrowers were underrepresented in the pool of applications. We estimate a difference of $5 billion in savings from refinancing between the top quintile of the income distribution and the rest of the market. This discrepancy has implications for the transmission of monetary policy and the evolution of wealth inequality.

Chile

The Chilean government has announced its commitment to achieving its fiscal target and containing expenditure growth. The fiscal target aims to reduce the structural balance by 0.2 percent of GDP for each year of the four-year Presidential term from 2018–21. To achieve this target, the government announced a four-year consolidation plan to gradually reduce expenditure each year by approximately US$1.1 billion to realize a total of US$4.4 billion in savings over the period.1 The government has achieved its 2018 structural balance target. To help meet its goals in the coming years, and to find fiscal space for the President’s program, the government is adopting a new tool, spending reviews (SRs).

Belief, Behavior, and Belonging: How Faith is Indispensable in Preventing and Recovering from Substance Abuse

This study reviews the voluminous empirical evidence on faith’s contribution to preventing people from falling victim to substance abuse and helping them recover from it. We find that 73% of addiction treatment programs in the USA include a spirituality-based element, as embodied in the 12-step programs and fellowships initially popularized by Alcoholics Anonymous, the vast majority of which emphasize reliance on God or a Higher Power to stay sober. We introduce and flesh out a typology of faith-based substance abuse treatment facilities, recovery programs, and support groups. This typology provides important background as we then move on to make an economic valuation of nearly 130,000 congregation-based substance abuse recovery support programs in the USA. We find that these faith-based volunteer support groups contribute up to $316.6 billion in savings to the US economy every year at no cost to tax payers. While negative experiences with religion (e.g., clergy sex abuse and other horrendous examples) have been a contributory factor to substance abuse among some victims, given that more than 84% of scientific studies show that faith is a positive factor in addiction prevention or recovery and a risk in less than 2% of the studies reviewed, we conclude that the value of faith-oriented approaches to substance abuse prevention and recovery is indisputable. And, by extension, we also conclude that the decline in religious affiliation in the USA is not only a concern for religious organizations but constitutes a national health concern.

Paris Agreement benefits to fishing

Ecological Economics Traditional arguments against environmentalist regulation often focus on the cost. However, Sumaila et al. estimated that implementing the Paris Agreement would be financially helpful to the world's fishing industry and to seafood consumers. They combined models of fish habitat, climate variation, and seafood prices given the two projections of 1.5°C increase in global temperatures, as stipulated by the Paris Agreement, and the 3.5°C anticipated if present trends continue. The authors conclude that the Paris Agreement would mean an extra $4.6 billion in revenue for fishers, $3.7 billion in wages for seafood workers, and $6.3 billion in savings for consumers. Sci. Adv. 10.1126/sciadv.aau3855 (2019).

PDB37 - Projected Savings in Direct and Indirect Costs Due to Reduced Diabetes Prevalence with Vegetarian Diets

Plant-based diets, or “vegetarian” diets, have been shown to be associated with reduced risk of diabetes, cardiovascular disease (CVD), and cancer. Diabetes, a major risk factor for CVD, is among the most prevalent and costly conditions worldwide. The aim of the study was to evaluate the economic impact of switching to vegetarian diets, from a United States (US) societal perspective. The annual direct and indirect costs due to type 2 diabetes are initially calculated based on US population size, diabetes prevalence, and annual per-patient costs associated with diabetes. Based on diabetes rate reductions reported in the literature, and assuming that 50% of patients follow a vegetarian diet, the costs are recalculated. The number of patients with diabetes is reported with and without vegetarian diet uptake. Total direct, indirect, and overall costs are reported in 2017 US dollars. Sensitivity analyses are conducted for diabetes rate reductions reflecting different diet types, and by varying diet uptake rates. A 12% reduction (~2.7 million patients) in the number of patients with diabetes was estimated with the adoption of a vegetarian diet. This led to $23.8 billion and $9.3 billion in savings of direct and indirect costs, respectively, summing to an overall $33.1 billion. In sensitivity analyses, the savings doubled with 100% adoption and varied between $3.9 billion and $66.1 billion when different risk reduction figures and vegetarian diet types were considered. The results from this economic assessment suggest that the adoption of a vegetarian diet will result in considerable savings in direct and indirect costs in the US. The type of vegetarian diet chosen may have a significant role in the amount of savings predicted.

Alaska: Are We the Waiting?

Author(s): Wright, Glenn | Abstract: In the wake of 2014’s global collapse in oil prices, Alaska continues to struggle with a hugedeficit. Fortunately, the state has over $60 billion in savings to finance its fiscal gap, but Alaskanscontinue to fight over the need for spending cuts and new taxes. Outside of state governmentrevenue, Alaska’s economy remains relatively unaffected by low oil prices, and the state’sreserve funds are growing. So far, though, Alaska’s legislature has not generated a coherent solutionto the state’s unbalanced budget for the long term.

Chrysler Group Supplier Cost Reduction Program (a)

Chrysler's innovative supplier cost reduction (SCORE) program had made over $7 billion in savings for Chrysler during the 1990s, but issues of program management are raised after the 1998 merger with Daimler Benz. Prompted by worsening automotive industry conditions and Chrysler's third-quarter losses in 2000 of over $500 million, the new Daimler-Chrysler management team is considering major changes in the SCORE program for 2001. Excerpt UVA-OM-1064 Rev. Jan. 20, 2017 Chrysler Group Supplier Cost Reduction Program (A) In the fall of 2000, John Tremain, director of strategic operations for the Chrysler Group's procurement and supply office, faced a problem. He administered the company's much-vaunted SCORE (supplier cost reduction) program and was charged with proposing revisions to the program for the upcoming 2001 calendar year. SCORE was a Chrysler program that had been implemented as part of its collaborative extended enterprise concept. Chrysler's extended enterprise and SCORE, which Chrysler had been working to develop during the previous 12 years, had become industry benchmarks for collaborative supplier relationships and supply chain management in the automotive industry. Many observers thought these programs were important contributors to Chrysler's reduced product-development cycle time, Lean R&D budgets, and increased profits per vehicle during much of the 1990s. Although the SCORE program had been an industry benchmark for a number of years, the fall of 2000 brought a series of new challenges: . . .

Meaningful Use of Electronic Health Records and Medicare Expenditures: Evidence from a PanelData Analysis of U.S. Health Care Markets, 2010-2013.

To determine if recent growth in hospital and physician electronic health record (EHR) adoption and use is correlated with decreases in expenditures for elderly Medicare beneficiaries. American Hospital Association (AHA) General Survey and Information Technology Supplement, Health Information Management Systems Society (HIMSS) Analytics survey, SK&A Information Services, and the Centers for Medicare & Medicaid Services (CMS) Chronic Conditions Data Warehouse Geographic Variation Database for 2010 through 2013. Fixed effects model comparing associations between hospital referral region (HRR) level measures of hospital and physician EHR penetration and annual Medicare expenditures for beneficiaries with one of four chronic conditions. Calculated hospital penetration rates as the percentage of Medicare discharges from hospitals that satisfied criteria analogous to Meaningful Use (MU) Stage 1 requirements and physician rates as the percentage of physicians using ambulatory care EHRs. An increase in the hospital penetration rate was associated with a small but statistically significant decrease in total Medicare and Medicare Part A acute care expenditures per beneficiary. An increase in physician EHR penetration was also associated with a significant decrease in total Medicare and Medicare Part A acute care expenditures per beneficiary as well as a decrease in Medicare Part B expenditures per beneficiary. For the study population, we estimate approximately $3.8billion in savings related to hospital and physician EHR adoption during 2010-2013. We also found that an increase in physician EHR penetration was associated with an increase in lab test expenses. Health care markets that had steeper increases in EHR penetration during 2010-2013 also had steeper decreases in total Medicare and acute care expenditures per beneficiary. Markets with greater increases in physician EHR had greater declines in Medicare Part B expenditures per beneficiary.

NHS must invest in staff development.

Plans to make £22 billion in savings and create a seven-day NHS by 2020 will not be realised unless the health service reconnects with staff and develops their skills, warns a leading think tank.

Economic evaluation of procalcitonin-guided antibiotic therapy in acute respiratory infections: a US health system perspective.

Whether or not antibiotic stewardship protocols based on procalcitonin levels results in cost savings remains unclear. Herein, our objective was to assess the economic impact of adopting procalcitonin testing among patients with suspected acute respiratory tract infection (ARI) from the perspective of a typical US integrated delivery network (IDN) with a 1,000,000 member catchment area or enrollment. To conduct an economic evaluation of procalcitonin testing versus usual care we built a cost-impact model based on patient-level meta-analysis data of randomized trials. The meta-analytic data was adapted to the US setting by applying the meta-analytic results to US lengths of stay, costs, and practice patterns. We estimated the annual ARI visit rate for the one million member cohort, by setting (inpatient, ICU, outpatient) and ARI diagnosis. In the inpatient setting, the costs of procalcitonin-guided compared to usual care for the one million member cohort was $2,083,545, compared to $2,780,322, resulting in net savings of nearly $700,000 to the IDN for 2014. In the ICU and outpatient settings, savings were $73,326 and $5,329,824, respectively, summing up to overall net savings of $6,099,927 for the cohort. RESULTS were robust for all ARI diagnoses. For the whole US insured population, procalcitonin-guided care would result in $1.6 billion in savings annually. Our results show substantial savings associated with procalcitonin protocols of ARI across common US treatment settings mainly by direct reduction in unnecessary antibiotic utilization. These results are robust to changes in key parameters, and the savings can be achieved without any negative impact on treatment outcomes.

Diabetes Research and the Public Good: Federal Support for Research on Type 1 Diabetes

Diabetes is one of the most common, rapidly-growing life-threatening medical conditions in the United States today: Nearly 26 million Americans had diabetes in 2011, up from 24 million in 2007; and epidemiologists estimate that by 2020, nearly 12 percent of Americans or 39.2 million people will have diabetes. Diabetes is the underlying cause of death of over 70,000 Americans a year and a contributor to an additional 160,000 deaths. Diabetes also exacts a large toll on the U.S. economy. This study analyzes these economic effects and assesses whether continuing the Special Diabetes Program, which funds research into treating and curing Type 1 Diabetes (T1D) through the National Institutes of Health, could contribute to meaningfully ameliorating the adverse economic effects associated with diabetes. We found that treating people with diabetes cost Americans $128 billion in 2007 or about 0.9 percent of GDP; and we estimate that by 2020, these medical costs will reach $410 billion or an estimated 1.8 percent of a projected GDP of $23.4 trillion in 2020. We further estimate that the productivity losses associated with missed work, permanent disabilities and premature deaths from diabetes and its complications totaled $65 billion in 2007 or 0.5 percent of U.S. GDP in that year. We further estimate that by 2020, these non-medical, economic costs will reach $196 billion or more than 0.8 percent of projected GDP in that year. The NIH currently provides $150 million per-year to support research into T1D, as well as additional funds through other grant programs, and we cannot know if this research will ultimately produce better treatments for the disease. However, after 15 years of NIH support for T1D research, the likelihood of additional breakthroughs should increase if the program is maintained. We further project that if such those advances reduce the incidence and severity of T1D by 10 percent by 2020, the savings in medical costs would exceed $2.6 billion per-year, including $1.9 billion in savings for Medicare and Medicaid, plus another $2.2 billion in annual non-medical economic savings, for a total savings of $4.8 billion a year. In this scenario, the advances would produce an annual rate of return of 163 percent year after year. We also estimate that if spillovers from these advances reduce the incidence and severity of Type 2 Diabetes (T2D) by 5 percent in 2020, that would save nearly $17.4 billion per-year in medical costs, including more than $12.3 billion per-year in Medicare and Medicaid costs, plus nearly $7.5 billion per-year in non-medical economic costs. Based on this analysis, we conclude that federal support for research in T1D should continue.

The CMS Innovation Center: Delivering on the Promise of Payment and Delivery Reform

The CMS Innovation Center: Delivering on the Promise of Payment and Delivery Reform

The FTTdp technology option for the Australian National Broadband Network

Fibre to the Distribution Point (FTTdp) is a broadband access network technology that encompasses fibre to the street lead-in pit at the front fence, with an average copper lead-in length of 30m. FTTdp promises very high VDSL2 capability, with easy upgrading to G.fast or individual FTTP (Fibre to the Premises) on an on-demand basis. The network capability of FTTdp is thus very close to the capability of a full FTTP deployment. Cost savings compared to FTTP promise to be substantial ? a possible $12 billion in savings for the Australian National Broadband Network ? due to the use of existing copper pair lead-ins, thus avoiding civil engineering works for each individual fibre lead-in. Indeed, there is reason to expect that the initial cost of FTTdp deployment will be comparable to that of FTTN (Fibre to the Node). FTTdp has additional benefits of reduced copper maintenance and limited ongoing upgrade costs compared to FTTN. Significantly deeper fibre network penetration is potentially cost-neutral (or better) with FTTdp when compared to the FTTN baseline due to elimination of time-consuming activities involved with FTTN deployment. The reduced street impact of FTTdp is also important