Comparative Cost Analysis Research Articles

Analysis of extemporal production trends in pharmacies for children

Medicines for children are insufficiently represented in pediatric dosages and appropriate dosage forms in the pharmaceutical market of Ukraine. Pediatricians are forced to prescribe children's medicines in dosages that are not available in the State Register of Medicines of Ukraine. Extemporaneously compounded medicines (ECM) are useful when a required dose or dose form is unavailable commercially, or is needed for individualised dosing.
 The aim of the study was to analysis a real data of the list of medicines which are produced in hospital and public pharmacies of Lviv region during 2020–2021.
 Methods. Content analysis of extemporal prescriptions for children, depending on the composition of the active pharmaceutical ingredient, dose and dosage form, comparative cost analysis of ECM and industrial medicines.
 In the hospital doctors prescribe ECМ in liquid forms (75%) – solutions for injection and in solid forms (25%) – dosed simple powders – 19%, dosed complex powders – 6%. It was determined the structure of ECM, which are produced in 6 studied pharmacies in 2020–2021. There are soft ECM 61.6% in dosage forms: ointments, creams, paste; liquid ECM are 28.3% in mixtures, solutions, mumbles; solid ECM are 8.3% in mono, combine powders, suppositories and 1.8% – other ECM: powders and nail polishs. There were highlighted unique recipes of ECM which analogues were not present in industrial dosage forms.
 We conducted analysis of the cost of children’s ECM in these pharmacies. It was determined that ECM cost were 40.5–305.6 UAH depending on the dosage form. The comparative analysis showed that ECM are in 2.2–4.9 times more cheaper for children compare with similar active ingredients in industrial medicines.
 ECMs are much more compliant for treatment in children and babies, they provide higher effect, safety, reduce dosing errors, especially at the inpatient stage, and continuation of therapy on an outpatient basis and more cost-effective for individual needs. The use of ECMs allows parents to properly dose them for children, to avoid errors in dosing, improper administration, which is extremely important to ensure the rational use of medicines in pediatric practice.

Energy Efficiency in Ports: Comparative Performance and Cost Analysis of Heat Demand in Port Facilities Using Solar Energy

Energy efficiency for less energy consumption, as well as using eco-friendly and sustainable energy to provide port services in a most efficient way play a key role in the competitiveness of ports both at national and at international level. Port facilities are complex systems with various energy demands for different functions and applications. Renewable energy systems are applications that have been handled in recent years, especially for energy efficiency and sustainable energy management. These preferences are valuable choices not only for energy efficiency but also for reducing CO2 emissions. This study is based on the audit for evaluation of the energy consumption of a port building and saving potential with use of a concentrated solar system. Besides, CO2 emission saving potential with this preference was also examined. The energy demand of the port buildings, which uses heat and electric energy during whole year, were examined affordability of consumption with solar-powered systems. The research results indicated that the solar aided system preference provides 44.31% saving potential. At the end of the work, recommendations were given on energy efficiency and management.

Global Outsourcing and Local Tendering Supply Chain Systems in the Public Healthcare Sector: A Cost Comparison Analysis, Namibia

ObjectivesTo compare supplier prices for local tendering and global outsourcing supply chain systems that are used to purchase pharmaceutical products by the Ministry of Health in Namibia and to compare the supplier prices for both systems to the international reference buyer median prices. MethodsThis study was quantitative in design and compared local and international supplier prices for a basket of vaccines, antiretrovirals, and anti-tuberculosis (TB) drugs from 2015 to 2020. Prices were retrieved from the procurement documents obtained from the Central Medical Stores division of the Ministry of Health, Namibia. The study also compared local and international supplier prices with the international reference buyer median prices obtained from the Management Sciences for Health International Drug Price Indicator Guide (2015 edition). ResultsIt was found that 77% of all the pharmaceutical products in the study were more expensive when obtained from the local suppliers than from international suppliers—that is, vaccines (70%), antiretrovirals (86.6%), and anti-TB drugs (67%). More than 50% of all the pharmaceutical products had local and international supplier prices, which were higher than the international reference buyer median prices. The price differentials were found to be higher for pharmaceutical products that were newly introduced into TB and human immunodeficiency virus treatment guidelines. ConclusionsThe study has concluded that local suppliers were costlier than international suppliers for vaccines, antiretrovirals, and anti-TB drugs. The international price comparisons have shown that there is a need for improving the pricing mechanisms in Namibia to reduce the prices of several essential medicines.

129. Safety and Cost-effectiveness Analysis Outpatient Continuous Parenteral Antibiotics via a Disposable Elastomeric Pump at Two County Hospitals in Houston, Texas

BackgroundOutpatient parenteral antibiotic therapy (OPAT) is a therapeutic option for patients who require longer intravenous (IV) antimicrobial courses, yet do not need to remain hospitalized. HarrisHealth system OPAT programs implement a disposable elastomeric continuous infusion pump (eCIP) for IV antibiotics. Here we report the clinic-demographic features, outcomes of a cohort of patients receiving OPAT via eCIP (OPAT-eCIP), as well as the cost-effectiveness of OPAT in comparison to standard inpatient care. MethodsWe retrospectively obtained the clinic-demographic characteristics and outcomes of 91 patients discharged from HarrisHealth-affiliated hospitals from December 2018 to February 2021 who underwent OPAT-eCIP. We then compared the total costs associated with home OPAT-eCIP care with that of an equivalent of inpatient IV antimicrobial treatment based on previous studies.ResultsWe identified 481 total OPAT patients; 91 (18.9%) received intravenous antibiotics via eCIP, with two initiating therapy outpatient. In total, 1925 days of IV antimicrobial therapy were administered outpatient by OPAT-eCIP, with a median treatment course of 12 days. Eighty-three (92.2%) patients completed their antimicrobial course, with 85 (93.4%) cured of respective infections (Table 1). Antimicrobial-associated adverse events and PICC line associated complications were 6.6% and 14.3% respectively. 30-day hospital readmission rates were under 10% with 21 patients (23.1%, 28 total visits) presenting to the emergency room over the course of IV therapy. Estimated costs of OPAT-eCIP care over the study period ranged from &417,000-&576,750 with costs of equivalent inpatient care estimated at &2,945,250 to &3,927,000; estimated overall cost savings of OPAT-eCIP were &2,368,500 to &3,509,900 (Table 2).Table 1. Characteristics and Outcomes of Patients Receiving Continuous IV Antibiotics via Disposable Elastomeric Pump Table 2. Cost Analysis Comparison of OPAT-eCIP therapy versus inpatient antimicrobial therapy in patients from December 2018 from February 2021 ConclusionOPAT-eCIP therapy in a cohort of patients was highly effective and well-tolerated. While ED visit frequency indicates the necessity of close patient monitoring, low 30-day hospital readmission rates were encouraging. Along with the above, the significant cost savings demonstrated when compared with standard inpatient antimicrobial therapy suggest that OPAT-eCIP should be increasingly utilized as an effective therapeutic option.Disclosures All Authors: No reported disclosures

Unsupervised type III polygraphy in children undergoing adenotonsillectomy: a technical and economic report.

ObjectiveTo evaluate the economic and technical viability of the sleep study (type III) in children with adenotonsilar hypertrophy.Methods141 children were submitted to sleep study (type III), aged between three and 11, all with symptoms of OSA. The frequency of failed examinations and a comparison of cost analysis between complete polysomnography were described.Results41 exams lost at least one sensor. The sensor with the highest number of losses was the oximetry, observed in 14.28%. The 100 valid sleep studies allowed the diagnosis of severe OSA in 36 children. Sleep study accounts for approximately 63% of the value of the PSG type I, thus, it showed to be cost effective even with the repetition of the failed one.ConclusionSleep study (type III) may have high failure rates and it was a reliable exam for the identification of severe OSA. The cost analysis showed economic feasibility, even with a high failure rate and necessity of repetition.

Comparative Analysis of Cost and Time on Pier Head Elevated Works with Sosrobahu and Conventional Methods

The rapid population growth causes the need for mobility that is quite high for each individual. This must also be balanced with adequate transportation facilities. One of them is the construction of the Cimanggis – Cibitung Toll Road Project section 2 on the Elevated Transyogi. The construction of an elevated structure located in the median of the existing road with heavy traffic if applying conventional work methods can disrupt the activities of the surrounding community, especially traffic flow because scaffolding and heavy equipment will cover all Cibubur Alternative roads, so that a more appropriate work method is selected for pier head construction work in terms of cost and time by comparing the sosrobahu work method with conventional methods. The data analysis method used in this research is descriptive quantitative which consists of data collection techniques, and data analysis. The data used in this study are secondary data and primary data. After the required data is collected, then the cost and time calculations are carried out on the two pier head methods which refer to the Unit Price of Work in the Cimanggis – Cibitung project section 2 and PUPR No. 28 of 2016. sosrobahu is more expensive than the conventional method. With the cost of the conventional method of pier head work of Rp 2,725,021,973,00 Rp 396,083,025.00 cheaper than the sosrobahu method of pier head work of Rp 3,121,104,998.00.

Comparative Analysis of Actual Cost and INA CBG Rate in Diabetic Gangrene Inpatients

Background: Diabetic gangrene is a complication of diabetes mellitus that imposes a substantial financial burden on patients and their families as well as the health care system. Objective: To determine the total cost of disease, and the difference between real cost and INA CBG rate for diabetic gangrene inpatients from January - December 2017 at Universitas Airlangga Hospital, Surabaya Methods: The study was conducted retrospectively by using a total sampling method. The perspective used was the hospital perspective. This study's direct medical costs were laboratory, drug and consumable medical device costs, medical equipment rental, radiology examination, red cross, oxygen, service, and room costs. Data analysis was performed using an independent samples t-test. Results: The results showed that 148 patients met the inclusion criteria. The total real cost of diabetic gangrene inpatients at Universitas Airlangga Hospital in 2017 was IDR 1,339,949,381, and the total INA CBG rate for inpatients with diabetic gangrene was IDR 1,365,047,500. The difference was (p = 0.000) between real cost and INA CBG rate. Conclusion: There is a difference between the actual cost and the INA CBG rate for diabetic gangrene inpatients.

Optimization of regional distributed energy system under discrete demand distribution

This study break through the idealized demand-side distribution and build an optimization model of regional distributed energy systems under discrete conditions. Aiming at minimizing the system comprehensive cost, which includes the annual conversion cost of the initial investment and the annual operation and maintenance cost, the optimization model can determine the number, site, capacity of the energy station and the optimal pipe network layout path from the energy station to the load center, and make a comparative analysis of the annual costs in different situations. The main impact of the energy station site is the cost difference caused by the pipe network layout.

Ventilación mecánica simultánea: revisión histórica y análisis de costos

In times of crisis in public health where the resources available in the hospital network are scarce and these must be used to the fullest, innovative ideas arise, which allow multiplying the use of existing resources, as artificial mechanical ventilators can be. These can be used in more than one patient, by attaching a device to distribute the mixture of air and oxygen from the ventilator being used simultaneously (multiple mechanical ventilation). This idea, although innovative, has generated controversy among the medical community, as many fear for the safety of their patients, because attaching such devices to the ventilator loses control over the mechanical ventilation variables of each patient and can only maintain general vigilance over the ventilator. These misgivings about the device have led several researchers to take on the task of verifying the reliability of this flow splitter connector. It is for this reason that this article presents a thorough review of the studies carried out on the subject and additionally shows an analysis of comparative costs between the acquisition of a mechanical ventilator and the flow division system.

Orthopaedic Urgent Care Versus the Emergency Department: Cost Implications for Low-energy Fracture Care.

This study compared costs, length of visit, and utilization trends for patients with fractures seen in an immediate care orthopaedic center (I-Care) versus the emergency department (ED) in a major metropolitan area. A retrospective chart review of consecutive patients seen on an outpatient basis in the ED and I-Care over a 6-month period was conducted. Patient demographics, procedures done, care category, estimated costs, and disposition information were included for statistical analysis. Within the low-acuity fracture care group, a cost-comparison analysis was conducted. A total of 610 patients met inclusion criteria with 311 seen in I-Care and 299 in the ER. I-Care patients were more likely to have low-acuity injuries compared with ED patients (60.1% versus 18.1%, P < 0.001). The length of visit was longer for patients seen in the ED compared with I-Care (6.1 versus 1.43 hours, P value < 0.001). A cost analysis of low-acuity patients revealed that an estimated $62,150 USD could have been saved in healthcare costs by the initial diversion of low-acuity patients seen in the ER to I-Care during the study period. These results suggest that the I-Care orthopaedic urgent care model is a more cost-effective and more efficient alternative to the ED for patients with fractures requiring procedural treatment and low-acuity patients managed on an outpatient basis.

A Comparative Analysis of Cost and Affordability between Veterinary and Human Pharmaceutical Drugs in India

To analyze the comparison of cost and affordability between veterinary and human drugs in India. A comparative study was conducted in two regions of Chennai based on a simple random sampling technique. Both Veterinary and human drugs were collected from private veterinary and Human drug pharmacies. Price and availability data of veterinary medicines and human medicines were collected from private sector retail pharmacies. As per the data analysis, descriptive statistics are used. The comparison of various antibiotic, anti-helminthic, anti-inflammatory, anti-fungal, anti-histamine, anti-tick drug prices used in humans and Animals. The variation of a single unit Amoxicillin drug for veterinary costs Rs.30 whereas in Humans, the same drug costs to Rs.18.6.Cephalexin, ciprofloxacin, Sulfamethoxazole, tetracycline, clindamycin drugs showed a higher cost range in veterinary than in human drugs which had a difference of Rs.9 on average. Doxycycline, Chlorpheniramine, aspirin, Clotrimazole were the only veterinary drug cheaper than their similar human combination. The veterinary drugs are too expensive and we must take certain steps to avoid those high prices. Drug Regulation policies must be implemented for a veterinary drug similar to a human drug. Keywords: Veterinary Drugs, Human Drugs, Price, Affordability.

A novel solar assisted multigeneration system devoid of external utilities for drought adaptation considering water-exergy nexus analysis

• A sustainable solar multigeneration system was proposed to adapt to climate change. • Comparative thermodynamic, cost, risk, and environmental analysis were conducted. • The system offers 13 times less water withdrawal than conventional power plants. • Exergetic efficiency of the eco-friendly system can reach up to 74.37% • The novel system manages to generate products at a cost rate of 0.017 $.MWh −1. Conventional steam-driven multigeneration systems contribute to environmental damage by losing significant freshwater and emitting greenhouse gases. Here, a novel solar-powered steam jet ejector-based multigeneration system independent of external cold utilities is proposed for climate change adaptation. A Rankine cycle, an organic Rankine cycle, and a reverse osmosis desalination unit are fully integrated for clean power, cooling, and freshwater production employing. The thermo-mathematical model was evaluated considering thermodynamic efficiencies, annual costs, exergorisk, and global warming potential in a stand-alone and comparative framework. The water utilization of the hot utility was compared with two traditional fossil fuels by conducting a water-exergy nexus analysis. The analytical results showed that most of the total exergy destruction (73%) occurred in the solar collectors. The proposed system had 0.0171 $.MWh −1 cost of energy and an exergy efficiency of 57.29 % by employing R11. Compared to a natural gas-fired utility, the proposed solar-powered system reduced freshwater withdrawal, and consumption by 16 and 13 times, respectively. The system could achieve the exergetic efficiency of 74.37 % with the cost of energy of 0.013 $.MW −1 in a parametric model. Finally, R365mfc emerged as the optimal fluid for the proposed system by satisfying all performance criteria.

Stakeholders' Perceptions of Benefits of and Barriers to Using Video-Observed Treatment for Monitoring Patients With Tuberculosis in Uganda: Exploratory Qualitative Study.

BackgroundNonadherence to treatment remains a barrier to tuberculosis (TB) control. Directly observed therapy (DOT) is the standard for monitoring adherence to TB treatment worldwide, but its implementation is challenging, especially in resource-limited settings. DOT is labor-intensive and inconvenient to both patients and health care workers. Video DOT (VDOT) is a novel patient-centered alternative that uses mobile technology to observe patients taking medication remotely. However, the perceptions and acceptability of potential end users have not been evaluated in Africa.ObjectiveThis study explores stakeholders’ acceptability of, as well as perceptions of potential benefits of and barriers to, using VDOT to inform a pilot study for monitoring patients with TB in urban Uganda.MethodsAn exploratory, qualitative, cross-sectional study with an exit survey was conducted in Kampala, Uganda, from April to May 2018. We conducted 5 focus group discussions, each comprising 6 participants. Groups included patients with TB (n=2 groups; male and female), health care providers (n=1), caregivers (n=1), and community DOT volunteer workers (n=1). The questions that captured perceived benefits and barriers were guided by domains adopted from the Technology Acceptance Model. These included perceived usefulness, ease of use, and intent to use technology. Eligible participants were aged ≥18 years and provided written informed consent. For patients with TB, we included only those who had completed at least 2 months of treatment to minimize the likelihood of infection. A purposive sample of patients, caregivers, health care providers, and community DOT workers was recruited at 4 TB clinics in Kampala. Trained interviewers conducted unstructured interviews that were audio-recorded, transcribed, and analyzed using inductive content analysis to generate emerging themes.ResultsThe average age of participants was 34.5 (SD 10.7) years. VDOT was acceptable to most participants on a scale of 1 to 10. Of the participants, 70% (21/30) perceived it as highly acceptable, with scores ≥8, whereas 30% (9/30) scored between 5 and 7. Emergent themes on perceived benefits of VDOT were facilitation of easy adherence monitoring, timely follow-up on missed doses, patient-provider communication, and saving time and money because of minimal travel to meet in person. Perceived barriers included limited technology usability skills, inadequate cellular connectivity, internet access, availability of electricity, cost of the smartphone, and use of the internet. Some female patients raised concerns about the disruption of their domestic work routines to record videos. The impact of VDOT on privacy and confidentiality emerged as both a perceived benefit and barrier.ConclusionsVDOT was acceptable and perceived as beneficial by most study participants, despite potential technical and cost barriers. Mixed perceptions emerged about the impact of VDOT on privacy and confidentiality. Future efforts should focus on training users, ensuring adequate technical infrastructure, assuring privacy, and performing comparative cost analyses in the local context.

Cancer biomarkers testing in Russia: implementation issues and ways to improve

Abstract Background In 2019 Russian Ministry of Health launched the federal program “Oncology”. Its main goals include an increase of 5-year cancer patient survival up to 60% or more by 2024. An improvement in survival may be achieved by prescribing innovative cancer drug regimens, which require prior molecular diagnosing. Healthcare in Russia is state-funded and every constituent territory defines the list of molecular tests available and their costs independently. The aim research was to perform a comparative analysis of molecular testing costs and availability in all 85 units of Russia. Methods The data for the research was obtained from the rate agreements of Territorial Compulsory Medical Insurance Funds of each territory, available online. The list of biological markers analyzed was based on local guidelines and included EGFR, ALK, ROS1, BRAF, KRAS/NRAS, BRCA1/2, HER2, PD-L1 and MSI. Results At the time of research, only 50 territories had all tests included in the rate agreements. 35 territories had only some of these tests available or stated the availability of “molecular diagnostics” with a fixed cost for any test falling into this category. The titles and costs of same molecular tests varied between different territories with up to 10-fold difference in cost for certain tests. The mean number of tests planned for payment by the state was 7 per 10,000 population per year, though the estimated number of tests required is 17.4 per 10,000 population per year. Conclusions Our research revealed significant variation in molecular testing naming, availability and costs. This complicates planning and funding of cancer diagnostics programs and obstructs the process of drug prescription, making it difficult to achieve an improvement in patient survival. The situation could be amended by the development of standardized test naming and cost calculation. Key messages Almost half of Russia’s constituent territories have legal obstructions to perform some or every of essential oncological molecular tests, which hinders improvement in survival of cancer patients. The naming and cost calculation of molecular tests in Russia’s Territorial Insurance Funds are not standardized, causing inadequate funding and reduced availability of molecular diagnosing.

Determination of the structural efficiency of short bridges according to their physical and economic characteristics

Bridges are structures designed and built to overcome natural and artificial obstacles. The analysis and design of bridges is carried out following principles of physics applied to engineering. The aim is to estimate the structural efficiency of short bridges according to their physical and economic characteristics through equations that measure the cost tendency, identifying which ones have the highest structural efficiency for a given length between supports. The design of short bridges was carried out by means of a mathematical modeling in a software based on finite elements. A comparative cost analysis was carried out for various types of short vehicular bridges designed with reinforced concrete decks supported by reinforced concrete beams; post-tensioned concrete beams; and structural steel beams. It was determined that the bridge with a reinforced concrete deck is the alternative with the best structural efficiency according to its physical and economic characteristics with spans of 12 meters and 18 meters. According to the estimated cost equations, it is concluded that, from 18.49 meters post-tensioned concrete bridges are the most efficient physically and economically. Structural steel bridges are the least structurally efficient for short bridges. Therefore, the construction of short vehicular bridges with structural steel is not feasible.

Comparative laboratory cost analysis of various activated carbon activation process

Activated carbon (AC) is an established adsorbent for organic pollutants reduction, metal removal, and liquid and gas adsorption. Cost analysis corresponds to determining the best approach for AC production depending on activation techniques with different degrees of activation is still minimal in literature. A cost estimation of AC production in laboratory scale using different conventional activation and post-activation surface modification process is performed in this study. This study attempts to develop a cost-friendly selection of activation process from laboratory scale prices. Chemicals and utility costs were acquired from vendor quotes (i.e., Sigma-Aldrich and Fisher Scientific) and Sarawak industrial electricity tariffs based on 100 g production. Oil palm-based ACs produced from five different activation or surface modification methods were compared to ascertain the least expensive production approach in terms of estimated production cost. Of the five methods investigated, method that quoted the least expensive production cost is chemical activation using potassium hydroxide (KOH) with minimum estimated cost of $7.30 whereas the most expensive production cost involves surface modification by polyethyleneimine (PEI) impregnation with cost of $873.00. Therefore, the estimated production cost for KOH activation is the minimum at $0.073 g−1 while the maximum is $8.73 g−1 for PEI impregnation.

FP01.02 A Comparative Cost Analysis Study of Robotic and Video-Assisted Lobectomy: Results of Randomized Controlled Trial (Bravo Trial)

Thoracic minimally invasive surgery has some proved postoperative advantages. Robotic-assisted thoracic surgery has brought relevant technical improvements with consistent equivalence in oncologic results when compared to video-assisted surgery. Despite these potential benefits of robotic surgery, the cost was still considered a limiting factor for the wide dissemination of the technique in many countries. This study evaluate the cost difference between pulmonary lobectomy in patients included in a randomized controlled trial that compared video-assisted and robotic-assisted lobectomy in lung cancer and lung metastases resection.

The effect of chemical- versus microbial-induced calcium carbonate mineralization on the enhancement of fine recycled concrete aggregate: A comparative study

This paper studies the effects of chemical- and microbial-based calcium carbonate mineralization on the enhancement of CDW-derived fine recycled concrete aggregate (RCA) in terms of microstructural, physical, and mechanical properties. The chemical mineralization process was conducted via carbonation cabinet with adjusted CO2 gas concentration, temperature, and relative humidity through 7 days of curing. The microbial-induced carbonation method was implemented by submerging RCA into the solution of nutrients and non-axenic nitrate reducing biogranules under ambient conditions. After that, scanning electron microscope (SEM), X-ray diffraction (XRD), and thermogravimetric (TG/DTG) analysis were applied to evaluate the crystallographic structure of carbonation products. Mortar specimens were prepared using untreated RCA (U-RCA), chemically-treated RCA (C-RCA) and microbially-treated RCA (M-RCA) to reveal the effects on the workability and, mechanical properties of the cementitious system. The results indicated that chemical carbonation significantly affected the water absorption of RCA, the volume of the permeable void, workability and, the compressive strength of the cementitious system. On the other hand, microbial-induced carbonation slightly influenced the compressive strength of mortar specimens and adversely affected the physical properties of M-RCA. Despite the greater calcium carbonate precipitation on M-RCA observed via TG/DTG and XRD analysis, heterogeneous precipitation of carbonation products and the presence of bacterial remains on M-RCA indicated that chemical-derived carbonation could have more pronounced effects on RCA improvement. Additionally, comparative cost analysis revealed that chemical carbonation is economically more feasible.

Implementation of robotic-assisted total knee arthroplasty in the public health system: a comparative cost analysis.

Robotic-assisted total knee arthroplasty (TKA) may improve the precision of bone preparation and component alignment when compared to the conventional surgical approach; however, the detailed cost analysis of robotic-assisted TKA is lacking. This study aims to compare in-hospital costs between robotic-assisted and computer-navigated TKA. Patients undergoing primary TKA at a public hospital in Sydney between October 2018 and June 2019 were included. Patient demographics, surgical outcomes and in-hospital cost variables including, staff, critical care, emergency department, diagnostic, prosthesis, operating room, ward and other related costs until the discharge to the community were collected. Differences across in-hospital costs between robotic-assisted and computer-navigated TKA were compared using independent Student's t-tests. Of the 258 primary TKAs, 181 (70.2%) were computer-navigated and 77 (29.8%) robotic-assisted. Surgical time (p < 0.001) and operating time (p < 0.001) were both significantly shorter in computer-navigated TKA, while robotic-assisted TKA cases were more likely to be discharged directly home without extended in-patient rehabilitation (p = 0.014). When removing the capital costs of surgical equipment and maintenance, there was no difference in total in-hospital cost between computer-navigated ($19,512.3) and robotic-assisted TKA ($18,347.1; p = 0.179). When these capital costs were included, the mean in-hospital cost of robotic-assisted surgery was $21,507.6 compared to $19,659.7 for computer-navigated TKA (p = 0.034). The total in-hospital cost, during the implementation period of robotic-assisted TKA, is comparable with computer-navigated TKA. Robotic-assisted TKA was significantly more expensive when the upfront cost of the robotic system and maintenance costs were included. Longer term cost benefit of robotic-assisted TKA should be investigated in future studies.

Design and analysis of 5G network architecture with orthogonal frequency division multiple access based passive optical network

The demand for high-speed internet with a high-capacity network is increasing at an exponential rate. It is quite challenging to accommodate a large number of users with multiple communication devices without degrading the quality of service at an acceptable cost. Therefore, strong communication technology is required that can provide high data rates along with the provision of multiple connecting devices for different users. The 5G network can adjust large users with multiple device connectivity by providing high bandwidth with a minimum delay which depends on the underlying network architecture for connecting different components of the systems. Optical Fiber is used as a transmission media to connect the densely deployed Remote Radio Units (RRUs) with the Baseband Units (BBUs) at the Centralized Radio Access Network (C-RAN) that makes the architecture quite complex and expensive in terms of deployment and maintenance cost. Here in this paper, we propose an architecture by replacing an optical fiber with Free Space Optics (FSO) at the front-end of the 5G network. In addition, an Orthogonal Frequency Division Multiple Access (OFDMA) is implemented to provide high spectrum efficiency and high data rate in an adverse channel environment. The performance analysis of the proposed system is done in Optisystem by using the constellation points which shows that the proposed architecture can support data rate up to 40 Gbps using 512 subcarriers and 10 Gbps per BBU with QPSK over 4 km of FSO medium. In the end, a comparative cost analysis of the proposed architecture with the conventional architecture is done, which shows a cost reduction of 21 % by the proposed system.