Cost Utility Research Articles

Economic evaluation of Polygenic Risk Scores in healthcare interventions: a systematic review

Abstract Background Polygenic Risk Scores (PRS) quantify genetic susceptibility to diseases, promising personalized healthcare. This review explores current evidence regarding the economic evaluation of strategies based on PRS or other polygenic risk stratification approaches, scrutinizing their methodologies. Methods The study protocol was registered in PROSPERO (CRD42023442780). A systematic search in PubMed, Scopus, and Web of Science identified full economic evaluations of intervention based on polygenic risk stratification strategies. The quality of the included articles was assessed using the Drummond checklist. This study was supported by the EC and MUR under PNRR - M4C2-I1.3 Project PE_00000019 ‘HEAL ITALIA”. Results Nineteen articles were included in the analysis, with oncological conditions being the most frequently investigated (13), followed by cardiovascular conditions (3). In nearly 80% of the studies, PRS was employed for screening interventions, with the general population being the primary target in 14 out of the 19 studies. All the economic analysis models investigated cost-utility in terms of QALYs, with Markov models and microsimulations being the most common structures. The majority of these models were based on simulated cohorts derived mostly from North American or European data, with 9 adopting a healthcare system perspective and 6 a societal perspective. Although delivery strategies for PRS testing were rarely addressed, PRS costs were included in nearly all studies. Indirect costs were examined in fewer than half of the studies. In 12 out of 19 studies, the conclusions claimed the cost utility of PRS involving strategies. Conclusions Despite the technique’s potential, evaluations of various strategies based on PRS approaches yield heterogeneous conclusions regarding cost-utility. Our study highlights the factors contributing to this heterogeneity and underscores the need for further exploration, ideally prioritizing real-world data. Key messages • PRS strategies evaluations vary in cost-utility conclusions, highlighting the need for further investigation. • Real-world data and practical implications should be prioritised in PRS research.

Impact of bundled payments on healthcare use and costs for cardiovascular diseases in the Netherlands

Abstract Background Bundled payments for patients with cardiovascular diseases (CVD) aim to enhance primary care utilization in the Netherlands. This study assesses changes in healthcare utilization patterns and costs for CVD between 2015 and 2019, while investigating the potential association with bundled payment adoption. Methods We studied patients at very high risk for CVD using routinely recorded nationwide healthcare data. Multilevel logistic- and gamma regressions were conducted to assess healthcare utilizations patterns between 2015 and 2019, and the impact of bundled payments on the likelihood of receiving medical specialist care and the height of associated costs. Results The odds of medical specialist involvement declined over time for the 148,876 patients included in our study. This decline was significantly associated with practices’ use of bundled payments. Medical specialist costs did also significantly decrease between 2015 and 2019, and patients in practices with the highest level of bundled payments had significantly lower medical specialist costs. When general practice costs were included however, healthcare costs per patient stayed the same, both over time and stratified by use of bundled payments. Conclusions Our findings suggest an association between bundled payments and specialized healthcare use, potentially facilitating the transition to primary care. While we found no evidence for costs savings, our findings do support a reduction in spending growth. Key messages • We evaluated the impact of bundled payments as a means to facilitate integrated care, and found that bundled payments were associated with lower uptake of specialized medical care. • We found no cost savings were found, but findings do support reduced spending growth.

Pharmacotherapy sequencing strategies for patients with heart failure with reduced ejection fraction: a cost–utility analysis

Pharmacotherapy sequencing strategies for patients with heart failure with reduced ejection fraction: a cost–utility analysis

Study on the influence of high permeability magnetic iron on energy consumption reduction in high gradient magnetic separator

The green processing of weakly magnetic iron ore is inseparable from high-intensity and high-gradient magnetic separator (HGMS), which is one of the most energy-intensive magnetic separation equipment. Iron (Fe) armor serves as the key primary structure for enhancing magnetic field conduction efficiency within the magnetic system. The order of magnetic properties of commonly used magnetic yoke materials is: ordinary carbon structural steel < Q235 steel < DT4 electrical pure iron. But the utilization cost of DT4 electrical pure iron is the highest, especially the magnetic properties of DT4C super electrical pure iron are unstable and the yield is low. On the basis of ordinary pure iron materials, this article has developed a new type of 411 pure iron (411) upon controlling the levels of harmful elements, while increasing the concentration of beneficial elements.intensity Furthermore, through the utilization of magnetic field simulation software, the impact of 411 on the background magnetic field intensity of HGMS was analyzed. The results indicated that the newly developed 411 pure Fe exhibited a coercivity of 24.07 A/m, a saturation magnetization intensity of ∼ 1.69 T, a maximum relative magnetic permeability of 24.38 × 10-3H/m, demonstrating superior magnetic properties in comparison with Q235 and DT4C. When using 411 pure iron as the magnetic yoke material, the background magnetic field intensity of the HGMS can be increased by 6.85 % − 14.64 % compared with using DT4C super pure iron under the same excitation current conditions. The magnetic yoke with better magnetic conductivity will enhance the magnetic field utilization efficiency of the magnetic system, a reduce the excitation energy consumption, and improve the sorting performance of HGMS.

Outcomes of percutaneous coronary intervention in patients with chronic total occlusion (CTO): a single-center study evaluating a new dedicated CTO program in Egypt

PurposeThe conundrum of limited resources in developing countries leads to the abonnement and underutilization of percutaneous coronary intervention for chronic total occlusion, in addition to lack of expertise, limited supplies, and success rates. We embraced this challenge by initiating a dedicated program in a tertiary academic center in Egypt, aiming for optimum utilization of resources, limit cost, and gaining experience. We present our outcomes and the proficiency in establishing the program.MethodsWe enrolled all patients undergoing percutaneous coronary intervention for chronic total occlusion during the first year of initiating our dedicated program. Analysis of clinical data, angiographic findings, and procedural features were evaluated, aiming to evaluate outcomes. Our primary outcome was successful recanalization achievement, utilization of available resources and cost. Secondary outcomes such as peri-procedural myocardial infarction, coronary perforation, urgent need of coronary artery bypass grafting, cerebrovascular stroke, and mortality were assessed.ResultsOur study enrolled 64 patients electively admitted to the Critical Care Department, Cairo University, undergoing percutaneous coronary intervention for chronic total occlusion. The median J-CTO score was 2 (0–5). We achieved successful recanalization in 47 patients (73%). The mean procedural time was 123 ± 48.8 min, mean contrast volume was 359.03 ± 151.9 ml, and mean radiation dose was 9.4 ± 4.2 Gy. The mean number of wires per patient was 2.69 ± 1.32, and the most successful crossing strategy was antegrade wiring (56.3%). The commonest cause of failure was failure of re-entry (46.7%). One patient had peri-procedural MI (1.6%), and one patient required urgent CABG. There was no in-hospital mortality or cerebrovascular stroke. The cost ranged from 6520 Egyptian Pounds (EP) ($415) to 63,720 EP ($4058), with a mean of 26,213 EP ($1670).ConclusionsEstablishing a dedicated program for percutaneous coronary intervention for chronic total occlusion proved to be feasible and proficient, achieving high success rates with limited complications in view of limited resources, rationalized utilization of equipment, and limitation of hospital costs.

National Costs for Cardiovascular-Related Hospitalizations and Inpatient Procedures in the United States, 2016 to 2021

The current economic burden of cardiovascular-related hospitalizations grouped by diagnoses and procedures in the U.S. has not been well characterized. The objective was to identify current trends in cardiovascular-related hospitalizations, procedural utilization, and health care costs, using the most recent 6 years of hospitalization data. A retrospective analysis of discharge data from the National Inpatient Sample (NIS) database was conducted to determine trends in cardiovascular-related hospitalizations, costs, and procedures for each year from 2016 to the most recent available dataset, 2021. Total cardiovascular-related costs were adjusted to and reported in 2023 dollars. In 2021, there were 4,687,370 cardiovascular-related hospitalizations at a cost of $108 billion. Heart failure hospitalizations accounted for the highest costs at $18.5 billion, followed by Non-ST-Elevation Myocardial Infarction at $11.2 billion, and stroke at $10.9 billion. Significant upward trends in costs from 2016 to 2021 were observed for heart failure, stroke, atrial fibrillation, ST-elevation myocardial infarction, chest pain, hypertensive emergency, ventricular tachycardia, aortic dissection, sudden cardiac death, pericarditis, supraventricular tachycardia, and pulmonary heart disease. Over the 6 observational years, total costs increased by over $10 billion, representing a 10 percent increase. However, the increases were not linear, as there was a significant increase of 6.5% from 2018 to 2019, then a dip of over 7% from 2019 to 2020, followed by a rise of about 6% from 2020 to 2021. By 2030, total CV-related costs are projected to reach $131.3 billion. For all years, coronary procedures were the most performed, followed by ECMO, non-bypass peripheral vascular surgery, pacemaker placement, and CABG. Both TAVR and MitraClip procedures demonstrated significant upward trends from 2016 to 2021. Overall, from the years 2016 to 2021, cardiovascular-related hospitalizations, costs, and procedures demonstrated upward trends. In conclusion, cardiovascular disease remains a high burden in the hospital setting with tremendous health care costs.

Real world comparison of filgrastim to filgrastim-sndz in patients with chemotherapy-induced neutropenia.

There exists some apprehension by prescribers, healthcare providers, and other stakeholders regarding the real-world safety and effectiveness of biosimilars. While some of the apprehension is likely due to clinician knowledge gaps in the biosimilarity exercise, additional data (including those generated from the real-world) regarding safety and efficacy could reduce a clinician's perception of biosimilar uncertainty and can potentially increase biosimilar acceptance and uptake. The published literature is lacking regarding the real-world impact on healthcare costs and clinical outcomes when a single healthcare institution converts from filgrastim to filgrastim-sndz as its short-acting Granulocyte Colony Stimulating Factor (GCSF), especially within diverse populations and indications not explicitly studied through the registration trials. Specifically, both filgrastim and filgrastim-sndz possess FDA-approved indications within patients with hematologic malignancies receiving high-dose chemotherapy and in those undergoing bone marrow transplantation. As a biosimilar to filgrastim, the FDA did not require prospective, randomized controlled trials to obtain these indications for filgrastim-sndz. The purpose of this study is to describe real-world healthcare resource costs, utilization patterns, and clinical outcomes in patients with hematologic malignancies who received filgrastim-sndz or filgrastim to support neutrophil recovery following chemotherapy (i.e., induction or consolidation) or a bone marrow transplant (BMT) at Yale New Haven Hospital (YNHH). A total of 148 patients were identified and met the following criteria: at least 18 years old, Eastern Cooperative Oncology Group (ECOG) performance status of 0 to 2, absence of fever or infection, newly diagnosed acute myeloid leukemia or newly post-bone marrow transplant and received filgrastim-sndz (Zarxio®) or reference filgrastim (Neupogen®). Healthcare resource utilization outcomes were compared between biosimilar and reference filgrastim using descriptive statistics. There were no major differences between either cohort, including duration of hospitalization, the number of overall emergency room visits and additional hospital admissions with a primary diagnosis of febrile neutropenia or neutropenia within 30 days post-discharge from initial hospital admission, time to neutrophil recovery following GCSF support, and the incidence and duration of both fever and febrile neutropenia. The total cost based on treatment of all patients in each arm differed significantly with filgrastim-sndz being the most cost-effective choice. filgrastim-sndz significantly reduced healthcare utilization costs compared to reference filgrastim with similar effect on absolute neutrophil count, incidence of fever, and febrile neutropenia.

Costs Associated with Transcatheter Aortic Valve Implantation and Surgical Aortic Valve Replacement in Korea.

This study compared the costs associated with transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR) in Korea by utilizing the National Health Insurance Service database. Between June 2015 and May 2019, 1,468 patients underwent primary isolated transfemoral TAVI, while 2,835 patients received primary isolated SAVR with a bioprosthesis. We assessed the costs of index hospitalization and subsequent healthcare utilization, categorizing the cohort into 6 age subgroups: <70, 70-74, 75-79, 80-84, 85-89, and ≥90 years. The median follow-up periods were 2.5 and 3.0 years in the TAVI and SAVR groups, respectively. The index hospitalization costs were 41.0 million Korean won (KRW) (interquartile range [IQR], 39.1-44.7) for the TAVI group and 24.6 million KRW (IQR, 21.3-30.2) for the SAVR group (p<0.001). The TAVI group exhibited relatively constant index hospitalization costs across different age subgroups. In contrast, the SAVR group showed increasing index hospitalization costs with advancing age. The healthcare utilization costs were 5.7 million KRW per year (IQR, 3.3-14.2) for the TAVI group and 4.0 million KRW per year (IQR, 2.2-9.0) for the SAVR group (p<0.001). Healthcare utilization costs were higher in the TAVI group than in the SAVR group for the age subgroups of <70, 70-74, and 75-79 years, and were comparable in the age subgroups of 80-84, 85-89, and ≥90 years. TAVI had much higher index hospitalization costs than SAVR. Additionally, the overall healthcare utilization costs post-discharge for TAVI were also marginally higher than those for SAVR in younger age subgroups.

Multi-scale retrofit pathways for improving building performance and energy equity across cities: A UBEM framework

Institutional inequality has created an environment in which our physical surroundings reflect racial and economic biases – causing inequitable thermal comfort and energy consumption across neighborhoods. Just as energy and thermal comfort challenges are unique to each climate and built environment, the solutions to address these issues should be optimized for their context. We introduce a novel integrated data-driven and building energy simulation method that incorporates urban context, satellite imagery, and socioeconomic data to analyze multi-scale retrofit scenarios across disparate communities. We apply this method to case studies in New York City and Los Angeles to analyze energy and thermal comfort inequities across distinct climate zones and urban morphologies. Through parametric analysis, we demonstrate the efficacy of multi-scale retrofits at improving building performance and reducing existing thermal inequities. Our research shows that retrofit effectiveness is influenced by the microclimatic changes induced by the urban context and existing infrastructural inequity. For example, instantaneous building cooling energy demand in a disadvantaged community of Los Angeles is reduced more due to window retrofits (around 30 kWh) than by a greenspace retrofit (around 3 kWh). Greenspace installation dissipates more heat overnight and in the early morning, whereas window retrofits reduce solar heat gain during the day, showing the different heat reduction pathways that retrofits can achieve. Although the window retrofits lead to an order of magnitude higher utility cost savings ($70 savings from windows vs $9 for greenspace and $12 for reduced cars), the district-scale retrofits show promising pathways for reducing the cost burden across all residents. We also analyze pathways for achieving city-specific CO2 reduction targets and find that building-level retrofits are most effective at meeting building performance standards (reducing CO2 by 40%), whereas district-level retrofits should be used to achieve city-scale climate goals because of the sequestered and abated emissions offered by these pathways. This generalizable modeling framework empowers policymakers, urban planners, and building owners around the world to analyze pathways for meeting their climate action plan goals by reducing extreme heat, reducing greenhouse emissions, and reducing energy cost burden while improving environmental justice in their cities.

Sintilimab plus chemotherapy with or without bevacizumab biosimilar IBI305 in EGFR-mutated non-squamous NSCLC patients who progressed on EGFR TKI therapy: A China-based cost-effectiveness analysis.

This study aims to compare the cost-effectiveness of sintilimab in combination with chemotherapy, with or without bevacizumab biosimilar IBI305, versus chemotherapy alone for patients with epidermal growth factor receptor (EGFR)-mutated non-small-cell lung cancer (NSCLC) who have progressed on tyrosine-kinase inhibitor (TKI) treatment from the perspective of the Chinese healthcare system. 10-year Markov model was developed using a 21-day cycle length. Transition probabilities were derived from the ORIENT-31 trial, while cost and health state utilities were obtained from publicly databases, local hospitals, and published literature. Incremental cost-effectiveness ratios (ICERs) were calculated as the primary model output and compared to a willingness-to-pay (WTP) threshold range of $15,289.34 to $38,223.34 per quality-adjusted life-years (QALY). Sensitivity analyses were performed to assess the robustness of the model. In the base-case analysis, sintilimab plus IBI305 and chemotherapy had an ICER of $53,266.32/QALYs, exceeding the upper WTP threshold. Sintilimab plus chemotherapy had an ICER of $15,329.11/QALY, slightly above the lower WTP threshold. Subgroup analysis yielded consistent results. Deterministic sensitivity analyses found no ICER for sintilimab plus chemotherapy beyond the upper WTP threshold. Most model input changes did not decrease the ICER of sintilimab plus IBI305 and chemotherapy below the upper WTP threshold. Probabilistic sensitivity analyses further demonstrated the cost-effectiveness superiority of sintilimab plus chemotherapy over sintilimab plus IBI305 and chemotherapy. This study supports the cost-effectiveness of using sintilimab in combination with chemotherapy. Nevertheless, the cost-effectiveness of combining sintilimab with IBI305 and chemotherapy in this particular patient group may be lacking.

Cold Start Latency in Serverless Computing: A Systematic Review, Taxonomy, and Future Directions

Recently, academics and the corporate sector have paid attention to serverless computing, which enables dynamic scalability and an economic model. In serverless computing, users only pay for the time they actually use resources, enabling zero scaling to optimise cost and resource utilisation. However, this approach also introduces the serverless cold start problem. Researchers have developed various solutions to address the cold start problem, yet it remains an unresolved research area. In this article, we propose a systematic literature review on clod start latency in serverless computing. Furthermore, we create a detailed taxonomy of approaches to cold start latency, which we use to investigate existing techniques for reducing the cold start time and frequency. We have classified the current studies on cold start latency into several categories such as caching and application-level optimisation-based solutions, as well as Artificial Intelligence (AI)/Machine Learning (ML)-based solutions. Moreover, we have analyzed the impact of cold start latency on quality of service, explored current cold start latency mitigation methods, datasets, and implementation platforms, and classified them into categories based on their common characteristics and features. Finally, we outline the open challenges and highlight the possible future directions.

Reservation and allocation model considering the user cost and the utilization of parking space

In order to alleviate the problem of imbalance between parking supply and demand by improving the utilization rate of parking resources, and considering the game relationship between user benefits and system benefits in parking allocation, the optimization objective function of maximum parking space utilization and minimum user cost in parking reservation mode is established from the two aspects which are system optimization and user optimization respectively. Then, the optimal allocation parking integer programming model (OPA) considering users' preferences is established. An Augmented Lagrangian-Alternating Direction Method of Multipliers Algorithm is designed to solve the optimal solution of the model. Finally, in order to test the validity of the model, the proposed model and the classical distribution model are compared and analyzed under different supply and demand conditions. The results show that the performance of the proposed model in three performance metrics which are parking utilization, average user cost and request acceptance rate is significantly better than that of the classical allocation model. The research results of this paper can provide theoretical reference for the management of parking reservation platform.

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.

Functional Impairments, Phenotypic Frailty, and Sector-Specific Incremental Healthcare Costs in Older Adults.

This study quantifies incremental healthcare expenditures of functional impairments and phenotypic frailty in specific healthcare sectors. Pooled 2023 analysis of 4 prospective cohort studies linked with Medicare claims including 4318 women and 3847 men attending an index examination (2002-2011). Annualized inpatient, skilled nursing facility (SNF), home healthcare (HHC), and outpatient costs (2023 dollars) ascertained for 36 months following index examination. Functional impairments (difficulty performing 4 activities of daily living) and frailty phenotype (operationalized using 5 components) derived from cohort data. Weighted multimorbidity index including demographics derived from claims. Mean age at index examination was 79.2 years. After accounting for multimorbidity and each other, average annualized incremental costs of 3-4 functional impairments versus no impairment in women (men) were $2838 ($5516) in inpatient, $1572 ($1446) in SNF, and $1349 ($1060) in HHC sectors; average incremental costs of phenotypic frailty versus robust in women (men) was $4100 (not significant for men) in inpatient, $1579 ($1254) in SNF, and $645 ($526) in HHC sectors. Incremental inpatient costs were primarily due to a higher hospitalization risk, while incremental SNF and HHC costs were related to both increased risks of utilization and higher costs among individuals with utilization. Neither geriatric domain was associated with outpatient costs. In this study of community-dwelling beneficiaries, functional impairments were independently associated with higher subsequent expenditures in inpatient, SNF, and HHC sectors among both sexes. Phenotypic frailty was independently associated with higher subsequent inpatient costs in women, and higher SNF and HHC costs in both sexes.

Cost-Effectiveness of Fruquintinib for Refractory Metastatic Colorectal Cancer in the USA.

The FRESCO-2 trial established the efficacy and safety of fruquintinib in patients with refractory metastatic colorectal cancer. However, its cost-effectiveness in the US context is not well documented. This study evaluates the cost-effectiveness of fruquintinib versus placebo for this patient population from the perspective of US payers. We developed a partitioned survival model on the basis of patient-level data reconstructed from the survival curves of the FRESCO-2 trial. Parametric estimation was conducted to estimate long-term clinical outcomes and medical costs over a lifetime horizon. Cost inputs and utilities were sourced from public data and previous literature. We used a discount rate of 3.0% per year for both clinical outcomes and costs. We adopted an incremental cost-effectiveness ratio (ICER) threshold of US$100,000 per quality-adjusted life-year (QALY) gained. We performed sensitivity and scenario analyses to examine the robustness of cost-effectiveness results. Fruquintinib treatment resulted in incremental gains of 0.108 life years (LYs) and 0.073 QALYs compared with the placebo, at an additional cost of US$112,294, primarily driven by medication expenses. The ICER for fruquintinib versus placebo was calculated at US$1,037,855 per LY and US$1,546,619 per QALY gained, exceeding the predefined cost-effectiveness threshold. The cost-effectiveness results were robust across all sensitivity and scenario analyses. Despite the survival benefit, fruquintinib was not cost-effective compared with the placebo in patients with refractory metastatic colorectal cancer in the US setting, on the basis of the conventional willingness-to-pay threshold. Our findings may provide a basis for informing the pricing and reimbursement decisions regarding fruquintinib.

Increased access to pediatric specialist healthcare using eConsult: A retrospective observational cohort and case–control study

ABSTRACT Objectives Primary care practitioners (PCPs) report that using the Champlain BASE™ eConsult service (eConsult) averts one-third of face-to-face (FTF) specialist referrals, however, there are concerns about duplication of services and adverse patient outcomes. Following an eConsult, we evaluated patient healthcare utilization and associated treatment costs. Methods Retrospective cohort study (2014 to 2018) of patients (&amp;lt;18 years old) for whom an eConsult visit averted a FTF specialist referral. Patients were linked to provincial health administrative databases and hospital electronic medical records for healthcare use for the same diagnosis and specialty for the 18 months following the eConsult. Concurrently, a retrospective case–control study compared utilization and costs between an eConsult versus a matched FTF visit for the same diagnosis. We also assessed PCP satisfaction. Results In follow-up, &amp;lt;5% of the study cohort of eConsult patients (n = 242) later accessed the healthcare system for the identical diagnosis and specialty type. FTF visits generate more frequent outpatient visits (12.6 times more [95% CI: 2.28 to 69.66, P = 0.002]) and higher costs compared to eConsult visits. There were no hospital admissions or deaths in patients with eConsult. PCPs (98%) described eConsult as an excellent service. Conclusions Using eConsult is associated with &amp;lt;5% of patients subsequently having a FTF visit for the same reason. Matched FTF visits generated more healthcare utilization and higher costs compared with eConsult. eConsult in pediatrics is safe and can minimize FTF specialist visits in elective cases and increase capacity, towards a more efficient and cost-effective healthcare system.

B-282 Cost and Benefits of Utilization of Ion Mobility Mass Spectrometry Testing for Drugs of Abuse Compared to Immunoassay Screening in a Large Urban Hospital

Abstract Background Urine drugs of abuse testing (DOAU) in US hospitals are mainly orders from the emergency department performed by immunoassay screening. Testing can be relatively expensive, and results may suffer from non-idealities in sensitivity, specificity, and from panel limitations. A potential approach to these issues for immunoassays is instead to employ mass spectrometry (MS), where a large and flexible analyte list can be evaluated providing needed specificity and reducing send out costs for confirmatory testing. We compared results and cost impacts of a DOAU assay on a prototype, ion mobility mass spectrometry system to those obtained from an array of immunoassays offered as routine tests at a large urban hospital. Methods Immunoassay screen-positive and screen-negative urine samples were isolated from among those submitted for a DOAU panel (amphetamines, barbiturates, benzodiazepines, cannabis, cocaine, opiates, and methadone) or for additional single drug tests (fentanyl, oxycodone, phencyclidine, buprenorphine, propoxyphene). Sample aliquots (3 mL) were retrieved after not more than 5 days of refrigerated storage of the original sample and were subsequently frozen. These samples were then subjected to MS analysis using the prototype system where identification of 62 compounds was based on mass and ion mobility-derived Collision Cross Section (CCS). An established library of m/z, SLIMCCSHe, peak intensity, and peak width for each analyte was used, with acceptable method performance characteristics as based on applicable CLIA validation guidelines. The MS list included compounds covered by the immunoassay classes as well as additional drugs not expected to be positive among the immunoassays test results but of value for routine toxicological assessments. Results comparisons, utility of results, sample-to-result turnaround times, and overall financial implications were compared between the two workflows. Results Among immunoassay screen-negative samples, MS analysis showed additional positive results for metabolites of parent drugs as well as novel psychoactive substances and known adulterants in &amp;gt;10% of cases. Among the immunoassay screen-positive results, MS analysis confirmed immunoassay results (&amp;gt;90%) but picked up an additional positive component in over 15% of cases. Cost per complete patient result for the immunoassay was approximately $2.80 in comparison to an estimated cost of $5 for the MS method. Confirmation testing for positive immunoassay screen results (16% of all samples) would cost an additional $70 per sample, whereas the need for confirmation testing is eliminated for the MS method. Thus, use of the MS testing workflow would be superior to an immunoassay with reflex testing workflow while at the same time providing a clinically superior service of more diverse positive test results and elimination of often overlooked false negatives. Turnaround time between immunoassay (1h) and MS (50m) were judged to be similar. Conclusions The MS approach confirmed &amp;gt;90% of all immunoassay positive screen results. In addition, the MS method identified additional positive results not detected by the immunoassay despite an overall similar estimated time for sample to patient. Need for development of a user friendly, MS analyzer for use in hospitals is supported based on cost-effective and analytically superior tests for DOAU compared to screens performed using immunoassay panels.

A Cost–Utility Analysis of the Use of −125 mm Hg Closed-incision Negative Pressure Therapy in Oncoplastic Breast Surgery

Background: Closed-incision negative pressure therapy (ciNPT) decreases the rate of wound complications in oncoplastic breast surgery (OBS) but at a fiscal cost. Our aim was to examine the cost-utility of ciNPT in OBS. Methods: A literature review was performed to obtain the probabilities and outcomes for the treatment of unilateral breast cancer with OBS with ciNPT versus without. Reported utility scores in the literature were used to calculate quality-adjusted life years (QALYs) for each health state. A decision analysis tree was constructed with rollback analysis to determine the more cost-effective strategy. An incremental cost–utility ratio was calculated. Sensitivity analyses were performed. Results: OBS with ciNPT is associated with a higher clinical effectiveness (QALY) of 33.43 compared to without (33.42), and relative cost increase of $667.89. The resulting incremental cost-utility ratio of $57432.93/QALY favored ciNPT. In one-way sensitivity analysis, ciNPT was the more cost-effective strategy if the cost of ciNPT was less than $1347.02 or if the probability of wound dehiscence without was greater than 8.2%. Monte Carlo analysis showed a confidence of 75.39% that surgery with ciNPT is more cost effective. Conclusion: Despite the added cost, surgery with ciNPT is cost-effective. This finding is a direct result of decreased overall wound complications with ciNPT.

TCT-970 Cost and HealthCare Utilization by Age, Sex, and Race in the Years Leading Up to a Severe or Clinically Significant Status for Patients With Tricuspid Regurgitation

TCT-970 Cost and HealthCare Utilization by Age, Sex, and Race in the Years Leading Up to a Severe or Clinically Significant Status for Patients With Tricuspid Regurgitation

A joint vehicular device scheduling and uncertain resource management scheme for Federated Learning in Internet of Vehicles

Federated learning (FL) offers an effective framework for the efficient process in vehicular edge computing. However, FL encompasses the process of distributing and uploading model parameters, which are inevitably transmitted in a wireless network environment. Some challenges in FL-assisted Internet of Vehicles (IoV) sceneries gradually emerging, such as data heterogeneity, concerned device resources, and unstable communication environment, which necessitate intelligent vehicle selection schemes that accelerate training efficiency. Based on these, we consider a new scenario, specifically an FL-assisted IoV system under uncertain communication conditions, and develop an interval many-objective vehicle selection and bandwidth allocation (IMoVSBA) joint optimization scheme. This scheme takes into account computation latency, energy consumption, server utilization, and data quality, while meeting multi-criteria resource optimization requirements. Among these, server utilization is a new objective designed specifically for this joint optimization problem. For the proposed problem, a novel interval many-objective evolutionary algorithm with individual comprehensive indicator to control the evolution direction (IMaOEACI) is designed. Simulation results demonstrate that this method outperforms other schemes in terms of accuracy, training cost, and server utilization, effectively improving training efficiency in wireless channel environments and reasonably utilizing bandwidth resources. It provides significant scientific value and application potential in the field of the IoVs.