System Cost Savings Research Articles

Managing Heat in Underground Mines: the Importance of Incorporating the Thermal Flywheel Effect into Climatic Modeling

Understanding the effects of various ventilation and climatic parameters on the work conditions and comfort in underground mines is critical for efficient ventilation system design and cost savings and to ensure the health and safety of mine workers. To understand the effects that the thermal damping effect (TDE) and the thermal flywheel effect (TFE) have on the ventilation system design and potential cooling system, this paper compares and analyzes the wet and dry-bulb temperatures at the bottom of an intake shaft using two modeling software packages, Ventsim™ and Climsim™. The comparison shows the consequences and importance of taking into account the TDE/TFE when predicting the climatic conditions in future underground mines, especially when deciding on whether a cooling system should be employed in order to provide adequate climatic conditions in the production stopes, dead-end development headings, and throughout the mine. Ventsim™ is able to account for the TFE, while Climsim™ does not. Both software packages have their uses and are used within the mining industry, but it is useful to understand their limitations and where the future of underground climatic modeling will lead.

PCN52 IMPACT OF LOWER COST BIOSIMILAR OPTIONS ON PATIENTS IN THE U.S. HEALTHCARE SYSTEM

This study assessed the potential impact of physician-administered biosimilars for the originator products trastuzumab, bevacizumab, and rituximab on patient out-of-pocket cost in the U.S. healthcare system. A retrospective medical claims analysis evaluated claims for patients taking trastuzumab, bevacizumab, and rituximab in 2018 and 2019. Expected patient cost reductions due to biosimilars were modeled using a Markov model based on pricing assumptions for biosimilars and current patient costs for originator products based on payer coverage and type of cost (deductible, coinsurance, co-pay). A total of 24,164 trastuzumab claims, 24,641 bevacizumab claims, and 18,113 rituximab claims in 2018 and 2019 were analyzed. Of the average monthly system cost savings, patients could see 7% of the savings for trastuzumab’s biosimilars ($1,692 average system savings), 8% for bevacizumab’s biosimilars ($1,875), and 9% for rituximab’s biosimilars ($7,697). Patients whose cost sharing is based on coinsurance could see a direct cost reduction due to the lower cost of biosimilars, impacting 13%-17% of all claims, 12%-16% of which are Medicare Fee-for-Service patients without supplemental insurance. Some commercial patients (5%-12%) and Medicare Advantage patients (21%-23%) who face coinsurance could also experience cost savings. While total spend may not change for commercial and Medicare Advantage patients due to U.S. mandated out-of-pocket limits, patient costs could be redistributed across more procedures for 17% to 25% of all claims. Physician-administered biosimilars are driving down the cost of care to the U.S. healthcare system. However, only a portion of patients realize the savings generated by biosimilars, specifically patients who face coinsurance. The U.S. healthcare system limits annual out-of-pocket expenses for commercial and Medicare Advantage patients, eliminating a portion of cost saving realized by patients with high cost healthcare expenses. Without system changes, these dynamics pose a risk to the use of biosimilars in the U.S. market.

Real-World Budget Impact of Listing a Biosimilar of Rituximab

The approval of new biosimilars by national health agencies is expected to generate significant cost savings for health care systems. This is particularly the case with the biosimilar of rituximab approved for the Canadian market in 2019. However, several uncertainties remain regarding utilization of this agent. To determine the proportion of total annual drug expenses for each indication for rituximab in the hospital setting and to determine potential savings related to introduction of a biosimilar. A budget impact analysis was performed through 3 real-world scenarios, based on data obtained from a large university teaching hospital for a 12-month period. This study involved data for 420 patients. Annual expenses for rituximab for all indications represented 7.7% of total annual drug spending for the hospital, of which 5.0% was related specifically to indications approved by Health Canada. More than 6% of the annual drug expenses was attributable to the use of rituximab for oncologic indications, including 1.8% for uses not approved by Health Canada. Overall, each 10% reduction in the price of a biosimilar of rituximab (relative to the reference rituximab) would result in annual savings of about 0.8% of total drug expenses in the hospital if a biosimilar was used for all real-world indications, whether approved by Health Canada or not. The introduction of a biosimilar of rituximab to the Canadian market would generate significant savings. To properly assess the potential savings that this agent could generate in the limited budget environment of a hospital, it seems important to consider all of the indications for which it could be used.

Understanding the Role of Comparative Clinical Studies in the Development of Oncology Biosimilars.

Biosimilars have the potential to broaden patient access to biologics and provide cost savings for health care systems. During the development of a biosimilar, data that directly compare the proposed biosimilar with the reference product are required. Such comparative data are generated in a stepwise hierarchical process that begins with extensive laboratory-based structural analyses and functional assays. This initial analytical phase serves as the foundation for the demonstration of biosimilarity and is followed by nonclinical in vivo testing (if required) and then clinical evaluation, including a comparative pharmacokinetics/pharmacodynamics study that is usually conducted in healthy volunteers. The development program typically culminates with a comparative clinical efficacy study. The aim of this study is to confirm clinical equivalence of the potential biosimilar and reference product on the basis of prespecified margins, using a study population and efficacy end point that are sufficiently sensitive for detecting potential product-related differences. Such studies also include detailed analyses of safety as well as evaluation of immunogenicity. As biosimilars become more widely available in oncology, especially with recent regulatory approvals of rituximab, trastuzumab, and bevacizumab biosimilars, it is critically important that clinicians understand how the comparative clinical study differs from a traditional phase III efficacy and safety study in the development of a novel biologic originator product. Here, we review the role of comparative clinical studies in biosimilar development, with a focus on trials conducted to support approved trastuzumab biosimilars. We discuss the study populations and end points used, extrapolation of indications, and the confirmatory nature of these studies within the totality of evidence supporting biosimilarity.

A Framework for evaluating the potential for using air-maritime integration in modern supply chains

In today’s economic context most supply chains are global and complex. Therefore integrating different transportation modes have become crucial for achieving cost and time savings in most supply chain systems. This paper presents a framework for evaluating the potential for implementing air-maritime integration. First we identified ten most influencing factors to establish a air-maritime integrated logistics hub using expert opinion and literature. Meanwhile two methods of integration, substitution and complementary were identified. AHP analysis was used to derive important weights to influencing factors and to determine the best method of integration. Finally IPA analysis was used to identify relative importance and current performance of individual factors and to classify them to four quadrants. Future actions required for implementing air-maritime integrated logistics were discussed based on the IPA classification. The framework was applied to assess the air-maritime integration potential of Sri Lanka. As per the results of the analysis, the best suited method for Sri Lanka was found to be the complementary method. Results also suggested that worldwide connectivity and centralized location are the most important criteria for implementing integrated logistics. By further improving the analysis procedure, this can be used for any other scenario in the world for evaluating the potential for air-sea integration.

Optimal Configuration and Diversification of Wind Turbines: A Hybrid Approach to Improve the Penetration of Wind Power

Literature indicates a decline in the market value of wind power with increasing market penetration. Two promising measures to mitigate this market value drop are system-friendly turbines and geographical diversification. This study analyzes the combined potential of a hybrid approach used to simultaneously improve market values, reduce system costs and the overall subsidy needs in Germany. Therefore, promising diversification regions and site optimal turbine configurations are identified. The corresponding market values and levelized cost of electricity are forecasted for penetration rates of up to 65% (2030). The analysis shows that the market value drop in diversified regions using system-friendly turbines is less severe. Furthermore, the hybrid approach results in system cost and subsidy savings. Additional analyses show that the dominant share of the hybrid approach benefits can be attributed to the use of system-friendly turbines and that diversification does not seem to be a promising alternative for Germany.

A deterministic mathematical model to support future investment decisions for developing inland container terminals

Agriculture is a leading sector in the Midwest economy. Grain production is particularly important to the natural resource-based economy of the upper Midwest. Exporters are at a competitive disadvantage when they are unable to obtain containers at a reasonable cost. To mitigate this shortage of containers and avoid excessive empty vehicle miles, it is proposed to strategically establish inland depots in regions with sufficiently high trade volumes. Inland depots would minimize total system costs for empty container repositioning while providing customers with desired levels of service. Mathematical models are formulated to evaluate the proposed system and implementation is performed as a case study for soybean container shipments in the study region of Minnesota. The proposed system has been demonstrated to significantly reduce empty vehicle miles travelled and total system costs, yielding benefits to regional exporters and individual stakeholders. Findings show that even if soybean trade volumes in the region remain static or decrease, inland depots will still result in noteworthy system cost and empty vehicle mile savings. Finally, the model can be applied similarly to other commodities and/or be used to analyze the potential for new intermodal points.

Fiscal Stewardship, Choice, and Control: The Context of Self-Directed Services for People With Intellectual and Developmental Disabilities (IDD) in the United States.

Self-directed home and community based services (HCBS) waiver services and supports for people with intellectual and developmental disabilities (IDD) have become a viable and widely used method of service provision in the United States. Grounded in theories of self-determination, previous literature on self-direction has suggested high satisfaction and positive outcomes for people who use self-directed programs as well as cost savings for state IDD service systems. This study explored the ways in which state IDD service administrators think about how self-direction may be used as a method of achieving cost savings while providing opportunities for people with IDD and their families to exercise choice and control. Informed by 54 high-level IDD service administrators in 34 states, and guided by a thematic analysis approach to data interpretation, the study found evidence that administrators typically see strong potential for self-direction to have cost-savings benefits, while also fostering choice. In the current political climate, the need for cautious fiscal stewardship may become a stronger driving force behind self-direction for people with IDD in the United States.

Pan-European Economic Analysis to Identify Cost Savings for the Health Care Systems as a Result of Integrating Glucose Monitoring Based Telemedical Approaches Into Diabetes Management.

Self-monitoring of blood glucose supported by the diabetes-app OneTouch Reveal® has demonstrated to improve HbA1c. We aimed at analyzing costs savings related the integration of telemedical features into diabetes management. Data from a randomized controlled trial were used to assess the 10-year risk of patients for fatal myocardial infarction (MI). On the basis of this risk assessments-also related to a 5% or 10% reduction of hypoglycemic episodes-cost savings for the health care systems of five European countries-France, Germany, Italy, Spain, and the United Kingdom-were modeled. HbA1c reduction of 0.92% in insulin-treated type 2 diabetes patients (T2DM) was associated with a 2.3% decreased 10-year risk for fatal MI. In combination with a 10% reduction of hypoglycemic events this risk reduction led to cost savings of €16.1 million (France), €57.8 million (Germany), €30.9 million (Italy), €23.8 million (Spain), and €5.8 million (UK), considering all insulin-treated T2DM patients in the respective countries. Improving metabolic control and thus risk for comorbidities like MI by combining the glucose meter with CRI with telemedical features has the potential to reduce costs for European health care systems.

A Deployable LPWAN Platform for Low-Cost and Energy-Constrained IoT Applications.

Many commercial platforms for fast prototyping have gained support for lpwan technologies. However, these solutions do not meet the low-cost and low-power requirements for a large-scale distribution of battery-powered sensor nodes. This paper presents the design, realization and validation of an open-source lpwan versatile platform. Energy and cost are considered key constraints for this hardware design. A power-efficient LoRa radio interface is implemented by hosting MAC functionality on the application microcontroller, eliminating the need for a modem. In the system architecture, power and cost savings are obtained by omitting and controlling lossy power circuitry. The resulting platform allows entry-level prototyping, while featuring an ultra-low sleep power of . This makes lpwan sensor applications accessible in domains that would otherwise require custom hardware development. The proposed design is validated by an illustrative but functional example of sensor nodes deployed in the field.

Sarcopenia: Aging-Related Loss of Muscle Mass and Function.

Sarcopenia is a loss of muscle mass and function in the elderly that reduces mobility, diminishes quality of life, and can lead to fall-related injuries, which require costly hospitalization and extended rehabilitation. This review focuses on the aging-related structural changes and mechanisms at cellular and subcellular levels underlying changes in the individual motor unit: specifically, the perikaryon of the α-motoneuron, its neuromuscular junction(s), and the muscle fibers that it innervates. Loss of muscle mass with aging, which is largely due to the progressive loss of motoneurons, is associated with reduced muscle fiber number and size. Muscle function progressively declines because motoneuron loss is not adequately compensated by reinnervation of muscle fibers by the remaining motoneurons. At the intracellular level, key factors are qualitative changes in posttranslational modifications of muscle proteins and the loss of coordinated control between contractile, mitochondrial, and sarcoplasmic reticulum protein expression. Quantitative and qualitative changes in skeletal muscle during the process of aging also have been implicated in the pathogenesis of acquired and hereditary neuromuscular disorders. In experimental models, specific intervention strategies have shown encouraging results on limiting deterioration of motor unit structure and function under conditions of impaired innervation. Translated to the clinic, if these or similar interventions, by saving muscle and improving mobility, could help alleviate sarcopenia in the elderly, there would be both great humanitarian benefits and large cost savings for health care systems.

A Comparison of Widespread Flexible Residential Electric Heating and Energy Efficiency in a Future Nordic Power System

Integrating ever-increasing amounts of variable renewable energy (VRE) into the power system could benefit from harnessing widespread residential demand-side management. This paper presents case studies on the potential benefits of power-to-heat (P2H) flexibility and energy efficiency improvements in a hypothetical future Finnish detached housing stock in the year 2030, both as a part of the larger Nordic power system and in an isolated Finnish power system. The housing stock was depicted using two archetype houses modeled using a simple lumped capacitance approach, integrally optimized as a part of a stochastic linear programming unit commitment model of the power system. With sufficient amounts of VRE, residential P2H with thermal storage was found to yield more system cost savings than simple energy efficiency improvements. However, energy efficiency improvements remained more beneficial for house owners, as excessive use of residential P2H for assisting the power system could result in increased heating costs.

Estimation of satellite‐derived regional photovoltaic power generation using a satellite‐estimated solar radiation data

AbstractA large number of photovoltaic (PV) power systems have been adopted in Japan after a feed‐in tariff was introduced in 2012. However, PV power generation data from residential rooftop and/or ground‐mounted PV systems, and larger MW‐size PV plants have not been measured accurately in real‐time. This is because PV power monitoring instruments (eg, smart meters) have not collected a sufficient amount of power generation data. In order to realize adequate safety control of electric power systems under high PV‐penetration conditions, it is important to fully understand the temporal and spatial variations associated with PV power generation. In this study, we estimated the PV power generation for a regional area (ie, prefecture or municipality) in terms of PV power installation capacity and satellite‐estimated solar irradiance using a Japanese geostationary satellite, Himawari‐8. The satellite‐derived regionally integrated PV power estimations were validated with reference data provided by electric power companies. The validation results showed that these estimations were comparable to the reference data, provided by the Kyushu Electric Power Company Inc. (Kyushu) and the Tokyo Electric Power Company Inc. (TEPCO). However, the results also identified slight overestimations of PV power in the spring and summer seasons. An advantage of the proposed method is that it does not require land‐based monitoring instruments, which can lead to increased operational cost savings for PV power systems. Furthermore, in consideration of future PV power penetration scenarios, it is suggested that PV power in excess of regional power demands could be generated under the same weather conditions.

Increased medication costs for filaggrin-related eczema and asthma

Eczema and asthma are common chronic diseases. Eczema affects 15‐20% of schoolchildren and 2‐10% of adults while asthma affects 16‐18% of the UK population. Almost three‐quarters of children with early onset eczema, a severe and persistent form of eczema, will develop asthma in later life. The filaggrin gene helps produce a protein that creates a protective barrier on the skin against the entry of outside substances that trigger allergies. About 1 in 10 people carry a change in the filaggrin gene and this results in the production of defective protein that can no longer help maintain this skin barrier. This UK study aimed to find whether filaggrin mutations were associated with increased prescribing of medication for eczema and asthma and /or an increased number of asthma exacerbations (i.e. worsening) and whether this translated into different healthcare costs. The study shows that children with eczema and asthma carrying this gene change have substantially increased needs for both eczema and asthma medication through most of their childhood. Children with asthma carrying the gene change were also more prone to suffer asthma attacks over a nine‐year period, enhancing both hospital and human costs of the disease. It follows that a simple ‘spit’ gene test, that can be done anytime in life, including at birth or early childhood, could help predict long‐term healthcare costs and the long‐term risk of more severe disease for individuals with common chronic conditions such as eczema and asthma. Children and adults with filaggrin gene mutations may benefit from targeted treatment regimes, such as daily use of emollients from birth, which could lead to cost savings for healthcare systems and improvements in disease control and quality‐of‐life.

Cost-minimization analysis of community pharmacy-based point-of-care testing for strep throat in 5 Canadian provinces.

Strep throat point-of-care (POC) testing in community pharmacies will enable pharmacist-based care for this condition. Our objective was to conduct an economic evaluation of treating severe sore throat when this service was offered in pharmacies in 5 Canadian provinces. We conducted 5 separate cost-minimization analyses for the provinces of Alberta, British Columbia, Nova Scotia, Ontario and Saskatchewan, from the public payer perspective, to estimate mean cost per patient of treating severe sore throat in 2 scenarios: 1) physician-based usual care in a family physician's office, a walk-in clinic or an emergency room (ER) and 2) a new scenario where patients received care described above or in a pharmacy offering strep throat POC testing. One-way sensitivity analyses were conducted to account for model uncertainty. Mean cost per patient for each pathway in the base-case analyses for the 5 provinces ranged from 1) $37.55 to $61.57 for family physician, 2) $37.55 to $61.57 for walk-in clinic, 3) $38.88 to $57.56 for ER and 4) $19.12 to $21.83 for pharmacy, representing savings ranging from $12.47 to $24.36 per patient for the new scenario. Approximate total cost savings range from $1.3 million to $2.6 million per year across the 5 provinces. All sensitivity analyses yielded cost savings for the new scenario. Across 5 provinces, strep throat POC testing in pharmacies was cost saving compared to physician-based care. Sensitivity analyses demonstrated the robustness of these results. Funding strep throat POC testing in community pharmacies in these 5 provinces would lead to public health system cost savings and potentially improve patients' access to care for severe sore throat.

Floseal only versus in combination in spine surgery: a comparative, retrospective hospital database evaluation of clinical and healthcare resource outcomes

ABSTRACTObjective: Flowable agents such as Floseal® (F) are often reserved as adjuncts to non-flowable agents (i.e. gelatin (G) sponges and thrombin (T)) when bleeding is not sufficiently controlled. Based on their perceived positive impact, it is postulated that flowable agents alone may result in better clinical and resource utilization outcomes. Clinical and health-care utilization outcomes were compared in this retrospective analysis of spine surgery cases with charges for Floseal only (FO) and F + G/T.Methods: The United States Premier Hospital Database was searched for adult spine surgeries performed between October 2010 and September 2015 with FO or F and G/T charges. To obtain an unbiased treatment estimate, 1:1 propensity-score matching was used to identify FO and F + G/T cohorts. The cohorts were compared for rates of intraoperative, perioperative, postoperative and transfusion; blood loss-related, serious and other complications; hospital length-of-stay (LOS), surgical time, and volume of hemostat charged.Results: Among 40,335 spine surgeries, 15,105 FO and F + G/T matched pairs were compared. Significantly (p < 0.0001) lower percentages of FO than F + G/T cases received intraoperative (1.4% vs. 2.5%), perioperative (1.6% vs. 2.8%), postoperative (1.6% vs 3.0%), and any transfusion (2.3% vs. 4.3%). FO cases had significantly less blood loss complications than F + G/T cases (0.5% vs. 0.8%, p = 0.0022) and significantly (p < 0.0001) shorter hospital LOS (−0.45 days), surgical time (−39.0 min), and used less hemostat (−12.5 mL).Conclusions: Results from this observational hospital database analyses indicate that FO use in spine surgery is associated with lower blood transfusion use and blood loss complications compared to its use with adjunct non-flowable hemostatic agents. The shorter hospital stay, reduced surgical time, and less hemostat volume health-care utilization outcomes that favored FO versus combination use may translate to health system cost savings. Further validation of these findings using controlled clinical trials and cost-consequence studies is warranted.Clinical relevance: The use of flowable hemostatic agents alone may result in better clinical and possibly economic outcomes in spine surgery.

The value(s) of flexible heat pumps – Assessment of technical and economic conditions

Residential heat pumps are one of the most resource-efficient means for space heating, and their market shares are expected to rise substantially over the next few decades. Through installation of a thermal energy storage, the operation of a heat pump is – to a certain extent – decoupled from heat demand. Such flexibility is frequently claimed to bear a high potential for demand-side management. This study investigates the operational cost savings achievable through the use of such a flexibility option. To this end, a dynamic model of a coupled building and heating system is developed, and several economic model-predictive control strategies for heat-pump operation are derived. These strategies exploit real-time prices and the flexibility of the thermal capacity of the building and/or heat storage. The proposed algorithms are applied using perfect and imperfect foresight. Furthermore, different variations of real-time prices along with several building and storage configurations are investigated. The resulting operational cost savings are contrasted with different paths of investment-cost developments. Results of this investigation demonstrate that investments in flexibility measures (smart-home equipment, thermal storage capacity, etc.) are, for the most part, economically unviable. However, it is also realized that economic feasibility depends greatly on the technical set-up and economic conditions. This study demonstrates that the potential of flexible heat-pump operation is frequently overstated. On the other hand, configurations for which overall system-cost savings could be deemed achievable are also identified.

Cost-Optimized Submarine Cables Using Massive Spatial Parallelism

We study the techno-economics of submarine systems constrained by a fixed electrical power supply. We show significant cost savings for high-capacity submarine systems using massive space-division multiplexing (SDM), even without assuming any savings from SDM-specific subsystem integration. Systems with about 100 parallel optical paths, e.g., $\sim$ 50 fiber pairs are shown to provide minimum cost/bit, operating at reduced spectral efficiencies and deep within the linear regime. While advanced nonlinearity-optimized fibers and digital nonlinearity compensation schemes provide little to no gain in such systems, SDM integration of amplifiers and transponders is shown to be a source for significant additional cost savings. We further examine the permissible cost premium for multicore fibers in such massively parallel systems and revisit various design tradeoffs for optical amplifiers, showing that a reduced noise figure can be traded for better power conversion efficiency. We also evaluate potential gains from increasing the available electrical supply power and discuss reliability aspects of massively parallel submarine systems.

The role of telemedicine in postoperative care.

Telemedicine has become one of the most rapidly-expanding components of the health care system. Its adoption has afforded improved access to care, greater resource efficiency, and decreased costs associated with traditional office visits and has been well established in a wide array of fields. Telemedicine has been adopted in several domains of surgical care. In recent years, the role of telemedicine in postoperative care has caught attention as it has demonstrated excellent clinical outcomes, enhanced patient satisfaction, increased accessibility along with reduced wait times, and cost savings for patients and health care systems. In this narrative review, we describe the history of telemedicine, its adoption in the field of surgery and its various modalities, its use in the postoperative setting, and the potential benefits to both patients and healthcare systems. As telemedicine continues to emerge as a powerful tool for health care delivery, we also discuss several barriers to its widespread adoption as well as the future utility of telemedicine in postoperative care.

Towards a fully integrated North Sea offshore grid: An engineering‐economic assessment of a power link island

An increasing share of variable power feed‐in is expected in the next decades in the European power system, with a particularly high offshore wind potential in the North Sea region. This demands more temporal‐ and spatial flexibility in the system, an adequate grid infrastructure can provide both. This study presents an engineering‐economic approach evaluating the impact of novel infrastructure designs towards a fully integrated North Sea offshore grid, including TenneT’s vision of a power link island (PLI). A PLI is an artificial island for transnational power exchange and distribution of offshore wind resources. We introduce the concept and evaluate the economic benefits and system implications under three different case studies incorporating 2030 scenarios from European Network of Transmission System Operators. The results demonstrate system cost savings up to 15.8% when comparing a fully integrated PLI solution with traditional, radial typologies. The PLI did in general result in more efficient system dispatch of wind resources, where the involvement from Norway, Great Britain, and Germany occurred most frequently in terms of grid reinforcements and expansions.This article is categorized under: Wind Power &gt; Systems and Infrastructure Energy Infrastructure &gt; Systems and Infrastructure Energy Systems Economics &gt; Systems and Infrastructure