Variation In Costs Research Articles

Lifestyle Transitions in ‘Monga’-Affected Regions: A Micro-Level Study in Northern Bangladesh

This study examines the gradual lifestyle changes in the Monga-affected regions of northern Bangladesh, focusing mainly on the Nilphamari district. Monga, a cyclical phenomenon, exacerbates unemployment, food shortages, and poverty, forcing many agricultural workers to abandon farming. This research explores Monga's impact on vulnerable populations and their coping strategies, including migration to urban areas for low-wage employment. A qualitative methodology was employed, including in-depth interviews and focus group discussions with 30 randomly selected respondents from Dimla Upazila in the Nilphamari district. Findings reveal that illiterate labourers and marginal and landless farmers are most affected, often migrating to cities seasonally for survival despite harsh conditions, relying on microcredit loans and the mercy of nature. Lifestyle changes at both the micro and macro levels are found in Monga-affected zones; changes include variations in consumption, livelihood, challenges, and social costs in personal and community relationships and diversification in agriculture. Government and NGO interventions play a critical role in alleviating these challenges by creating alternative employment opportunities. The study's limitations include a small sample size and geographical focus, which may limit the generalizability of its findings. However, the practical implications suggest that targeted interventions can mitigate Monga's impact, offering valuable insights for policymakers. This research provides original insights into the socioeconomic transformations caused by Monga, shedding light on the survival strategies of the affected population.

Marked variations in medical provider and out-of-pocket costs for radical prostatectomy procedures in Australia.

Objectives Unwarranted clinical variations in radical prostatectomy (RP) procedures are frequently reported, yet less attention is given to the variations in associated costs. This issue can further widen disparities in access to care and provoke questions about the overall value of the procedure. The present paper aimed to delve into the disparities in hospital, medical provider and out-of-pocket costs for RP procedures in Australia, discussing plausible causes and potential policy opportunities. Methods A retrospective cohort study using Medibank Private claims data for RP procedures conducted in Australian hospitals between 1 January 2015 and 31 December 2020 was undertaken. Results Considerable variations in both medical provider and out-of-pocket costs were observed across the country, with variations evident between different states or territories. Particularly striking were the discrepancies in the costs charged by medical providers, with a notable contrast between the 10th and 90th percentiles revealing a substantial difference of A$9925. Hospitals in Australia exhibited relatively comparable charges for RP procedures. Conclusions Initiatives such as enhancing transparency regarding individual medical provider costs and implementing fee regulations with healthcare providers may be useful in curbing the variations in RP procedure costs.

Cost-Effectiveness Analysis of Endoscopic Sleeve Gastroplasty

BACKGROUND AND AIMSObesity is prevalent in the United States. Endoscopic sleeve gastroplasty (ESG) has been shown to produce effective weight loss and improvement in obesity-related disease. The cost effectiveness of ESG is currently unclear in patients with obesity with and without type 2 diabetes (T2DM). METHODSA decision analytic model with time horizon of 5 years and lifetime, from a health system's perspective was constructed to compare ESG to no weight loss intervention (no ESG) in patients with obesity aged 35-45 years with a body mass index of ≥30 kg/m2 with or without T2DM. Parameters were obtained based on peer-reviewed data. One-way and 2-way sensitivity analyses were performed for variations in T2DM resolution and ESG costs. RESULTSFor the 5-year time horizon in patients with T2DM, ESG produced 4.28 quality-adjusted life years (QALYs) and cost $77,874, compared with 3.99 QALYs and a cost of $73,738 for no ESG, resulting in an incremental cost-effectiveness ratio (ICER) of $13,922 per QALY. For the lifetime horizon, ESG produced 29.57 QALYs and a lifetime cost of $451,261, compared with 26.69 QALYs and a lifetime cost of $493,806 for no ESG, resulting in a negative ICER (ie, cost saving). The 5-year time horizon in patients without T2DM demonstrated that ESG produced 4.42 QALYs, compared with 4.08 QALYs with no ESG, resulting in an ICER of $39,116 per QALY gained. For the lifetime horizon ESG produced 34.21 QALYs, compared with 31.60 QALYs for no ESG, resulting ICER of $4752. CONCLUSIONThis cost-effectiveness analysis suggests that ESG is cost effective in 5 years and cost saving over a lifetime for patients with obesity and type 2 diabetes. ESG remains cost effective at 5 years and over a lifetime in patients without T2DM.

The cost of mass drug administration for trachoma in two counties of the Republic of South Sudan.

Community-wide distribution of azithromycin, otherwise known as mass drug administration (MDA), is a component of the World Health Organization-endorsed SAFE strategy for the elimination of trachoma as a public health problem. In the Republic of South Sudan, 2.9 million people are known to live in areas that are known to require interventions and warrant MDA. This study estimated the total costs and cost per person treated during MDA in two counties, Kapoeta North and Kapoeta East, in South Sudan. MDA was conducted in Kapoeta North and Kapoeta East counties from October 2020 to January 2021. Following training and community sensitization, a core team, consisting of a height measurer, a drug dispenser, and a data recorder, delivered the intervention. A detailed costing database was developed in Microsoft Excel. An ingredients approach was used to capture all financial and economic costs incurred from a payer perspective. Primary outcomes included the total cost of MDA in each county and the cost per person treated in each county. In Kapoeta North, 58,226 people were treated at a financial cost of $71,350 USD. This corresponds to a unit cost of $1.22 per person treated. The total economic cost of the intervention was $99,036, at a unit cost of $1.70 per person treated. In Kapoeta East, 156,092 people were treated at a total financial cost of $168,404. This corresponds to a unit cost of $1.08 per person treated. The total economic cost of the intervention was $243,205, at a unit cost of $1.56 per person treated. The study highlights the cost variation for MDA implementation across two counties of South Sudan. As the South Sudan trachoma program expands, this information will be valuable for program planning.

Systematic Review of the Cost-Effectiveness of Home-Based Palliative Care Interventions in Patients with Cancer: A Critical Analysis.

The increased prevalence of cancer and the negative impact of pain on the quality of life of patients underscore the need to implement efficient palliative care interventions and management of pain. The cost-effectiveness of palliative care interventions for cancer, mostly pharmacological and delivered through home-based palliative care services, is unclear. Most of the studies do not take into account indirect costs nor consider variations across different geographical regions. To describe existing and cutting-edge knowledge on cost-effectiveness or item costs related to palliative home-based care for patients with cancer. We evaluated various costs, including direct medical, non-medical, and indirect costs in different geographical regions and analysed how different options for careaffect the patients' quality of life and associated expenses. This Prospero-registered systematic review (CRD42023404217) adhered to the PRISMA criteria. Following a multistep selection process, we selected 22 articles published between 2013 and 2023 focused on quality of life outcomes and cost-effectiveness of home-based palliative care for cancer patients. Home-based palliative care decreases the number of hospital visits, while its influence on patients quality of life is currently difficult to demonstrate across geographic regions based on available evidence. Overall, home care decreases the costs associated to the palliative care of patients with cancer. The cost structure analysis revealed that besides healthcare costs, informal care expenses and productivity losses represent a significant proportion of overall expenses). In Europe, the direct medical, non-medical, and indirect costs (in purchasing power parity) were on average $1,941, $842, and $1,241, per month per person, respectively. In the USA and Asia, direct medical and indirect costs are on average $1,095 (USA) vs $1,444 (Asia) and $2,192 (USA) vs $1,162 (Asia). In conclusion, the studies reviewed highlight significant cost variations and potential savings associated with palliative home-based care for cancer patients. Home-based palliative care, particularly involving medications, has shown favorable cost-effectiveness compared to hospital care. Specialized palliative home care, psychological interventions, and outpatient services further contribute to overall cost savings. However, the economic impact varies across different geographical contexts and cost categories, emphasizing the need for tailored approaches in palliative care planning and implementation.

Container Scheduling considering Customer Satisfaction in the Context of Internal Circulation

As China’s foreign trade continues to progress, a trade surplus in inland container transportation has emerged. At the same time, businesses need to not only focus on transportation tasks but also prioritize customer service requirements. To address the issues of container supply shortages and inefficient empty container allocation, this article establishes a container truck scheduling model that includes multiple terminals and yards. With the objective of minimizing total costs and maximizing customer satisfaction during the allocation process, the model incorporates coupling constraints between vehicle flow and container flow. Instance verification using Cplex demonstrates that the proportions of different cost types and the range of expected time windows can impact the formulation of transportation plans and, consequently, total costs. Lastly, numerical experiments are conducted to analyze the cost variations and transportation plan preferences under different ranges of time windows and different weights assigned to transportation costs and fixed costs.

A Multi-State Analysis of the Fiscal Impact of Commercial Insurance Coverage for General-Use & Activity-Specific Prosthetic & Orthotic Devices in the United States

Prosthetic and orthotic devices are assistive devices utilized by individuals with limb loss, limb difference, and mobility impairment. Research has shown these devices improve mobility and functionality, independence, and overall quality of life for individuals with disabilities who depend on them. This report focuses on two use types of prosthetic and orthotic devices: general-use and activity-specific. General-use prostheses and orthoses are designed to achieve the basic needs of ambulation and upper-limb functionality. In contrast, activity-specific devices are designed to support higher-intensity physical activities and recreation. Currently, 29 states do not require insurance coverage for general-use prosthetic and orthotic devices, and 45 states do not require insurance coverage for activity-specific devices, hindering individuals with limb loss, limb difference, and mobility impairment from essential life functions, including regular exercise required to prevent chronic illnesses. This study analyzes proposed legislation in 11 states, aiming to expand state-regulated coverage for prosthetic and orthotic devices for the purpose of improving quality of life and longevity of health, including chronic illness prevention. The methodology includes estimating the per member per month (PMPM) and net cost variations per state based on U.S. Census populations, Center of Medicare and Medicaid Services (CMS) Public Use Data Files and state-specific Medicaid fee schedules. The authors hypothesize that expanded insurance coverage could yield long-term social and fiscal benefits to the patient and healthcare systems. Results show PMPM estimates for states pursuing various levels of coverage, encompassing both general-use and activity-specific devices. The analysis conservatively estimates small PMPM increases based on assumptions related to device coverage costs and utilization. The results further emphasize potential overall healthcare savings from insurance coverage for these devices with the implementation of the 11 legislative initiatives, from improved health outcomes, with minimal fiscal impact.

Cost Variation Analysis of Branded Generics Used for Initial Treatment of Type 2 Diabetes, Hypertension and Dyslipidemia in India: A Pharmacoeconomic Perspective

Background: Branded generics are off-patent medications with proprietary names which are bioequivalent to the innovator medications. Cardiovascular diseases, driven by diabetes, hypertension, and dyslipidemia, are major health concerns, where patient compliance is crucial for long-term management. This analysis investigates cost variations of first-line branded generics for these conditions in Indian primary care settings.
 Methods: First-line medications preferred for type 2 diabetes, hypertension, and dyslipidemia were identified through an online survey of prescribers. Data from 1mg.com, an Indian online pharmacy, was used to compile a list of available brands for each medication. The study compared the prices of the five most prescribed brands, the three lowest-cost and one highest-cost brand per medication, and calculated the percentage cost difference.
 Results: First-line medications preferred for type 2 diabetes, hypertension, and dyslipidemia in India include Metformin 500mg, Enalapril 5mg, Telmisartan 40mg, Amlodipine 5 mg, and Atorvastatin 20mg. The analysis reveals significant cost disparities among commonly prescribed brands, with Metformin, Enalapril, Telmisartan, and Atorvastatin being notably more expensive (up to 1177%) than lower-cost alternatives, potentially placing a financial burden on patients. Amlodipine, however, exhibits modest cost variation (26-113%), with commonly prescribed brands leaning toward lower-cost options.
 Conclusion: Cost disparities among commonly prescribed brands could harm patient compliance and outcomes, emphasizing the need for cost-effective medication selection. This study offers crucial insights into cost variations in India's treatment of Type 2 Diabetes, Hypertension, and Dyslipidemia, underscoring the importance of cost awareness for improved patient compliance and healthcare system sustainability.

Pharmacoeconomic evaluation of Levothyroxine in the treatment of Hypothyroidism in Nepal

INTRODUCTION: Hypothyroidism, is an endocrine disorder, wherein the thyroid gland does not make enough thyroid hormones to meet the body’s needs. Levothyroxine is the mainstay of hormone replacement therapy for hypothyroidism. This study was aimed to evaluate the cost ratio and percentage cost variation, of different brands of levothyroxine, available in the Nepali market. MATERIALS AND METHODS: This observational pharmacoeconomic study was carried out at Department of Pharmacology of Janaki Medical College, Janakpurdham, Nepal from 5 April to 30 May, 2023. Maximum retail price (Cost) in Nepalese currency (NRs), of various brands of levothyroxine available in Nepali market, of same dosage form, strength and number was reviewed for calculating the cost ratio and the percentage cost variation of levothyroxine manufactured by Nepali and Indian Pharmaceutical companies. RESULTS: For 120 tablets of levothyroxine, maximum cost ratio of 1.37 and percentage cost variation of 37.14% was observed with 50 mcg of levothyroxine. For 100 tablets of levothyroxine, maximum cost ratio of 1.65 and percentage cost variation of 65.44% was observed with 50 mcg of levothyroxine. CONCLUSIONS: The findings of this study can be used by a treating physician for prescribing an alternative cheaper brand of levothyroxine for better compliance and for reducing the total health-care cost. Continuous pharmacoeconomic analysis, if carried out at government level, can greatly minimize the cost variation as well as reduce the overall treatment cost for hypothyroid patients in Nepal.

Productivity and Costs of Mechanized Skidding operations at Sao Hill Forest Plantation, Tanzania

Due to global advancement of technology in forest operations, utilization of advanced machineries such as grapple skidder (GS) in timber harvesting has been increasing in the last decades. However, in order to understand their contribution in sustainable harvesting operations, it is important to understand their performance under different operating environment. Therefore, this study aimed to quantify productivity and cost of mechanised skidding operations at Sao Hill Forest plantation (SHFP). Six variables; diameter at a breast height (dbh), tree height, skidding distance, slope, costs, and cycle time (determined using detailed continuous time study) were collected in 120 GS observations.GS productivity and costs were estimated using productive machine hour (PMH) and delays inclusion approach. Regression models were developed using a generalized linear model (GLM) approach. GS productivity under PMH was 2.6% higher than the one including delay time, while skidding costs was 2.1% higher in the approach including delays. This study revealed significant variations (p-value <0.05) in productivity and cost on various terrain classes. At 0 m – 50 m distance, an average delays free GS productivity was 85.5 m3/h, with costs amounting to 1.7 USD/m3. On the distance exceeding 150 m, productivity dropped to 20.1 m3/h, and costs increased to 12.7 USD/m3. Likewise, in 0.0% - 10.0% slope range, average delays free GS productivity and costs was 100 m3/h and 1.5 USD/m3 respectively, while at 20.1% - 30.0% slope range, productivity dropped to 32.6 m3/h and costs raised to 3.9 USD/m3. Skidding distance, slope, and volume per trip were robust predictors of the GS productivity and costs, yielding pseudo-R2 values of 58.1% and 64.3%, respectively. Therefore, this study developed statistical models useful for predicting GS productivity and costs, however, their applications are recommended to be within the ranges of the variables used to develop the models.

Optimizing Cost Management in Dynamic Business Environments: An In-depth Analysis of Production Cost Budgeting, Considering Specific Elements and External Factors

This research discusses the effectiveness of using budgets as a means of controlling production costs at PT. Sari Tuna Makmur in the 2017-2021 period. By examining the budget and realization of direct labor costs (salary costs), factory overhead costs, as well as differences in budgeted tuna production costs, this research aims to identify factors that influence variations between budget and realization. The research results show that the company is generally successful in controlling production costs. Although there are variations in direct labor costs during the COVID-19 pandemic, PT. Sari Tuna Makmur was able to achieve production costs that were lower than the budget in previous years. Internal factors such as business policies, production capacity, and production facilities, as well as external factors such as competition and consumer demand, play an important role in successful cost control. However, special challenges arise during the pandemic, where the decision not to reduce the workforce may result in direct labor cost deviations. Therefore, this research recommends increasing the accuracy of budget preparation and more detailed attention to factors that influence production costs, especially in unexpected situations. This research contributes to the understanding of production cost control strategies amidst the dynamics of the business environment. The practical implication is the need for companies to continue to optimize cost control strategies, consider changes in external conditions, and increase accuracy in preparing budgets to maintain the company's operational and financial sustainability.

Drug utilization pattern evaluation and cost variation analysis of anti-fungal agents in tinea infected patients in dermatology department of a tertiary care teaching hospital

Background: Tinea infections are chronic superficial fungal infections, highly prevalent in tropical countries like India. Therefore, long-term therapy is needed and this can inflict a financial burden on the patients. Aim of the study was to assess drug utilization patterns in patients diagnosed with tinea infection and to evaluate the cost variability of anti-fungal agents. Methods: A cross-sectional observational study was conducted in patients for 3 months after taking permission from IEC. All adult patients already diagnosed with tinea infection were enrolled. Evaluation of drug utilization pattern was carried out using WHO core drug prescribing indicators and percentage of cost variability was calculated between different brands of anti-fungal agents. Results: A total of 252 patients were enrolled. Tinea corporis and cruris were the most commonly diagnosed tinea infection. Pruritus was the most common presenting symptom. Past history of similar illness was seen in 74 (29.4%) patients mean of 3.83±0.87 drugs were prescribed per patient. Drugs prescribed from NLEM was only 42.1%. Most commonly prescribed drugs were oral itraconazole and topical miconazole. Percentage of cost variability was seen maximum with capsule itraconazole 200 mg (237.5%) by oral route and luliconazole 30 gm (175.6%) by topical route. Conclusions: Prescribing practices of drugs can be improved by promoting generic drug and prescribing drugs from NLEM. Wide range of cost variation can lead to high economic burden in tinea infected patients.

Technoeconomic Analysis of Torrefaction and Steam Explosion Pretreatment Prior to Pelletization of Selected Biomass

Lignocellulosic biomass has demonstrated great potential as feedstock for pellet production, notwithstanding the fact that the industrial production of pellets is faced with some economic challenges. This study presents a technoeconomic analysis of six scenarios to develop a process model for pellet production from sawdust and oat straw that employs torrefaction and steam explosion pretreatment prior to pelletization. SuperPro Designer was used to carry out this evaluation. The pellet plants were designed to have a capacity of 9.09 t/h of sawdust and oat straw each. The pellet yield ranged from 59 kt to 72 kt/year. The scenarios analyzed included variations of steam explosion and torrefaction. In some scenarios, materials were lost in the form of liquid and gas due to the pretreatment process. The breakdown of equipment purchase cost showed that the torrefaction reactor is the most expensive unit with approximately 51% of the purchase cost. Facility-dependent and feedstock costs were the major significant contributors to the pellet production cost. The minimum selling prices of the pellets obtained from Scenarios 1–6 were $113.4/t, $118.7/t, $283.4/t, $298.7/t, $200.5/t, and $208.4/t, respectively. The profitability of pellet production as determined by the net present value (NPV), internal rate of return (IRR), and payback period was found to be sensitive to variations in feedstock cost.

Surgeon-Dependent Variability in Cost of Gastrointestinal Operations in a Single Cancer Center

IntroductionCancer operations are increasingly utilizing specialized equipment and technology. Related costs are often not known to the responsible surgeon. We seek to evaluate cost aspects of care episodes attributable to the surgeon's management decisions. MethodsFinancial cost data in a tertiary academic cancer center were queried over 3 y. Consecutive patients undergoing gastrointestinal operations followed by inpatient admission of two or more days were included, excluding patients with 40+ d admissions. Analysis of variance, Kruskal–Wallis, and multiple regression statistics were utilized. ResultsThe study population included 1540 patients: 54% men and 46% women, with a median age of 64 y (range 15-95). Eight surgeons conducted major (82%) and minor (18%) operations, with a minimally invasive surgical approach in 60.4%. Procedures included colorectal (37%), pancreatic (19%), esophagogastric (18%), hepatobiliary (18%), and small bowel resections (8%). Total direct costs differed between surgeons with an analysis of variance coefficient range between −$3265 and +$6163 (P < 0.001). Surgeons' cost differences were observed for central medical supply, operating room (OR) supply, total OR, inpatient room, laboratory, pharmacy, supportive care (P < 0.001), and radiology costs (P < 0.02). OR supply cost was the dominant consistent domain with significant differences between surgeons in all case subcategories. When controlled for case category and minimally invasive surgical approach, multiple regression showed the most significant variations between surgeons in ORs, medical supply, and nutrition costs (P < 0.001), followed by laboratory costs (P < 0.01). Top OR supply costs were staplers and energy devices. ConclusionsEven in a highly subspecialized surgical environment, surgeons’ variable utilization of ORs and medical supplies is strongly linked to variations in care-related costs. Specific queries into supply items should reduce costs and optimize value generated.

Out-of-Pocket Costs and Physician Payment Variations in Abdominal Contouring: Evidence From United States Claims Data

Background: Abdominal contouring after massive weight loss has positive impacts on quality of life. There are often cost and access barriers for patients who desire these procedures. Objectives: To examine levels of access to body contouring in the era of price transparency, this study aims to characterize the out-of-pocket expenses and physician/facility payments in abdominal contouring procedures. Setting: The IBM MarketScan Commercial Databases were queried to identify patients who underwent outpatient abdominal contouring surgeries in the United States in 2021. Methods: Financial variables of interest included gross payments to the provider (facility and/or physician) and out-of-pocket costs (total of coinsurance, deductible, and copayments). Univariate analysis and mixed-effects linear regression were utilized to study the variations in costs across regions, insurance plan types, and places of service. Results: A total of 1319 abdominal contouring episodes were identified. The average age was 44.7, and the majority of patients were female (91%) and in the South region (44%). Median out-of-pocket costs were low overall ($30, IQR $768) and median total physician/facility payments for abdominal contouring was $4982.47 (IQR $7392.46). Out-of-pocket costs were highest in the South ($105) and $0 in all other regions ( P &lt; .05). The highest physician/facility payments were in the Northeast ($6392) and the lowest was in the South ($3936). Conclusions: Patients undergoing abdominal contouring incur relatively low out-of-pocket costs overall, but there is a need for further reimbursement negotiation in regions where physician payments are lower and out-of-pocket costs are higher. Further study should explore reimbursement and payment gaps in procedural coverage.

Variations in Site-Specific Costs for Infants Born Extremely Preterm in Canadian Neonatal Intensive Care Units

To quantify site-specific costs and their association with survival without major morbidity (SWMM) in Canada for neonates <28weeks of gestation admitted to large tertiary neonatal intensive care units. We conducted a retrospective analysis of infants born at <28weeks of gestation and admitted to Canadian Neonatal Network sites from 2010 through 2021. Sites that cared for at least 50 eligible infants by gestational age in weeks over the study period were included. Using a validated costing algorithm that assessed physician, nursing, respiratory therapy, diagnostic imaging, transfusions, procedural, medication, and certain indirect costs, we calculated site and resource-specific costs in 2017 Canadian dollars (CAD) and evaluated their relationship with SWMM. Seven sites with 8180 (range 841-1605) eligible neonates with a mean (SD) gestation of 25.4 [1.3] weeks were included. Survival to discharge or transfer was 85.3% with a mean (SD) length of stay of 75 (46) days. The mean (SD) total and daily costs per neonate varied between $94 992 ($60 283) and $174 438 ($130 501) CAD and $1833 ($916) to $2307 ($1281) CAD, respectively. Between sites, there was no relationship between costs and SWMM. There was marked variation in costs and SWMM between sites in Canada with universal health care. The lack of concordance between both outcomes and costs among sites may provide possibilities for outcomes improvement and cost containment.

Modeling and investigating the dilemma of early and delayed vaccination driven by the dynamics of imitation and aspiration

This study aims to evaluate mankind’s vaccination behavior for two alternative vaccines through the incorporation of imitation and aspiration dynamics in an existing setup of the mean-field approximation. Individuals may be immunized in advance of an outbreak to prevent infection. However, due to the immunization’s imperfections, expense, or people’s reluctance to get immunized, a number of individuals might opt to be immunized later. Our model can simulate two scenarios of social conundrums, one caused by early vaccination and operating on a global time scale. The other is driven by delayed vaccination and working on a local time scale. The epidemic scenario gets worse as the strategy updating interval gets longer. This work provides a comparative analysis between the dynamics of imitation and aspiration. We integrate the imitation dynamics with various cost and efficacy variations of these vaccines. Then, we demonstrate the impact of symmetric and asymmetric level of expectations for both vaccines on aspiration dynamics. The symmetric expectations for both vaccines continue to have a negative relationship with their cost and a positive association with the efficacy of the vaccines. If one of the vaccines is more expensive, the consumer may opt for another. However, fewer aspiration for the early vaccine can improve the total vaccine coverage and hence help to limit epidemic disease in the case of an asymmetric degree of aspiration for the early-delayed vaccination model.

Pharmacy and neighborhood-level variation in cash price of diabetes medications in the United States

Background Diabetes medications place significant financial burden on patients but less is known about factors affecting cost variation. Objective To examine pharmacy and neighborhood factors associated with cost variation for diabetes drugs in the US. Research design, subjects and measures We used all-payer US pharmacy data from 45,874 chain and independent pharmacies reflecting 7,073,909 deidentified claims. We divided diabetes drugs into insulins, non-insulin generic medications, and brand name medications. Generalized linear models, stratified by pharmacy type, identified pharmacy and neighborhood factors associated with higher or lower cash price-per-unit (PPU) for each set of drugs. Results Cash PPU was highest for brand name therapies ($149.4±203.2), followed by insulins ($42.4±25.0), and generic therapies ($1.3±4.4). Pharmacy-level price variation was greater for non-insulin generic therapies than insulins or brand name therapies. Chain pharmacies had both lower prices and lesser variation compared with independent pharmacies. Conclusions Cash prices for diabetes medications in the US can vary considerably and that the greatest degree of price variation occurs in non-insulin generic therapies.

Economic Feasibility Analysis According to Seam Location of Ship Pieces

The structure of a ship is completed by processing various steel plates and welding these plates. This butt welding of plates is defined as a seam in shipyards, and this study seeks to find a way to decrease costs by reducing the utilization of steel through effective seam arrangement. Seams were defined and classified according to purpose, and examples of “pieces” and “main plates” where seam creation had an economical saving effect were selected. For “pieces,” the change in the weight of steel utilized depending on the presence or absence of a seam was calculated, and the resulting change in cost increase was presented. In the case of the “main plate,” the quantity of seams does not change, but an example of cost variation due to the appropriate placement of seams is presented. Hence, a large difference was found in the costs of “pieces” depending on seam location. Thus, it was advantageous to create additional seams. For the “main plate,” it was found that narrow-width and wide-width materials incur more costs. This study demonstrates that creating seams is economically advantageous but may not be preferred owing to the increased workload from a production perspective.

Cost Variation Analysis of Anti-Migraine Drugs Available in Indian Market

Cost Variation Analysis of Anti-Migraine Drugs Available in Indian Market