Cost Management Research Articles

The Role of Activity-Based Costing in Reducing Environmental Impact: A Systematic Literature Review

Accounting professionals play a pivotal role in reducing environmental impact through systems like activity-based costing (ABC). This study offers a thorough review of research on ABC and environmental impact, providing insights into the current literature and guiding future developments. It systematically reviews 58 articles published in the Web of Science from 1998 to 2023, using Excel and the R package Bibliometrix for data analysis. The findings indicate a steady increase in research on ABC and environmental impact. Key contributions highlight the advantages of ABC in minimizing environmental impact across industries such as sustainable construction, metallurgy, transportation, and manufacturing. Emerging research directions include developing costing systems to reduce environmental impact, optimizing supply chain cost management models, and applying new technologies to tackle environmental challenges in production processes. Two primary research themes, identified as “motor themes,” are crucial for advancing this field: life-cycle assessment management models, which integrate environmental factors throughout a product or service’s life cycle; and the performance and impact of environmental cost management systems, which evaluate the effectiveness of these systems in reducing ecological footprints while maintaining profitability. These areas are essential for driving future research and innovation at the intersection of cost management and environmental sustainability.

The Management Pathway of Patients with Cystic Echinococcosis in Iran Prior to Definitive Surgical Treatment.

Patients with cystic echinococcosis (CE) regularly undergo surgery in medical centers in endemic countries. Our understanding of the challenges patients face on the pathway toward the final diagnosis and treatment of CE is poor. The present study was conducted to evaluate the medical care-seeking pathway and the underlying causes of the delayed surgical treatment of CE. Information related to 68 CE patients who underwent surgery in Kerman, Southeast Iran, was collected through face-to-face visits or telephone calls. All the patients were interviewed, and the medical records of each patient were reviewed. The pathway taken by the patient to seek care, the workups performed for diagnosis and management, and the length of time between the onset of symptoms and definitive diagnosis and surgery were evaluated. The patients were visited by at least two physicians; the median number of physicians was four. A total of 47% of the patients were referred to a general practitioner on their first visit. The mean times between the first visit and CE diagnosis and surgery were 1.5 and 3.2 months, respectively. A definitive diagnosis of CE was made for 35.3% of the patients in less than 1 month after the first visit. However, it took 4 months or more for 51.4% of the patients to receive hydatid surgery. The fear of anesthesia and surgery, the cost of management, unsuccessful chemotherapy for CE patients, pregnancy, and issues related to immigrant patients and refugees are among the factors involved in the protraction of CE diagnosis and treatment. Establishing practice guidelines for CE diagnosis and treatment, continuing education for healthcare professionals, and improving access to diagnostic facilities for endemic communities are required to address challenges in the management of CE in endemic regions.

ISDS Reform UNCITRAL: Implications For Indonesian Investment Policy

The United Nations Commission on International Trade Law (UNCITRAL) Working Group III (WG III) has been meeting intensively to formulate comprehensive reforms to Investor-State Dispute Settlement (ISDS) based on emerging criticisms. In July 2017, UNCITRAL established Working Group III with a mandate to identify and evaluate ISDS-related concerns, consider the need or desirability of reforms, and develop relevant solutions. Some of the issues that have been identified in relation to the current ISDS mechanism include lack of consistency and predictability of arbitral awards by ISDS forums, lack of independence and impartiality of arbitrators, cost and duration of proceedings, and third-party financing. The WG III forum has formulated several options to address these issues: 1) establishment of a court mechanism, 2) appointment of arbitrators and adjudicators, 3) parties' involvement and control, 4) dispute prevention and mitigation: strengthening dispute prevention and mitigation mechanisms, 5) cost management and third-party financing transparency: efforts to manage costs and related procedures, as well as transparency in third-party financing. The findings indicate that Indonesia actively participates in WG III by advocating for balanced reforms that safeguard state sovereignty and public interest while addressing investor rights. Key recommendations include enhancing transparency and leveraging regional alliances to strengthen Indonesia’s position in international investment frameworks.

Cost-Effective Modeling for Management Options in Charcot Neuroarthropathy.

Charcot neuropathic arthropathy (CN) impacts peripheral lower extremity nerves, leading to joint destruction, and has a significant economic burden on the healthcare system. This economic burden is further exacerbated by the projected increase in diabetes mellitus cases over the coming decades, with a corresponding anticipated rise in CN. This study assesses CN management costs through a single institution retrospective chart review and cost-effectiveness through economic modeling by utilizing a well-established equation to determine the cost-effectiveness of conservative management. This retrospective chart review from a single academic center analyzed costs and outcomes for CN patients undergoing exostectomy, arthrodesis, major amputation, minor amputation, or casting from 2000-2022. This retrospective review analyzed 216 CN patients (average age 58, 54% male). Costs were $57 949 for exostectomy, $149 009 for arthrodesis, $40 313 for major amputation, $55 035 for minor amputation, $125 851 for failed casting, and $8233 for casting. We conducted a break-even analysis that determined that intervention with casting was cost-effective compared to failed casting. Total contact casting is a cost-effective first-line treatment for CN, capable of managing non-advanced cases effectively and reducing the economic burden of surgical intervention. This study provides a critical framework for practitioners to assess cost-effectiveness in various institutional contexts.

Urban Regeneration: Economic and Social Impacts of a Multifunctional Sports Park in Reggio Calabria

Urban areas increasingly face complex challenges in achieving sustainability, particularly in balancing economic, social, cultural, and environmental needs. Despite their significant potential, multifunctional infrastructures remain underexplored, especially in socio-economically disadvantaged and marginal contexts, where they could play a crucial role in urban regeneration processes. This research, based on a case study of an unused urban infrastructure in Southern Italy, adopts a methodological framework to transform these abandoned urban spaces into integrated multifunctional infrastructures capable of providing social, sports, cultural, educational, and recreational services. The proposed framework offers a comprehensive decision-making tool for planners and policymakers, enabling the assessment of multifunctional infrastructures as strategic assets for urban regeneration. The study employs Discounted Cash Flow Analysis (DCFA) and Cost-Benefit Analysis (CBA) to assess the economic feasibility and social sustainability of the proposed project. Investment and management costs were analyzed and compared against both direct and indirect economic benefits, revealing scenarios that support the feasibility of public–private investment. Furthermore, sensitivity analysis corroborates the robustness of the model, demonstrating its applicability under variable economic and social conditions. In conclusion, the evaluation results highlight the transformative potential of multifunctional infrastructures, highlighting their ability to generate significant social and economic impacts.

Are visitors, biodiversity or timber production better for nature conservation? Findings from an econometric analysis of the management costs of protected areas in Serbia.

Protected areas (PAs) are designed to provide a wide range of ecosystem services (ES) and to conserve biodiversity, alongside cultural values. Understanding the production processes within PAs is crucial to decipher the relationships between different ES, including primary (timber) production and the provision of public goods, and to assess their degree of 'jointness'. This article models PA management as a joint production activity involving multiple outputs, including biodiversity, recreation, and timber production. Using panel data on management costs from 57 PAs in Serbia (representing 82% of the country's protected area), we estimate a variable cost function, that accounts for potential endogeneity due to unobserved PA-specific heterogeneity. Our results show that increasing species richness and extending strict protection zones leads to additional management costs, but with different elasticities. A 10% increase in species richness outside strict zones increases costs by 4.9%, while within strict zones the increase is 5.77%. Timber production shows diseconomies of scale, suggesting that large-scale timber operations should be limited. Marginal cost estimates show that managing one additional species costs €11.80, one additional visitor costs €0.41 and one additional cubic metre of timber costs €44.43. We find no evidence of jointness between timber production and recreation, but there is competition between timber production and biodiversity. Conversely, biodiversity and recreation show complementarity in terms of protection costs. These findings are consistent with the Serbian PA management approach, which uses a land-sparing principle by spatially separating activities. This zoning strategy facilitates coexistence, allowing biodiversity to support local tourism and benefit from recreational activities.

Behaviours and drivers of diagnosis-related group upcoding in China: A mixed-methods study.

As a highly destructive gaming behaviour in Diagnosis-Related Group (DRG), upcoding has garnered increasing scholarly attention. This study considers the prevalence, types and risk characteristics of upcoding during the pilot implementation of DRG payments in China, and it also explores the drivers of upcoding and provides corresponding policy recommendations for improving the system. Quantitative research data were sourced from the DRG payment audit database in City Z between the dates of June 1, 2019 and May 31, 2020, encompassing audit results comprising 200 medical records randomly selected from 28 hospitals. Qualitative research methods were used, including semi-structured interviews conducted with 10 stakeholders with interests in the DRG payment system, and thematic framework of the consequent data. 5,157 (92.01%) valid records were re-abstracted. 666 (12.91%) evaluated records were found to be upcoded, resulting in an additional payment at a rate of 45.27%. Several factors emerged as shedding light on the probability of upcoding, including cases with comorbidities, those undergoing non-operating room procedures and internal medical treatments, cases in for-profit hospitals and cases in tertiary hospitals. The main drivers of upcoding were found to be financial and administrative pressures, dysfunctional attitudes towards upcoding, technical facilitation and lack of supervision. This paper provides a comprehensive analysis of the behaviours and drivers of DRG upcoding in China, considering the unique hospital management system and incentive mechanisms in place. The results demonstrate that, following the initiation of the DRG payment system, providers have begun to engage in upcoding behaviour under various drivers, leading to additional health care expenditures and undermining the effectiveness of the scheme. In terms of mounting a response to this behaviour, understanding it and what drives it can aid in its prevention. This study suggests implementing intelligent audits to strengthen supervision and supporting hospitals in cost management.

Cost effective selective separation of indium and germanium from zinc processing waste leach liquor using D2EHPA-YW100 synergistic system and selective stripping with HCl and NH4F

Indium and germanium are rare elements and contribute to supporting materials for contemporary high technology new materials. Research and development of efficient separation and extraction of indium and germanium have important practical significance. A new process of “one step extraction and stepwise stripping” is proposed in this work to coextract indium and germanium with D2EHPA-YW100 synergistic system of Di(2-ethylhexyl) phosphoric acid (D2EHPA) and C7–9 hydroxamic acid (YW100) denoted by D2EHPA-YW100. In the coextraction process, 98.9 % of indium and 99.9 % germanium were extracted utilizing an organic phase consisting of YW100 (1.4 %), D2EHPA (15 %) and sulfonated kerosene (83.6 %). During the two-step stripping process, 99.9 % of indium was selectively stripped from the loaded organic phase in step-1 using 4 M HCl. In step-2, 99.5 % of germanium was stripped using a 1 M NH4F solution. This separation resulted the enrichment of germanium concentration by 6–7 fold and indium concentration by 19 fold. This method has four advantages: (i) simplifies the separation process, (ii) reduces equipment investment by nearly 50 %, (iii) minimizes extraction agent loss, and (iv) reduces management and labor costs.

Investigating the Effectiveness of Coal-Fired Power Plant Operations: Management, Technical and Air Pollution Aspects

Coal-fired energy has been a major part of Malaysia's power supply, causing environmental pollution and slowing sustainable growth. To address these issues, we evaluated a coal-fired power plant's efficiency using a questionnaire completed by industry experts. This study seeks to find factors affecting coal-fired power generation efficiency and create a statistical model. The questionnaire covered five areas: best management practices, technology efficiency, cost efficiency, fuel efficiency, air pollution control, and the best available technique. Principal Component Analysis (PCA) was used to simplify large data sets. The results showed that 15 principal components were valid, with a KMO value of 0.836 (greater than 0.50) and a Bartlett Test value below 0.05. The results show a strong correlation between the best available technique and various indicators: best management practice (r=0.614, p<0.01), technology efficiency (r=0.719, p<0.01), cost efficiency (r=0.529, p<0.05), fuel efficiency (r=0.662, p<0.01), and air pollution control efficiency (r=-0.752, p<0.01). The model indicates that verifying the standard operating procedure (SOP) is crucial for improving power generation efficiency and reducing human error (R²=0.914). This study pinpoints issues reducing power plant efficiency, particularly regarding emissions, and shows that the regression model is strong (R² = 0.916–0.647). It will assist policymakers and researchers in creating sustainable environmental management plans. Doi: 10.28991/ESJ-2025-09-01-06 Full Text: PDF

Cost-effectiveness of NALIRIFOX compared to other first-line treatments for metastatic pancreatic cancer.

733 Background: NALIRIFOX was recently approved for first-line treatment of metastatic pancreatic cancer, where combination chemotherapy remains the main treatment modality. We conducted a cost-effectiveness analysis of NALIRIFOX compared to both FOLFIRINOX and gemcitabine/protein-bound paclitaxel (GP). Methods: A partitioned survival model with three health states (progression-free, post-progression and death) was constructed to model the disease course. Using published data from NAPOLI-3, parametric survival curves were generated for NALIRIFOX, from which survival curves for FOLFIRINOX and GP were extrapolated using pooled efficacy data reported by a network meta-analysis of clinical trials. Model inputs were retrieved from the literature or other publicly available resources. Specifically, drug acquisition costs were from average wholesale prices in the Red Book while administration, disease monitoring and supportive care costs were from the CMS Physician Fee Schedule. Utility values to estimate quality-adjusted life years (QALY) were from the CALGB80303 trial. Adverse effects that were considered included anemia, neutropenia, febrile neutropenia, thrombocytopenia, diarrhea, peripheral neuropathy, nausea and vomiting, and fatigue. Adverse effect rates were based on data pooled from clinical trials while costs and disutility were obtained from a secondary analysis of claims data and a clinician survey, respectively. The time horizon was 5 years and utilized a third-party payer perspective. Both costs ($USD 2024) and outcomes were discounted at 3% annually. A probabilistic sensitivity analysis was conducted by varying model parameters based on 95% confidence intervals if known or 10% in both directions otherwise. Results: The overall cost associated with NALIRIFOX was $129,314, followed by GP ($104,593) and FOLFIRINOX ($41,528). Among the 3 regimens, NALIRIFOX incurred the highest treatment-related cost ($105,533) but the lowest adverse effects management cost ($16,541). On average, patients on NALIRIFOX gained a total of 1.14 life years (LY) or after adjusting for utility, 0.86 QALY. FOLFIRINOX led to 1.09 LY or 0.82 QALY while GP resulted in 0.99 LY or 0.75 QALY. Due to its higher cost and lower survival benefit, GP was dominated by FOLFIRINOX. Compared to FOLFIRINOX, the incremental cost-effectiveness ratio (ICER) of NALIRIFOX was $1,952,062/QALY. In our sensitivity analysis, the probability of NALIRIFOX being cost-effective was 0% at all conventional ICER thresholds up to $200,000/QALY. Conclusions: Due to the high drug acquisition cost, the ICER of NALIRIFOX far exceeds currently acceptable thresholds for economic value and NALIRIFOX is considered not cost-effective. This is despite that in our model among first line treatments for metastatic pancreatic cancer, NALIRIFOX was associated with reduced costs for managing adverse effects.

Economic burden of hepatocellular carcinoma recurrence after curative treatment in Spain.

640 Background: The literature on burden of disease studies of hepatocellular carcinoma is scarce. The aim of this analysis was to quantify the economic burden of disease recurrence in very early or early-stage HCC patients who underwent liver resection, ablation or transplantation in Spain. Methods: A decision-tree model was developed to estimate the cost of a recurrence after curative treatment with an initial complete response of very early or early-stage primary HCC tumor over a 5-year time horizon. Clinical parameters were collected by a multidisciplinary group of experts who also validated the assumptions and results of the analysis. According to the Barcelona Clinic Liver Cancer (BCLC) recommendations, patients with recurrent HCC were classified into five HCC stages (0, A, B, C, and D) and allocated to different treatment options. A payer perspective was adopted, so only direct costs (€2024) were considered (local/locoregional treatments costs, drug acquisition and administration costs, adverse events management costs, diagnostic and follow-up costs and end-of-life costs). Sensitivity analyses were performed to assess uncertainty. Results: A total of 1,250 HCC recurrences were estimated in Spain, resulting in a total cost of €32,817,142 in the first year of recurrence management. After 5-years follow-up, an additional €10,1M was estimated, mainly due to patient surveillance (€2,8M) and 228 new recurrences (€5,7M). The average cost of a relapse was €26,253 euros in the first year of recurrence management, rising to €34,342 euros for 5-years follow-up. A hypothetical patient experiencing a second relapse 5 years after their first relapse would incur costs of €58,758. Conclusions: This study is the first in Spain to explore the economic burden of hepatocellular carcinoma. Estimating the cost of recurrence after curative treatment and complete response of a primary HCC tumor is complex and depends on multiple factors, so further studies exploring both efficacy and costs in hepatocellular carcinoma are needed.

AI-Powered Predictive Analytics for Dynamic Cloud Resource Optimization: A Technical Implementation Framework

This article explores the transformative impact of AI-driven predictive analytics on cloud resource optimization, presenting a comprehensive technical implementation framework. The article shows how artificial intelligence and machine learning architectures revolutionize traditional cloud management approaches through advanced predictive capabilities and dynamic resource allocation. It examines the evolution from static threshold-based systems to sophisticated AI-driven solutions, analyzing their implementation strategies across various organizational contexts. The article delves into multiple optimization domains, including capacity provisioning, cost management, performance enhancement, and energy efficiency, while presenting real-world applications and impact analyses across different industries. Through extensive case studies and empirical evidence, the article demonstrates how organizations leverage AI-powered solutions to address complex cloud resource management challenges, achieve operational efficiencies, and maintain competitive advantages in the digital marketplace. The article also explores future developments and provides strategic recommendations for organizations implementing cloud optimization frameworks, emphasizing the importance of standardized approaches, stakeholder engagement, and sustainable practices in cloud resource management.

Building Scalable Cloud Databases with Database Reliability Engineering

This comprehensive article explores the evolution and implementation of Database Reliability Engineering (DBRE) in cloud environments, focusing on the transformation from traditional database management to modern cloud-based solutions. The article examines key aspects of scalable database architectures, including elastic scalability, serverless solutions, and advanced scaling techniques. The article investigates various strategies for ensuring database reliability, performance optimization, and cost management while addressing challenges in data distribution and consistency maintenance. Through analysis of multiple cloud platforms and implementation approaches, the article demonstrates how organizations can effectively leverage automation, monitoring, and best practices to build robust, scalable database solutions that meet contemporary demands for performance and reliability.

The intersection of healthcare procurement and health insurance policies in Medicare and Medicaid administration

This comprehensive review examines the complex relationship between healthcare procurement processes and health insurance policies within the Medicare and Medicaid systems in the United States. The study analyzes how procurement strategies influence healthcare delivery, cost management, and patient outcomes while considering the intricate policy frameworks governing these public insurance programs. Through analysis of existing literature, policy documents, and administrative data, this review identifies key challenges and opportunities at the intersection of procurement and insurance administration. The research reveals significant variations in procurement practices across states and their impact on healthcare access, quality, and cost-effectiveness. Notable findings include the critical role of value-based purchasing initiatives, the influence of formulary management on pharmaceutical procurement, and the evolving landscape of managed care contracting. The study also highlights the importance of data integration and technological infrastructure in improving procurement efficiency and insurance administration. The findings suggest that optimizing the alignment between procurement strategies and insurance policies could significantly enhance healthcare delivery efficiency while maintaining program sustainability.

Economics Education and Counselling in Enhancing Production and Efficiency

The research examined economic education and counselling as drivers of improved production capacity and organisational efficiency: The case of Nasco Manufacturing Firm, Jos, Nigeria. The study population was 500 people, and the sample size was 222 people. Data was collected by administering standard questionnaires to respondents. In this investigation, the survey research design approach was used. Data were presented in percentage tables, and the hypotheses were tested with basic linear regression analysis. Product quality has a significant effect on the performance of Nasco manufacturing firms in Jos, Nigeria; productivity has a significant effect on the performance of Nasco manufacturing firms in Jos, Nigeria; product quantity has no significant effect on the performance of Nasco manufacturing firms in Jos, Nigeria; and profitability has a significant effect on the performance of Nasco manufacturing firms in Jos, Nigeria. The study indicated that to increase organisational performance, such companies must implement modalities that promote production capacity in their production process. Using it in the manufacturing process is guaranteed to improve the performance of such a company. It was recommended that Nasco conduct regular training sessions on economics and business fundamentals tailored to the manufacturing sector, focusing on cost management, efficiency, and market analysis, and offer individual and group counselling to address workplace challenges, encourage goal setting, and enhance interpersonal dynamics, among several other things.

Pengaruh Biaya Hutang, Corporate social responsibility, dan Manajemen Laba terhadap Tax avoidance dimoderasi oleh Kepemilikan Institusional

This study aims to analyze the factors that influence tax avoidance namely debt costs, corporate social responsibility, earning management and institutional ownership, in mining companies listed on the Indonesia Stock Exchange for the 2019-2023 period. Using the Moderate Regression Analysis (MRA) technique and 32 samples selected by purposive sampling. The results of the analysis show that the cost of debt, earnings management and institusional ownership have a significant effect on tax avoidance, while corporate social responsibility has no significant effect. In addition, institutional ownership moderates the effect of debt costs and earning management on tax avoidance, but does not moderate corporate social responsibility on tax avoidance Keywords: Tax avoidance; Debt of Cost; corporate social responsibility; Earning Manajemen; Institutional Ownership.

The Impact of Blockchain Technology and Big Data on Strategic Cost Management and Accountants' Skills in the Iraqi Technological Environment

The Impact of Blockchain Technology and Big Data on Strategic Cost Management and Accountants' Skills in the Iraqi Technological Environment

P-907. Burden of Hospitalization for Coccidioidal Meningitis: A National Cohort Study

Abstract Background Coccidioidal meningitis (CM) is a severe complication of an endemic fungal infection requiring life-long aggressive medical and often surgical management necessitating hospitalization. Few data evaluating the burden of CM on hospitals have been published. This report assesses inpatient healthcare utilization, total costs, and mortality in hospitalized CM patients.Table 1:Demographics, Comorbidities and Outcomes of Patients Admitted with Coccidioidal MeningitisCI=confidence intervals; CM=coccidioidal meningitis†Primary diagnosis code for a common meningitis complication including hydrocephalus, cerebral vascular accident, encephalitis, encephalopathy, cerebral vasculitis or vasospasm, cerebral abscess, shunt complication, infusion device failure.*Includes ventricular shunt, drain or infusion device placement, revision, or removal. Methods We used the National Inpatient Sample (NIS) to evaluate CM hospitalizations for the years 2019 t0 2021. The NIS is a 20% stratified systematic randomized sampling of all hospital discharges, drawn from States participating in the Healthcare Utilization Project (HCUP) (including all states in which coccidioidomycosis is endemic) and covering >97% of the US population. The sample weighted to reflect all hospitalizations in the US per year. CM was identified by the International Classification of Diseases-10th Revision (ICD-10) diagnosis code of B38.4 in any coding position. All analyses were performed on the weighted population using methods prescribed by HCUP. We estimated frequencies or mean/median values for demographics, comorbidities, need for CM-related procedures (i.e., ventricular shunt, drain or infusion device placement, revision, or removal), inpatient mortality, length-of-stay (LOS), and all cause total hospital costs (in 2023 US$) with 95% confidence intervals (CIs). Results We identified 2,305 CM hospitalizations (Table 1). The annual rates of CM hospitalizations ranged from 2.7-3.2 per million Americans for the three years studied. The mean age of CM patients was ∼48 years, most were men (73.3%) and occurred in the West census region (89.7%). Concurrent pulmonary coccidioidomycosis was present in 18.2% of patients. In total, 63.6% (59.3-67.6%) of patients required a CM-related procedure during the stay and 7.6% (5.6-10.3%) died prior to discharge. Mean LOS was 13.0 days (11.3-14.6) and mean hospital costs were $48,155 ($42,382-$53,929) per stay. Conclusion Hospitalization of CM patients in the US are associated with substantial medical and economic burden. The complex management and high costs associated with CM suggest a need for novel management approaches including novel antifungal treatments. Disclosures Craig I. Coleman, PharmD, F2G Ltd: Advisor/Consultant|F2G Ltd: Grant/Research Support Fariba Donovan, MD, PhD, F2G: Advisor/Consultant|F2G Ltd: Advisor/Consultant|F2G Ltd: Grant/Research Support|F2G Ltd: Honoraria Mark Bresnik, MD, F2G Ltd: Employee Belinda Lovelace, PharmD, MS, MJ, F2G, Inc.: Employee

Health Care Costs After Lumbar Fusion and Disk Replacement for Diskogenic Pain.

Lumbar fusion is the most common surgical intervention for chronic or severe low back pain. However, lumbar disk replacement (LDR) may be appropriate for certain patients. The objective of this study was to describe the postoperative management costs associated with both lumbar fusion and LDR in the 2-year period after surgery. An observational cohort study was conducted using the Merative MarketScan databases. Patients who underwent lumbar fusion or LDR between January 1, 2017, and December 31, 2017, were identified and included in the study. The primary outcome was the cost of payments for physical therapy, pain medication, injections, and bladder management in the 2-year period after surgery. A total of 1660 patients (mean age, 50.1±10.6 years; lumbar fusion, 99%; LDR, 1%) were included in the study. The mean total cost of postoperative interventions identified was $2832±$5461 per patient, with no differences found between patients for identified interventions. The mean 30-day episode-of-care cost was $65,777±$40,869 and was similar (P=.894) between the two groups of patients. The main driver of cost was physical therapy for both groups of patients (lumbar fusion, 53.7%; LDR, 64.9%). Patients who underwent lumbar fusion and LDR had similar postoperative management costs. The shorter recovery periods associated with LDR may not necessarily translate into reduced long-term health care expenditure. [Orthopedics. 202x;4x(x):xx-xx.].

STRATEGIC MANAGEMENT OF THE UNIVERSITY'S ECONOMIC SUSTAINABILITY

The article is devoted to the strategic management of universities' economic sustainability in the context of digital transformations. The study examines the main approaches to ensuring the economic sustainability of higher education institutions, which are particularly relevant in the era of globalization and technological change. The impact of digitalization on university management processes is analyzed, focusing on the integration of advanced technologies, resource optimization, and increased financial efficiency. The role of digital tools in reducing the costs of educational services, improving management processes, and enhancing the competitiveness of universities is explored. A comprehensive model of strategic management of economic sustainability is proposed, encompassing financial flow assessment, cost management, investment analysis in digital technologies, and their integration into university development strategies. The model aims to enhance resilience to economic challenges, ensure stability, and increase competitiveness in the educational services market.