Decrease In Total Cost Research Articles

Cost comparison between ultrasound-guided 14-g large core breast biopsy and open surgical biopsy: An analysis for Austria

Purpose To examine the budget impact of ultrasound-guided 14-g large core breast biopsy (US-guided LCBB) by comparing the costs of US-guided LCBB and open surgical biopsy (OSB); to calculate the cost savings attributable to US-guided LCBB; and to assess the frequency with which US-guided LCBB obviates the need for an OSB. Materials and methods In a retrospective study, we reviewed 399 suspicious breast lesions on which US-guided LCBB and OSB or, in cases of benign histology, clinical follow-up, were performed. Cost savings were calculated using nationally allowed flat rates (A-drg) and patient charges. Costs were measured from both, a hospital and a socioeconomic perspective. Deterministic sensitivity analyses were simulated to assess the extent of achievable cost savings. Results Overall cost savings for US-guided LCBB over OSB were €977 (€2,337/€3,314) per case from a hospital perspective, resulting in a total cost decrease of 30% for the diagnosis of suspicious breast lesions. From a socioeconomic perspective, cost savings were €1,542 (€2,600/€4,142) per case, resulting in a 37% reduction in biopsy cost. US-guided LCBB obviated the need for a surgical procedure in 240 (60%) of 399 women. In all four sensitivity analyses, costs of US-guided LCBB remained lower than that of OSB. Conclusion From an economic perspective, US-guided LCBB is highly recommended for the diagnosis of suspicious breast lesions, as this procedure reduces the cost of diagnosis substantially. In Austria, annual cost savings would be €18.5 million.

An integrated economic lot-size model for vendor–buyer inventory system when input is random

An integrated strategy is discussed for both vendor and buyer when the input is random. It is shown numerically that the cooperative approach is beneficial to reduce the cost when compared with an independent decision by both the parties. Though the integrated total cost decreases, the buyer’s cost increases due to random input in his inventory. To encourage the buyer to order a large quantity, a trade credit is offered by the vendor to the buyer to settle the account. A conciliation factor is suggested to share the benefits.

A computational method for pricing of delivery service in a logistics network

In this paper, the problem of finding a fast computational method for pricing of the delivery service in a logistics network is analysed. The objective is to develop a supporting method for effective interaction among logistics service providers and customers. We make use of an analytical function to predict the final total cost of distribution and to develop an interaction protocol that, using the function, leads to a final win-win solution, in which the majority of the customers have agreed to accept a delivery time comporting a reduction of total distribution costs. We also validated the method by use of simulation software, evaluating the results in terms of cost-efficiency and stability. The experimental results show how the method led to a decrease in total costs.

A WIN-WIN STRATEGY FOR AN INTEGRATED VENDOR‐BUYER DETERIORATING INVENTORY SYSTEM

An integrated approach considering the view of both the buyer and the vendor is discussed in this study. It can be shown numerically that the integrated approach results in an impressive cost reduction when compared with an independent decision approach by the buyer. Although the integrated total cost decreases, the buyer's cost increases due to larger orders. To entice the buyer to accept larger order quantity, a permissible delay in payment is offered by the vendor to the buyer. A negotiation factor is also incorporated to share the benefits.

Declining Emergency Department Visits and Costs During the Severe Acute Respiratory Syndrome (SARS) Outbreak

BackgroundThe immediate and long-term impact of severe acute respiratory syndrome (SARS) outbreak on emergency department (ED) visits and hospital expenditures for these visits has not been thoroughly investigated. The objectives of this retrospective observational study investigated the impact of SARS outbreak on ED visits and the cost of these visits in a designated SARS medical center.MethodsData related to the total number of ED visits and their costs were collected for the SARS epidemic period in 2003 and the same period in the preceding year in 2002. Data collected included total number of ED visits, services provided, triage categories, and total expenditures for all patients. Data for before and during the outbreak were retrieved and compared.ResultsAt the peak of the SARS epidemic, the reduction in daily ED visits reached 51.6% of pre-epidemic numbers (p < 0.01). In pediatric, trauma and non-trauma patients, the maximum mean decreases in number of visits were 80.0% (p < 0.01), 57.6% (p < 0.01) and 40.8% (p < 0.01), respectively. In triage 1, 2 and 3 patients, the maximum mean decreases were 18.1% (p < 0.01), 55.9% (p < 0.01) and 53.7% (p < 0.01), respectively. The maximum decrease in total costs was 37.7% (p < 0.01). The maximum mean costs per patient increased 35.9% (p < 0.01). The proportions of increases in mean costs for each patient were attributed to laboratory investigations (31.4%), radiography (21.9%) and medications (29.5%).ConclusionThe SARS outbreak resulted in a marked reduction in the number of ED visits which persisted for 3 months after the end of the epidemic. Total cost of treating individual patients showed a simultaneous marked increase, while overall operational costs in the ED showed a marked decrease. The increased total cost for each patient was attributed to the increased number of diagnostic procedures to screen for possible SARS in the ED.

Agent-based demand forecast in multi-echelon supply chain

Supply chain management (SCM) is an emerging field that has commanded attention and support from the industrial community. Demand forecast taking inventory into consideration is an important issue in SCM. There are many diverse inventory systems, in theory or practice, which are operated by entities (companies) in a supply chain. In order to increase supply chain effectiveness, minimize total cost, and reduce the bullwhip effect, integration and coordination of these different systems in the supply chain (SC) are required using information technology and effective communication. The paper develops a multi-agent system to simulate a supply chain, where agents operate these entities with different inventory systems. Agents are coordinated to control inventory and minimize the total cost of a SC by sharing information and forecasting knowledge. The demand is forecasted with a genetic algorithm (GA) and the ordering quantity is offered at each echelon incorporating the perspective of “systems thinking”. By using this agent-based system, the results show that total cost decreases and the ordering variation curve becomes smooth.

A Distributed Dynamic Micro-Mobility Management Scheme for Mobile IPv6

A distributed dynamic micro-mobility management scheme is proposed to make up the deficiency of not supporting well for highly Mobile Host (MH) in Mobile IP. The scheme places a few of Regional Mobility Agents (RMA) to distributedly manage hosts’ mobility in region. An algorithm is presented for MH to decide its RMA and regional size in terms of its mobility characteristics and some informed network parameters, which results in minimum signaling cost and packet delivery cost, but does not impose any restrictions on network’s topology and RMAs’ locations. Analysis shows when MH’s average packet arrival rate increases, the regional size decreases while the total cost increases; when MH’s average residence time in Access Router increases, both the regional size and total cost decrease. Finally, a performance comparison demonstrates that the total costs produced in Hierarchical Mobile IPv6 with several distinct regional sizes are all higher than the possible highest total cost produced in the scheme.

The effect of Medicaid managed care on mental health care for children: a review of the literature.

Despite its widespread adoption, little is known about the effect of Medicaid managed care (MMC) on children using mental health services. To assess the state of current research, we reviewed the literature on MMC and synthesized findings regarding access to care, expenditures, utilization, cost-shifting, and quality of care. A literature search was conducted and updated in November 2001. Studies were included if they involved evaluations of MMC, included children with mental health or substance abuse disorders, and had a non-MMC comparison group. Eight studies were included in the review. Most involved carve-outs and capitation. All of the studies that measured cost and service use showed decreases in total costs, inpatient care costs, and inpatient service use. These changes were frequently accompanied by increases in outpatient care. Some evidence suggests that MMC increased access to care for those with less serious conditions. There was no convincing evidence of cost-shifting from mental to physical health or other public agencies. Finally, no study directly measured health outcomes or quality of care. By reducing service use in inpatient settings, MMC has the potential to reduce children's mental health expenditures. The available research provides virtually no evidence on quality of care.

Economic evaluations of novel antipsychotic medications: a literature review

Objective: To evaluate the evidence that novel antipsychotic medications offer a cost advantage compared to traditional antipsychotic medications. Methods: Literature for this review was identified through a computerized search of Medline, Healthstar and Psyc-INFO databases inclusive from January 1989 to January 2002. Articles included in the review were required to include cost evaluation and to be published in peer-reviewed journals. Results: Twenty-two studies met inclusion criteria. All five studies that used experimental designs found that second-generation antipsychotic medications were associated with a cost advantage or were cost-neutral, and, in some cases, improved quality of life. Of the ten studies using a pre-post design, four found an increase in total costs, six reported a decrease in total costs, and four reported increased effectiveness with use of a second-generation antipsychotic. All seven of the simulation studies reported a cost advantage for novel antipsychotics for specific patient populations under certain conditions. Conclusions: The majority of studies found that novel antipsychotics are at least cost-neutral and may offer cost advantages compared to traditional agents. Some studies also reported greater improvement in effectiveness and quality of life when novel antipsychotics were compared to traditional antipsychotic medications. However, it is difficult to draw firm conclusions given the small sample sizes and limited study designs available in this literature.

Simulation model of multi-compartment distribution in the catering supply chain

An efficient distribution system of high performance is needed to anticipate market developments in the catering supply chain (CSC) in the Netherlands. A simulation model was developed to analyse a multi-compartment distribution system which should satisfy customer demands for shorter lead times, increased delivery frequency and improved quality of process and product. The simulation model quantifies logistic and financial performances in various alternative logistic scenarios for multi-compartment distribution in the catering supply chain. This stochastic simulation model was constructed on the basis of a value chain analysis yielding activities and performance indicators (PIs). The model proved to be accurate in its predictions when applied to a case situation taken from the Dutch CSC. It is concluded that discrete event simulation is an effective tool to evaluate promising logistic scenarios. The new, multi-compartment method of distribution allowed for a 14% decrease in total costs in the Dutch CSC while satisfying customer demands.

Value Analysis: Capturing Total Cost of Ownership reduction opportunities in E&amp;P projects

AbstractValue Analysis is a powerful tool to increase the value of a capital investment project and to capture cost saving opportunities. It is a method conceived during WorldWar II and frequently used on infrastructure projects, especially in the USA.The Value Analysis process typically consists of a well prepared 3 to 5 day workshop with focus on generating ideas to improve the current engineering concept. Emphasis is on screening all proposals in order to identify the most promising ideas. The workshop results in a number of proposals to modify the existing engineering concept.Stork Engineers &amp; Contractors have used the Value Analysis method on several projects as well as in proposals for Engineering, Procurement and Construction (EPC) projects in the Exploration and Production (EP) industry.Typical results of Value Analysis led to a decrease of Total Cost of Ownership by some 10 to 30%. A well facilitated Value Analysis workshop also leads to mutual trust and understanding between the parties involved.A key element in a Value Analysis is (re)definition of the proposed functionality of a project. This is done through challenging the existing technical concept by increasing this functionality or by meeting this functionality at a lower cost.

Improved management of radiotherapy departments through accurate cost data

Background and purpose: Escalating health care expenses urge governments towards cost containment. More accurate data on the precise costs of health care interventions are needed. We performed an aggregate cost calculation of radiation therapy departments and treatments and discussed the different cost components. Materials and methods: The costs of a radiotherapy department were estimated, based on accreditation norms for radiotherapy departments set forth in the Belgian legislation. Results: The major cost components of radiotherapy are the cost of buildings and facilities, equipment, medical and non-medical staff, materials and overhead. They respectively represent around 3, 30, 50, 4 and 13% of the total costs, irrespective of the department size. The average cost per patient lowers with increasing department size and optimal utilization of resources. Radiotherapy treatment costs vary in a stepwise fashion: minor variations of patient load do not affect the cost picture significantly due to a small impact of variable costs. With larger increases in patient load however, additional equipment and/or staff will become necessary, resulting in additional semi-fixed costs and an important increase in costs. A sensitivity analysis of these two major cost inputs shows that a decrease in total costs of 12–13% can be obtained by assuming a 20% less than full time availability of personnel; that due to evolving seniority levels, the annual increase in wage costs is estimated to be more than 1%; that by changing the clinical life-time of buildings and equipment with unchanged interest rate, a 5% reduction of total costs and cost per patient can be calculated. More sophisticated equipment will not have a very large impact on the cost (±4000 BEF/patient), provided that the additional equipment is adapted to the size of the department. That the recommendations we used, based on the Belgian legislation, are not outrageous is shown by replacing them by the USA Blue book recommendations. Depending on the department size, costs in our model would then increase with 14–36%. Conclusion: We showed that cost information can be used to analyze the precise financial consequences of changes in routine clinical practice in radiotherapy. Comparing the cost data with the prevailing reimbursement may reveal inconsistencies and stimulate to develop improved financing systems.

How much do persons with Alzheimer's disease cost Medicare?

Medicare claims are increasingly being used to identify persons with chronic diseases such as Alzheimer's disease (AD) for the purpose of determining the cost to Medicare of caring for such persons. Past work has been limited by the use of only 1 or 2 years of claims data to identify cases, leading to worries that this might lead to an undercount of prevalent cases and bias cost findings. To analyze the average total cost to the Medicare program in 1994 of persons with a claims-based diagnosis of AD, using a 12-year period of claims history to identify prevalent cases, and to investigate the effect on cost of time since diagnosis. A cross-sectional design with a 12-year retrospective period to identify persons with AD. Medical care practices, hospitals, and other providers of services to Medicare beneficiaries in the US in 1994. Respondents to the screener (n = 10,858) and community (5429) and institutional (n = 1341) questionnaire of the 1994 National Long Term Care Survey, with and without a claims-based diagnosis of AD. Average total cost to Medicare in 1994, measured as the actual amount Medicare paid for inpatient, outpatient, home health, skilled nursing facility, hospice, and Part B services, including payments to physicians, and other items such as durable medical equipment. We also measured disability in a variety of ways, including cognition, activity limitations, and residence in a nursing home. The average total cost to Medicare of persons with a claims-based diagnosis of AD was $6021 versus $2310 (P < .001) for persons without a diagnosis. When adjusting for patient characteristics, the ratio of cost between persons with AD and those without was reduced to about 1.6 to 1. Time since diagnosis was an important predictor of average total cost in 1994, with each additional year since diagnosis resulting in a $248 (P = .04) decrease in total cost (about 10% of the total sample mean cost of $2426). There was mixed evidence that persons with a diagnosis of AD incurred less cost than otherwise similarly disabled Medicare beneficiaries. Time since diagnosis with AD is an important predictor of cost and one that should be explicitly included in any rate-setting formula. Expanding the period used to identify cases resulted in an increase in the unadjusted ratio of cost of a Medicare beneficiary with AD relative to one without primarily because our control group costs are lower compared with those of past work.

U.S. Army Nutrition Care Initiatives Creating Efficient Organizations Through Best Practices

Army dietitians are leading the way in the Military Health System with innovative thinking and cost efficiencies while simultaneously meeting the demands of their wartime roles. In 1997, senior Army dietitians devised a strategic plan to identify the best practices in foodservices and medical nutrition operations. An integral part of that plan was the Nutrition Care Benchmarking Program. This program enhances customer satisfaction and improves operational efficiencies through cost analysis. It ensures that dietitians are critically reviewing their operations and identifies the most efficient and innovative strategies. Information for the baseline year of 1997 and 1998 was collected on Total Meals Served, Labor Costs Per Meal Served, and Total Costs Per Meal Served. A survey of business practices and initiatives designed to increase cost efficiencies was also conducted. Outcomes shown were: A 7% increase in total meals served while decreasing labor costs by 7%. Business reengineering led to an 11% decrease in total costs per meal, 67% of facilities reduced labor costs through staffing and scheduling changes and 89% of operations increased revenues through innovative programs such as mobile food carts, menu redesign and expansion of the customer base.

Beam search filtrado com inserção de ociosidade na programação de uma máquina em ambiente do tipo jit

Este trabalho avalia a utilização do beam search filtrado (BSF) combinado com um algoritmo de inserção de ociosidade (AIO). O caso estudado é baseado em uma única máquina, com datas de entrega múltiplas e com penalidades distintas de adiantamento e de atraso para cada ordem. O objetivo a ser alcançado é a minimização do custo total. Para isso, o BSF é utilizado para gerar as seqüências, e o AIO, para definir os programas. Assume-se que a dificuldade de solução do problema é dependente de dois parâmetros: fator de atraso médio e amplitude relativa das datas de entrega. Testes empíricos comparativos são realizados por meio de simulação computacional, no qual se mede o tempo de solução e o valor alcançado pela função-objetivo. Os resultados indicam que de uma forma geral, o procedimento proposto propicia uma diminuição no custo total e, além disso, que para a escolha de um procedimento apropriado, o ideal é se conhecer o valor dos parâmetros.

Reduction of hospital resources utilization in vascular surgery: A four-year experience

Purpose: Managed care whether through risk or through capitated contracts results in reduction in resources, reduced length of hospital stay, and reduced utilization of hospital resources (collectively referred to as resource reductions). These resource reductions will become even more noticeable as a greater proportion of Medicare patients who need vascular operations select a managed-care senior product. We examined the results of a 4-year experience with resource management in an academic vascular surgery practice during which best practice plans were developed and implemented. Methods: We analyzed hospital cost data, which included both total hospital and intensive care unit length of stay, average units per operation for laboratory, pharmacy, and radiology services and operating room and direct hospital costs for 257 carotid endarterectomies performed over fiscal years (FY) 1994, 1995, 1996, and 1997 (6 month data) and 175 infrainguinal bypass procedures performed during the same period. Results: For carotid endarterectomy, length of stay decreased 66% over the 4-year period to an average of 2.07 days in FY97. Both radiology and pharmacy utilization were reduced after the first year of institution of best practice plans (56% and 32% respectively) with 4-year total reductions of 86% and 55% by FY97. The most notable changes included elimination of routine postoperative laboratory testing, use of aspirin rather than low-molecular-weight dextran, emphasis on oral rather than intravenous vasoactive drugs, and routine use of duplex scanning alone rather than angiography for diagnosis after FY94-95. The length of operating room time for carotid endarterectomy remained relatively constant from FY94 to FY97. As a result of these multiple factors, our study showed a 30% decrease in total average direct hospital costs for carotid endarterectomy from $9974 to $7002 in this 4-year period. Infrainguinal bypass graft procedures showed a progressive decrease in total cost of 28% for patients without complications to $15,186 but remained unchanged for those with complications. Laboratory use, pharmacy use, and radiology use were not significantly different. Conclusions: Case management for patients undergoing carotid endarterectomy and infrainguinal bypass grafting involving an integrated team of vascular surgeons, surgical house staff, a dedicated vascular nurse, and a social work case manager resulted in dramatic reductions both in length of stay and hospital resource utilization. As these costs decreased, operating room expenses assumed increasing importance. Operating room costs account for 60% of the direct costs of carotid endarterectomy and a comparable percentage for uncomplicated infrainguinal bypass grafting. Further substantial reductions in direct hospital costs will depend primarily on reductions in operating room costs, particularly those related to length of time in the operating room.(J Vasc Surg 1998;27:1066-77.)

Progress payments and cost overruns in defence contracts

In recent years military procurement agencies have used “progress payments” in contracting. Although, overall, the adoption of such a policy may well have contributed to a decrease in total costs of procurement, we identify a class of inefficiencies that are likely to have been generated by it.

Cost effectiveness of clozapine in neuroleptic-resistant schizophrenia.

The goal of this study was to determine whether clozapine is a cost-effective treatment for treatment-resistant schizophrenia. Data were collected on 96 treatment-resistant patients with schizophrenia for 2 years before they entered a clozapine treatment study and for at least 2 years after they entered the study. Information about the cost of inpatient and outpatient treatment, housing costs, other costs, and family burden through direct interview or questionnaire of these patients and their families were available for 47 of the 96 patients. Data on lost income and Social Security disability insurance were also obtained. Outcome measures included psychopathology, quality of life, global functioning, work function, and rehospitalization. The cost of treatment was significantly decreased in the patients who continued clozapine treatment for at least 2 years. This was primarily due to a dramatic decrease in the frequency and cost of rehospitalization. Costs were nonsignificantly lower in patients who dropped out of treatment. The estimated total 2-year cost for the 59 patients who continued clozapine treatment, the 34 patients who dropped out, and the three who interrupted treatment decreased from $7,390,206 to $5,719,463, a savings of $8,702/year per patient. There was a decrease in total costs of $22,936/year for the 37 patients who continued clozapine treatment for whom cost data were available. There were no significant changes in lost income or Social Security disability insurance payments in either group. Clozapine produced a marked improvement in Brief Psychiatric Rating Scale total scores as well as positive negative symptom scores, Global Assessment Scale scores, Quality of Life Scale scores, work functioning, capacity for independent living, and rehospitalization rates. Clozapine is a cost-effective treatment for treatment-resistant schizophrenic patients. Cost savings result almost exclusively from the reduced cost of hospitalization.

A study on production lot-sizing in MRP system. 1st report. Single-item, uncapacitated lot-sizing.

This paper considers a single-item, uncapacitated lot-sizing problem in MRP system, and new heuristic approaches, called Forward-Forward (FF) method and Forward-Backward (FB) method, are proposed. These methods are based on Silver-Meal (SM) method. For the initial production plan obtained by SM method, a cost minimum procedure for successive two lot-sizing periods is repeated forward from the first period or backward from the last period, which results the decrease of total cost for whole planning horizon. And to evaluate the performance of FF and FB methods, four heuristic approaches (FF, FB, SM, Part-Period-Balancing) are compared in fixed horizon and rolling horizon environments. By testing each method for various coefficiences of cost (set-up, holding) and demand variance, the cost deviation from the minimum cost by Wagner-Whitin (WW) method is analyzed. The result has showed that FF, FB methods may outperform the other heuristics and even WW method for, rolling horizon.

Upper and lower urinary tract infections: Amikacin's role in managing surgical complications

Approximately one out of every 40 patients admitted to United States hospitals each year acquires a urinary tract infection while hospitalized. Urologic instrumentation is the precipitating cause in 75 to 80 percent of the cases. Such infections are responsible for a mortality rate among these patients that is three times the rate observed for all other hospitalized, patients. When associated with gram-negative bacteremia, nosocomial urinary tract infections can progress rapidly to an irreversible state, resulting in death in 10 percent of those patients affected. Survivors are faced with escalating costs of hospital care and drug therapy. Presumptive administration of antibiotics is routinely recommended in selected types of genitourinary surgery, primarily because of the contaminated nature of the procedures, and especially advised when the surgery is likely to be followed by the placement of an indwelling urinary catheter. Quite often, the regimen for presumptive treatment of urinary tract infections includes aminoglycosides, such as amikacin, alone or in combination. The role of amikacin in empiric management of postoperative urinary tract infections is even more obvious. The fact that it has the broadest spectrum of activity compared with other aminoglycosides reduces the chance of therapeutic failure and results in a shorter hospital stay. In that respect, amikacin may effect an overall decrease in total costs of hospitalization.