Cost Drivers Research Articles

Cost drivers associated with autologous stem-cell transplant (ASCT) in patients with relapsed/refractory diffuse large B-cell lymphoma in a Japanese real-world setting: A structural equation model (SEM) analysis 2012-2022.

Diffuse large B-cell lymphoma (DLBCL) is the most prevalent non-Hodgkin lymphoma, with increasing incidence, in Japan. It is associated with substantial economic burden and relatively poor survival outcomes for relapsed/ refractory (r/r) DLBCL patients. Despite its association with economic burden and the relatively limited number of eligible patients in Japan as reported in previous real-world studies, Japanese clinical guidelines recommend stem-cell transplantation (SCT) for transplant-eligible r/r DLBCL patients. This is the first study to elucidate the total healthcare cost, associated cost drivers and healthcare resource use of SCT among patients with r/r DLBCL in a nationwide setting. The study design included a follow-up period of up to 24 months with subsequent lines of therapies using retrospective nationwide claims data from the Medical Data Vision Co., Ltd. Health Insurance Association from April 2012 to August 2022. Included patients had a confirmed diagnosis of DLBCL, received allogeneic SCT (allo-SCT) or autologous SCT (ASCT) after the first DLBCL diagnosis, and received high-dose chemotherapy during the 6-monthlook-backperiod. The results confirmed that no patients had allo-SCT, hence only ASCT was included in the analysis. Structural equation modeling was used to identify potential total healthcare cost drivers by evaluating direct, indirect, and total effects and provide a benchmark reference for future innovative therapies. A total of 108 patients (3.8%) among all DLBCL patients who received SCT met the eligibility criteria and were considered ASCT patients; majority of which were males (n = 63, 58.33%), with a mean [median] (SD) age of 52.04 [55] (9.88) years. A total of 15 patients (13.89%) received subsequent therapies. The most frequent subsequent therapy was GDP-based with or without rituximab (n = 8, 7.41%). The mean [median] (SD) number of follow-up hospitalizations on or after SCT-related hospitalizations was 1.66 [1] (1.36), with a mean [median] (SD) length of hospital stay being 36.88 [34] (12.95) days. The total mean [median] (SD) healthcare cost after adjustment incurred per patient per year during follow-up was $79,052.44 [$42,722.82] ($121,503.65). Number of hospitalizations and Charlson Comorbidity Index scores (+5) were the key drivers of total healthcare costs in patients with r/r DLBCL. Index years 2020-2022 and heart disease as a complication were other statistically significant factors that had positive effects as increase on total healthcare costs.

Unlocking the Full Potential of High-Value Licenses through License Management Systems

In today's fast-paced digital world, businesses rely on software for nearly everything. From operations to innovation, it's all powered by tech. But is managing software licenses possible? That's getting trickier. As companies grow and adopt more diverse tech, keeping track of what's being used, where, and by whom is harder. License Management Systems (LMS) come to help in such scenarios. These tools have become a game-changer for businesses trying to grasp their software assets. The Customer Communications Management (CCM) community is fully committed to License Management Systems (LMS), and it is reasonable. It's not only about checking the compliance requirements when companies use an LMS. It is about optimizing the CCM tools to the maximum. Therefore, Companies see to it that every tool is deployed and used properly. The LMS system adoption is the main driver of these Benefits lower costs. lower risks. and all software resources are fully aligned with what the company needs. This smooth data exchange between the company and the customer enhances the service, simplifies the workflows, and ensures that everything is in sync with the customer's needs. Keywords License Management Systems (LMS), Customer Communications Management (CCM) systems

Distribution of Operating Costs Along the Value Chain of an Open-Pit Copper Mine

This study analyzes the distribution of operating costs along the value chain of an open-pit copper mine with a focus on key operational units or operations such as drilling, blasting, loading, hauling, stockpiling, blending, crushing, milling, and flotation. Using process costing analysis, key cost drivers were identified, and their individual contributions to total expenses were quantified. Results revealed that comminution processes dominate the operational cost structure, with milling accounting for 6.18 USD/ton, representing 59.1% of total operating costs, and crushing costing 1.15 USD/ton, that is, 11% of total operating expenditure. The study also highlighted several opportunities for cost reduction and enhanced mining sustainability through strategies such as energy consumption optimization, the use of alternative energy sources, and optimized blast design. Finally, valuable insights aimed at promoting sustainable resource utilization, improved cost efficiency, and data-driven decision-making in mining operations are offered to mine planners and operators. This is eventually expected to lay the foundation for benchmarking work on the establishment of a baseline and standards for similar mining operations.

The Cost of Providing Mechanical Thrombectomy for Patients in Private Hospitals Across India: A Macro-costing Study

Purpose The benefits of using mechanical thrombectomy (MT) to treat large vessel occlusion stroke in terms of clinical efficacy and cost-effectiveness have been widely recognised. However, the cost of delivering MT to treat large vessel occlusion stroke in private tertiary care centres in India is unclear. This study aimed to determine the cost of MT and analyse cost-influencing factors. Methods A retrospective cost analysis of stroke patients who underwent MT with or without intravenous thrombolysis (IVT) was conducted at multiple centres (January–December 2022). The macro-costing method was used to examine the discharge bills and identify cost-influencing factors. The study gathered data on patients treated according to normal clinical procedures at four skilled and frequently performing thrombectomy centres. Results The study was conducted on 115 stroke patients who underwent MT with or without IVT. Results showed an average total cost of ₹555,399 (95% confidence interval: 246,306–864,492) per patient. Key cost drivers were length of hospital stay (9.7 ± 7.0 days, p < .01), modified Rankin Scale (mRS) score at discharge (3.6 ± 1.6, p < .01) and use of decompressive surgery (10.7/115, p < .03). Lower costs were seen in patients with mRS scores 1, 2 or 6 on day 3 after MT (57/115, 50.4%, p < .01). Neither MT type nor concomitant use of IVT had a significant cost impact. Conclusion In conclusion, the mRS score is a critical factor in determining the cost of acute stroke therapy with MT in India. Efforts must be made to identify patients with poor mRS as early as 3 days after MT and devise a strategy to reduce their stay in the ICU and in the hospital, which would, in turn, help reduce their hospitalisation costs. It is crucial to gather accurate and comprehensive data on micro-costing to inform policies and allocate resources effectively.

Time-Driven Activity-Based Costing for Transsphenoidal Endoscopic Pituitary Surgery: What Are the True Drivers of Cost?

Time-Driven Activity-Based Costing for Transsphenoidal Endoscopic Pituitary Surgery: What Are the True Drivers of Cost?

Vanadium recovery from oil sands petcoke fly ash: A comprehensive techno-economic assessment.

Bitumen-derived petcoke contains significant quantities of vanadium, recoverable from the fly ash formed during combustion. Despite efforts to process vanadium recovery from petcoke, detailed cost information, critical for stakeholders and decision-makers, remains absent in the public domain. To address this gap, we developed data-intensive techno-economic models specifically for vanadium recovery from petcoke fly ash. The considered route involves roasting with NaCl, followed by water-leaching and vanadium precipitation. Through process modeling, we performed material and energy balances, sized equipment, assessed capital and operating costs, and determined the vanadium cost. For instance, a plant processing 16,000 tonnes of fly ash annually recovers 404 tonnes of vanadium pentoxide at $18.77/kg V2O5. Operating expenses constitute 88% of the total recovery cost, dominated by labor, gas cleaning, solid waste disposal, feedstock, and consumables. The developed scale factors reveal that production costs vary with plant size; currently, the cost exceeds market prices, but profitability could be achieved with a threefold increase in capacity. Uncertainty analysis indicates a vanadium cost ranging from $16.88 to $25.80 per kg V2O5, with a mean of $21.15/kg V2O5. Key cost drivers include carbon removal from off-gases, the on-stream factor, and solid waste management. Strategies such as alternative means of fly ash decarbonization and the use of leaching solid cake in commercial applications could significantly reduce production costs.

Real-world treatment patterns, healthcare resource utilization (HCRU), and costs in newly diagnosed patients with rectal cancer (RC) in the United States (US).

295 Background: RC constitutes 30% of colorectal cancer cases, the fourth most common cancer in the US, and is associated with a substantial economic burden. This retrospective claims analysis examined patient (pt) characteristics, all-cause and RC-related HCRU, and costs in pts who received surgery, radiotherapy (RT), or systemic therapy (ST) for RC. Methods: Medicare Fee-for-Service and MORE 2 Registry claims data were used to select pts with RC (RC cohort) and matched, non-RC controls (non-RC cohort). Pts with RC were required to have a diagnosis of RC in the primary position of ≥1 inpatient claim or in any position of ≥2 outpatient claims between Jan 1, 2016, and Dec 1, 2021, and ≥1 claim for an RC surgery, RT, or ST after diagnosis. Pts (aged ≥18 y) also needed to have continuous enrollment for 12 months preceding and minimum 30 days following the treatment index date (earliest RC treatment claim). Non-RC controls were matched to pts with RC on birth year, sex, payer type, and Deyo-Charlson Comorbidity Index (DCI). All-cause HCRU and costs (per pt per month [PPPM]) were compared for the RC and non-RC cohorts. Results: A total of 20,953 pts were included in each cohort (median age, 70 y; 52.5% male; median DCI, 1.0 in both cohorts). Median follow-up time was 24 months. In the RC cohort, 88.5% of pts underwent ≥1 surgery after RC diagnosis and 51.3% had ≥4 surgeries during follow-up. Colonoscopy and biopsies (59.4%), total mesorectal excision (47.7%), and proctectomy (45.2%) were the most frequent surgeries/procedures. RT was used as neoadjuvant and adjuvant therapies in 21% and 15.7% of pts, respectively; 5-fluorouracil was the most common neoadjuvant (12.7%) and adjuvant (20.9%) ST. Among nonsurgical pts (11.5%), 72.8% were treated with RT and 49.9% with 5-fluorouracil; a small proportion received immunotherapy (pembrolizumab, 1.2%; nivolumab, 0.7%). All-cause HCRU was significantly greater ( P <0.001) in the RC cohort vs the non-RC cohort (proportion of pts with ≥1 claim for physician office/clinic visit, 81.3% vs 73.6%; emergency room visits, 68.7% vs 45.3%; hospitalization, 71.1% vs 25.9%). The mean all-cause costs PPPM were $6043 for the RC cohort vs $1538 for the non-RC cohort ( P <0.001); mean RC-related costs PPPM were $3119. Outpatient and inpatient services were the main cost drivers in the RC cohort, accounting for 57.1% and 36.6% of all-cause expenditure, respectively, and 58.1% and 40.5% of RC-related expenditure. Conclusions: Most pts newly diagnosed with RC received standard of care surgical treatment, often with neoadjuvant or adjuvant RT or ST. All-cause HCRU was significantly greater for pts with RC vs those without RC; all-cause costs were almost 4 times higher, with about half of these costs related to RC and driven by outpatient services and hospitalizations. These results show a high economic burden and a need for additional treatments for pts with RC.

The cost-efficiency of vitamin A supplementation services in Kenya: An assessment of a Malezi Bora event in Kenya.

Vitamin A supplementation (VAS) remains a cornerstone of global child survival programs. As available funding declines, countries are seeking alternative delivery platforms. We examine a VAS-deworming delivery event in 2019 in Kenya, called Malezi Bora (MB), that employed four delivery platforms: health clinics, Early Childhood Development centers, community distribution points, and home visits. VAS coverage data were collected via household surveys in four subcounties, three of which received financial and technical assistance, and one of which received technical assistance only. Data on costs were collected using structured and semi-structured questionnaires. Only one subcounty achieved the targeted VAS coverage rate (80%) across most age subgroups; the subcounty not receiving financial assistance covered just 37% of children 6-59 months of age. Two other funded subcounties had higher coverage rates but failed to achieve 80% coverage for any age subgroup. Most children in the funded subcounties received VAS in their homes. Most children in the unfunded subcounty received VAS at a health facility. Being aware of MB was the most important factor associated with receiving VAS. Cost per child reached, including opportunity costs, varied across subcounties from $1.81 to $11.13 USD. Salaries were the main cost drivers.

24-week, all-oral regimens for pulmonary rifampicin-resistant tuberculosis in TB-PRACTECAL trial sites: an economic evaluation.

New 6-month rifampicin-resistant tuberculosis treatment regimens containing bedaquiline, pretomanid, and linezolid (BPaL) with or without moxifloxacin or clofazimine, could improve treatment efficacy, safety, and tolerability, and free up resources within the health system. Following a change to WHO rifampicin-resistant tuberculosis treatment guidelines, countries are facing difficult decisions about when and how to incorporate new drug regimens into national guidelines. We aimed to assess the probability of BPaL-based regimens being cost-saving using data collected in the TB-PRACTECAL trial. This economic evaluation using a cost-utility analysis was embedded in five TB-PRACTECAL trial sites in Belarus, Uzbekistan, and South Africa. Between Nov 19, 2020, and Sept 27, 2022, we collected detailed primary unit cost data in six hospitals and four ambulatory health facilities and collected data on patient-incurred costs from 73 trial participants. The primary efficacy endpoint of the main trial, a composite of unfavourable outcomes (death, disease recurrence, treatment failure, early discontinuation of therapy, withdrawal, or loss to follow-up) and clinically important safety outcomes by 72 weeks of follow-up were incorporated into the analysis. Societal perspective cost data and effect outcome data were input into a Markov model to estimate the cost per disability-adjusted life-year (DALY) averted by BPaL-based regimens compared with the standard of care over a 20-year time horizon. We conducted a range of univariate and probabilistic sensitivity analyses to test our findings. BPaL-based regimens averted a mean of 1·28 DALYs and saved a mean of US$14 868 (SD 291) per person from the provider perspective compared with standard-of-care regimens over 20 years. Patient-incurred costs were reduced by a mean of $172 (SD 0·84) in BPaL-based regimen groups compared with standard of care. The main cost drivers for both providers and patients were inpatient bed-days; the duration of the inpatient period varied across countries. Varying a range of model parameters affected the degree of cost savings but did not change the finding that BPaL-based regimens are cost-saving compared with standard of care. This trial-based evidence adds to consistent indications from modelling studies that BPaL-based regimens are cost-saving for both the patient and health system. Urgent implementation of BPaL-based regimens in countries with a high burden of tuberculosis could improve treatment of rifampicin-resistant tuberculosis, reduce pill burden, and free up desperately needed resources within the health system. Médecins Sans Frontières.

Short-term costs of alcohol-associated hepatitis care in different clinical settings.

Alcohol-associated hepatitis (AH) leads to high rates of mortality and health care costs. Understanding the immediate costs after an AH diagnosis and identifying key cost factors is crucial for health care policies and clinical decisions. This study quantifies medical costs within 30 days of an AH diagnosis across outpatient (OP), emergency department (ED), and inpatient (IP) settings. It also explores concurrent diagnoses and their effects on care costs. We conducted a retrospective cohort study using deidentified data from Optum's Clinformatics Data Mart. The cohort included individuals aged 21 years and older diagnosed with AH from January 1, 2016, to September 30, 2023. Patients were categorized by care setting (OP, ED, or IP). Costs were calculated for the 30 days before and after AH diagnosis and adjusted to 2023-dollar values. Comorbidities were identified using Elixhauser comorbidity software, and multivariable linear regression models were used to analyze medical costs. The cohort included 34,974 individuals diagnosed with AH: 8048 in OP (23%), 2736 in ED (7.8%), and 24,190 in IP (69.2%). Average spending in the 30 days prior to AH diagnosis was $7334 for OP, $5740 for ED, and $14,458 for IP. Following AH diagnosis, average costs rose to $8345 for OP, $20,990 for ED, and $88,655 for IP, reflecting increases of 14%, 266%, and 413%, respectively. Significant cost drivers in IP included comorbidities associated with moderate-to-severe liver disease, metabolic syndrome, liver transplant, and mortality during the 30-day follow-up period. Immediate costs following an AH diagnosis are substantial, particularly for IP care. Costs increase significantly with high-cost comorbidity clusters and among patients who die, underscoring the need for effective management of comorbidities in AH care.

What will introducing and delivering new maternal vaccines cost in Ghana and Mozambique? A prospective analysis.

The maternal vaccine landscape is expanding, including the anticipated global rollout of the now approved respiratory syncytial virus maternal vaccine. Integrating maternal immunization (MI) into health systems in low-and middle-income countries (LMICs) will require adaptation to existing immunization delivery platforms and have cost implications. In this study, we project the cost of maternal vaccine introduction and delivery in Ghana and Mozambique to help inform introduction decisions and ensure financial sustainability of future MI interventions. We used an activity-based prospective cost projection approach to estimate MI introduction and delivery costs for a five-year period from a health system perspective. Country stakeholders informed the strategies for MI delivery. Interviews with key immunization and maternal health program representatives informed on the anticipated health system adaptation requirements, activities, and resource needs taken into account in the cost projections. Supplementary data from a sample of sub-national health administrative units, vaccine stores, and health facilities also informed the costing analysis. Financial and economic costs are estimated and presented in 2023 USD units. New maternal vaccines in both countries are anticipated to be delivered leveraging the existing maternal tetanus vaccine delivery practices. The non-vaccine cost of delivering one dose of maternal vaccine was estimated at $3.42 (financial) and $4.12 (economic) in Ghana, and $1.84 (financial) and $2.21 (economic) in Mozambique. Health worker training, communication and social mobilization, and program planning and coordination constitute the main cost drivers. Cost differences between countries are partly driven by the anticipated baseline coverage and baseline health system capacity gaps. Very few studies exist on the costs of delivering maternal vaccine in LMICs. This study begins to fill this gap. These MI cost projections are comparable to other new vaccine introduction costs in similar settings, providing insights for local and global stakeholders seeking to understand costs of MI delivery.

Prophylaxis of HBV reinfection and disease in liver transplanted patients: 2024 update on the role of HBIG and cost-effectiveness evaluation.

Hepatitis B virus (HBV) infection is a major global health concern, with liver transplantation (LT) serving as a critical treatment for end-stage liver disease caused by HBV. However, the risk of HBV reinfection after LT remains significant, necessitating effective prophylaxis. Today, the combination of hepatitis B immune globulin (HBIG) and high-barrier nucleos(t)ide analogues (NUCs) is the standard of care for preventing HBV recurrence post-LT but concerns about the cost of HBIG and access to high-barrier NUCs have led to a reduction in the use, dose, and duration of HBIG in recent years. This review provides an updated analysis of the role of HBIG in preventing HBV recurrence post-LT, alongside a detailed evaluation of its cost-effectiveness, leveraging recent pharmacoeconomic data from Italy. The cost analysis showed that HBIG contributes approximately 12.4% (€ 49,000) to the total lifetime cost of LT-related healthcare (€395,986). Short-term HBIG prophylaxis reduced costs by 11.1%, while lifetime usage increased total costs by only 6.6%. However, the primary cost drivers were renal failure and immunosuppressive therapy. In conclusion, despite advancements in NUCs therapy, HBIG remains a cornerstone of HBV prophylaxis post-LT, particularly in high-risk patients, and discontinuation of HBIG in favor of alternative prophylaxis strategies lacks robust supporting evidence. Tailoring prophylaxis to individual patient needs and risk factors allows for personalized treatment while maintaining efficacy.

Protocol for the economic evaluation of integrated community-based care compared with integrated facility-based care for HIV, hypertension and diabetes in Tanzania and Uganda (INTE-COMM trial)

Background The number of people living with multiple chronic conditions in sub-Saharan Africa is increasing, but health facilities are unable to meet demand. To improve health system capacity and access to care, community models of HIV care have been trialled in countries such as Tanzania and Uganda. However, no evidence exists to inform policymakers on the effectiveness and cost-effectiveness of integrated community-based models of care for HIV and chronic non-communicable conditions. This protocol outlines a within-trial economic evaluation to address this gap. Methods & analysis We will estimate the costs and cost-effectiveness of integrated community-based care for HIV, hypertension and diabetes compared with facility-based care within the INTE-COMM pragmatic cluster-randomised trial in Tanzania and Uganda. Analyses will adopt a 52-week time horizon, the duration of trial follow-up. The full enrolled trial sample will be analysed from a societal perspective, comprising provider and patient perspectives. Economic costs will be estimated, which includes valuing inputs such as donated goods or time foregone by participants because of receiving care. For provider costs, participant case report forms will inform resource use along with data from facilities and community sites. Resources will be valued using project accounts, facility spending, and locally available cost data. Patient costs will be estimated based on a care-seeking and cost questionnaire administered to participants. Estimated costs will be analysed with co-primary trial outcomes on plasma viral load suppression, glycaemia and blood pressure control to calculate incremental cost-effectiveness ratios (ICER). We will also calculate ICERs for secondary trial outcomes related to health-related quality of life and wellbeing. Cost drivers and outcomes will be varied within confidence bounds in a two-way sensitivity analysis. We will investigate equity impact by estimating the mean difference in outcomes between integrated community-based and facility-based care across household socio-economic quintiles and by measuring whether participants incurred catastrophic health expenditures. Trial registration number The ISRCTN Registry: ISRCTN15319595. Registered on 07 June 2022: https://doi.org/10.1186/ISRCTN15319595

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.].

422. Household Economic Burden and Social Consequences of Childhood Severe Pneumonia in India: A Cost of Illness based Pharmacoeconomic Analysis

Abstract Background Childhood pneumonia stands as a leading cause of mortality among young populations. Providing care for pediatric pneumonia poses significant challenges in resource-constrained regions, where caregivers often bear treatment expenses directly. This study aimed to evaluate the burden, social impact, and economic ramifications of childhood pneumonia, as well as to identify associated risk factors. Methods An incidence-based Cost of Illness (COI) study was conducted, focusing on one episode of severe childhood pneumonia from a household perspective. The study was carried out across three distinct sites in the South Indian state of Kerala, India. Through face-to-face interviews, data on socioeconomic status, resource utilization, and associated costs were gathered from caregivers of children aged between 1 month and 6 years. Utilizing a micro-costing bottom-up methodology, medical, non-medical, and time-related costs were computed. Multiple regression analysis was employed to examine factors influencing COI, while sensitivity analysis was conducted to assess the robustness of cost estimations. Results A total of 436 children with severe pneumonia were enrolled between January 2022 and December 2023. The mean age of participants was 14 months (SD ±9.1), with males constituting 58.7% (256). The average household cost per episode amounted to USD 149 (95% CI; 139.7 - 155.9), with indirect costs serving as the primary cost drivers (65%, USD 98). While household expenses for the poorest income quintile were lower in absolute terms, they represented a higher proportion of monthly income. Notably, COI was significantly higher for treatments sought at urban health facilities compared to rural counterparts (difference USD 54.3, 95% CI 73.3 to 96.3). Additionally, factors such as age, parental education level, and healthcare facility location emerged as significant predictors of household COI. Conclusion This study underscores the substantial economic burden imposed on households by severe childhood pneumonia, with cost differentials evident across various socioeconomic strata. In light of these findings, tailored management strategies should be devised for resource-limited settings to enhance treatment affordability and alleviate household economic strain. Disclosures All Authors: No reported disclosures

Total Cost of Ownership and Evaluation of Google Cloud Resources for the ATLAS Experiment at the LHC

The ATLAS Google Project was established as part of an ongoing evaluation of the use of commercial clouds by the ATLAS Collaboration, in anticipation of the potential future adoption of such resources by WLCG grid sites to fulfil or complement their computing pledges. Seamless integration of Google cloud resources into the worldwide ATLAS distributed computing infrastructure was achieved at large scale and for an extended period of time, and hence cloud resources are shown to be an effective mechanism to provide additional, flexible computing capacity to ATLAS. For the first time a total cost of ownership analysis has been performed, to identify the dominant cost drivers and explore effective mechanisms for cost control. Network usage significantly impacts the costs of certain ATLAS workflows, underscoring the importance of implementing such mechanisms. Resource bursting has been successfully demonstrated, whilst exposing the true cost of this type of activity. A follow-up to the project is underway to investigate methods for improving the integration of cloud resources in data-intensive distributed computing environments and reducing costs related to network connectivity, which represents the primary expense when extensively utilising cloud resources.

Real-world assessment to estimate multiple attributes related to treatment cost driver for mantle cell lymphoma in Japan by econometric modeling

This study was conducted using a nationwide health care database of Japan between 1 April 2008 and 30 September 2022 to evaluate the economic burden on patients with mantle cell lymphoma (MCL). Structural equation modeling (SEM) is an advanced multivariate analysis framework used to assess the relationships between observed and latent variables within predefined causal models. In this study, SEM was employed to identify cost drivers and estimate variables related to MCL treatment cost. A total of 2,838 patients having at least one confirmed diagnosis of MCL participated in this study. As for the index regimen, a combination of bendamustine rituximab was the most frequently used (n = 328), followed by rituximab combined with cyclophosphamide, doxorubicin, vincristine, and prednisolone-like regimen (n = 112), and others. The median of total health care cost (unadjusted and adjusted) were 32,228 USD and 31,918 USD, respectively. The mean (SD) of the frequency of bleeding treatment was 23 (35) per year, and that of outpatient visits was 19 (12) per year. SEM analysis revealed Bruton tyrosine kinase inhibitor-based treatment as a cost driver (β: 0.398 [0.340; 0.457], p < 0.001). Key health care resource utilization (HCRU) factors associated with an increased cost were the total length of hospitalization (β: 0.598 [0.551; 0.646], p < 0.001) and number of outpatient visits (β: 0.132 [0.083; 0.180], p < 0.001). This real-world study delivers insights for optimizing MCL care in Japan.

Assessing costs and constraints of forest residue disposal by pile burning

Pile burning of thinned residues is a critical tool to dispose of fuels and to reduce wildfire risk in overstocked, fire-prone forests globally. However, cost estimates of pile burning are limited. In the Western United States, where fuel reduction and pile burning are key strategies to mitigate risk of severe wildfire, previous reports estimate that the average cost of pile burning after machine treatment is $543 ac−1 ($1,343 ha−1). There is, however, limited information on the costs of hand thinning and pile burning. In response, this study quantified the costs of cutting and yarding, piling, and burning residues via two pathways: the USDA Forest Service (USFS) Activity Tracking System (FACTS) database, and interviews with 11 USFS fire management professionals from California, Oregon, and Washington. Interviews highlighted cost drivers, implementation constraints, and opportunities for efficiency improvements. The average costs of piling and burning machine piles as determined from the interviews were $735 ± $464 ac−1 ($1,817 ± $1,146 ha−1; all mean ± SD), 80% higher than reported in the FACTS database and 35% higher than previous reports. The average costs of piling and burning hand piles as determined from the interviews were $1,291 ± $717 ac−1 ($3,190 ± $1,722 ha−1), 135% higher than reported in the FACTS database. Interview participants reported proximity to roads and terrain as key cost drivers, and described common practices, challenges, and constraints to pile burning. Geospatial analyses supported interviewee-identified cost drivers, district road density (a proxy for accessibility) and district maximum elevation (a proxy for terrain). Simulations of direct emissions from pile burning on National Forests included in this study indicated annual emissions of 11,322 metric tons (MT) of particulate matter (PM), 8,029 MT of PM10, and 6,993 MT of PM2.5 across the study area. In addition, pile burning on these National Forests annually emits &amp;gt;1.7 million MT CO2, 61,515 MT of carbon monoxide, 3,823 MT of methane, and 3,211 MT of non-methane hydrocarbons. Given the economic, human health, and climate implications of current pile burning practice, removing residues as feedstocks for carbon-negative utilizations is recommended as a near-term priority. Policy mechanisms, such as feedstock production, transport, or offtake subsidies of a similar magnitude to such avoided costs, could efficiently incentivize residue removal and support such climate-positive utilizations.

Costs analysis of integrating group interpersonal therapy into HIV care services in Senegal

IntroductionGroup Interpersonal Therapy (IPT), an evidence-based treatment of depression recommended by the WHO mhGAP Intervention Guide, was implemented through a task-shifting approach in Senegal, as a treatment for depressed people living with HIV (PLWH). Since a description of the resources used and the implementation costs incurred is necessary to inform policymakers better, this study aimed to estimate the costs associated with its implementation.MethodsIntervention costs were analyzed using an “ingredients-based costing approach” from the provider’s perspective. We identified and described the start-up and implementation costs for the initial phase and a projection over 5 years (implementation at capacity). We estimated total annual costs and cost per beneficiary. We conducted a scenario analysis to highlight some cost uncertainties and their impacts.ResultsThe total annual costs were estimated at $4064 for the initial phase and $8161 for the implementation at capacity. The training was the main cost driver representing approximately 60% of the total annual costs. The cost per beneficiary receiving group IPT was estimated at $65 for the implementation at capacity. The scenario analysis also illustrated the importance of parameters like the screening strategy, training activities, and allocation to cover transport costs mobilized by participants.ConclusionThis cost analysis highlighted the costs and cost allocations required to implement group IPT in Senegal to treat depression in PLWH. This preliminary work should enable policymakers to identify the optimal resources to be mobilized to implement and ensure the sustainability of this therapy in HIV at a country-level program.

Catastrophic expenditure associated with childhood hospitalisation for acute illness in Kenya and Uganda: a cross-sectional study

IntroductionChildhood illness and hospitalisation result in both direct and indirect costs to families before, during and after admission. We aimed to estimate the catastrophic expenditure during hospitalisation for children with...