Cost Drivers Research Articles

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...

A Cost-Effectiveness Analysis of Corequisite English Developmental Education: Evidence from a Randomized Controlled Trial in Texas Community Colleges

Abstract We estimate the cost effectiveness of corequisite English developmental education at community colleges compared to a traditional prerequisite pathway. Our context is the randomized controlled trial conducted by Miller et al. (2022) that estimated the effects of three different approaches to English corequisites implemented in five Texas community colleges. The main drivers of differential costs across pathways and colleges are the number of credit and contact hours in each pathway, class sizes, and the type of faculty used to teach courses (adjunct or full-time). Corequisites are less expensive than prerequisite pathways in two colleges, they are roughly similar in two other colleges, and they are much more expensive in one college. Miller et al. (2022) find that corequisites induced more students to pass the required college-level English course in all colleges but find no impact on persistence in college. From students' point of view, corequisites should be preferred because tuition payments are lower, and they entail a higher likelihood of success.

Kann das Bürgergeld die Lebensmittelkosten einer gesunden Ernährung von Kindern und Jugendlichen decken?

ZusammenfassungEinleitungVon Armut betroffene Familien in Deutschland erhalten im Rahmen der Sozialgesetzgebung (SGB) existenzsichernde Leistungen. Das Bürgergeld umfasst auch Regelsätze für Kinder und Jugendliche, gestaffelt in 3 Altersgruppen. Der Bedarf für Ernährung ist die größte Kategorie des Regelsatzes. Die Optimierte Mischkost (OMK) ist ein praxisnahes Konzept einer gesunden Ernährung für Kinder und Jugendliche im Alter von 1–18 Jahren. Herkömmliche Lebensmittel und selbsthergestellte Speisen werden bevorzugt. Ziel des Projektes war es, die Lebensmittelkosten der OMK anhand des zugrunde liegenden 7‑Tage-Speiseplans zu berechnen.MethodikEs wurden die niedrigsten Regalpreise der 87 Lebensmittel der OMK im Lebensmitteleinzelhandel (1 Supermarkt, 1 Discounter; November 2022, Bochum) erfasst. Der Ernährungsregelsatz wurde mit den Lebensmittelkosten pro Monat nach den SGB-Altersgruppen sowie nach den Altersgruppen der Deutschen Gesellschaft für Ernährung (DGE) verglichen. Weiterhin wurden die Beiträge der Lebensmittelgruppen zu den Gesamtkosten und der Gesamtenergiezufuhr der OMK aufgeschlüsselt.ErgebnisseDie Kosten der OMK wurden mit dem Ernährungsregelsatz des Bürgergeldes für die 3 SGB-Altersgruppen zu 101–109 % gedeckt, für die enger gefassten DGE-Altersgruppen war der Betrag mit wenigen Ausnahmen ebenfalls ausreichend. Hauptsächliche Kostenträger der OMK waren Gemüse/Rohkost, hauptsächliche Energielieferanten waren Brot/Getreideprodukte.DiskussionMit dem Bürgergeld kann der ernährungsphysiologische Bedarf von Kindern und Jugendlichen gedeckt werden, unter der Voraussetzung der Selbstherstellung der Speisen und der Verwendung preiswerter Lebensmittel. Es bleibt zu diskutieren, inwieweit auch mit der Ernährung verbundene Bedürfnisse der sozialen Teilhabe erfüllt werden können.

Hybrid hydrogen-electricity production using Spherical Tokamaks: a cost-driver sensitivity study and techno-economic analysis

Abstract Hybrid fusion power plants able to produce hydrogen and electricity are proposed here as a way of decarbonising the fossil-fuel-dominated primary energy market and to improve the plant economics. The main cost drivers of a fusion power plant based on a spherical tokamak have been identified using statistical analysis (Morris and Sobol methods) from a wide range of cases obtained with the systems code PROCESS. Showing the relevance of parameters such as &amp;#xD;β, A, BT max.&amp;#xD;&amp;#xD;Three scenarios of advancing technophysical assumptions (conservative, moderate and optimistic) have been chosen to study the integration of the fusion reactor with the power block (Rankine, He-Brayton or super-critical-CO2-Feher) and with the PEM electrolyser. The super-critical-CO2 cycle returns the best results for the studied temperature range (500ºC-800ºC), with an efficiency between 40%-56%. The modelled PEM is in line with current commercial models with a consumption of 51.97 kWh/kg H2.&amp;#xD;&amp;#xD;The economic feasibility of these scenarios has been explored for a set of learning factors that consider the cheapening of the capital costs tied to experience. The LCOE of these scenarios have been compared against current price ranges of solar, wind and fission power and the LCOH against PEM prices, showing that the moderate and optimistic scenarios could be competitive for learning factors lower than 0.5 and capacity factors larger than 0.7. A showcase case using the optimistic scenario shows that the hybrid fusion power plant in the French and German market can improve the plant profits by 15% and 66% respectively.

Time-Driven Activity-Based Costing Analysis of Coronary Flow Velocity Reserve Assessment with Regadenoson Stress Echocardiography

Objective: Accurate measurement of healthcare costs is required to assess and improve the value of Regadenoson stress echocardiography (RSE). The purpose of this study was to determine the costs associated with Regadenoson stress echocardiography. Methods: Time-Driven Activity-Based Costing (TDABC) was used to calculate the non-directly traceable cost of RSE. Data were collected between January 2021 and December 2023. TDABC steps involved (1) constructing process maps for the RSE pathway; (2) determining capacity cost rates for staff, medical equipment, space, water and electricity; (3) measuring the time required for each process through direct observation and participation and (4) calculating the total non-directly traceable cost of RSE. Finally, the total costs of RSE were obtained by summing up the direct retroactive cost and non-directly traceable cost. Results: Total costs of RSE were 1306.18 Chinese Yuan ($181.60), of which Regadenoson, human resources and equipment accounted for 61.09%, 19.96% and 13.17%, respectively. Conclusion: Regadenoson expense was the greatest contributor to the costs of RSE, followed by labor cost. Understanding the actual costs and cost drivers of RSE may better inform resource utilization to lower the cost and improve the quality of RSE.

Real-world psoriasis treatment patterns and disease burden in Germany, with a focus on biologics and apremilast: data from a German statutory health insurance database

Background Psoriasis is a chronic, systemic, inflammatory skin disease, with increasing prevalence; however, few studies have reported real-world prescription patterns and healthcare burden. Objectives This retrospective, observational cohort study used statutory health insurance claims data (January 2014–December 2019) to estimate prevalence/incidence of moderate-to-severe psoriasis in Germany. Patient characteristics, treatment patterns/compliance, and healthcare resource utilization (HCRU)/costs were evaluated, focusing on apremilast and anti-interleukin (IL), and anti-tumor necrosis factor (TNF) biologics. Methods The epidemiology population included adults with psoriasis; 1-year prevalence/incidence rates were extrapolated to the statutory health insurance population. The HCRU/costs population included adults with psoriasis and a first prescription for a drug of interest (index date). Baseline periods were 12 or 48 months before the index date, with 12‑month follow-up. Results In 2019, the estimated psoriasis prevalence/incidence was 2,672.9 per 100,000 individuals/508.7 per 100,000 person-years. Of 2,809 patients in the HCRU/costs population, 3.6% (n = 101) received index drug apremilast, 10.2% (n = 287) anti-IL, 6.8% (n = 191) anti-TNF, and 79.4% (n = 2,230) traditional/other systemic therapy. Patients initiating apremilast were older and were more often biologic-naïve than those initiating anti-IL/TNF biologics. Twelve months after treatment initiation, drug adherence (medication possession rate >80%) and persistence (<60 days between prescriptions/no switch) were lower for apremilast vs. anti-IL and anti-TNF groups (24.8% vs. 59.6% and 53.9%; 36.6% vs. 66.9% and 57.6%, respectively). During a 12-month baseline period, psoriasis-related hospitalization was lower for apremilast vs. anti-IL and anti-TNF groups (4.95% vs. 15.68% and 14.14%) and higher during 12 months’ follow-up (5.94% vs. 2.44% and 3.14%). Adjusted index drug costs during follow-up were €4,105, €3,498, and €13,777 higher for adalimumab, other anti-TNF and anti-IL biologics vs. apremilast, respectively, and the main driver for lower overall apremilast costs. Conclusion Given variation in treatment adherence/persistence, HCRU, and costs between apremilast and biologics, these findings could be key considerations during treatment selection.

Decarbonization and technology cost drivers: considerations for potential future thermoelectric water use in the power sector

Abstract The power sector is currently undergoing significant changes, driven by a combination of factors, including decarbonization and technology innovation. This study aims to assess implications of these drivers on U.S. power sector technology futures and the associated water and environmental implications for cooling thermoelectric power plants. Specifically, we evaluate four decarbonization scenarios for the contiguous United States that vary in assumptions concerning demand growth and technology costs, with technology costs driving alternative outcomes that prioritize either technologies that require low amounts of water (such as wind, solar, and battery) or high amounts of water (such as nuclear and carbon capture and storage). These scenarios are executed in a power sector capacity expansion model and compared to two reference scenarios that assume status quo with policy and cost drivers. Our analysis indicates that future U.S. thermoelectric water withdrawals could decrease by 25%–60%, but water consumption could more than triple in some scenarios. These changes are driven by a combination of retirement of some power facilities, shifts in cooling technologies, and new technology deployment. The water use patterns vary across the United States, with the eastern regions demonstrating a lot more variability in water consumption across scenarios than western regions. However, local concerns can influence these possible investments, since increased water consumption can exacerbate water scarcity, leading to conflicts among competing users and affecting regional social, environmental, and economic dynamics. Future work should consider possible costs associated with alternate water sources, as well as improve the representation of water constraints within simulations. Inclusion of extreme events and alternate modeling platforms (e.g. production cost modeling and resource adequacy) may also be warranted to further stress test the robustness of these possible technology futures. Such assessments will be critical for ensuring decarbonization and other infrastructure-oriented investments lead to a reliable and resilient power grid.

Socioeconomic Burden of Pulmonary Embolism in Europe: Shifting Priorities and Challenges for Novel Reperfusion Strategies.

In-hospital case fatality related to acute pulmonary embolism (PE) has been falling since the beginning of this century. However, annual incidence rates continue to climb, and an increasing number of PE survivors need long-term follow-up, chronic anticoagulation treatment, and readmission(s) to the hospital. In European countries, median reimbursed hospital costs for acute PE are still moderate compared with the United States but can increase several-fold in patients with comorbidities and those necessitating potentially life-saving reperfusion treatment. The use of catheter-directed treatment (CDT) has constantly increased in the United States since the past decade, and it has now entered a rapid growth phase in Europe as well, estimated to reach an annual penetration rate of up to 31% among patients with intermediate-high- or high-risk PE by 2030. Ongoing randomised controlled trials are currently investigating the clinical efficacy and safety of these devices. In addition, they will deliver data permitting calculation of their cost-effectiveness in different health care reimbursement systems, by revealing the extent to which they can reduce complications and consequently the need for intensive care and the overall length of hospital stay. After discharge, key cost drivers are related to chronic cardiopulmonary diseases (other than PE itself) leading to frequent readmissions, persistent symptoms, and functional limitations which result in poor quality of life, productivity loss, and substantial indirect costs. Implementation of structured outpatient programmes with a holistic approach to post-PE care, targeting overall cardiovascular health and the patient's well-being, bears the potential to cost-effectively reduce the overall socioeconomic burden of PE.

Cost analysis of laparoscopic total versus open total gastrectomy in gastric cancer

PurposeDespite ongoing discussions concerning clinical equivalence of laparoscopic total gastrectomy (LTG) compared to open total gastrectomy (OTG) in gastric cancer (GC) surgery, complementary evidence regarding financial implications is sparse. The aim of this study was to compare hospital associated expenses and perioperative outcomes between both approaches.MethodsClinicopathological and financial data from 80 consecutive GC patients undergoing LTG or OTG between 2015 and 2022 were investigated. Patient baseline characteristics, perioperative results, long-term outcomes and financial expenses up to 30 days after discharge were compared. A binary logistic regression model to identify individual cost drivers was performed.ResultsLTG was associated with significantly prolonged operating time (281 min vs. 245 min, p < 0.02). However, LTG demonstrated a trend towards lower total (18,708 € vs. 22,810 €, p = 0.11) and median daily (1,516 € vs. 1,721 €, p = 0.25) expenses, yet not reaching statistical significance. Decreased ICU costs emerged as the greatest single cost reducer in LTG (962 € vs. 2,147 €, p = 0.10). Hospital length of stay ≥ 15 days was the only independent cost driver for increased expenses (HR [95% CI] = 13,2 [3.0-58.9], p < 0.01). Ultimately, patients undergoing LTG and OTG demonstrated similar outcomes in terms of perioperative morbidity (n = 8, 13% vs. n = 3, 17%, p = 0.70), median number of resected lymph nodes (n = 32 vs. n = 33, p = 0.72), absence of 90-day mortality, and long-term survival (p = 0.47).ConclusionAlthough typically involving longer operating times, LTG tends to be linked with decreased hospital costs, yet not reaching statistical significance. The ongoing establishment of LTG seems not to pose additional financial burdens for surgical departments.

The Costs of a Multisectoral Nutrition Program Implemented Through a Poultry Value Chain Platform in Burkina Faso

ABSTRACTUndernutrition in women and young children in Burkina Faso is a critical problem. Egg consumption is low despite many households raising poultry. The Soutenir l'Exploitation Familiale pour Lancer l'Élevage des Volailles et Valoriser l'Économie Rurale (SELEVER) project, an integrated agriculture‐nutrition intervention, promoted egg consumption and sales to investigate the impact of poultry production on child nutrition. Multisectoral nutrition‐sensitive agriculture programs address nutrition deficits but lack comparable cost information. This study estimates the costs of the SELEVER program, an integrated poultry and nutrition intervention. The study estimates the program's economic costs using a standardized methodology from the Strengthening Economic Evaluation for Multisectoral Strategies for Nutrition (SEEMS‐Nutrition) consortium, which aligns financial and economic costs along program impact pathways, allocating costs by activities and inputs. We conducted qualitative interviews and focus groups on time allocation and beneficiary out‐of‐pocket costs. Incremental economic costs were calculated by combining expenditures and economic costs. The total incremental program cost was USD$18,084,727.68 over 5 years, with annual incremental costs of USD$209.20 per direct beneficiary and $796.26 per household. Major cost drivers included overhead (18%), poultry extension (17%), training (16%), household counseling (7%), technical assistance (7%) and microcredit (6%). Total input costs were dominated by personnel (51%), supplies (13%), agricultural inputs (10%) and overhead (9%). We present the total incremental costs of a multisectoral nutrition intervention to generate revenue with poultry. The costs per beneficiary were higher than similar interventions, underscoring the need for cost‐effectiveness evaluations of multisectoral nutrition programs. A standardized cost methodology facilitates comparisons with multisectoral nutrition interventions and builds the evidence base.

A Multivariate Linear Regression on Cost Analysis of Tesla

This paper provides an in-depth cost analysis of Tesla Inc., focusing on the companys operational strategies and financial efficiencies through a multivariate linear regression model. Key cost drivers, including research and development (R&amp;D) expenditures, Gigafactory capital investments, and supply chain resilience, are critically examined to understand Teslas ability to manage high production costs while maintaining its competitive edge in innovation. The study explores Tesla's unique approach to balancing aggressive expansion with financial sustainability, particularly in its efforts to scale production of electric vehicles (EVs) globally. Recommendations for improving cost control are also discussed, such as modular manufacturing processes, the use of green financing for capital projects, and supplier diversification to mitigate risks. Additionally, the paper highlights Teslas leadership in cost-efficient, sustainable practices and offers insights that could be adopted by other EV manufacturers. The findings underline Teslas financial sustainability and its role as a model for the broader EV industry, illustrating how strategic cost management can drive long-term success in the rapidly evolving clean energy sector.

Trends and cost structure of drug-based secondary prevention of ischemic strokes

BackgroundAdvances in secondary stroke prevention, including direct oral anticoagulants (DOACs), dual antiplatelet therapies (DAPT), and cardiovascular risk management, have changed costs over the past decade. This study aimed to evaluate annual treatment costs and trends in drug-based secondary prophylaxis after ischemic strokes.MethodsAnnual treatment costs were evaluated using the net costs per defined daily dosage (DDD) of discharge medications for ischemic stroke patients treated in 2020 at the University Hospital Frankfurt, Germany. Evaluated drugs included acetylsalicylic acid, adenosine diphosphate inhibitors, DOACs, vitamin K antagonists, lipid-lowering drugs (LLD), antihypertensives (AHT), and oral antidiabetics (OD). Kruskal–Wallis test examined intergroup differences in substance groups and stroke etiologies. DDD development between 2004 and 2021 was further evaluated for significant trend changes using an interrupted time series analysis.ResultsThe study included 422 patients (70.5 ± 12.9 years, 43.1% female). Etiologies divided into large-artery atherosclerosis (29.9%), cardioembolic (25.6%), cryptogenic (26.8%), and small-vessel disease (17.8%). The total estimated annual drug expenditure was € 241,808; of which 51.6% was due to DOACs (median € 1157 [Q1–Q3:1157–1157], p < 0.006), 20.0% to AHTs (€127.8 [76.7–189.8]), 15.7% to ODs (€525.6 [76.7–641.5]), and 8.7% to LLDs (€43.8 [43.8–43.8]). Cardioembolic strokes had the highest annual costs per patient (€1328.6 [1169.0–1403.4]) with higher expenditure for DOACs (p < 0.001) and AHTs (p < 0.026). DAPT costs were highest for large-vessel strokes (p < 0.001) and accounted for 2.5% of total costs. There was a significant trend change in DDDs for clopidogrel in 2010 (p < 0.001), for prasugrel in 2017 (p < 0.001), for ASA in 2015 (p < 0.001) and for DOACs in 2012 (p = 0.017).ConclusionsDOACs for cardioembolic strokes were the primary cost driver in drug-based secondary stroke prevention, whereas permanent ASA and DAPT only accounted for a minor cost proportion. LLDs were associated with lower costs than AHTs and ODs. There were significant changes in DDDs for the respective substances, whereas the costs for DOACs as the most expensive pharmaceuticals remained widely stable across the last decade.

Burden of coeliac disease in Germany: real-world insights from a large retrospective health insurance claims database analysis.

Coeliac disease (CeD) is a chronic immune-mediated disease triggered by exposure to dietary gluten in genetically predisposed individuals. The burden of CeD on patients and the healthcare system remains poorly evaluated in Germany. To assess the healthcare resource utilisation (HCRU) and costs of diagnosed CeD patients in a German claims database. A retrospective CeD case-control study was conducted using German claims data between 2017 and 2021. CeD diagnosis was defined by at least one inpatient or two outpatient diagnostic codes (International Statistical Classification of Diseases and Related Health Problems, 10th Revision, German Modification (ICD-10-GM) K90.0) within four quarters (irrespective of calendar year) for CeD during the study period. Controls (non-CeD patients) were matched in a ratio of 5:1 by age, Charlson Comorbidity Index, sex and region. HCRU (hospitalisations, outpatient visits, medication use, sick leaves) and healthcare costs (outpatient services, inpatient services, outpatient pharmaceuticals, sick leaves and aids and remedies) were compared between CeD patients and controls. From the 3,352,188 patients with continuous enrolment during the study period (2017-2021), 8258 (0.25%) patients were identified as having a CeD diagnosis. The mean number of hospitalisations and outpatient visits within 5 years was 1.8- and 1.5-fold higher among matched CeD patients (n = 8243) compared to their controls (n = 41,215), resulting in an excess healthcare cost of €5251. Inpatient expenses were the main cost driver and accounted for 31.5% of total incremental costs. The current study showed that CeD patients have considerably higher HCRU and related costs compared to matched controls. Our findings suggest the need for improved treatment options for CeD patients in addition to a gluten-free diet.

Green hydrogen production from offshore wind: A techno-economic analysis for Türkiye

Green hydrogen production from offshore wind: A techno-economic analysis for Türkiye

Improving Profitability and Reducing Downside Risks using Statistical Models

Energy demand will increase due to the increasing population, improved standard of living, and rising artificial intelligence applications. The existing energy sources may not be sufficient, and we need multiple sources of energy in the near future to meet the increased demand. The oil &amp; gas energy sector will face several challenges such as stricter regulation, the rise of renewable energy, and aging assets. The industry, therefore, needs sophisticated tools to forecast the price and cost more accurately than ever for reliable and sustainable profits with reduced downside risks. In this paper, we develop statistical models for a profitable refinery to forecast the key cost driver as crude oil price, and the key revenue driver as gasoline/diesel prices, 6 months in advance. We first identify statistically significant variables and then refine further using collinearity to identify key variables. Our analysis indicates that both oil and gasoline prices depend on the Dow Jones industrial average, WTI oil price, average miles used per gallon, average well production per day, number of refineries, refinery capacity, and rig count. These variables are statistically significant with p-values less than 0.05. We tested the 6-month future price and found that the model can predict the oil price within 5% variability and the gasoline price within 7%. For the oil price variation, the Dow Jones industrial average accounts for ~24%, the number of refineries for ~21%, average well production per day for ~20%, and the remaining variation is attributed to other variables. For the gasoline price variation, oil price contributes ~40%, the Dow Jones industrial average covers ~25%, and the remaining variables account for the remaining ~35%. The Dow Jones industrial average impacts both the cost and revenue aspects of a refinery business. Thus, we recommend contracting crude oil and gasoline using an index tied to the broader economy to reduce the downside risk and improve profitability. These results could enable the refinery management team to seek long-term contracts to lock in high-margin crude oil supply and favorable gasoline price contracts with customers when a decline in price is forecasted to improve the profit margin. This methodology and strategy are applicable beyond the refinery business to any cyclical business to maintain margin, particularly in a down cycle.

THE ROLE OF MANAGED CARE IN HOME- AND COMMUNITY-BASED SERVICES SPENDING

Abstract The provision and management of Medicaid-financed long-term services and supports (LTSS) has changed dramatically over the last 25 years, including a substantial expansion of both home and community-based services (HCBS) and managed care programs. However, evidence on the costs of these services and drivers of costs is limited. The objective of this study is to describe LTSS and HCBS spending across states, over time, and to examine the impact of managed care on spending. We used a difference-in-difference approach, accounting for the staggered timing of managed care implementation, to analyze data from annual Medicaid LTSS reports and think tank reports from the year 2000 and onward. We find that, after adjusting for inflation, national LTSS spending increased from approximately $410 per capita in 2000 to $570 per capita in 2021; HCBS spending more than tripled during this period. Nineteen states introduced managed care into their LTSS programs between 2000 and 2021 (seven states had implemented programs prior to 2000). States that used managed care to provide some of their Medicaid LTSS demonstrated lower overall LTSS spending post-implementation, but no differences were observed in HCBS spending. However, uncertain fidelity of the data, particularly among states implementing managed LTSS programs, leads to questions of whether these differential trends are due to differences in reporting or changes in the efficiency of care delivery. Our findings highlight the need for increased accuracy and transparency in spending data to facilitate studies that will produce the evidence base for state and federal Medicaid policy makers.

REPURPOSED FOR AGING

Abstract Chronic diseases represent the leading driver of health care cost, with detrimental impact on function, independence, and quality of life in the aging society. Geroscience-guided approaches seek to target aging biology to extend healthspan, defined as the period of life spent without major disease and disability. Repurposing Food and Drug Administration (FDA) - approved drugs as gerotherapeutics (geroscience-guided pharmacologic interventions) offers the advantage of known pharmacologic profile and existing clinical experience and can represent a cost-effective strategy to test interventions for extension of healthspan. Among FDA-approved drugs, candidates with geroscience potential can be identified based on the evidence of extension of healthspan and lifespan in model organisms coupled with clinical evidence of benefits extending beyond the diseases targeted by the drug, through mechanisms that involve modulation of hallmarks of aging. Given the inseparable connections between metabolism and aging, it is not surprising that several FDA-approved drugs developed for treatment of metabolic dysfunction are emerging as potential gerotherapeutics. Metformin (discussed by Dr. Sara Espinoza), a widely used oral antidiabetic drug, extends lifespan in preclinical models, while observational clinical evidence supports its role in prevention of several chronic diseases. Two newer antidiabetic drug classes, glucagon-like peptide 1 (GLP1) receptor agonists (discussed by Dr. John Newman) and sodium- glucose cotransporter 2 (SGLT2) inhibitors (discussed by Dr. Carolina Solis-Herrera), have demonstrated healthspan and lifespan benefits above and beyond treatment of diabetes. Emerging evidence for modulation of multiple hallmarks of aging supports gerotherapeutic properties of these drugs. Clinical trials targeting several aging-relevant outcomes are underway.