Cost Estimates Research Articles

Costs of Care in Relation to Alzheimer's Disease Severity in Sweden: A National Registry-Based Cohort Study.

The advancement of diagnostic and therapeutic interventions in early Alzheimer's disease (AD) has demanded the economic evaluation of such interventions. Resource utilization and cost estimates in early AD and, more specifically, the amyloid-positive population are still lacking. We aimed to provide cost estimates in AD in relation to disease severity and compare these with the control population. We also aimed to provide cost estimates for a subset of the AD population with both clinical diagnosis and amyloid-positive confirmation. This was a retrospective longitudinal analysis of resource utilization using data from national registries. A cohort from the national Swedish registry for cognitive/dementia disorders (SveDem) includes all clinically diagnosed AD between 2013 and 2020. The study population included 31,951 people with AD and 63,902 age- and sex-matched controls (1:2). The population was followed until death, the end of December 2020, or 2years from the last clinic visit. Direct medical and social costs were estimated from other national registries. Direct medical costs include costs for medications and inpatient and outpatient clinical visits. Direct social costs include costs for institutionalization, home care, short-term care, support for daytime activities, and housing support. Mean annual costs and 95% confidence intervals were obtained by bootstrapping, presented in 2021 Swedish Krona (SEK) (1 SEK=0.117 USD, 1 SEK=0.0985 EUR in 2021), and disaggregated by AD severity, cost component, sex, age group, and care setting. Mean annual costs for individuals with clinically diagnosed AD were SEK 99,906, SEK 290,972, SEK 479,524, and SEK 795,617 in mild cognitive impairment (MCI), mild, moderate, and severe AD. The mean annual costs for the population with both clinical diagnosis and amyloid-positive AD confirmation (N=5610) were SEK 57,625, SEK 179,153, SEK 333,095, and SEK 668,073 in MCI, mild, moderate, and severe AD, respectively. The mean annual costs were higher in institutionalized than non-institutionalized patients, females than males, and older than younger age groups. Inpatient and drug costs were similar in all AD severity stages, but outpatient costs decreased with AD severity. Costs for institutionalization, home care, support for daytime activities, and short-term care increased with AD severity, whereas the cost of housing support decreased with AD severity. This is the first study estimating annual costs in people with AD from MCI to severe AD, including those for the amyloid-positive population. The study provides cost estimates by AD severity, cost components, care settings, sex, and age groups, allowing health economic modelers to apply the costs based on different model structures and populations.

Influence of Technical Reasons on Cost Overruns of Infrastructural Projects: A Sustainable Development Perspective

Cost overruns are a significant issue in infrastructure projects, adversely affecting not only economic performance but also sustainability goals by straining resources and extending project timelines. There is consensus among researchers about the persistence of cost overruns and the importance of accurate estimates. However, there are significant differences in the explanation of the reasons for the overruns. While we recognize the importance of understanding the reasons for cost overruns at all stages of project development, we have focused on the reasons for cost overruns after contract award due to the rarely available real and valid data collected at the source of the information. We analyze the deviations between actual and contracted costs, as well as the dependence of cost deviations of individual project types on the size of the contract. For example, the size of the tunnel significantly affects relative cost deviations, while for standard viaducts or road sections this effect is minimal. The results confirmed that cost overruns are less frequent in standard facilities than in those where the experience factor has little influence on the final cost estimate. For example, deviations in the average value of the contracted costs for highway sections range between −12.1% and 27.9% of the contracted value, and for standardized viaduct projects they range between −16.73% and 6.27% of the contracted value. The type of distribution function of deviations between actual and contractually agreed costs was investigated, and a predictive model for estimating future cost deviations of project programs was presented. The goal is to improve economic sustainability and the related optimization of resources in the development of infrastructure, which contributes to the broader agenda of sustainable development. The results encourage the adoption of improved project documentation and forecasting tools, which are essential for sustainable project management.

Economic burden of suicide in Sweden in 2022

Abstract Background Suicide and suicidal behaviors bring massive human, social and economic impacts. Estimates of the cost of suicide can give some guidance as to where research on developing new interventions might be focused to give the greatest potential gain. The aim of the study is to quantify the economic cost of suicide in Sweden in 2022. Methods Incidence of suicide attempts and mortality due to suicide, intentional and undetermined (ICD10 X60-X84 and Y10-Y34) were sourced from the Swedish National Board of Health and Welfare databases for 2022. Cost were estimated from a societal perspective, including costs for inpatient and outpatient care, medication, police and justice activities as well as productivity losses due to early mortality. Results In 2022, a total of 1,569 suicide death were registered in Sweden (1,102 men and 467 women). The incidence rate remains stable during the last ten years, 17 death per 100 000. In total, 18,854 patients (10, 359 women and 8,459 men) were treated in inpatient and outpatient hospital care with suicide-related diagnoses, generated 32,843 days in inpatient care and 11,471 outpatient care visits. Direct costs for suicide death including forensic examination, emergency services, police investigation and property damage were estimated as €6,02 million, while indirect costs for productivity losses totaled €690 million. Direct healthcare costs for suicide related treatment were estimated at €54.3 million. Overall, suicide and suicide attempts cost around €750 million per year to society. Conclusions Estimates of the economic burden of suicide are needed for the Swedish setting, and these amounted to €60.3 million in direct costs and €690 million in indirect costs in 2022. The cost might be underestimated because the societal cost of suicide bereaved persons was not considered. These cost estimates can provide useful inputs to a cost-effectiveness analysis of a specific preventive intervention, and to its subsequent evaluation. Key messages • Economic burden of suicide is substantial for society. • Public health policies aimed at the prevention of suicide should be increased.

Cost-benefit analysis: just a step in the HIA process

Abstract The economic analysis within Health Impact Assessments (HIA) is a critical component in informing public policy decisions by assessing the financial implications of health outcomes associated with the different intervention options. Health metrics play a role defining the cost-effectiveness and societal value associated with the interventions. These metrics, quantifying the health impacts, include quality-adjusted life years (QALYs), years of life lost (YLLs) or disability-adjusted life years (DALYs). On another level, such metrics need to be translated into cost-effectiveness and societal value in which other methods play a role, such as the value of statistical life (VSL) or the value of a life year (VOLY). While VSL quantifies the value individuals place on reducing mortality risk, VOLY evaluates the value attributed to extending life expectancy. On another hand, uncertainties related to economic valuation pose challenges to the accuracy and reliability of cost estimates within HIA. These come from several factors, including data quality, methodological differences across studies, and subjective judgments involved in valuing health states. In fact, estimating the economic value of a prevented death involves multifaceted considerations and important assumptions. Additionally, assigning monetary values to non-fatal health outcomes, such as disability or reduced quality of life, involves subjective assessments and value judgments. By selecting appropriate metrics, considering diverse data sources, and addressing methodological steps and uncertainties, HIA practitioners can improve the utility of economic assessments, facilitating evidence-based decision-making in public health policy and resource allocation. This work was supported by National Funds through FCT - Fundação para a Ciência e a Tecnologia,I.P., within CINTESIS, R&D Unit (reference UIDP/4255/2020).

Unraveling Social Health Inequalities during COVID-19 in Belgium: The Vital Role of Data Linkages

Abstract Background During the COVID-19 crisis, data linkages were set up to efficiently monitor the outbreak and identify vulnerable population groups. Yet, considerable technical, administrative and data security issues have hindered the effectiveness of data linkages as a critical instrument during public health emergencies. This workshop aims to provide a practical demonstration of the challenges encountered in a Belgian data linkage during the COVID-19 crisis, along with the strategies implemented to overcome these challenges. This case study offers insights into the development of a highly sensitive linkage between COVID-19 hospital data and information related to social and health use in Belgium. Methods The HELICON data linkage is developed at the individual level to investigate the risk of COVID-19 hospitalization and the influence of various social and biomedical factors during and after the crisis. Data are drawn from data collections on hospitalization from the COVID-19 health surveillance (Sciensano), on the socioeconomic and sociodemographic context (Statistics Belgium), and on healthcare use and reimbursement (InterMutualistic Agency). Results A representative case-cohort study is established comprising 1,149,264 million randomly selected Belgians and 44,508 hospitalized patients. Annual follow-up is scheduled over a four-year span, allowing the investigation of pre- and post-pandemic health data from July 2020 to January 2026. Conclusions The HELICON data linkage took 3.5 years to complete. Among the many challenges, we were faced with complicated approval procedures, ambiguous data security guidelines, unclear cost estimates, and technical issues related to the analysis environment. Building on these experiences, we explore the strengths and weaknesses of data linkages as a research instrument during the COVID-19 pandemic and discuss which lessons should be drawn to for the post-pandemic era.

Utility Cut Impact Assessment and Fee Development Using Pavement Management System

The purpose of this study is to estimate any damage caused by utility cuts to pavements and develop a fee schedule to recover the costs associated with such damage using the City of Pacifica, CA, U.S.’s pavement management system (PMS). To accomplish this, the study looked at the functional deterioration of pavements resulting from utility cuts. The City of Pacifica’s PMS containing a vast dataset of pavement distress spanning 15 years, comprising thousands of data points encompassing various pavement ages and conditions, was analyzed to assess the impact of utility cuts. The findings from this study include: 1) Pavements with cuts of any size deteriorate more than pavements without cuts across all age groups with one exception for older residentials with small cuts; 2) On average, pavement condition index drops by 30% if the cut area is greater than 10% of the section area; and 3) Utility cuts inflict greater damage on newer pavements (<10 years old) compared with older ones (≥10 years old). Consequently, new pavements experience an average percent reduction of approximately 33% in their remaining service life, while older pavements suffer a reduction of about 17%. The statistical analyses indicate that utility cuts caused significant damage, and supported a tiered utility cut fee structure based on functional classification, age of pavement, and size of the cut. The resulting fee schedule is based on 2021 material and construction cost estimates; consequently, implementation including an annual adjustment for inflation is recommended. Example fee calculations are provided.

Estimating the Incremental Cost Per QALY Produced by the Spanish NHS: A Fixed-Effect Econometric Approach.

Knowing the health opportunity costs of funding decisions is crucial to assess whether the health gains associated with new interventions are larger than the health losses imposed by the displacement of resources. Empirical estimates based on the effect of health spending on health outcomes have been proposed in several countries, including Spain, as a proxy to capture these opportunity costs. However, there is a need to regularly update existing health opportunity cost estimates and to explore the role of omitted variable bias in these estimations. The aim of this paper is to provide an updated and refined estimate of the causal impact of health spending on health in Spain that can be translated into an estimate of the incremental cost per quality-adjusted life-year produced by the Spanish national health system. We applied fixed-effect models using data for 17 Spanish regions from 2002 until 2022 to estimate the impact of public health spending on health outcomes and explored the extent of omitted variable bias. Changes in these estimates over time were assessed and alternative specifications were tested. Based on fixed-effect models with control variables, the estimated spending elasticity was 0.061, which translated into an incremental cost per quality-adjusted life-year of approximately €34,000. The bias-corrected elasticity was 0.075, with a corresponding incremental cost per quality-adjusted life-year of €27,000. We found that the estimated impact of spending on health decreases when recent years of data are added, and that the extent of omitted variable bias appears to increase, particularly when adding the COVID-19 pandemic period. This study provides an updated estimation of the incremental cost per quality-adjusted life-year produced by the Spanish national health system. The estimates provided can be easily updatable as new data become accessible, and the methods applied might be transferable to other settings with similar available data.

Improving Cost Estimates for Risk-Based Food Safety Management and Policy.

Improving Cost Estimates for Risk-Based Food Safety Management and Policy.

Exploring the demand for inter-annual storage for balancing wind energy variability in 100% renewable energy systems

As research in 100% renewable energy systems progresses, closing remaining research gaps, such as quantifying inter-annual balancing requirements, is necessary. For this study, inter-annual variations of wind power yield and the resulting balancing requirements are analysed for the energy transition towards 100% renewable energy of the United Kingdom and the Republic of Ireland. The energy system components are determined and cost implications are quantified comparing two options for inter-annual storage: e-hydrogen and e-methane for a low, medium, and high security case, which are expanded over ten years. The results indicate that more than 300 TWhth,LHV and 500 TWhth,LHV of inter-annual gas storage capacity in 2050 for the low and the high security case, respectively are required. For both investigated cases, the annual system costs increase notably compared to the reference scenario without inter-annual storage. For the case of e-hydrogen, the annualised system costs increase by 19% compared to an increase of 7% for e-methane for medium security cases. The difference in cost growth is due to significantly higher hydrogen underground storage costs that overcompensate additional system costs for e-methane production. This study provides an expansion from seasonal to inter-annual storage and a first estimate of inter-annual balancing requirements and costs.

Impacts of PM2.5 exposure near cement facilities on human health and years of life lost: A case study in Brazil

Cement factories significantly contribute to atmospheric pollution by generating fine particulate matter (PM2.5), which can potentially increase the mortality risk. The lack of information on the health impacts of PM2.5 pollution from cement operations in Brazil prompted this investigation. We used corrected PM2.5 measurements from low-cost sensors from March 2021 to October 2022 in Rio Branco do Sul, city in the southern region of the country and home to Latin America's largest cement plant, to assess exposure data. Disability-adjusted life years (DALY) method was applied to estimate the years of life lost (YLL) and cost estimate due to deaths from non-accidental causes, cardiovascular and respiratory diseases. The total YLL attributable to PM2.5 concentration was estimated by calculating the attributable fraction (AF) through relative risk. We also collected PM2.5 using a Harvard impactor to evaluate health risks from toxic metals components. During the study period, the analysis of chemical characterization of PM2.5 showed enrichment factors for most elements and the possible influence of the calcination process facilities on the PM2.5 levels. The mean concentration of PM2.5 exceeded the annual WHO air quality guideline (AQG) level, accounted for 3.5%, 4.7%, and 4.3% of total YLL from all causes, cardiovascular, and respiratory diseases, which corresponded to 0.23 (95% CI: 0.17–0.26), 0.06 (95% CI: 0.05–0.07) and 0.03 (95% CI: 0.01–0.06) years loss in life expectancy, respectively. An indirect health cost attributable to PM2.5 resulted in US$ 1.4 million, equivalent to about 3.5% of the total local annual health costs in Rio Branco do Sul, underscoring the significant financial burden of PM2.5 exposures. The greatest economic loss was found in the male age group of 40–69 years and among those with cardiovascular disease, rather than those with respiratory disease. Despite this, the carcinogenic and non-carcinogenic risks from inhalation of hazardous elements were within safe ranges. This work demonstrated PurpleAir's potential for air quality and public health applications. Our findings indicate health and economic benefits from reducing PM2.5 levels by adopting WHO air pollution standards. The results can guide policies toward delivering more effective health care.

Quantifying cost-savings in the treatment of neovascular age-related macular degeneration in Aotearoa New Zealand.

To estimate the cost-impact if faricimab were approved for the treatment of neovascular age-related macular degeneration (nAMD) in New Zealand. A retrospective, single-centre cost-analysis study. Data on intravitreal agent and injection intervals were obtained and statistically compared. Cost estimates were based on internal facility and publicly available data. The current costs of care were compared to two scenarios: one where all eyes receive faricimab, and another where eyes receiving aflibercept switch to faricimab. A total of 352 eyes from 292 patients were analysed. Present values locally over 10 years were estimated at -$6,776,340 for the first scenario and $5,015,922 for the second, releasing 252 and 176 hours of clinical time per year, respectively. Nationally, the savings extrapolated to -$187,925,737 and $139,104,706, respectively. The analysis indicates significant direct cost savings for the health sector and potential reductions in patient harm due to fewer injections. The approval of faricimab for the treatment of nAMD could result in substantial direct cost savings for the health sector. Additional benefits include reducing patient harm and improving ophthalmic health inequalities for Māori and Pacific peoples. Further research in diverse patient populations across multiple centres is needed to estimate the magnitude of cost savings more accurately. This study highlights the potential of faricimab to alleviate the treatment burden and provide a more sustainable healthcare option for nAMD in New Zealand, especially in cases of recalcitrant nAMD, if used in a tailored and patient-specific manner alongside the existing armamentarium of treatments.

The Impact of the EU Carbon Border Adjustment Mechanism on Chinas Exports and Suggestions on Countermeasures

The European Parliament plans to gradually introduce the Carbon Border Adjustment Mechanism in 2023, with a complete implementation set for 2026. As an essential trading partner of the EU, China will shoulder an additional carbon border tariff due to the lack of low-carbon technology and the dependence on extensive development patterns. These extra costs will undermine the profit margins of Chinas carbon-intensive industry sectors, possibly resulting in decreased exports and a restructuring of production. The latest estimate of the exact costs of Chinas embedded carbon exports to the EU is a problem that has received limited academic attention. Using the IPCC carbon emission accounting methodology and non-competitive single-region input-output analysis, this research precisely measures the embedded carbon in Chinas exports to the EU for the nine most affected industries. Furthermore, this study quantifies the impact of the CBAM on Chinas exports of these nine industry sectors. The findings suggest that China should improve the domestic carbon emission trading system and take the initiative to participate in formulating a carbon pricing consultation and dialogue mechanism, mitigating the negative impact of the EU CBAM on exports.

The economic cost of malaria in Brazil from the perspective of the public health system.

This paper presents an economic evaluation aimed at estimating malaria-related health care expenditures in Brazil from the perspective of the public health system. Comprehensive estimates of the costs of malaria remain scarce, in part because of limited data. Brazil has a universal health system (Sistema Único de Saúde-SUS) in which all cases of malaria are diagnosed and treated. In addition, antimalarial drugs are only available through the SUS. We compiled comprehensive data from multiple administrative sources. Expenditure indicators were calculated for municipalities and states in the Brazilian Amazon, a region where more than 99% of the country's malaria cases are concentrated. We also developed a digital platform that allows interactive visualization of the malaria cost indicators, disaggregated by cost type and geography. Our results show that control and prevention activities are the primary cost in all states, followed by human resources and disease treatment. Expenditures per malaria notification in the Amazon ranged from PPP (purchasing power parity)-US$59.00 (2017) to PPP-US$77.00 (2016), while per capita expenditures remained relatively stable at around PPP-US$3.50. The malaria cost estimates presented here contribute to a better negotiation of the financial resources needed by the NMCP and are one of the critical pieces of information for a strategic plan of activities needed to achieve the elimination goal.

Attributable one-year healthcare cost of incident type 2 diabetes: A population-wide difference-in-differences study in Denmark.

The aim of this study is to estimate the causally attributable one-year healthcare costs for individuals getting a type 2 diabetes diagnosis compared to a matched sample and show the incurred costs of medication and in primary and secondary healthcare. Causal estimation using a difference-in-differences design to estimate the one-year health care costs attributable to type 2 diabetes. Danish registry data consisting of the entire population in years 2016-2019. Newly diagnosed individuals with type 2 diabetes in 2018 were identified using a validated method. Sociodemographic and historical health data were used to identify a matched control group. Individuals were followed for two years before and one year after the date of diagnosis using. Three cost components were analysed: medication and primary and secondary healthcare costs. A total of 18,133 individuals were diagnosed with type 2 diabetes in 2018 and matched successfully 1:1 to a control group. The total attributable one-year cost of type 2 diabetes was EUR 1316. The main cost component was hospital care (EUR 1004) and primary care (EUR 167). The total attributable cost of incident diabetes in Denmark in 2018 was approx. EUR 24 million. The majority of the first year health care cost of incident diabetes is incurred at the hospital level followed by primary care and medication. Our yearly cost estimate per newly diagnosed is considerably lower than estimates from the US and Australia.

Who pays to treat malaria, and how much? Analysis of the cost of illness, equity, and economic burden of malaria in Uganda.

Case management of malaria in Africa has evolved markedly over the past twenty years and updated cost estimates are needed to guide malaria control policies. We estimated the cost of malaria illness to households and the public health service and assessed the equity of these costs in Uganda. From December 2021 to May 2022, we conducted a costing exercise in eight government-run health centres covering seven sub-regions, collecting health service costs from patient observations, records review, and a time-and-motion study. From November 2021 to January 2022, we gathered data on households' cost of illness from randomly selected households for 614 residents with suspected malaria. Societal costs of illness were estimated and combined with secondary data sources to estimate the total economic burden of malaria in Uganda. We used regression analyses and concentration curves to assess the equity of household costs across age, geographic location, and socio-economic status. The mean societal economic cost of treating suspected malaria was $15.12 (95%CI: 12.83-17.14) per outpatient and $27.21 (95%CI: 20.43-33.99) per inpatient case. Households incurred 81% of outpatient and 72% of inpatient costs. Households bore nearly equal costs of illness, regardless of socio-economic status. A case of malaria cost households in the lowest quintile 26% of per capita monthly consumption, while a malaria case only cost households in the highest quintile 8%. We estimated the societal cost of malaria treatment in Uganda was $577 million (range: $302 million-1.09 billion) in 2021. The cost of malaria remains high in Uganda. Households bear the major burden of these costs. Poorer and richer households incur the same costs per case; this distribution is equal, but not equitable. These results can be applied to parameterize future economic evaluations of malaria control interventions and to evaluate the impact of malaria on Ugandan society, informing resource allocations in malaria prevention.

Profitability and Cost Estimates for Producing Tropical Hibiscus in South Florida

Tropical hibiscus (Hibiscus rosa-sinensis) is a bushy evergreen shrub or small tree native to the temperate regions of Asia and an economically significant crop in Florida. According to the 2017 Census of Agriculture, the market value of the ornamental industry in Miami-Dade County was $697 million, and approximately 25% of the production was in hibiscus. Demand for the cultivation of plants with minimal pesticides is rising due to concerns about potential adverse environmental and health effects. Integrated pest management, or IPM, is an alternative to conventional pesticide application. A broad-based approach, it integrates both chemical and non-chemical practices for sustainable control of pests. To help growers and other stakeholders determine the best approach to changing demands for pesticide management, this publication estimates the costs and returns of producing tropical hibiscus on an established nursery in south Florida using both traditional and IPM methods.

Evaluating the contributions and economic costs for Walleye fry and fingerling stocking in a large midwestern reservoir

Stocking is a common management practice to maintain Walleye populations where natural recruitment is low or to introduce and sustain Walleye populations outside of their native range. Walleye can be stocked at multiple lengths (e.g., fry and fingerling) and different sizes of stocked Walleye may contribute differently to Walleye year class strength, depending on the system into which they are stocked. The cost associated with stocking also varies by product. Therefore, it is important to determine the contributions from different stocked products within a region or for an individual waterbody. The objectives of our research were to 1) compare the relative contribution of and total length and body condition at the time of capture at age-0 between stocked Walleye fry and fingerlings and naturally produced individuals; and 2) estimate and compare the economic costs of Walleye fry and fingerling production relative to their contribution to the age-0 catch in Lake McConaughy during 2022 and 2023.We collected 178 and 263 age-0 Walleyes from Lake McConaughy during the summer and fall of 2022 and 2023, respectively. Fingerling-stocked Walleye contributed 2.12 times in 2022 and 2.92 times more in 2023 than fry-stocked Walleye. Production cost estimates revealed that fry cost 1.08 and 1.35 times greater than fingerlings per stocking unit in 2022 and 2023, thus fingerlings were deemed the most cost-effective product in this study. Walleye stocked as fry were significantly longer at the time of collection in 2022 and were in significantly better condition in both years compared to fingerling stocked Walleye. Our results provide valuable insights for fisheries managers by offering a case study example as well as offering a practical approach to guide effective management decisions on which stocked product is most appropriate for other systems. Overall, this research enhances the existing literature on Walleye stocking in large reservoir systems, offering practical and useful information for effective management decisions.

Navigating Economies of Scale and Multiples for Nuclear-Powered Data Centers and Other Applications with High Service Availability Needs

Nuclear energy is increasingly being considered for such targeted energy applications as data centers in light of their high capacity factors and low carbon emissions. This paper focuses on assessing the tradeoffs between economies of scale versus mass production to identify promising reactor sizes to meet data center demands. A framework is then built using the best cost estimates from the literature to identify ideal reactor power sizes for the needs of the given data center. Results should not be taken to be deterministic but highlight the variability of ideal reactor power output against the required demand. While certain advocates claim that with the gigawatts of clean, firm energy needed, large plants are ideal, others advocate for SMRs that can be deployed in large quantities and reap the benefits from learning effects. The findings of this study showcase that identifying the optimal size for a reactor is likely more nuanced and dependent on the application and its requirements. Overall, the study does show potential economic promise for coupling nuclear reactors to data centers and industrial heat applications under certain key conditions and assumptions.

Challenges and recommendations for collecting and quantifying implementation costs in practice: a qualitative interview study

BackgroundThe cost of implementation is typically not accounted for in published economic evaluations, which determine the relative value for money of health innovations and are important for allocating scarce resources. Despite key papers outlining relevant implementation costs, they continue to be under reported in the literature and often not considered in practice. This study sought to understand and outline current practices for capturing the costs associated with implementation efforts, with examples from the digital health setting.MethodsA qualitative study of semi-structured interviews with purposefully sampled experts in implementation science, health economics and/or digital health was conducted. The interview guide was informed by a literature review and was pilot tested. Interviews were digitally recorded and transcribed. A hybrid inductive/deductive framework analysis was conducted using thematic analysis to elicit key concepts related to the research question.ResultsInterviews were conducted with sixteen participants with specialist expertise in implementation science (n = 8), health economics (n = 6), and/or digital health (n = 8). Five participants were experienced in more than one field. Four key themes were elicited from the data: difficulty identifying and collecting implementation cost data; variation in approaches for collecting implementation cost data; the value of implementation costs; and collaboration enables implementation costing. Broadly, while interviewees recognised implementation costs as important, only some costs were considered in practice likely due to the perceived ill-defined boundaries and inconsistencies in terminology. A variety of methods were used to collect and estimate implementation costs; the most frequent approach was staff time tracking. Multidisciplinary collaboration facilitated this process, but the burden of collecting the necessary data was also highlighted.ConclusionsIn current practice, standardised methods are not commonly used for data collection or estimation of implementation costs. Improved data collection through standardised practices may support greater transparency and confidence in implementation cost estimates. Although participants had industry exposure, most were also academic researchers and findings may not be representative of non-academic industry settings.

Cost analysis of CYP2C19 genetic testing in percutaneous coronary intervention patients.

CYP2C19 loss of function (LOF) carriers undergoing percutaneous coronary intervention (PCI) have an increased risk of ischemic events when treated with clopidogrel. PCI patients in TAILOR-PCI were randomized to clopidogrel or genotype-guided (GG) therapy in which LOF carriers received ticagrelor and non-carriers clopidogrel. Direct medical costs associated with a GG approach have not been described before. TAILOR-PCI participants for whom direct medical costswere available for the duration from the date of PCI to one-year post PCI were included. Primary cost estimates were obtained from the Mayo Clinic Cost Data Warehouse. There were no differences in direct medical costs between the GG and clopidogrel groups (mean $20,682 versus $19,747, p = 0.11) however total costs were greater in the GG group (mean $21,245 versus $19,891, p = 0.02) which was primarily driven by ticagrelor costs. In conclusion the increased expense of a GG strategy post PCI as compared to clopidogrel for allis primarily driven by the cost of ticagrelor.