Cost Estimates Research Articles

State of HIV costing in Latin America and the Caribbean: a systematic literature review.

To summarize available data on unit costs for human immunodeficiency virus (HIV) testing, prevention, and care interventions in Latin America and the Caribbean. We conducted a systematic literature review of costing studies published between 2012 and 2024, and selected those reporting empirically measured costing data. The available data were categorized according to predefined intervention categories and compared by time and place. We also explored variations in unit costs by intervention type. Of 1 746 studies identified, 22 met the inclusion criteria, which provided 103 unique unit cost estimates from nine countries. About 50% of the included studies were published between 2019 and 2021. Antiretroviral therapy services had the most cost data available (39% of unit costs), followed by inpatient care (27%) and HIV testing (24%). Considerable cost variations were observed both within and between interventions. Our analysis underscores the need for accurate and reliable cost data to support HIV budgeting and decision-making efforts. We identified several gaps in the availability of cost data and emphasize the importance of presenting results more effectively by incorporating key contextual variables. Given the challenges of shrinking budgets and sustainability risks, robust evidence is indispensable to inform priority setting and budget allocation for HIV services.

A cost comparison of GLP-1 receptor agonists and bariatric surgery: what is the break even point?

With the prevalence of obesity rising in the US, medical management is of increasing importance. Two popular options for the treatment of obesity are bariatric surgery (e.g. sleeve gastrectomy and Roux-en-Y gastric bypass) and the increasingly popular GLP-1 Receptor Agonists (GLP-1s). This study examines the initial and long-term costs of GLP-1s compared to bariatric surgery. We compared average 2023 national retail prices for GLP-1s to surgical cost estimates from 2015 adjusted for inflation. We then plotted the cumulative medication cost over time against the flat cost of each surgery, thus calculating "break-even points" (when medication costs equal surgery costs). The findings revealed a crucial insight, for some GLP-1s like Saxenda and Wegovy, the high cost of ongoing use surpasses the cost of RYGB in less than a year and sleeve gastrectomy within nine months. Even the most affordable option, Byetta, becomes costlier than surgery after around 1.5years. This highlights the importance of looking beyond the initial financial investment when considering cost-effectiveness. Additionally, while not directly assessed, this study acknowledges that GLP-1s take time to reach full effectiveness, potentially delaying weight loss while accumulating costs. Concerns also exist about weight regain after discontinuing the medication. This study is limited by the real-world variation for individual treatment costs (e.g. insurance), a limited evaluation of long-term costs associated with either treatment modality and their co-morbidities, and the reality of patient preference providing subjective value to either modality. Overall, the study offers insights into the financial trade-offs between GLP-1s and bariatric surgery.

Dynamic soaring decouples dynamic body acceleration and energetics in albatrosses.

Estimates of movement costs are essential for understanding energetic and life-history trade-offs. Although overall dynamic body acceleration (ODBA) derived from accelerometer data is widely used as a proxy for energy expenditure (EE) in free-ranging animals, its utility has not been tested in species that predominately use body rotations or exploit environmental energy for movement. We tested a suite of sensor-derived movement metrics as proxies for EE in two species of albatrosses, which routinely use dynamic soaring to extract energy from the wind to reduce movement costs. Birds were fitted with a combined heart-rate, accelerometer, magnetometer and GPS logger, and relationships between movement metrics and heart rate-derived V̇O2, an indirect measure of EE, were analyzed during different flight and activity modes. When birds were exclusively soaring, a metric derived from angular velocity on the yaw axis provided a useful proxy of EE. Thus, body rotations involved in dynamic soaring have clear energetic costs, albeit considerably lower than those of the muscle contractions required for flapping flight. We found that ODBA was not a useful proxy for EE in albatrosses when birds were exclusively soaring. As albatrosses spend much of their foraging trips soaring, ODBA alone was a poor predictor of EE in albatrosses. Despite the lower percentage of time flapping, the number of flaps was a useful metric when comparing EE across foraging trips. Our findings highlight that alternative metrics, beyond ODBA, may be required to estimate energy expenditure from inertial sensors in animals whose movements involve extensive body rotations.

Food Insecurity Cost Estimates for El Paso, Texas

Food insecurity is a fairly pervasive problem throughout the United States that is especially burdensome for low-income regions. While the latter is generally recognized, there have been very few efforts to quantify the dollar costs of food insecurity, especially at the regional level. This study attempts to do so for El Paso County, Texas. This is achieved by first adjusting for inflation cost estimates in a prior national level study. Regional differences with respect to the nation are then utilized to calculate comparable costs for El Paso. Results indicate that the economic damage wrought by food insecurity in El Paso during 2023 exceeded $745 million. That represents nearly 2 percent of total personal income in the county for that year.

System-based ship design of a deep-sea mining vessel

ABSTRACT This paper applies the system-based ship design (SBSD) method to the conceptual design of a deep-sea mining vessel. The anticipated mine site is situated on the Norwegian extended continental shelf, where three production scenarios are assessed. The design process is documented, including a problem statement, mission description, functions, space requirements of various sub-systems, stability calculations, and preliminary cost estimates. A combination of data from existing technologies and estimates is used to set the relevant parameters, and the applicability of SBSD in the conceptual design of novel vessels is discussed. We find that when data is lacking in conceptual ship design, inspiration can be found from similar systems in established maritime industries, such as the offshore oil and gas industry.

393 The role of on-animal sensors in understanding feed intake, behavior, and performance of grazing livestock

Abstract Intake by grazing animals is difficult to reliably measure in the field, particularly in more diverse grazing systems where pastures vary greatly across time and space in resource availability, which in turn leads to greater variation in animal time budgets and intake patterns. Advances in remote livestock monitoring (e.g., on-animal sensors, walk -over-weighing), and advanced analytics such as machine learning algorithms can contribute to the development of robust, adaptable tools for better understanding of animal performance and behavior in grazing systems. Many existing tools for predicting livestock production require estimates of feed intake, and while estimates based on forage sward characteristics have been developed and used for temperate, relatively homogenous pastures, they are less well defined for more diverse rangelands. These diverse pastures are more difficult to characterize due to their greater variation in quantity and quality; consequently, animal selectivity is greater in more variable pastures. However, such feedback loops between pasture diversity and animal behavior may not yet be adequately represented in biophysical models. On-animal sensors such as accelerometers and GPS devices can be used to develop new ways of assessing relative intake by providing accurate estimates of animal location and behavior profiles, such as the use of machine learning algorithms to detect how much time is spent grazing, walking, ruminating, or resting. Measurements of animal behavior could then be combined with other animal-based methods such as walk-over-weighing and fecal NIR to improve estimates of intake and production for a wide range of extensive grazing environments. Sensor-derived measurements of animal movement could also be used to improve estimates of the energetic costs of grazing, thereby improving estimates of energy available for growth. As an example, data on recent activity and paddock use from on-animal sensors could be entered into a model to estimate current feeding requirements, then combined with weather and pasture quality forecasts. The ensuing baseline could then be used to explore the potential variability of these projections and generate a range for possible expected performance over the next month or season. This approach could be repeated over time, and animal performance and behavior measures used to update model estimates and improve forward projections. These methods could also be used in conjunction with estimates of animal energy requirements to provide real-time prediction of relative feed intake, which would provide a step-change in modelling livestock production in extensive grazing systems. For these approaches to be successful, additional calibration data are needed across a wide variety of environments and species, and the tools must be cost-effective to implement. In summary, on-animal measurements provide an adaptable, data-driven approach that could be integrated with existing tools to improve our understanding of feed intake, behavior, and performance of grazing animals.

Towards a social cost of carbon with national characteristics

The majority of estimates of the social cost of carbon use preference parameters calibrated to data for North America and Europe. We here use statistically representative data for attitudes to time and risk across the world. The social cost of carbon is substantially higher in the global north than in the south. The difference is more pronounced if we count people rather than countries.

Cost of a Healthy Diet: A Population-Representative Comparison of 3 Diet Cost Methods in Canada

BackgroundDifferent food price sources and dietary assessment tools may impact the estimation of diet costs and hamper our understanding of the relationship between diet costs and dietary intakes. ObjectivesWe aimed to investigate the effect of 3 diet cost derivation methods, with increasing numbers of food prices and geographic specificity, holding consistent the dietary assessment tool, on the estimation of diet costs overall and by food group. MethodsWe matched 24-h dietary recall data from the 2015 Canadian Community Health Survey-Nutrition (CCHS-N) to food price data from 3 Canadian Consumer Price Index (CPI) food price lists; national short list, national long list, and provincial long list. We compared the daily ($/day) and energy-adjusted ($/2000 kcal) diet costs overall and by food groups for the overall population (4+), children (4–18), and adults (19+). ResultsThe proportion of dietary intakes (grams) that were covered by CPI prices significantly increased from the national short list to the national long list but did not significantly differ from the national long list to the provincial long list. The national short list resulted in the highest daily and energy-adjusted diet costs overall. No difference in diet costs was noted between the national and provincial long lists. Diet costs for 4 food groups—additions, sweets, fruits, and vegetables, which were poorly covered by the national short list—significantly differed using the national and provincial long lists. All 3 diet cost methods were significantly correlated with energy intakes; however, a strong/very strong correlation was detected for children, and a weak/moderate correlation for adults. ConclusionsThe choice of food price data may introduce bias in the diet cost estimate, as well as limiting our understanding of how individuals allocate their diet costs. Refinement of diet cost estimation methodology and measures can strengthen future studies of how consumers allocate their purchases to their diets.

Inferring local social cost from renewable zoning decisions. Evidence from Lower Austria’s wind power zoning

Large infrastructures, such as wind turbines, may adversely affect their environment, so their deployment is often regulated. These regulations are frequently based on a dichotomy between areas considered feasible or infeasible areas for infrastructure deployment. To overcome the inability of such a binary distinction to adequately represent the involved economic trade-offs between, but also within feasible and infeasible areas, we establish a discrete choice framework to elicit social preferences implicit in Lower Austria’s wind power zoning and generate comprehensive estimates of local social costs in high spatial resolution. Our findings suggest that wind turbines were attributed significant local social costs in the political zoning process. These local social cost estimates can inform siting decisions, improve power system modelling and open a novel perspective on the assessment of potentials for renewable energies.

Reshaping water distribution topology from the carbon emission reduction perspective: An exploratory analysis of water distribution reliability

As urban economies continue to evolve, the water distribution networks (WDNs) are expanding in scale and becoming more interconnected, leading to increased carbon emissions from operations and maintenance. Consequently, enhancing the stability and safety of WDNs while saving energy has emerged as a primary research focus. This study abandoned the original use of high economic costs for post-maintenance of WDNs. Instead, it reshaped the traditional water distribution topology to form a dynamic, storable, energy-efficient "WDN self-help" model. Drawing inspiration from the "deep tunnel" project in drainage systems, the proposal was to leverage underground spaces to create a deep aqueduct (DA) complementing the traditional WDN, forming a three-dimensional (3D) WDN. Hydraulic and water quality analyses of varying scales of the 3D WDN model demonstrated its superior ability to equalize node pressures, reduce pipeline head losses, and maintain water quality for end-users. Reliability assessments of the 3D WDN revealed enhanced system robustness for medium-to large-scale distributions, while energy consumption analyses indicated a significant increase in water supply energy utilization and significant long-term reductions in carbon footprint. A practical case study was presented to validate the effectiveness of the 3D WDN concept, confirming its ability to reliably distribute water even in the event of a failure. Finally, an estimate of the retrofit cost and the static payback period of the 3D WDN was conducted. This study aims to provide a theoretical reference for the renovation of water supply projects or the optimal design of new WDNs in the context of carbon neutrality.

Human-animal contact to inform zoonotic disease risk across gradients of agricultural land use change in the Central River Region (CRR) of The Gambia (ZooContact): a formative study.

Pilot studies are important initial steps in research, providing a preliminary assessment of the practicality, feasibility, and potential challenges of a proposed study. This study attempts to assess the feasibility, practicality, and acceptability of a study that integrates a human-animal contact (HAC) questionnaire, animal biodiversity survey using acoustic analysis, and zoonotic disease investigation in animals among rural households in the Central River Region (CRR) of The Gambia. The pilot study revealed granular insights that would otherwise go unnoticed, providing vital information that directly guided the design and implementation of the subsequent full-scale study on zoonotic disease risk. A pilot study was conducted in five villages in the CRR of The Gambia. Community sensitization was carried out together with the village leadership, followed by a familiarization tour of the study setting. Questionnaire-based interview was conducted among participants (n = 50) randomly selected to assess the acceptability and reliability of the questionnaire. The feasibility and acceptability of biodiversity surveys and animal sampling were assessed using verbal inquiries from participants and community leaders. The recruitment rate was 96%, and most participants, 50 out of 52, were willing to participate without compensation for lost time during interviews. For animal sampling, 45 out of 50 participants were willing to allow the study team to sample blood and feces from their animals without any form of incentive. All five village heads agreed to the usage of sound recorders to be placed within their community for animal biodiversity assessment. For the survey effort, one field assistant interviewed 25 participants per week. It took a total of 1 h to complete an interview, including random household selection, consenting, and questionnaire interview. The pilot study confirmed the feasibility of the research and informed the design of the larger study. Key parameters, such as community access, acceptability, recruitment success, and logistical requirements, contributed to robust sample size calculations and realistic project cost estimates. Additionally, the study enabled the research team to familiarize themselves with the communities and refine the methods for the full study.

SP5.9 - A cost-benefit analysis of a digital post-operative integrated care plan app for surgical patients

Abstract Aims To study the cost-benefit analysis of a digital post-operative integrated care plan app for surgical patients. Methods 1. Preliminary data from patient survey - we designed a questionnaire to assess patients’ views of the Post Op app. 2. Estimates for NHS services cost - derived from the King’s Fund latest report (2023) and the NHS Digital National schedule of reference costs (2017, 2021-22). 3.Estimates for travel-associated costs - We assumed a total cost per mile of 16p, and also assumed the patients would need to pay an average cost of £1.6/h for hospital parking for an average of 3h per visit. We assumed a carbon emission of 221.4 grams per mile (Department for Transport data). 4.Modelling approach - We used a conservative modelling approach simulating different patient groups with varying levels of postoperative anxiety/complications. Results Taking into account avoidable presentations to ED, costs borne by the patients, lost productivity, environmental costs, avoidable re-operations and the costs related to antibiotic tolerance/resistance, the lower boundary of total savings from a digital post-operative follow-up tool equates to £58,739 per 100 patients and the upper boundary is £79,949 per 100 patients. Conclusion Post Op application provides excellent support for most patients in the immediate postoperative period and is likely to result in a significant reduction in the number of contacts patients make with the GP or hospital, and with the Emergency Department resulting in significant cost saving for both the service and the patients. Furthermore, earlier recognition, monitoring and appropriate treatment of SSIs provides further savings whose magnitude is likely underestimated.

SP4.5 - Cost estimates of intra-operative cell salvage in patients undergoing major liver surgery: a retrospective cohort study

Abstract Aims Major liver surgery is associated with a high risk of blood loss. Autologous transfusion of blood salvaged intra-operatively (cell salvage) reduces the requirement for post-operative allogenic transfusion. Allogenic transfusion is associated with risks, and blood is a scarce and costly resource. However, the cost of cell salvage in liver resection has not been previously estimated. Objective To estimate the cost of cell salvage in patients undergoing major liver surgery. Methods We analysed a cohort of 243 patients who underwent major liver surgery between 2015 and 2022 at a large tertiary referral hospital in England. Cost of cell salvage was calculated as an average price for consumables and operator time. Cost of admission including cell salvage was assessed per year. Results The average cost of cell salvage per patient was £433. On average, consumables costed £240 and costs associated with operating cell salvage machinery were £193. The average cost for an index admission for this cohort of patients undergoing major liver surgery with cell salvage was £24,694. When comparing the required units of allogeneic blood required to replace the red cells lost during surgery, cell salvage led to cost-savings in one of the years under analysis. Conclusions Our findings suggest that cell salvage has the potential to be cost-effective in patients undergoing major liver surgery. These findings should be assessed in an economic evaluation conducted alongside a randomised controlled trial.

Foslevodopa/foscarbidopa (LDp/CDp) in advanced Parkinson’s Disease (aPD): demonstration of savings from a societal perspective in the UK

Aims In advanced Parkinson’s disease (aPD), adequate 24-hour control of OFF-time may not be achievable using oral/transdermal therapies. Clinical trials of foslevodopa/foscarbidopa (LDp/CDP) demonstrate meaningful reductions in OFF-time and OFF-related sleep disturbance in aPD. Previous analyses have only considered direct medical costs: this analysis considers a broader societal perspective (direct non-medical costs, informal care, loss of earnings, productivity, and tax). Methods Inputs for the societal impact model were taken from a cost-utility model comparing LDp/CDp with best medical treatment (BMT), accepted by the UK National Institute of Health and Care Excellence (NICE). Quintiles of normalized OFF-time across a 16-hour waking day in each treatment group were applied to literature-based estimates for direct medical, non-medical, and indirect costs. The resulting state-specific cost estimates were applied to the modelled aPD patient population. Results The model estimates the potential UK population for LDp/CDp at 17,505. Continuous 24-hour delivery of LDp/CDp results in greater time spent in OFF-time states 0–1 (0–4 hours of OFF-time/16-hour waking day) vs BMT alone. Net savings if all eligible patients receive LDp/CDp are £79.1 M in year 1, £235.4 M in year 2, rising to £262.2 M in year 3, declining to £222.9 M in year 4 and £153.7 M in year 5 as disease progresses and the efficacy of LDp/CDp declines. The estimated total net savings are £953 M after 5 years. Results are robust in scenario analyses (excluding costs of excessive sleepiness, earnings loss, productivity, and tax loss). Limitations A NICE-accepted model was used as the economic modelling basis for the societal impact model, however, much of the data was derived from Adelphi datasets, with the potential for inconsistent definitions. Conclusion When considered from a societal perspective, the use of LDp/CDp in aPD patients inadequately controlled on oral therapy is associated with net healthcare and societal annual savings of over £79.1 M vs BMT.

A practitioner's guide to estimate overland transportation costs*

Poor infrastructure and high domestic shipping costs are often cited as important impediments to economic activity in developing countries. Domestic shipping being mostly overland, understanding the level and structure of costs in road freight transportation could thus help formulate policies that aim to lower them. This review provides a summary of overland transport cost estimates with a focus on trucking, the dominant mode of domestic freight. By describing conceptual issues, highlighting sources of data and alternative methodologies with their key findings, it is intended to help practitioners and researchers navigate the literature.

Radial Basis Function (RBF) and Multilayer Perceptron (MLP) Comparative Analysis on Building Renovation Cost Estimation: The Case of Greece

Renovation of buildings has become a major area of development for the construction industry. In the building construction sector, generating a precise and trustworthy cost estimate before building begins is the greatest challenge. Emphasizing the value of using ANN models to forecast the total cost of a building renovation project is the ultimate objective. As a result, building firms may be able to avoid financial losses as long as there is as little discrepancy between projected and actual costs for remodeling works in progress. To address the gap in the research, Greek contractors specializing in building renovations provided a sizable dataset of real project cost data. To build cost prediction ANNs, the collected data had to be organized, assessed, and appropriately encoded. The network was developed, trained, and tested using IBM SPSS Statistics software 28.0.0.0. The dependent variable is the final cost. The independent variables are initial cost, estimated completion time, actual completion time, delay time, initial and final demolition-drainage costs, cost of expenses, initial and final plumbing costs, initial and final heating costs, initial and final electrical costs, initial and final masonry costs, initial and final construction costs of plasterboard construction, initial and final cost of bathrooms, initial and final cost of flooring, initial and final cost of frames, initial and final cost of doors, initial and final cost of paint, and initial and final cost of kitchen construction. The first procedure that was employed was the radial basis function (RBF). The efficiency of the RBFNN model was evaluated and analyzed during training and testing, with up to 6% sum of squares error and nearly 0% relative error in the training sample, which accounted for roughly 70% of the total sample. The second procedure implemented was the method called the multi-layer perceptron (MLP). The efficiency of the MLPNN model was assessed and examined during training and testing; the training sample, which made up around 70% of the overall sample, had a relative error of 0–7% and a sum of squares error ranging from 1% to 5%, confirming specifically the efficacy of RBFNN in calculating the overall cost of renovations.

Proposal for zero energy housing designs in Jordan

BackgroundAchieving zero-energy targets in residential buildings is challenging due to improper energy design and the selection of energy-related systems. Moreover, the absence of benchmarks for zero-energy residential buildings, along with the scarcity of studies tailored to diverse climates and building characteristics, highlights the urgent need for further research. This study aimed to address these gaps by designing zero-energy buildings to suit diverse climate zones in Jordan, acting as benchmarks to enhance energy efficiency and promote renewable energy use in the residential sector.MethodsEnergy simulation tools were employed to design and verify zero-energy systems. The energy use intensity (EUI) results from the IDA ICE tool were compared with the reported targets and OpenStudio tool outcomes, ensuring that deviations among the proposed designs within the same climate zone consistently remained within acceptable limits, averaging 2, 1, and 1 kWh/m2 year in 1B (very hot dry), 2B (hot dry), and 3B (warm dry), respectively. Additionally, an economic evaluation was conducted by comparing the cost estimates of a Jordanian code-compliant house and the most acceptable proposed zero-energy design.ResultsThe proposed designs exhibited average EUI values of 64.4, 64, and 60 kWh/m2 in diverse climate zones. Outperforming typical Jordanian houses by 56%, 55%, and 60% in 1B, 2B, and 3B, respectively, these designs surpassed national and international benchmarks by at least 35%. Notably, the proposed zero-energy designs achieved substantial cost savings of 1938 USD, equivalent to 11 USD per square meter, throughout the construction phase.ConclusionsConsidering Jordan’s ambitious energy strategy for 2030 and the significant energy consumption in the residential sector, the proposed zero-energy building designs play a crucial role in advancing the national transition towards zero-energy buildings. This study provides valuable insights by presenting precise designs, benchmarks, and a comprehensive guide tailored to Jordan’s distinctive building and climate characteristics with potential applications beyond its immediate context.

Decision and economic evaluation of abortion availability in the United States military

BackgroundActive-duty service women rely on the civilian sector for most abortion care due to limits on federal funding for abortion. Abortion is now banned in many states with large military presences. The Department of Defense has implemented policies to assist active-duty service women in accessing abortion, but there is debate to reverse this support. ObjectiveOur goal was to compare the cost-effectiveness and incidence of adverse maternal and neonatal outcomes of a hypothetical cohort of active-duty service women living in abortion-restricted states comparing restricted abortion access (abortion not available cohort) to abortion available with Department of Defense travel support (abortion available cohort). Study DesignWe developed a decision tree model to compare abortion not available and abortion available cohorts for active-duty service women living in abortion-restricted states. Our cohorts were subdivided into normal pregnancies and those with a major fetal anomaly. Cost estimates, probabilities, and disability weights of various health conditions associated with abortion and pregnancy were obtained and derived from the literature. Effectiveness was expressed in disability-adjusted life years and the willingness to pay threshold was set to $100,000 per disability-adjusted life year gained or averted. We completed probabilistic sensitivity analyses with 10,000 simulations to test the robustness of our results. Secondary outcomes included numbers of stillbirths, neonatal deaths, neonatal intensive care unit admissions, maternal deaths, severe maternal morbidities, and first and second trimester abortions. ResultsThe abortion not available cohort had a higher annual cost to the military ($299.1 million, 95% CI 239.2 – 386.6, vs. $226.0 million, 95% CI 181.9 – 288.5) and was associated with 203 more disability-adjusted life years compared to the abortion available cohort. The incremental cost effectiveness ratio was dominant for abortion available. Abortion not available resulted in an annual additional 7 stillbirths, 1 neonatal death, 112 neonatal intensive care unit admissions, 0.016 maternal deaths, 24 severe maternal morbidities, 27 less second trimester abortions, and 602 less first trimester abortions. Probabilistic sensitivity analysis revealed that the chance of the abortion available cohort being the more cost-effective strategy was greater than 95%. ConclusionLimiting active-duty service women’s access to abortion care increases costs to the military, even with costs of travel support, and increases adverse maternal and neonatal outcomes. This analysis provides important information for policymakers about economic and health burdens associated with barriers to abortion care in the military.

An Economic Cost Analysis of Implementing a Frailty Care Bundle to Reduce Risk of Hospital Associated Decline Among Older Patients.

To conduct an economic cost analysis and budget impact assessment (BIA) of implementing the Frailty Care Bundle (FCB) intervention nationally over five-years for hip fracture patients. The FCB was designed to reduce hospital associated decline in older hospitalised patients. The FCB was delivered in two Irish hospitals on two wards per hospital. A micro level cost analysis, from the Irish health service perspective was undertaken. Direct costs of the FCB were considered (personnel, training, resources), expressed in Euros (2020). For the BIA national population estimates for hip fracture and costs avoided were based on 18% difference in patients returning to their baseline capability in the post compared to pre-intervention group, valued using cost estimates of functional decline. We estimated total intervention costs at €53,619 (89% for personnel) and the average cost per patient was €156.03. The expected costs of implementing the FCB nationally over 12-months was €57,274 per hospital (€72.92 per patient). The BIA for an expected targeted population (16,000 over 5 years), estimated that the cost of implementing the FCB (€1.2m) was less than the expected value of functional decline avoided owing to the intervention (€3.6m), suggesting a positive net effect (€2.4m). Investment in the FCB can be offset with more rapid patient return to baseline functional capability, reducing health care costs. Trial and Protocol Registration (retrospective): BMC ISRCTN 15145850, (https://doi.org/10.1186/ISRCTN15145850).

Redesigning automated market power mitigation in electricity markets

Electricity markets are prone to the abuse of market power. Several U.S. markets employ algorithms to monitor and mitigate market power abuse in real-time. The performance of automated mitigation procedures is contingent on precise estimates of firms' marginal production costs. Currently, marginal cost is inferred from the past offers of a plant. We present new estimation approaches and compare them to the currently applied benchmark method. We test the performance of all approaches on auction data from the Iberian power market. The results show that our novel approaches outperform the benchmark approach significantly, reducing the mean (median) absolute estimation error from 11.53 (6.08) €/MWh in the benchmark to 4.03 (2.64) €/MWh for our preferred approach. This approach also performs best in our subsequent simulation of mitigation procedures. Here we find large welfare transfers from supplier to buyer surplus as well as a robust overall welfare gain, stemming from both productive and allocative efficiency gains. Our research contributes to accurate monitoring of market power and improved automated mitigation. Although we focus on power markets, our findings are applicable to monitoring of renewable energy tenders or market power surveillance in rail and air traffic.