Cost Evaluation Research Articles

An Unexpected Finding in an Adolescent Rowing Athlete With Angina Pectoris. A Case Report.

Significant intraventricular gradient development during exercise is rare, usually occurring with left ventricular hypertrophy. The etiopathogenesis consists of the increase in nonobstructive physiological gradients; ventricular cavitary obliteration with consequent end-systolic obstruction; and midsystolic obstruction caused by systolic anterior movement of the mitral valve compromising flow. A correlation between intraventricular gradient development and various symptoms has been established. Chest pain is common in children and is a frequent reason for referral to pediatric cardiologists. Despite the benign nature of most pediatric chest pain, extensive and costly cardiac evaluation is common in these patients. In the case presented here, we describe an adolescent rowing athlete with excruciating effort angina only during upright exercise, which was replicated while performing an exercise stress echocardiography.

An integrated tool for cost-effectively applying nutrient management practices for corn, soybeans, and wheat.

Harmful algal blooms (HABs) problem in Lake Erie has become critical recently-primarily triggered by phosphorus losses from cropland in the Maumee River watershed (major crops of corn/soybeans/wheat). Implementing agricultural best management practices (BMPs) is crucial to reduce excess nutrient loadings. Nutrient management is the management of nutrient applications for crop production that maximizes nutrient use efficiencies and minimizes nutrient losses. However, an integrated watershed-scale tool is needed for cost-effectively applying nutrient management practices for corn/soybeans/wheat considering the 4Rs (Right nutrient source, Right rate, Right time, and Right place of nutrient applications). In this study, by combining an improved Soil and Water Assessment Tool (SWAT) for nutrient management (SWAT-NM) and an improved BMP Cost Evaluation Tool (BMP-COST) for economic evaluations of nutrient management (BMP-COST-NM) considering the 4Rs for corn/soybeans/wheat, an integrated tool SWAT-COST-NM was created. SWAT-COST-NM was demonstrated in the AXL watershed (a typical agricultural area in the Maumee River watershed). The impacts of single nutrient management practices (single-NM, which separately changed the rate, place, time, or nutrient source of fertilizer applications) and combined-NM practices (multiple single-NM practices combined as one nutrient management practice) for corn/soybeans/wheat were evaluated. Tradeoffs in yearly net costs, crop yields, and March-July/yearly nutrient losses (Total Phosphorus-TP, Dissolved Reactive Phosphorus-DRP, and Total Nitrogen-TN) existed. Nutrient management did not necessarily lead to sufficient increases in crop yields to generate extra revenues that match or exceed the additional costs of the activities (compared to existing practices). One of the combined-NM practices could simultaneously reduce March-July TP, DRP, and TN losses by 5.89%, 8.19%, and 8.23%, respectively, while increasing crop yields with additional income (0.50 $/ha/yr of cropped area). SWAT-COST-NM, which can quantify various factors and tradeoffs when evaluating the impacts of nutrient management practices for corn/soybeans/wheat, can assist decision-makers in cost-effectively applying nutrient management practices considering the 4Rs.

Evaluating the combined effect of sugarcane bagasse ash, metakaolin, and polypropylene fibers in sustainable construction

The major challenge for the construction industry is to design and produce sustainable construction materials that are efficient in their performance and can be affordable for construction projects. The objective of this study is to determine the viability of incorporating waste products such as sugarcane bagasse ash (SCBA) to produce concrete with polypropylene (PP) fibers. SCBA is an industry waste that has certain pozzolanic properties, however, it shows limited mechanical properties when used as a cement replacement. To improve the mechanical and durability performance, metakaolin (15%) and PP fiber (0.5%, 1%, and 1.5%) were incorporated in the SCBA blend as a ternary additive. Some of the important characteristics explored include compressive strength, tensile strength, density, water absorption, acid resistance, and sorptivity. The study reveals that the incorporation of 15% metakaolin in the composite enhanced the compressive strength by 7%, 8.2%, and 9.1% for PP fiber additions of 0.5%, 1%, 1.5%, while the acid resistance enhanced by 4%, 6% and 8% relative to the control mix for the same value of pp fiber. Furthermore, cost evaluation confirms that the overall costs of concrete with 15% metakaolin and 5% SCBA were 12.2% less than the control concrete, thus making this option economically feasible. This research proves that the inclusion of SCBA, metakaolin, and PP fibers into the concrete mixture brings a sustainable approach that enhances mechanical properties and durability while assisting sugar manufacturing plants in the proper disposal of wastes.

Real-World Evaluation of Treatment Patterns, Healthcare Costs, and Healthcare Resource Utilization Among Patients with Non-small Cell Lung Cancer in the US Receiving Sotorasib.

Sotorasib was the first drug approved for adults with Kirsten rat sarcoma G12C-mutated locally advanced/metastatic non-small cell lung cancer (NSCLC) who received prior systemic therapy in the US. This study aimed to provide initial real-world evidence on patient characteristics, treatment patterns, healthcare resource utilization (HCRU), and healthcare costs (HCC) associated with sotorasib in US clinical practice. A retrospective observational study was conducted using the Optum Clinformatics® Data Mart US claims database spanning January 2016 to March 2023. The study population included adults with a diagnosis of lung cancer (diagnosis (Dx) date), claims for sotorasib on/post-Dx date (index date), Continuous enrollment for medical/pharmacy benefits from 180 days pre-Dx date to≥30 days post-index date was required. Patients receiving treatments for small-cell lung cancer (SCLC) pre-index were excluded. Outcomes were analyzed for patients receiving sotorasib as second or subsequent line (2L+) treatment and included adherence [proportion of days covered (PDC)], treatment duration, time to next treatment (TTNT), HCRU, and HCC during sotorasib treatment. Among 169 patients with lung cancer that met all inclusion criteria, 140 patients received sotorasib as 2L+ treatment (mean age: 71 years; 67.1% females). Mean PDC for sotorasib was 94.9%. Kaplan-Meier median treatment duration was 4.3 months. Median TTNT in patients with subsequent treatment (n=31) was 6.8 months. During sotorasib treatment, patients had a mean 3.87 outpatient, 0.09 inpatient, and 0.11 emergency visits per month. Mean monthly HCC during sotorasib treatment were US$23,063 versus $25,541 during the 180-day pre-index period. Patients in the US receiving sotorasib as 2L+ therapy for NSCLC in real-world clinical practice showed high adherence, TTNT comparable to progression-free survival observed in clinical trials, and HCC similar to those immediately prior to treatment demonstrating real-world benefits with no additional impact on healthcare resources with sotorasib.

Hydrothermal pretreatment with microwaves: A new strategy for ensuring the sustainability of biorefineries

Lignocellulosic biomass (LCB) includes agricultural residues, crop wastes, and food wastes that are ubiquitously present and can be used as renewable resources to generate bioenergy or biofuels. Still, direct utilization of LCB to produce biofuel is not an easy task due to the recalcitrance property of LCB. The pretreatment strategy is an important step in a biorefinery to reduce biomass recalcitrance and to use it for bioenergy including value-added product generation. Microwave irradiation is procuring interest regarding LCB and waste material pretreatment over time before moving to biological transformation to biofuels. The coupling of microwave heating with water has made it the most effective treatment for biomass valorization to generate biofuel and other value-added products, turning it into the most cost-effective and eco-friendly approach. Despite its numerous advantages, scaling up microwave pretreatment from laboratory experiments to industrial applications faces several challenges. These limitations become significant hurdles in scaling up. As a result, it is necessary to focus research on cost evaluations and life cycle assessment (LCA) studies for commercialization that will benefit the bioeconomy and the environment. This review discusses microwave-assisted pretreatment significance in valorizing LCB for biofuel generation including the cost evaluation and LCA studies that have the most important role in commercializing the microwave-assisted pretreatment from lab scale to industrial scale.

A comprehensive quantitative lifecycle cost and environmental impact analysis model for computing infrastructure

This paper presents a comprehensive quantitative model for quantitative assessment of the lifecycle costs and environmental impacts of computing infrastructure, with a focus on internet data centers (IDCs) and high-performance computing (HPC) facilities. The key innovation lies in the integration of interdisciplinary cost evaluation and carbon emission methods for the establishment of this quantitative model. This framework, which outlines key cost components and carbon emission factors, enables the calculation of total costs, electricity expenses, and greenhouse gas emissions throughout the lifecycle of infrastructure. With IDCs as a case study, the research clarifies the intricate cost structure associated with equipment procurement, energy usage, land acquisition, and operational expenses. This paper provides an in-depth understanding of the cost structure and environmental impact of computing infrastructure in support of sustainable decision-making in its development.•Based on established cost estimation methods, such as Lifecycle Cost Analysis (LCCA) and the Analogous Estimating Method, this study examines costs across construction and operation phases.•The Emission Factor Method is used to quantify environmental impact, emphasizing the significance of regional energy mix and power usage effectiveness (PUE).

Economic Analysis of Falls in a Private Hospital in Southern Brazil-A Case-Control Study.

In-hospital falls represent significant health and economic concerns, but previous studies regarding the economic cost of falls do not account for other cofounders (comorbidities and clinical aspects) in this cost evaluation. The aim of this study is to analyse the cost of in-hospital falls comparing those who had falls to nonfalls patients while accounting for several risk factors associated with falls. Data were collected from January 2020 to December 2022, in a private hospital in Brazil. The sample was divided into two groups: one with patients who fell and the other with nonfallers on a 1:2 ratio, and these groups were matched to avoid confounding variables. The median cost for patients who experienced falls was US$7520.26 compared to US$6144.24 for those without falls (p < 0.01). This trend was especially marked in men aged 20-40 who suffered falls and showed a significantly elevated median cost of US$29 722.02 distinguishing them from those without falls with a median cost of US$1179.48 (p < 0.01). Hospital falls significantly increase financial costs compared to nonfall cases, irrespective of comorbidities, length of stay or case-mix variations. The findings recommend a universal precautions approach to fall prevention in hospitals, targeting all hospitalised patients to effectively minimise the economic burden associated with in-hospital falls.

Evaluation and comparison of the production costs of Argania spinosa (L.) Skeels plantlets produced by microcuttings and micrografting

Evaluation and comparison of the production costs of Argania spinosa (L.) Skeels plantlets produced by microcuttings and micrografting

Evaluation of Reporting Quality of Systematic Reviews on Health Economic Evaluation Studies Based on the CHEERS Statement: An Overview of Reviews

Background: Economic evaluations in healthcare are designed to inform decisions by the estimation of cost and effect trade-off of two or more interventions. We aimed to evaluate the standards of systematic reviews on health economic evaluation studies using the CHEERS (Consolidated Health Economic Evaluation Report Standards) tool. Methods: We searched the PubMed database with keywords CHEERS and its complete form in combination with keywords related to cost or economic evaluation without language and time limits until November 17, 2021. The CHEERS tool was then used to include systematic reviews. Results: Overall, 32 systematic reviews, included 610 primary studies were included. Of the 32 included studies, only 1 study (3.1%) had poor quality, 5 studies (15.6%) had good quality, remaining studies had very good and excellent quality. Conclusion: Some studies still have problems in expressing the standards. The necessity of standards for reporting economic evaluation studies in the field of health is very serious, and Cheers is one of the most important tools.

Commentary on the Article of Philipp Moog, Edith Gawlik, Stefan Eisenreich et al. The Cost of Lipedema Treatment Exceeds the DRG Revenues - Evaluation of the Surgical Treatment Costs Of Lipedema (Stage III) at a German University Clinic

Commentary on the Article of Philipp Moog, Edith Gawlik, Stefan Eisenreich et al. The Cost of Lipedema Treatment Exceeds the DRG Revenues - Evaluation of the Surgical Treatment Costs Of Lipedema (Stage III) at a German University Clinic

Evaluation of Lithium-ion Batteries in Electric Vehicles

Growing awareness of climate change concerns and the environmental impacts of fossil fuel vehicles has heightened interest in electric vehicles (EVs). Therefore, EVs represent a significant component of sustainable transportation solutions. Additionally, with advancements in battery technology, EVs now have longer ranges and are offered at more competitive prices. With their notable features such as high energy density, lightness, low maintenance requirement, and long life, lithium-ion batteries (LiBs) appear to be the most suitable battery option for EVs. Nevertheless, current LiB technology faces battery costs, energy storage capacity, charging times, and safety issues. In this context, it is clear that future research and development will focus on improving the efficiency of LiB technology and making these batteries more sustainable, reliable, and economical. This study aims to provide an evaluation of the LiBs used in the automotive sector by examining the historical development, basics of operational principles, various geometric types, cost evaluation, and their advantages and disadvantages. By covering these aspects, the study seeks to offer a comprehensive assessment of the LiBs employed in the automotive industry, spanning from their historical evolution to their presentday utilization. The study also intends to serve as a reference source for researchers planning to conduct studies on LiBs in EVs by providing fundamental concepts and evaluations related to these batteries.

The high price of equity in pulse oximetry: A cost evaluation and need for interim solutions.

Disparities in pulse oximetry accuracy, disproportionately affecting patients of color, have been associated with serious clinical outcomes. Although many have called for pulse oximetry hardware replacement, the cost associated with this replacement is not known. The objective of this study was to estimate the cost of replacing all current pulse oximetry hardware throughout a hospital system via a single-center survey in 2023 at an academic medical center (Duke University) with three hospitals. The main outcome was the cost of total hardware replacement as identified by current day prices for hardware. New and used prices for 3,542/4,136 (85.6%) across three hospitals for pulse oximetry devices were found. The average cost to replace current pulse oximetry hardware is $6,834.61 per bed. Replacement and integration costs are estimated at $14.2-17.4 million for the entire medical system. Extrapolating these costs to 5,564 hospitals in the United States results in an estimated cost of $8.72 billion. "Simply replacing" current pulse oximetry hardware to address disparities may not be simple, cheap, or timely. Solutions for addressing pulse oximetry accuracy disparities leveraging current technology may be necessary, and might also be better. Trial Registration: Pro00113724, exempt.

Techno-Economic Assessment of Amine-Based Carbon Capture in Waste-to-Energy Incineration Plant Retrofit

This study offers a detailed techno-economic assessment of Carbon Capture (CC) integration in an existing Waste-to-Energy (WtE) incineration plant, focusing on retrofit application. Post-combustion carbon capture using monoethanolamine (MEA) was modeled for various low-scale plant sizes (3000, 6000, and 12,000 t of CO2 per year), using a process simulator, highlighting the feasibility and implications of retrofitting a WtE incineration plant with CC technology. The comprehensive analysis covers the design of the CC plant and a detailed cost evaluation. Capture costs range from 156 EUR/t to 90 EUR/t of CO2. Additionally, integrating the CO2 capture system reduces the overall plant absolute efficiency from 22.7% (without carbon capture) to 22.4%, 22.1%, and 21.5% for the different capture capacities. This research fills a gap in studying small-scale CC applications for the WtE incineration plants, providing critical insights for similar retrofit projects.

Biodiesel synthesis from low cost biomass wastes and its cost assessment inducing process optimization

This study employed low-cost biomass wastes for the synthesis of biodiesel that is cost-effective and environmentally friendly. The major raw material (oil) was obtained by steam distillation (SD) from Croton heliotropiifolius Kunth leaf (CHKL) and was characterized for its aptness for biodiesel production. Dwarft green coconut husk ash (DGCHA) was used as a bio-adsorbent for acid value reduction of Croton heliotropiifolius Kunth leaves oil (CHKLO). A novel, highly potassium-based catalyst was derived from Karpuravalli banana peels (KBP), calcined, and characterized using TGA, ZETA, FTIR, SEM-EDX, XRF-FS, and BET analysis. Biodiesel was synthesized using a microwave-assisted method, characterized, and compared with the recommended standard. The catalytic strength of the calcined Karpuravalli banana peel powder (CKBPP) was tested using a reusability test, and the cost evaluation of production was estimated. Results showed that the CHKL was rich in oil (43% wt./wt.), and the oil is highly acidic (5.23 mg KOH/g oil). At high particle size, the dwarf green coconut husk ash (DGCHA) bagasse reduced the acid value to a minimum (1.4 mg KOH/g oil) at 3 days. The developed novel catalyst from CKBPP indicated high potassium-calcium contents for base transesterification. Process optimization indicated that the predicted response data of 95.285% (wt./wt.) at T1 = 90 min, T2 = 60 oC, T3 = 4.5% (wt.), and T4 = 9 (vol./vol.) was validated in triplicate, and the average data value of 95.10% (wt./wt.) was established. Dataset on the quality of biodiesel showed that the produced biodiesel properties were in line with recommended standards. Economic appraisal data showed that the cost of producing 20 L of CHKLOB (biodiesel) was $4.73 at 1,500 to $1. The study concluded that the production of biodiesel from waste can be cost-effective and environmentally friendly if wastes are harness.Graphical

Dynamical Sphere Regrouping Particle Swarm Optimization Programming: An Automatic Programming Algorithm Avoiding Premature Convergence

Symbolic regression plays a crucial role in machine learning and data science by allowing the extraction of meaningful mathematical models directly from data without imposing a specific structure. This level of adaptability is especially beneficial in scientific and engineering fields, where comprehending and articulating the underlying data relationships is just as important as making accurate predictions. Genetic Programming (GP) has been extensively utilized for symbolic regression and has demonstrated remarkable success in diverse domains. However, GP’s heavy reliance on evolutionary mechanisms makes it computationally intensive and challenging to handle. On the other hand, Particle Swarm Optimization (PSO) has demonstrated remarkable performance in numerical optimization with parallelism, simplicity, and rapid convergence. These attributes position PSO as a compelling option for Automatic Programming (AP), which focuses on the automatic generation of programs or mathematical models. Particle Swarm Programming (PSP) has emerged as an alternative to Genetic Programming (GP), with a specific emphasis on harnessing the efficiency of PSO for symbolic regression. However, PSP remains unsolved due to the high-dimensional search spaces and local optimal regions in AP, where traditional PSO can encounter issues such as premature convergence and stagnation. To tackle these challenges, we introduce Dynamical Sphere Regrouping PSO Programming (DSRegPSOP), an innovative PSP implementation that integrates DSRegPSO’s dynamical sphere regrouping and momentum conservation mechanisms. DSRegPSOP is specifically developed to deal with large-scale, high-dimensional search spaces featuring numerous local optima, thus proving effective behavior for symbolic regression tasks. We assess DSRegPSOP by generating 10 mathematical expressions for mapping points from functions with varying complexity, including noise in position and cost evaluation. Moreover, we also evaluate its performance using real-world datasets. Our results show that DSRegPSOP effectively addresses the shortcomings of PSO in PSP by producing mathematical models entirely generated by AP that achieve accuracy similar to other machine learning algorithms optimized for regression tasks involving numerical structures. Additionally, DSRegPSOP combines the benefits of symbolic regression with the efficiency of PSO.

An inter-hospital performance assessment model for evaluating hospitals performing hip arthroplasty

The value of hospital care to patients is expressed as a combination of reduced healthcare costs, fewer medical complications, and improved patient satisfaction. Few studies highlight the value hospitals provide to their patients through hip replacement surgery.This study aims to define a methodology for inter-hospital comparison purposes that can assess the value of hip replacement management to patients by using indicators of costs, medical complications, and patient outcomes.We identified medical complications and costs from medico-administrative data collected by three hospitals. We associated a Disability Adjusted Life Years (DALYs) impact with medical complications, readmissions (within 30 days), and hospital mortality. Costs were analysed from a social security perspective. Patient outcomes were collected through a questionnaire-based survey after hip surgery. To compare the three hospitals, we created a composite indicator by standardizing each dependent variable and combining a weighting of importance provided by patients.This study analysed 342 hospital stays. The mean (standard deviation) number of DALYs per stay was estimated to be more than 0.0028 (0.016) for a mean (standard deviation) cost of €4,834 (€3,665). The composite indicator allowed hospitals to be ranked and areas for improvement to be identified. In our case mix, Hospital 3 is the lowest-ranked hospital, with excessively high costs and a relatively low level of satisfaction compared to the others.The simultaneous evaluation of medical complications, patient outcomes, and costs is a prerequisite for quality improvement efforts by managers and practitioners. In our opinion, this experiment, which sought to estimate the value hospitals bring to patients, may be viewed as the first step towards value-based purchasing in Belgium.

Nitrogen Fertilization Using Conventional and Slow-Release Fertilizers at Multiple Levels in Lolium multiflorum Lam. Pastures

Pastures are essential for sustaining dairy production, particularly in temperate climates where year-round grazing is feasible. However, comprehensive analyses of their productivity, efficiency, and cost evaluation remain uncommon. This study evaluated the productivity, quality, nitrogen fertilization use efficiency, and production costs of Lolium multiflorum Lam pasture on a farm in São Miguel Island. The research compared conventional nitrogen fertilizer with slow-release nitrogen fertilizer at application rates of 320 and 160 kg N ha−1, alongside a control treatment. A Latin square design with five treatments was employed to assess both agronomic and economic performance. The results showed that the type of fertilizer did not significantly influence productivity or quality, while nitrogen levels had a notable impact. Higher nitrogen doses increased dry matter yield and crude protein content. Fiber characteristics remained relatively stable, though neutral detergent fiber and acid detergent fiber levels tended to rise with increased nitrogen application. Nitrogen fertilizer use efficiency consistently exceeded 70%, regardless of the fertilizer type or application rate. Regarding production costs, conventional fertilizer was significantly more cost-effective than slow-release fertilizer, underscoring the importance of selecting economically viable options without compromising agronomic performance in forage production.

Incorporation of coffee grounds powder as reinforcement in epoxy resin for high-performance industrial coatings: a cost of goods sold and blue ocean strategy analysis

In some organic waste treatment facilities, coffee grounds are utilized for biogas production through anaerobic digestion processes. However, this method is expensive and complex. An innovative alternative involves transforming coffee grounds into a new product, a high-performance coating. This study explores a strategic analysis for this new product. The composite is created by adding coffee grounds in an epoxy matrix as reinforcement. Different proportions of coffee grounds were added to epoxy, and resulting composites evaluated for mechanical and thermal properties. Previous analysis shows some promising results for the material, but none evaluations of fabrication cost or revenue were done, so a cross-analysis between the cost of goods sold (COGS) and the Blue Ocean Strategy model was used to identify market opportunities and compared the obtain product with nowadays market ones. Coffee grounds in epoxy offer a sustainable option, opening new market avenues with competitive performance and cost. This composite could impact industrial coatings, promoting eco-friendly practices.

A Systematic Review on Unique Characteristics of Generation Z and Their Impact on Purchasing Decisions

The Generation Z, also recognized as "centennials," stands out for its complete immersion in technology, exerting a significant influence on their purchasing decisions. This study applied the PRISMA method to conduct a systematic review of the distinctive attributes of this generation and their impact on consumer choices. Results, extracted from 14 articles analyzed between 2019 and 2023, indicate an increase in scientific production in 2023, with a notable focus on purchasing trends. Indonesia emerges as a focal point of research, demonstrating a particular interest in the consumption practices of Generation Z. "Sustainability" leads in publications, emphasizing the convergence between youth and sustainable consumption. Scopus stands out as the primary database, indicating a preference for journal articles. Generation Z, identified by its connection to digital commerce and the influence of social media, especially TikTok, exhibits a blend of contemporary and traditional values in their purchasing decisions. Their focus on adopting innovative technologies and the meticulous evaluation of sustainability and cost reflect thoughtful and critical consumption. In conclusion, Generation Z redefines the market landscape with an innovative and socially conscious perspective, underscoring the importance of authentic and personalized strategies in an ever-evolving commercial environment.

The Use of Nudge Strategies in Improving Physicians' Prescribing Behavior: A Systematic Review and Meta-analysis.

Nudges have been proposed as a method of influencing prescribing decisions. The purpose of this article is to 1) investigate associations between nudges' characteristics and effectiveness, 2) assess the quality of the literature, 3) assess cost-effectiveness, and 4) create a synthesis with policy recommendations. We searched health and social science databases. We included studies that targeted prescribing decisions, included a nudge, and used prescribing behavior as the outcome. We recorded study characteristics, effect size of the primary outcomes, and information on cost-effectiveness. We performed a meta-analysis on the standardized mean difference of the studies' primary outcomes, tested for associations between effect size and key intervention characteristics, and created a funnel plot evaluating publication bias. We identified 21 studies containing 25 nudges. In total, 62 of 85 (73%) outcomes showed a statistically significant effect. The average effect size was -0.22 standardized mean difference. No studies included heterogeneity analyses. We found no associations between effects and selected study characteristics. Study quality varied and correlated with study design. A total of 7 of 21 (33%) studies included an evaluation of costs. These studies suggested that the interventions were cost-effective but considered only direct effects. We found evidence of publication bias. Heterogeneity and few studies limit the possibilities of statistical inference about effectiveness. Nudges may be effective at directing prescribing decisions, but effects are small and health effects and cost-effectiveness are unclear. Future nudge studies should contain a rationale for the chosen nudge, prioritize the use of high-quality study designs, and include evaluations of heterogeneity, cost-effectiveness, and health outcomes to inform decision makers. Moreover, preregistration of the protocol is warranted to limit publication bias. Nudging as a method to improve prescribing decisions has gained popularity during the past decade.We find that nudging can improve prescribing decisions, but effect sizes are mostly small, and the size of derived health outcomes is unclear.Most studies use feedback and error-stopping nudges to target excessive opioid or antibiotic prescribing, making heterogeneity analyses across nudge types difficult.Further research on the cost-effectiveness of nudges and generalizability is needed to guide decision makers considering nudging as a tool to guide prescribing decisions.