Facility Costs Research Articles

Inpatient cost comparison of total and unicompartmental knee arthroplasty in patients with medial compartmental osteoarthritis using time-driven activity-based costing.

Using time-driven activity-based costing (TDABC), we sought to compare the total facility costs, comprising supply and personnel costs during the episode of care for the index procedure, in patients with isolated medial compartmental knee osteoarthritis (OA) undergoing unicompartmental knee arthroplasty (UKA) versus total knee arthroplasty (TKA). We conducted a retrospective analysis of 100 UKAs and 100 TKAs from 2019 to 2022. From a larger sample of 4899 TKAs and 137 UKAs, patients with isolated medial OA (Kellgren-Lawrence Grade <2 in other compartments) were radiographically identified. Demographic data included age, sex and body mass index, with comorbidities controlled using the Charlson comorbidity index. Facility costs were calculated using TDABC and standardized in cost units (CUs), a metric for comparing costs across procedures. Multiple regression analysis was used to assess the independent effect of TKA versus UKA on facility costs. TKA patients had similar operative times (TKA vs. UKA: 1.01×, p = 0.783) and supply costs (1.00×, p = 0.866), where 'x' denotes the relative cost ratio. However, TKA was associated with higher personnel costs (260.0 vs. 222.5 CUs [1.17×], p < 0.001) and total facility costs, both including (706.3 vs. 667.5 CUs [1.06×], p = 0.007) and excluding implants (353.8 vs. 312.5 CUs [1.13×], p < 0.001). Adjusted for demographics and comorbidities, TKA had increased facility costs, including (32.2 CUs, 95% confidence interval [CI]: 2.9-61.5, p = 0.031) and excluding implants (37.8 CUs, 95% CI: 15.2-60.3, p = 0.001). TDABC analysis revealed higher total facility costs for the index procedure in TKA, suggesting UKA may be a cost-saving alternative for isolated medial compartment knee OA. Level III, retrospective comparative study.

Study of aluminum corrosion in contact with biogas before and after purification on different carbons

The study of aluminium corrosion in contact with biogas before and after purification on different types of carbon aims to understand the impact of impurities present in biogas, in particular hydrogen sulphide (H₂S), on aluminium degradation. The study highlights the importance of biogas purification in minimising aluminium corrosion. Depending on the level of purification and the types of carbon used for filtering, it is possible to improve the durability of infrastructures in contact with biogas. This has direct implications for the maintenance and operating costs of facilities using biogas as an energy source. Hydrogen sulfide (H₂S) is a colorless, flammable and highly toxic gas characterized by an unpleasant odor. It is often present in industrial and natural environments, particularly in biogas. This gas is involved in the degradation of metals used in anaerobic digestion equipment, in the petrochemical industry, etc. The aim of this work is to study the performance of biochar and activated carbon prepared from corn cobs in removing H2S from biogas, and to evaluate the reduction of the corrosive effect of filtered biogas on metallic aluminum. The impregnation and carbonization method was used to prepare activated carbon from corn cobs, and the gravimetric method to study the corrosion rate of metal in biogas. The results indicate that the activated carbon prepared is microporous, has a good specific surface and a better adsorption capacity. Furthermore, the prepared activated carbon samples also showed good H2S removal efficiency in the biogas. The aluminum-induced protective power values in filtered biogas for biochar and activated carbon are 58 % and 82.22 % respectively. We plan to increase the contact time and experiment with other metals and carbons.

Assessment of Socio-Economic Determinants of Maize Production among Smallholder Farmers in Nassarawa State, Nigeria

The study focused on assessment of socioeconomic determinants of maize production among smallholder farmers in Nasarawa State. A multistage sampling technique was used for the selection of 171 small holder farmers for the study. A well-structured questionnaire containing both open and closed ended questions was used to collect the data for the study descriptive statistics such as percentage and frequencies and multiple regression analysis were used to achieve the objectives of the study. The socioeconomic result of the smallholder maize farmers in showed that the majority (36.3%) of the farmers were within the age range of 31-40 years of age and were mostly 76.6%) male farmers with the majority married and literate. Also, a greater number (66.1%) were members of association, 71.3% had farming experience between the range of 16-20 years with household size of 4-6, cultivating average farm size of 2-3 acres, had good contact with extension agents though only 4.1% had access to credit facility. The result of the multiple regression analysis showed that farm size, educational status and household size have positive significant effect on the output of maize at 1% and 10% level of significance respectively. The maize production technologies adopted by the majority (88.4%) of the farmers were herbicides and improved variety while the major constraints were high cost of labour, high cost of inputs and poor credit facility. The federal Government should create an enabling environment that guarantees available farmland to farmers since farm size is a critical determinant to maize production.

A Bilevel Approach to the Facility Location Problem with Customer Preferences Under a Mill Pricing Policy

This paper addresses the facility location problem under a mill pricing policy, integrating customers’ behavior through the concept of preferences. The problem is modeled as a bilevel optimization problem, where the existence of ties in customers’ preferences can lead to an ill-posed bilevel problem due to the possible existence of multiple optima to the lower-level problem. As the commonly employed optimistic and pessimistic strategies are inadequate for this problem, a specific approach is proposed bearing in mind the customers’ rational behavior. In this work, we propose a novel formulation of the problem as a bilevel model in which each customer faces a lexicographic biobjective problem in which the preference is maximized and the total cost of accessing the selected facility is minimized. This allows for a more accurate representation of customer preferences and the resulting decisions regarding facility location and pricing. To address the complexities of this model, we apply duality theory to the lower-level problems and, ultimately, reformulate the bilevel problem as a single-level mixed-integer optimization problem. This reformulation incorporates big-M constants, for which we provide valid bounds to ensure computational tractability and solution quality. The computational study conducted allows us to assess, on the one hand, the effectiveness of the proposed reformulation to address the bilevel model and, on the other hand, the impact of the length of the customer preference lists and fixed opening cost for facilities on the computational time and the optimal solution.

A Study to Assess Anti-TB Treatment Compliance, Factors Predictive for Poor Adherence and Perpetual Defaulting among Patient Living with TB in Namuseche Chipata Eastern Province–Zambia

Background of the Study: Tuberculosis (TB) is the ninth leading cause of death worldwide. According to WHO at least 1.5 million people each year succumb to TB, thus making it the world's top infectious killer as well as the leading cause from a single infectious agent, ranking above HIV/AIDS. Zambia is one of the top 30 high TB burden countries. People with active TB can infect 5– 15 other people through close contact over the course of a year. TB patients with compromised immune systems, such as people living with HIV, malnutrition or diabetes, or people who use tobacco, have a higher risk of falling ill. Without proper treatment, 45% of HIV-negative people with TB on average and nearly all HIV-positive people with TB will die. Defaulting on TB medication is a major barrier to both local and global TB control. Defaulting increases, the risk of drug resistance, treatment failure, relapse and death, and may prolong infectiousness. Poor adherence to treatment means that patients remain infectious for longer and are more likely to relapse or succumb to tuberculosis. The rate of anti-TB treatment compliance, adherence and perpetual defaulting TB treatment was and is still high during the intensive phase of treatment. Most people who are called “lost to follow up” don’t have adequate information as to why they should continue and finish their TB medication.  Methodology: A qualitative, phenomenological cross-sectional research design was used. Namuseche Prison Clinic and surrounding compounds of Chipata Township in Eastern Province Zambia. A total of 141 participants was recruited through purposive sampling. In-depth interviews were conducted. The SPSS package version 23 was applied to conduct quantitative analysis. The proposal was approved by the Chreso University Ethics Clearance Committee and National Health Research Authority. Researcher ensured confidentially and voluntary participation with informed consent.  Results: The age of the respondents in this study ranged from 18 years to 50 years. Knowledge on TB related questions was very high in this study and stood at 87.3%. TB treatment default was found in 34 (32.7%) respondents and was associated with distance to the facility and transport costs, feeling unwell and the drug side effects.  Conclusion: TB treatment default was found in 34 (32.7%) respondents and was associated with distance to the facility and transport costs, feeling unwell and the drug side effects.

Functional Impairments, Phenotypic Frailty, and Sector-Specific Incremental Healthcare Costs in Older Adults.

This study quantifies incremental healthcare expenditures of functional impairments and phenotypic frailty in specific healthcare sectors. Pooled 2023 analysis of 4 prospective cohort studies linked with Medicare claims including 4318 women and 3847 men attending an index examination (2002-2011). Annualized inpatient, skilled nursing facility (SNF), home healthcare (HHC), and outpatient costs (2023 dollars) ascertained for 36 months following index examination. Functional impairments (difficulty performing 4 activities of daily living) and frailty phenotype (operationalized using 5 components) derived from cohort data. Weighted multimorbidity index including demographics derived from claims. Mean age at index examination was 79.2 years. After accounting for multimorbidity and each other, average annualized incremental costs of 3-4 functional impairments versus no impairment in women (men) were $2838 ($5516) in inpatient, $1572 ($1446) in SNF, and $1349 ($1060) in HHC sectors; average incremental costs of phenotypic frailty versus robust in women (men) was $4100 (not significant for men) in inpatient, $1579 ($1254) in SNF, and $645 ($526) in HHC sectors. Incremental inpatient costs were primarily due to a higher hospitalization risk, while incremental SNF and HHC costs were related to both increased risks of utilization and higher costs among individuals with utilization. Neither geriatric domain was associated with outpatient costs. In this study of community-dwelling beneficiaries, functional impairments were independently associated with higher subsequent expenditures in inpatient, SNF, and HHC sectors among both sexes. Phenotypic frailty was independently associated with higher subsequent inpatient costs in women, and higher SNF and HHC costs in both sexes.

A-182 Applications of artificial intelligence optical character recognition in laboratory clerical functions offsetting staffing shortages and error reduction

Abstract Background The clinical laboratory profession has been dealing with a decade long, and now critical retention and staffing problem. The average national turnover rate for laboratory technicians is 17%, and the highest turnover rate exhibited for phlebotomists is 36%. While turnover rates have an impact on a laboratory, or hospitals budget, more importantly they have a substantial impact on quality and error rates, particularly in the pre-analytical stage of testing; with studies showing up to 65.09% of errors impacting the pre-analytical phase. Methods In an effort to remedy this high error rate, a meta-analysis was performed on paper order entry and clerical pre-analytical error, in parallel with performance and accuracy data of advanced optical character recognition driven by artificial intelligence and machine learning (AI OCR). Results AI OCR studies demonstrated an untrained accuracy percentage, to include handwriting of 91.08%, and when trained utilizing both relational and hierarchal logic data bases accuracy increased to 98.4%. The rate at which AI OCR processed and classified medical information was 3-4 pages per second. It is estimated that 99.9%-100% accuracy can be achieved with additional form field training and mapping. The level of accuracy and efficiency for laboratory paper order-entry utilizing AI OCR can also be increased with the addition of natural language processing and data recognition algorithms when combined with logic databases containing information such as medical record numbers, ICD-10 codes, and laboratory test compendiums. Conclusions The performance of this technology demonstrates a strong application to reduce the burden of clerical paper order entry, while addressing the 30.8% dissatisfaction rate regarding manual entry processes among lab professionals surveyed. Moreover, AI OCR clerical data classification, extraction and entry processes augmented with human verification steps examined, demonstrated overall accuracy of 99.99%. The application of AI OCR in laboratory pre-analytical processes has the potential to improve test order accuracy and efficiency, ultimately impacting the quality of patient care and operational costs for healthcare facilities. When examined through the lens of staff retention, studies show that 80% of laboratory employees feel that a workplace with the necessary tools and technology positively impacts their job satisfaction. While organizations investing in technologies that drive both job efficiency and satisfaction see a 125% return on investment through productivity. Demonstrating that the application of sophisticated technologies that both increase productivity and decrease error rates have a substantial impact on job satisfaction and ultimately retention. Although laboratory clerical data and order entry processes were examined for this meta-analysis, the aggregate data compiled showed that the application of AI OCR in clerical processes could also have a substantial impact on the 25.9% annual turnover rate for hospitals as a whole in the United States.

Управление основными производственными средствами предприятия в условиях изменчивой внешней среды

The study of strategies for managing the main production facilities of an enterprise in conditions of geopolitical instability and the introduction of mutual sanctions is an urgent topic, since effective management of production resources of organizations of any type of activity is critical for their successful functioning. Geopolitical factors and sanctions can seriously affect the availability and cost of production facilities, as well as their operating conditions, which requires the development of adequate management strategies to ensure the sustainability of production processes and minimize negative consequences. In this regard, the strategies formulated in the article for managing the main production facilities of the enterprise are of significant scientific interest and practical importance for the business community.

Region specific economic model for solid sorbent direct air capture using geothermal energy resources (S-DAC-GT)

Low temperature geothermal resources, ranging from 80° to 120 °C, may substantially lower both the cost and the CO2 emissions footprint of CO2 direct air capture (DAC) systems. This paper provides a model for determining a region-specific economic analysis for DAC with solid sorbent (S-DAC) using geothermal resources (S-DAC-GT).This paper provides a methodology and program for calculating estimated cost and carbon emissions for potential S-DAC facilities on a region-specific basis. The paper outlines the necessary region-specific characteristics required as parameters for the techno-economic model. The region-specific characteristics are then applied to an S-DAC energy and cost model based on existing literature to calculate the levelized cost per tonne of CO2 captured and stored. Further, the model provides a reasonable approximation of the carbon intensity of the S-DAC-GT system. These calculations allow selecting and prioritizing regions appropriate for potential S-DAC-GT facilities operating at a scale of ∼1 Mt CO2 captured and stored per year.This paper presents a novel approach that addresses several gaps in current DAC techno-economic analyses found in literature. First, the model is highly customizable, allowing the user to apply their own proprietary sorbent properties and region specific parameters to determine precise costs and carbon emissions for their hypothetical S-DAC-GT facility. Second, the overwhelming majority of DAC techno-economic analyses in literature assume away variability of ambient conditions, presuming stable temperature and humidity during operations. This paper directly integrates these large local ambient effects on sorbent performance and evaluates S-DAC-GT costs and carbon emissions based on specific and variable conditions dictated by the user. Third, the flexibility of the model allows the user to rapidly compare S-DAC-GT costs and carbon emissions in different user selected regions, with custom sorbent characteristics. The model provides visualizations of the sensitivity of S-DAC-GT costs and carbon emissions to different parameters and provides visualizations of the cost and carbon emissions due to variability in ambient conditions.Existing techno-economic analyses are either region agnostic or constrain their results to a specific region. The novelty of this paper and its model is the deeper technical and economic analysis of using geothermal energy as the thermal resource, coupled with customizability and visualizations that enable accelerated differentiation of S-DAC-GT costs and carbon intensity by region.

Technological Paradigm Between the Production of Photovoltaic and Thermal Solar Energy in Sahelo-Sahelian Countries

The energy sector in Sahelian countries such as Burkina Faso, Mali and Niger is facing enormous challenges. Indeed, electricity shortages, characterized by recurrent breakdowns of means of production and import dependency due to an unfavorable energy mix, are numerous in these countries. Concerns about the high costs of facilities and operations, as well as environmental pollution, not forgetting to mention the matter of the countries&amp;apos; energy sovereignty, have led to the desire to use reliable, profitable and adapted means of production. The aim of this study is to review the literature on electric power generation systems in the world, in Africa and in Sahelian countries, with an emphasis focus on photovoltaic and thermal solar energy. In addition, it highlights, in views of the problems raised, works that have suggested solutions. To achieve this, scientific articles, theses and other scientific documents dealing with electric power generation systems from 2014 to 2024 have been consulted. This enabled us to get knowledge on the various electric power generation systems, to know their advantages and limitations, and above all the perspectives in terms of electric power generation. Additionally, they provided a source of inspiration for setting up an electric power generation system in line with the realities of the countries of the Alliance of Sahel States (ASS).

Direct Variable Cost Comparison of Monitored Anesthesia Care Versus Wide Awake Local Anesthesia No Tournique Carpal Tunnel Release: A Time-Driven Activity-Based Costing Analysis

Time-driven activity-based costing (TDABC) provides a more accurate and granular estimation of direct variable costs compared with traditional accounting methods. This study used TDABC to quantitatively compare the same-day facility costs of open carpal tunnel release (CTR) performed under monitored anesthesia care (MAC) versus wide awake local anesthesia no tourniquet (WALANT). We retrospectively identified 474 unilateral CTR (182 MAC and 292 WALANT) performed at an orthopedic specialty hospital between 2015 and 2021. Itemized facility costs were calculated using a TDABC algorithm. Patient demographics, surgical characteristics, and itemized costs were compared between those treated under MAC (MAC-CTR) and WALANT (WALANT-CTR). Multivariable regression was performed to determine the independent effect of MAC on true facility costs. Total facility costs were $170 higher in MAC-CTR compared with WALANT-CTR ($652 vs $482). Monitored anesthesia care-CTR cases had higher personnel costs ($537 vs $394), likely because of higher surgery personnel ($303 vs $185) and postanesthesia care unit personnel costs ($117 vs $95). Monitored anesthesia care-CTR cases also had higher supply costs ($119 vs $81). When controlling for demographics and comorbidities, MAC-CTR was independently associated with an increase in personnel costs by $150.65 (95% CI, $131.09-$170.21), supply costs by $24.99 (95% CI, $9.40-$40.58), and total facility costs by $175.66 (95% CI, $150.18-$201.09) per case. Using TDABC, MAC-CTR was found to be 35% more costly to the facility compared with WALANT-CTR. Notably, WALANT-CTR facility costs presented here do not include additional cost savings from anesthesiologist service fees or preoperative laboratory clearance required for MAC-CTR surgeries. To reduce costs related to CTR surgery, greater efforts should be made to reduce the number of intraoperative personnel and maximize the use of WALANT-CTR in an outpatient setting. Economic and Decision Analysis II.

Integration between Value Engineering Technology and Activity-based Costing and their Impact on Reducing Costs: Applied Research in Baghdad Soft Drinks Company/Private Shareholding

The research mainly aims to integrate activity-based costing and value engineering and consider their role in reducing costs for industrial facilities in the face of the modern business environment characterized by many developments and rapid changes. The research problem is that traditional cost accounting methods are insufficient to provide organizational units with useful information in many administrative decisions, especially those related to product quality, to calculate costs and meet requirements correctly and can be replaced by modern cost management methods. Moreover, to find compatibility between them in a competitive environment in the public and private sectors, The study is based on the following hypotheses: There is a significant relationship between the integration of value engineering technology and activity-based costing and cost reduction, and the integration of value engineering technology and activity-based costing has a significant effect on cost reduction.

Extending mechanical thrombectomy service provision to 24/7: a break-even analysis

BackgroundComprehensive stroke centres across England have developed investment proposals, showing the estimated increases in mechanical thrombectomy (MT) treatment volume that would justify extending the standard hours to a 24/7 service provision. These investment proposals have been developed taking a financial accounting perspective, that is by considering the financial revenues from tariff income. However, given the pressure put on local health authorities to provide value for money services, an affordability question emerges. That is, at what additional MT treatment volume the additional treatment costs are offset by the additional health economic benefits, that is quality-adjusted life years (QALYs) and societal cost savings, generated by administering MT compared to standard care.MethodsA break-even analysis was conducted to identify the additional MT treatment volume required. The incremental hospital-related costs associated with the 24/7 MT extension were estimated using information and parameters from four relevant business cases. The additional societal cost savings and health benefits were estimated by adapting a previously developed Markov chain-based model.ResultsThe additional hospital-related annual costs for extending MT to a 24/7 service were estimated at a mean of £3,756,818 (range £1,847,387 to £5,092,788). On average, 750 (range 246 to 1,571) additional eligible stroke patients are required to be treated with MT yearly for the proposed 24/7 service extension to be affordable from a health economic perspective. Overall, the additional facility and equipment costs associated with the 24/7 extension would affect this estimate by 20%.ConclusionsThese findings support the ongoing debate regarding the optimal levels of MT treatment required for a 24/7 extension and respective changes in hospital organisational activities. They also highlight a need for a regional-level coordination between local authorities and hospital administrations to ensure equity provision in that stroke patients can benefit from MT and that the optimal MT treatment volume is reached. Future studies should contemplate reproducing the presented analysis for different health service provision settings and decision making contexts.

The Annual Cost of Cancer Screening in the United States.

Cancer has substantial health, quality-of-life, and economic impacts. Screening may decrease cancer mortality and treatment costs, but the cost of screening in the United States is unknown. To estimate the annual cost of initial cancer screening (that is, screening without follow-up costs) in the United States in 2021. Model using national health care survey and cost resources data. U.S. health care systems and institutions. People eligible for breast, cervical, colorectal, lung, and prostate cancer screening with available data. The number of people screened and associated health care system costs by insurance status in 2021 dollars. Total health care system costs for initial cancer screenings in the United States in 2021 were estimated at $43 billion. Approximately 88.3% of costs were attributable to private insurance; 8.5% to Medicare; and 3.2% to Medicaid, other government programs, and uninsured persons. Screening for colorectal cancer represented approximately 64% of the total cost; screening colonoscopy represented about 55% of the total. Facility costs (amounts paid to facilities where testing occurred) were major drivers of the total estimated costs of screening. All data on receipt of cancer screening are based on self-report from national health care surveys. Estimates do not include costs of follow-up for positive or abnormal screening results. Variations in costs based on geography and provider or health care organization are not fully captured. The $43 billion estimated annual cost for initial cancer screening in the United States in 2021 is less than the reported annual cost of cancer treatment in the United States in the first 12 months after diagnosis. Identification of cancer screening costs and their drivers is critical to help inform policy and develop programmatic priorities, particularly for enhancing access to recommended cancer screening services. None.

Methods for Estimating Costs for Stays at Inpatient Rehabilitation Facilities and Long-Term Care Hospitals

ObjectiveTo describe and compare 3 methods for estimating stay-level Medicare facility (Part A) costs using claims and cost report data for inpatient rehabilitation facilities (IRFs) and long-term care hospitals (LTCHs), the 2 hospital-based postacute care providers. DesignWe calculated stay-level facility costs using different methods. Method 1 used routine costs per day and ancillary cost-to-charge ratios. Method 2 used routine and ancillary cost-to-charge ratios (freestanding IRFs and LTCHs only). Method 3 used facility-specific operating cost-to-charge ratios from the Provider Specific File. For each method, we compared the costs with payments and charges at the claim and facility levels and examined facility margins. SettingData are from 1619 providers, including 266 freestanding IRFs, 909 IRF units, and 444 LTCHs. ParticipantsThe analyses included 239,284 claims from 2014, of which 86,118 claims were from freestanding IRFs, 92,799 claims were from IRF units, and 60,367 claims were from LTCHs. InterventionsNot applicable. Main Outcome MeasuresCosts and payments in 2014 United States Dollars. ResultsFor freestanding IRFs, the mean facility stay-level costs were calculated to be $13,610 (method 1), $13,575 (method 2), and $13,783 (method 3). For IRF units, the mean facility stay-level costs were $17,385 (method 1) and $19,093 (method 3). For LTCHs, the mean facility stay-level costs were $36,362 (method 1), $36,407 (method 2), and $37,056 (method 3). ConclusionsThe 3 methods resulted in small differences in facility mean stay-level costs. Using the facility-level cost-to-charge ratio (method 3) is the least resource-intensive method. Although more resource-intensive, using routine cost per day and ancillary cost-to-charge ratios (method 1) for cost calculations allows for differentiation in costs across patients based on differences in the mix of services used. As policymakers consider postacute care payment reforms, cost, rather than charge or payment data, needs to be calculated and the results of the methods compared.

Impact of Regional Surgeon Competition on Use, Cost, and Outcomes of Breast Reconstruction in the United States.

Breast reconstruction following mastectomy is underused in the United States. Evidence suggests that more competitive hospital markets offer increased access to procedural care across specialties. This study aims to determine the impact of regional plastic surgeon competition on use, outcomes, and cost of breast reconstruction following mastectomy for breast cancer. We conducted a retrospective cross-sectional analysis using Marketscan claims data from 2009 to 2020. The Herfindahl-Hirschman Index (HHI), a measure of market concentration, was calculated using the sum-of-squares of the proportion of breast reconstruction cases performed by each surgeon in a metropolitan statistical area (MSA). Multivariable logistic regression was used to identify differences in rates, outcomes, and costs of reconstruction by HHI. Odds of receiving breast reconstruction within two years of mastectomy were higher for those in moderately competitive (OR: 1.51 [95% CI: 1.37 to 1.66]; p<0.001) or competitive (OR: 1.71 [95% CI: 1.58 to 1.86]; p<0.001) = regions compared to noncompetitive regions. Patient out-of-pocket costs decreased when comparing moderately competitive regions to noncompetitive regions (-$67.38, [95% CI: -$88.65 to -$46.11]; p=0.007), and further decreased when comparing competitive to non-competitive regions (-$113.06, [95% CI: -$137.00 to -$89.12]; p=0.02). No linear association between total, surgeon, or facility cost and market competition strata was identified. Greater competition among surgeons is associated with improved access to reconstructive surgery, but no difference in cost. Application of this evidence may include system-level strategies to bolster care coordination, while targeting drivers of cost, such as hospitals and hospital systems, through policy.

Cost of Cholera for Households and Health Facilities, Somalia

IntroductionCholera remains a substantial public health challenge in Somalia. Ongoing droughts in the country have caused significant outbreaks which have negatively affected the lives of many individuals and overwhelmed health facilities. We aimed to estimate the costs associated with cholera cases for households and health facilities in Somalia.MethodsThis cost-of-illness study was conducted in five cholera treatment centres in Somalia and 400 patients treated in these facilities. Data collection took place during October and November 2023. Given that a significant portion of the patients were children, we interviewed their caregivers to gather cost data. We interviewed staff at the centres and the patients. The data obtained from the household questionnaire covered direct (medical and non-medical) and indirect (lost wages) costs, while direct costs were estimated for the health facility (personnel salaries, drugs and consumables used to treat a patient, and utility expenses). All costs were calculated in US dollars (USD), using 2023 as the base year for the estimation.ResultsThe average total cost of a cholera episode for a household was US$ 33.94 (2023 USD), with 50.4% (US$ 17.12) being direct costs and 49.6% (US$ 16.82) indirect costs. The average total cost for a health facility to treat an episode of cholera was US$ 82.65. The overall average cost to households and health facilities was US$ 116.59. The average length of stay for a patient was 3.08 days. In the households, patients aged 41 years and older incurred the highest mean total cost (US$ 73.90) while patients younger than 5 years had the lowest cost (US$ 21.02). Additionally, 61.8% of households had to use family savings to cover the cost of the cholera episode, while 14.5% had to borrow money. Most patients (71.8%) were younger than 16 years– 45.3% were 5 years or younger– and 94.0% had never received a cholera vaccine.ConclusionOur study suggests that preventing one cholera episode in Somalia could avert substantial losses for both the households and cholera treatment centres. The findings shed light on the expenses associated with cholera that extend beyond healthcare, including substantial direct and indirect costs borne by households. Preventing cholera cases could lead to a decrease in this economic burden, consequently our study supports the need for preventive measures.

Optimizing environmental costs and economic benefits in new energy vehicle production: A case study of FAW Hongqi in China

This study focuses on the environmental cost accounting and economic benefit optimization of China’s FAW Hongqi New Energy Vehicle manufacturing enterprise under uncertain conditions, within the context of the emission permit system This study calculates the pollution situation throughout the manufacturing and production process of FAW Hongqi new energy vehicles, and constructs a multi-level environmental cost evaluation system for FAW Hongqi new energy vehicle manufacturing projects. Through the interval fuzzy model of FAW Hongqi new energy vehicle manufacturing projects, the maximum economic benefits of the enterprise are simulated. The research results indicate that the pollution emissions of enterprises are mainly concentrated in the three processes of welding, painting, and final assembly. Enterprises use their own exhaust gas and wastewater treatment devices to meet the standards for pollution emissions. At the same time, solid waste generated during the automobile manufacturing process is handed over to third-party companies for treatment. Secondly, based on the accounting results of enterprise pollution source intensity and a multi-layer environmental cost evaluation system, the environmental costs of enterprises are accounted for, and the environmental costs are represented in interval form to reduce uncertainty in the accounting process. According to the accounting results of enterprise environmental costs, the main environmental costs of enterprises are environmental remediation costs caused by normal pollution discharge and purchase costs of environmental protection facilities. Pollutant emission taxes and routine environmental monitoring costs are relatively low. Enterprises can adopt more scientific solutions from the aspects of environmental remediation and environmental protection facilities to reduce environmental costs. After optimization by the fuzzy interval uncertainty optimization model, the economic benefits of the FAW Hongqi new energy vehicle manufacturing project were [101,254.71, 6278.5413] million yuan. Compared with the interval uncertainty optimization model, the lower bound of economic benefits increased by 57.68%, and the upper bound decreased by 12.08%, shortening the results of the economic benefits interval. Clarify the current environmental pollution situation of FAW Hongqi’s new energy vehicle manufacturing enterprise, provide data support for sustainable development of the enterprise, and provide reasonable decision-making space for enterprise decision-makers.

Process design and global sensitivity analysis of hydrogen fuel station with dual-operating modes for a sustainable H2 city: Iterative optimization-based simulation using generalized disjunctive programming

This study proposes a novel process involving dual-mode operation for an on-site hydrogen (H2) refueling station. In particular, two distinct H2 production technologies, steam methane reforming (SMR), and autothermal reforming (ATR), are simultaneously considered, which enables a flexible operational mode that responds to operational variability. By synergistically combining the technical advantages of these two technologies (i.e., the low cost of SMR and the short start-up and shut-down times of ATR), the proposed fuel station can reduce a H2 storage tank cost, which is needed to respond to demand fluctuations. To achieve our goal, we developed iterative optimization-based simulation (IOS) framework. The proposed framework determines the optimal design configuration (e.g., the storage facilities and the capacity of production) and the dual-mode operational strategy (e.g., on/off timing) under demand fluctuations and given CO2 emission targets. The case study showed that lower storage costs and offset the increased capital cost of the production facility, thereby leading to a low H2 supply cost of 3.60 USD/kg and a production capacity of 1.2 tons/day. We then performed a global sensitivity analysis to provide a comprehensive strategy and practices for the deployment of the proposed system over demand levels, regional demand fluctuation, and CO2 emission targets.

Trends in Medicare Costs of Hyperbaric Oxygen Therapy, 2013 through 2022

ABSTRACT Gelly H, Fife C, Walker D, Eckert K. Trends in Medicare Costs of Hyperbaric Oxygen Therapy, 2013 through 2022. Undersea Hyperb Med. 2024 Second Quarter; 51(2):137-144. Objective: To analyze Hyperbaric Oxygen Therapy Registry (HBOTR) data to estimate the Medicare costs of hyperbaric oxygen therapy (HBO2) based on standard treatment protocols and the annual mean number of treatments per patient reported by the registry. Methods: We performed a secondary analysis of deidentified data for all payers from 53 centers registered in the HBOTR from 2013 to 2022. We estimated the mean annual per-patient costs of HBO2 based on Medicare (outpatient facility + physician) reimbursement fees adjusted to 2022 inflation using the Medicare Economic Index. Costs were calculated for the annual average number of treatments patients received each year and for a standard 40-treatment series. We estimated the 2022 costs of standard treatment protocols for HBO2 indications treated in the outpatient setting. Results: Generally, all costs decreased from 2013 to 2022. The facility cost per patient per 40 HBO2 treatments decreased by 10.7% from $21,568.58 in 2013 to $19,488.00 in 2022. The physician cost per patient per 40 treatments substantially decreased by -37.8%, from $5,993.16 to $4,346.40. The total cost per patient per 40 treatments decreased by 15.6% from $27,561.74 to $23,834.40. In 2022, a single HBO2 session cost $595.86. For different indications, estimated costs ranged from $2,383.4-$8,342.04 for crush injuries to $17,875.80-$35,751.60 for diabetic foot ulcers and delayed radiation injuries. Conclusions: This real-world analysis of registry data demonstrates that the actual cost of HBO2 is not nearly as costly as the literature has insinuated, and the per-patient cost to Medicare is decreasing, largely due to decreased physician costs.