Generate Cost Savings Research Articles

Cost-effectiveness of different strategies for screening and treatment of Strongyloides stercoralis in migrants from endemic countries to the European Union

BackgroundThe best strategy for controlling morbidity due to imported strongyloidiasis in migrants is unclear. We evaluate the cost-effectiveness of six possible interventions.MethodsWe developed a stochastic Markov chain model. The target...

Development and Integration of RFID Simulation Based Tool for Improved Schedule Performance in Saudi Arabia Precast Concrete Industry

A construction project is measured as a process that encompasses numerous activities and a huge amount of information of numerous types that are related to each other. Effective project management entails controlling all aspects of a construction project: quality and quantity of work, costs, and schedules to guarantee the accomplishment of the project. The construction industry in the kingdom of Saudi Arabia is implementing off-site construction with precast cement, for its higher quality, short cycle time, and negligible environmental influence. Amongst the various off-site construction approaches, such construction follows a manufacturing method where houses are built in smaller panels in an assembly line. Owing to the complex and exclusive nature of the home building process, prevailing manufacturing concepts such as automated production planning and control system are not applicable to the panelized home production facility. This research aims in the development and integration of radio frequency identification (RFID) technology to for production planning and control system, resulting in improved schedule performance, in Saudi Arabia precast concrete industry. Radio frequency identification is appropriate to numerous construction applications and generates cost savings via increased speed and accuracy of data entry. The study provides a set of helpful protocols for the deployment of passive RFIDs for automated on factory management of precast concrete operations. Further it aims at paving the way for managing the site for the sake of attaining the desired goals considering the guarantee of achieving high quality and quick conveyance to the related sites which, hence, prompts auspicious conveyance of development ventures. The study is beneficial for the construction professionals to assess the prevailing construction quality perception and the expectations from implementation of any quality improvement technique in construction projects.

Pharmaceutical actuation in intensive care units: contributions to rational use of drugs

Objective: Evaluate the performance of the clinical pharmacist in Adult Intensive Care Units of a special-sized hospital, wherein pharmacotherapeutic follow-up is the main activity developed by the pharmacist residing in intensive care. Methods: This is an observational, cross-sectional study with a quantitative approach, carried out in Adult Intensive Care Units, from March to June 2018. Data were collected from the Clinical Pharmacy Service, by means of already established indicators. Results: During the study period, 958 patients were admitted and 664 were included in the study. Regarding the place of hospitalization, 57% of the patients included in the study were hospitalized in the Post-operative Intensive Care Unit and 43% in the Clinical Intensive Care Unit. The suggested interventions were well accepted (99.6%), and in the clinical intensive care unit, the number of interventions performed and the cost saving were higher in all months of the study. The main interventions were drugs inclusion / withdrawal, dose reduction, infusion time and dilution. Of the interventions accepted, 25% generated cost savings, saving R $ 163,656.40 in total, and the types of interventions related to the most frequent cost saving were withdrawal of the drug (58.5%), dose reduction (32.6%) and change of pharmaceutical formula (3.0%). Conclusion: The performance of the clinical pharmacist in intensive care units was well accepted by the medical team. The various possibilities of interventions contribute to rational use of drugs and, in addition, some of these pharmaceutical interventions have a direct impact on cost savings.

Use of the Aptima mRNA high-risk human papillomavirus (HR-HPV) assay compared to a DNA HR-HPV assay in the English cervical screening programme: a decision tree model based economic evaluation

ObjectiveTo estimate the impact of using the Aptima messenger RNA (mRNA) high-risk human papilloma virus (HR-HPV) assay versus a DNA HR-HPV assay in a primary HPV cervical screening programme.DesignOne hypothetical...

Development of an IoT-Driven Building Environment for Prediction of Electric Energy Consumption

This article demonstrates the importance of integrating the Internet-of-Things (IoT) devices and technologies for efficient energy management in a building environment. An Elman recurrent neural network (RNN) model and an exponential model are developed for electric energy consumption prediction in an IoT-driven building environment. The models predict electric energy consumption by electric loads in the near future by: 1) recognizing the existence of a relationship between the net electric energy consumption of the building’s electric loads and the ambient temperature along with the occupancy state of the building and 2) employing the detected relationship to predict electric energy consumption using the forecasted temperature and the scheduled occupancy state. The building environment under consideration is the Real-Time Power and Intelligent Systems (RTPIS) laboratory integrated with intelligent monitoring and control capabilities using IoT devices and technologies. The electric loads under consideration include heating, ventilation, and air conditioning (HVAC) units and light panels. The developed Elman RNN and exponential models are also compared. These prediction capabilities are beneficial in overcoming variabilities in electric energy consumption by supplying electric energy as needed to meet the demands of the electric loads, thereby minimizing wasted electric energy, reducing carbon emissions, and generating cost savings.

Telemedicine, Cost Effectiveness, and Patients Satisfaction: A Systematic Review

Background: Telemedicine has been practiced since 1960. The objective of telemedicine was to establish feasible interactive telecommunication for medical diagnosis and treatment of patients at remote sites. Nowadays, with healthcare costs on the rise, telemedicine is increasing­ly being seen as a strategy for healthcare organizations to make cost-saving. This study aimed to explore the opportunity of telemedicine utilization in cost savings to patients and the health care system. Subjects and Method : A systematic review was conducted by searching the published articles from Pubmed, MEDLINE, EMBASE, CINAHL, and Science Direct databases. Keywords for this study were “telemedicine” AND “patient saticfaction”, “telemedicine” AND “cost-utility and cost-effective­ness”, “tele­medicine” AND “systematic review”, and “telemedicine” AND “meta analysis” . The data were analyzed by PRISMA flow diagram. Results: 8 articles were selected for this study. These studies reported that telemedicine utiliza­tion in dermatology, radiology, pediatrics, and intensive care unit (ICU) rooms reduced health cost by 56% and patients travel cost to health care by 94%. Telemedicine advantages for patients were reduced transportation time or cost, eliminated time off of work, on-demand option, and reduced time in the waiting room, so that it can increase patient’s satisfaction. A study reported that telemedicine utilization at the pediatrics department increased hospital’s revenue by USD 101,744 per year. Conclusion: Telemedicine is an alternative health care to generate cost savings for patient and hospital and it can increase patient’s satisfaction. Keywords: Telemedicine, cost effectiveness, patient satisfaction Correspondence: Joko Tri Atmojo. School of Health Sciences Mamba'ul 'Ulum, Surakarta, Jl. Ring Road Utara, Tawangsari, Mojosongo, Jebres, Surakarta, Central Java. Email: jokotriatmojo1@gmail.com. Mobile: 08139331900 Journal of Health Policy and Management (2020), 5(2): 103-107 https://doi.org/10.26911/thejhpm.2020.05.02.02

零碳之路: “十四五”开启中国 绿色发展新篇章

As the world’s largest emitter of greenhouse gases, China has a crucial role to play in tackling the climate crisis. Fortunately, China is signaling that it is taking this challenge seriously with President Xi Jinping’s recent announcement that China aims to peak its emissions before 2030 and reach carbon neutrality before 2060. New analysis by WRI finds that China can peak its carbon emissions as early as 2026 and get on track to achieving President Xi’s vision for carbon neutrality while generating nearly $1 trillion in net economic and social benefits in 2050. To realize this vision, China must focus on four key priorities during the next five years: transitioning to cleaner sources of electricity; improving industrial energy efficiency; electrifying the transportation sector; and accelerating the removal of carbon dioxide from the atmosphere using carbon capture methods. Scaling up plans to curb non-CO2 greenhouse gases are also necessary, as are efforts to phase out coal power. Strengthened climate policies will also reduce particulate emissions, which could improve air quality and help prevent the premature deaths of up to 1.89 million people by 2050—a benefit of $240 billion in avoided health impacts. Over 30 years, China can also expect to generate cost savings of $530 billion in fuel, operation, and maintenance expenditures and avoid $445 billion in climate damages. Three economically advanced regions—the Yangtze River Delta Region, Guangdong-Hong Kong-Macau Greater Bay Area, and Beijing-Tianjin-Hebei Area—can lead the way to achieving China’s 2030 peaking and 2060 net-zero climate goals early while generating millions of new jobs in the process.

PRO18 BUDGET IMPACT ANALYSIS OF DAMOCTOCOG ALFA PEGOL IN SEVERE HEMOPHILIA A IN GREECE

To estimate the impact on the Greek public payer budget from the use of damoctocog alfa pegol (DaPeg), an extended half-life recombinant factor VIII, for prophylactic and on-demand (OD)-treatment of patients ≥12 years with severe haemophilia A (HemA) having received previous treatment in Greece. A 5-year budget impact model (BIM) was adapted with local data. The BIM compares a market scenario where a proportion of HemA patients receives DaPeg to an alternative market scenario where DaPeg is not available and patients are treated with available comparators, namely efmoroctocog-alfa, turoctocog-alfa, moroctocog-alfa and octocog-alfa (rAHF-PFM, BAY 81-8973). Epidemiologic data were derived by combining data from three Greek hemophilia centers and the World Hemophilia Federation (2017). Assuming equivalent efficacy (bleeding rates) across all comparators, clinical outcomes were not modelled. Current and future market shares for prophylaxis and OD-treatment were provided by the manufacturer. Only treatment costs were considered for prophylaxis and OD-treatment (€, 2019) with the doses obtained from the SPC and clinical trials, respectively. The difference between the total costs in each market scenario was the net budget impact. For a total of 231 patients with severe HemA, the introduction of DaPeg with a market share ranging from 5% to 27% in prophylaxis and 3% to 9% in OD-treatment from year 1 to 5, respectively, results in cost savings compared to the world without DaPeg. The budget saving magnitude increases with each successive year of the model horizon, driven by the lower annual per-patient costs of DaPeg. The cost savings increase from €99,510 in year 1 to €833,567 in year 5. The cumulative cost-savings over the modelled period exceed €2.5million. The introduction of DaPeg into the Greek market of severe HemA results in a negative budget impact, generating cost savings for the public payer in the first 5 years of its use.

PUK12 ANALYSIS OF COST AND CONSEQUENCES RELATED TO THE PERSISTENCE OF MIRABEGRON AND ANTIMUSCARINIC TREATMENTS AND THEIR IMPACT ON QUALITY OF LIFE IN PATIENTS AGED ≥ 65 YEARS WITH OVERACTIVE BLADDER IN SPAIN

To evaluate whether a difference in treatment dropout rate with mirabegron in overactive bladder (OAB) patients aged ≥ 65 years could generate cost savings to the National Health System (NHS) and gain quality-adjusted life years (QALYs), compared with the most commonly prescribed antimuscarinics (AM) in Spain (tolterodine, fesoterodine, oxybutynin, solifenacin). A probabilistic model (second order Monte Carlo simulation) in a hypothetical cohort of 1,000 patients aged ≥ 65 years with OAB and a time horizon of 1 year was carried out. Persistence rates, defining treatment discontinuation after a period of at least 30 days without prescription renewal, for both mirabegron and AM were obtained from a Spanish observational study in 1,149 patients ≥ 65 years-old. Unit costs (€ 2019) and utility loss associated to treatment discontinuation were obtained from Spanish public prices and literature, respectively. Persistence rates were higher in patients aged ≥ 65 years treated with mirabegron (20.2%) versus AM (10.2%), leading to a QALY gain of 0.0192 ± 0.0027 QALYs per year. Treatment with mirabegron could generate savings of 68.32 ± 12.19 € per patient per year compared to AM, with a 100% probability of saving (in all patients in the cohort). For the discontinuation criteria at 45, 60 and 90 days, the gain of QALYs with mirabegron versus AM would be 0.0227 ± 0.0058, 0.0225 ± 0.0072 and 0.0230 ± 0.0099, respectively. Saving per patient/year would be 80.75 ± 40.14 €, 78.74 ± 56.23 € and 78.19 ± 83.35 €, respectively. The result was stable for all univariate deterministic sensitivity analyzes. The probabilistic model presented showed a greater persistence in patients aged ≥ 65 years treated with mirabegron compared to AM, leading to a positive impact in OAB patients' quality of life, as well cost savings to the NHS in Spain.

1232. Potential Health and Cost Outcomes of Optimized Statistical Process Control Use for Surgical Site Infection Surveillance

BackgroundSurgical site infections (SSIs) are common (160,000–300,000 per year in the United States) and costly ($6,000–$25,500 per event) healthcare-associated infections with potentially lethal outcomes (2.1%–6.7% mortality rate). A prior analysis by our group suggested that statistical process control (SPC) can detect SSI outbreaks earlier than traditional epidemiological surveillance methods. This study aimed to quantify the potential impact of SPC surveillance on patient outcomes (prevented SSIs and deaths) and healthcare costs.MethodsWe retrospectively analyzed 30 SSI outbreaks occurring over a period of 8 years in a network of 50 community hospitals from the Southeastern United States. We applied 24 control chart variations, including 2 optimized for SSI surveillance, 6 with expert-defined pre-outbreak baselines (used in our pilot study), 4 with lagged rolling baselines (idem), and 12 common practice ones (using rolling baselines with no lag or fixed baselines). The charts used procedure-specific data from either the outbreak hospital or the entire network to compute baseline SSI rates. We calculated the average SSI rates during, before and after the outbreaks, and the months elapsed between SPC and traditional detection. We then used these values to estimate the number of SSIs that could have been prevented by SPC, and corresponding deaths avoided and cost savings (Figure 1).ResultsOptimized charts detected 96% of the outbreaks earlier than traditional surveillance, while pilot study and common practice charts did so only 65% (58%) of the time (Figure 2). Optimized charts could potentially prevent 15.2 SSIs, 0.64 deaths, and save $226,000 in excess care costs per outbreak. Overall, charts using network baselines performed better than those relying on local hospital data. Commonly used variations were the least effective, but were still able to improve on traditional surveillance (Figure 3).ConclusionSPC methods provide a great opportunity to prevent infections and deaths and generate cost savings, ultimately improving patient safety and care quality. While common practice SPC charts can also speed up outbreak detection, optimized SPC methods have a significantly higher potential to prevent SSIs and reduce healthcare costs. Disclosures All authors: No reported disclosures.

Economic evaluation of passive monitoring technology for seniors

BackgroundAdvances such as passive monitoring technology (PMT), which provides holistic supervision of chronically ill and elderly patients, enable and support improved monitoring and observation, thus empowering the growing population of older adults to live more independently while lowering health care expenses.AimsThis study develops a conceptual model to estimate the potential savings associated with PMT.MethodsWe first develop a conceptual model to identify the main cost variables associated with independent living, focusing on three pathways: (1) PMT, (2) independent living supported by the current standard of care, and (3) facility-based care. We examined the impact on three outcomes [i.e., health care costs, institutional costs, and health-related quality of life (HRQoL)] along each of the three care pathways (i.e., PMT, independent living supported by the standard of care, and facility-based care) and developed a cost-benefit model to calculate the net costs and benefits associated with each care pathway.ResultsThe cost–benefit model showed savings between approximately $425 per-member per-month (PMPM) for those using PMT compared to those on the standard of care pathway. Sensitivity analysis demonstrated that a 5% increase in nursing home utilization generates cost savings of more than 30% PMPM.DiscussionThe total projected cost savings for individuals on the PMT arm are projected to be more than $425 PMPM, with annual savings of $5069 per-person per-year, and over $5.1 million for a target population of 1000 individuals.ConclusionsThe cost calculations in our cost–benefit simulation model clearly demonstrate the value of PMT and show the potential value to payers and integrated delivery systems in offering PMT to individuals who are likely to benefit the most from the services.

The cost of improving nutritional outcomes through food-assisted maternal and child health and nutrition programmes in Burundi and Guatemala.

Evidence on the cost‐effectiveness of multisectoral maternal and child health and nutrition programmes is scarce. We conducted a prospective costing study of two food‐assisted maternal and child health and nutrition programmes targeted to pregnant women and children during the first 1,000 days (pregnancy to 2 years). Each was paired with a cluster‐randomized controlled trial to evaluate impact and compare the optimal quantity and composition of food rations (Guatemala, five treatment arms) and their optimal timing and duration (Burundi, three treatment arms). We calculated the total and per beneficiary cost, conducted cost consequence analyses, and estimated the cost savings from extending the programme for 2 years. In Guatemala, the programme model with the lowest cost per percentage point reduction in stunting provided the full‐size family ration with an individual ration of corn–soy blend or micronutrient powder. Reducing family ration size lowered costs but failed to reduce stunting. In Burundi, providing food assistance for the full 1,000 days led to the lowest cost per percentage point reduction in stunting. Reducing the duration of ration eligibility reduced per beneficiary costs but was less effective. A 2‐year extension could have saved 11% per beneficiary in Guatemala and 18% in Burundi. We found that investments in multisectoral nutrition programmes do not scale linearly. Programmes providing smaller rations or rations for shorter durations, although less expensive per beneficiary, may not provide the necessary dose to improve (biological) outcomes. Lastly, delivering effective programmes for longer periods can generate cost savings by dispersing start‐up costs and lengthening peak operating capacity.

Does the addition of steroid to peripheral nerve blocks improve the perioperative experience for children and families undergoing orthopedic surgical procedures: Is it possible to have quality care and generate cost savings?

Does the addition of steroid to peripheral nerve blocks improve the perioperative experience for children and families undergoing orthopedic surgical procedures: Is it possible to have quality care and generate cost savings?

Reducing Hospitalizations and Costs: A Home Health Nutrition-Focused Quality Improvement Program.

BackgroundIdentification and treatment of malnutrition across the care continuum can help prevent illness onset or relapse and maximize the effectiveness of other medical treatments. This study aimed to evaluate the effect of a nutrition‐focused quality improvement program (QIP) conducted in a home health agency (HHA) on hospitalization rates and healthcare costs incurred over 90 days.MethodsThis was a multisite, pre‐post QIP implemented at 2 branches of an Illinois‐based HHA. The QIP included 1546 patients who were (1) at‐risk or malnourished hospitalized patients discharged to the HHA, (2) referred by a physician during an outpatient visit, or (3) enrolled in the HHA through a skilled nursing facility. A historic (n = 7413 patients) and concurrent group (n = 5235) of patients were used for comparisons. Propensity score matching was used to account for imbalances in patient characteristics.ResultsThe QIP led to reduced relative risk of hospitalization post‐enrollment to the QIP by 24.3%, 22.8%, and 18.3% at 30, 60, and 90 days, respectively, when compared with the historic group, and by 18.2%, 16.2%, and 12.1% when compared with the concurrent group. Total cost savings from reduced 90‐day healthcare resource utilization was $2,318,894, or $1500 per patient treated.ConclusionsRates of hospitalization and healthcare resources can be significantly reduced through the implementation of a nutrition‐focused QIP delivering oral nutritional supplements in home health settings for adults at‐risk/malnourished. These results highlight the importance of nutrition as a strategy for HHAs and other post‐acute care institutions to improve patients' health outcomes and generate cost savings.

The simplification of the diagnosis process of chronic hepatitis C is cost-effective strategy

BackgroundThe cascade of care of the hepatitis C are complex. The diagnosis of active infection in the same serum sample would simplify the process establishing a rapid access for patients to treatment. Our objective was to estimate the impact on healthcare and economic outcomes of the diagnosis of chronic infection in one-step diagnosis compared to standard diagnosis in Andalusia (8.39 million people). MethodsA decision tree was developed to estimate the referral of patients with chronic infection, loss of follow-up, access to treatment and costs of the diagnosis of the infection, for both processes. The unit costs (€, 2018) of the health resources (medical visits, antibodies, viral load and genotype), without considering the pharmacological cost, were obtained from public sources in Andalusia. ResultsOf the total estimated population (269,526 patients), 1389 patients would be referred to the specialised care in the one-step diagnosis and 1063 in de standard diagnosis, being treated 1320 and 1009, respectively. In one-step diagnosis, no negative viral loud patient would be referred to specialist versus 540 with standard diagnosis. One-step diagnosis would generate a cost saving of €184,928 versus standard diagnosis (€15,671,493 vs €15,856,421). When compared one-step diagnosis to standard diagnosis, the savings per patient with positive viral load referred to specialist would be €3634 (€11,279 vs €14,923). ConclusionThe one-step diagnosis will achieve an increase in diagnosed patients, will increase the access of chronic patient to treatment and will generate cost savings, demonstrating its efficiency in the system in Andalusia.

La simplificación del proceso de diagnóstico de la hepatitis C crónica es una estrategia coste-efectiva

BackgroundThe cascade of care of the hepatitisC are complex. The diagnosis of active infection in the same serum sample would simplify the process establishing a rapid access for patients to treatment. Our objective was to estimate the impact on healthcare and economic outcomes of the diagnosis of chronic infection in one-step diagnosis compared to standard diagnosis in Andalusia (8.39 million people). MethodsA decision tree was developed to estimate the referral of patients with chronic infection, loss of follow-up, access to treatment and costs of the diagnosis of the infection, for both processes. The unit costs (€, 2018) of the health resources (medical visits, antibodies, viral load and genotype), without considering the pharmacological cost, were obtained form public sources in Andalusia. ResultsOf the total estimated population (269,526 patients), 1,389 patients would be referred to the specialised care in the one-step diagnosis and 1,063 in de standard diagnosis, being treated 1,320 and 1,009, respectively. In one-step diagnosis, no negative viral loud patient would be referred to specialist versus 540 with standard diagnosis. One-step diagnosis would generate a cost saving of €184,928 versus standard diagnosis (€15,671,493 vs €15,856,421). When compared one-step diagnosis to standard diagnosis, the savings per patient with positive viral load referred to specialist would be €3,634 (€11,279 vs €14,923). ConclusionThe one-step diagnosis will achieve an increase in diagnosed patients, will increase the access of chronic patient to treatment and will generate cost savings, demonstrating its efficiency in the system in Andalusia.

Evaluation of Albumin 25% Use in Critically Ill Patients at a Tertiary Care Medical Center.

Background: Albumin 25% has been studied and has demonstrated benefit in a limited number of patient populations. The use of albumin 25% is associated with higher costs compared with crystalloid therapy. The aim of this study was to describe the prescribing practices of albumin 25% at a tertiary-care medical center and identify opportunities for restriction criteria related to its use to help generate cost savings. Methods: This evaluation was a retrospective, noninterventional, descriptive study of albumin 25% use between June 2015 and February 2016. Inclusion criteria consisted of patients ≥18 years old and who received at least one dose of albumin 25% while admitted to a Cleveland Clinic main campus intensive care unit (ICU). Inclusion was restricted to 150 randomly selected patients. Results: A total of 539 albumin 25% orders were placed for the 150 included patients. The cardiovascular ICU more frequently prescribed albumin 25% compared with the medical, surgical, neurosciences, and coronary ICUs (51% vs 23% vs 11% vs 9% vs 6%, respectively). Although the cardiovascular surgery ICU most frequently prescribed albumin 25% compared with other ICUs, the medical ICU prescribed a larger total quantity of albumin 25% compared with the cardiovascular, surgical, neurosciences, and coronary ICUs (8705 g vs 7275 g vs 3205 g vs 2162 g vs 625 g, respectively). The majority of patients (61%) did not have an indication listed for albumin 25% use and only 9% of patients were prescribed for indications supported by primary literature. Of the patients prescribed albumin for other indications not supported by primary literature (30%), the most common reasons for albumin 25% were hypotension, acute kidney injury, and volume resuscitation. The median cost per patient of albumin 25% was $417 with a total cost of $122 164 for the cohort. Only 19% of the total cost aligned with dosing regimens evaluated in primary literature. Conclusion: Prescribing patterns of albumin 25% at a tertiary academic medical center do not align with indications supported by primary literature. These findings identified a major opportunity for prescriber education and implementation of restriction criteria to target cost savings.

Predictive rule-based control to activate the energy flexibility of Norwegian residential buildings: Case of an air-source heat pump and direct electric heating

The building energy flexibility potential of a Norwegian single-family detached house is investigated using predictive rule-based control (PRBC) and building performance simulation (using IDA ICE). Norwegian timber buildings are lightweight and four different insulation levels are considered. Both on-off and modulating air-source heat pumps are analyzed and compared to direct electric heating which is the most common heating system for Norwegian residential buildings. A detailed model for both the heat pump system and the building is implemented, a level of detail not found in previous research on building energy flexibility. The three PRBC investigated have the following objectives: reduce energy costs for heating, reduce annual CO2eq. emissions and reduce energy use for heating during peak hours. This last objective is probably the most strategic in the Norwegian context where cheap electricity is mainly produced by hydropower. The results show that the price-based control does not generate cost savings because lower electricity prices are outweighed by the increase in electricity use for heating. The implemented price-based control would create cost savings in electricity markets with higher daily fluctuations in electricity prices, such as Denmark. For the same reasons, the carbon-based control cannot reduce the yearly CO2eq. emissions due to limited daily fluctuations in the average CO2eq. intensity of the Norwegian electricity mix. On the contrary, the PRBC that reduces the energy use for heating during peak hours turns out to be very efficient, especially for direct electric heating. For air-source heat pumps, the control of the heat pump system is complex and reduces the performance of the three PRBC. Therefore, results suggest that a heat pump system should be modeled with enough detail for a proper assessment of the building energy flexibility. First, by varying temperature set-points there is a clear interaction between the prioritization of domestic hot water and the control of auxiliary heaters which increases energy use significantly. Second, the hysteresis of the heat pump control and the minimum cycle duration prevent the heat pump from stopping immediately after the PRBC requires it. Finally, the paper shows that the influence of thermal zoning, investigated here by cold bedrooms with closed doors, has a limited impact on the building energy flexibility potential and the risk of opening bedroom windows.

The economic impact of biosimilars in Italy: a scenario analysis

Background: the first generation of biotechnology drugs is reaching, or has already reached, the patent expiry and a large number of biosimilars is entering the Italian pharmaceutical market. The objective of the analysis was to evaluate the economic impacts of biosimilars on the national health expenditure in Italy between 2014 and 2020. Methods: Based on the information deriving from consumption per standard unit and equivalent patients, it was estimated monthly expenditure for some of the biological drugs currently available in Italy that have had or will have a patent expiry within the analysis period (infliximab, etanercept, adalimumab, insulin glargine, trastuzumab, rituximab, bevacizumab and insulin aspart). Pharmaceutical expenditure was calculated on hospital sales prices net of transparent discounts required by law and visible from the AIFA database. Three alternative scenarios have been developed based on the perceptions of a board of clinical experts, pharmacologists and pharmacoeconomists involved in the study. The experts involved analyzed the estimates of treated patients between 2014 and 2017 and reports their hypothetical biosimilar penetration during the period 2018-2020. The results were represented as the difference between the estimated expenditure in the absence of biosimilars and the estimated expenditure in the presence of biosimilars with the real or hypothetical biosimilar penetration. Results: considering the standard units dispensed for each year, the economic model estimate an annual expenditure in 2014 equal to € 1.47 billion for the molecules considered in the analysis. These estimates rise to € 1.54, € 1.50 billion and € 1.51 billion during 2015, 2016 and 2017 in the scenario without biosimilar introduction. Biosimilar introduction generates cost savings between € 3.8 million in 2015 and € 32.9 million in 2017 if compared with the scenario without. Assuming an increasing biosimilar penetration between 2018 and 2020, scenario analysis estimates a cumulative cost reduction equal to € 597 million. Conclusions: Overall, biosimilar penetration generates important cost reduction that could be re-invested in the National Health Sistem.

Effects of mixed provider payment systems and aligned cost sharing practices on expenditure growth management, efficiency, and equity: a structured review of the literature

BackgroundStrategic purchasing of health care services has become a key policy measure on the path to achieving universal health coverage. National provider payment systems for health services are typically characterized by mixes of provider payment methods with each method associated with distinct incentives for provider behaviours. Reaching incentive alignment across methods is critical to enhancing the effectiveness of strategic purchasing.MethodsA structured literature review was conducted to synthesize the evidence on how purposively aligned mixed provider payment systems affect health expenditure growth management, efficiency, and equity in access to services with a particular focus on coordinated and/or integrated care management.ResultsThe majority of the 37 reviewed articles focused on high-income countries with 74% from the US. Four categories of payment mixes were examined in this review: blended payment, bundled payment, cost-containment reward models, and aligned cost sharing mechanisms. Blended payment models generally reported moderate to no substantive reductions in expenditure growth, but increases in health system efficiency. Bundled payment schemes consistently report increases in efficiency and corresponding cost savings. Cost-containment rewards generated cost savings that can contribute to effective management of health expenditure growth. Evidence on aligned cost-sharing is scarce.ConclusionThere is lacking evidence on when and how mixed provider payment systems and cost sharing practices align towards achieving goals. A guiding framework for how to study and evaluate mixed provider payment systems across contexts is warranted. Future research should consider a conceptual framework explicitly acknowledging the complex nature of mixed provider payment systems.