Health Care Cost Savings Research Articles

THE CRITICAL CONNECTION BETWEEN ORAL HEALTH AND CARDIOVASCULAR WELL-BEING

The relationship between oral health and cardiovascular health has gained significant attention, particularly regarding the prevention of periodontal diseases to mitigate cardiovascular complications, especially in hypertensive patients. Periodontal diseases, including gingivitis and periodontitis, are chronic infections affecting the gums and supporting structures of teeth, potentially leading to systemic inflammation and the release of inflammatory mediators into the bloodstream. This chronic inflammation is associated with cardiovascular diseases, as it can contribute to plaque formation in arteries, increasing the risk of adverse cardiac events. Hypertension is a notable risk factor for cardiovascular diseases, and studies suggest that individuals with periodontal diseases are more likely to develop hypertension and related conditions. Therefore, proper prevention and treatment of periodontal diseases play a crucial role in the cardiovascular health of hypertensive patients. Early detection and intervention through periodontal screening programs can help reduce systemic inflammation and healthcare costs related to cardiovascular complications. Various studies support the positive effects of periodontal therapy on cardiovascular risk factors, indicating significant reductions in blood pressure and inflammatory markers following periodontal treatment. Furthermore, the alarming prevalence of hypertension, affecting approximately 45% of the global population, necessitates increased awareness of its links to periodontal health. Collaborative approaches between dentists and primary care physicians are essential to improve early detection and management of both periodontal and systemic health issues. Investing in preventive dental care not only enhances oral health but can also lead to substantial savings in healthcare costs by alleviating the financial burden associated with treating cardiovascular diseases. Ultimately, integrating oral health into broader health strategies is vital for promoting overall health and preventing chronic diseases.

Policy predictive model for better management of chronic obstructive pulmonary disease: economic-organisational implications in the Italian healthcare system

Background: Chronic obstructive pulmonary disease (COPD) represents a significant public health problem in Italy, with a high prevalence and a substantial economic burden on the National Health Service (NHS). Effective management of the disease is crucial for reducing exacerbations and improving patients’ quality of life. Methods: This study employs a dynamic predictive model to assess the economic impact of implementing three specific health policies aimed at improving COPD management over a five-year horizon. The analysis is conducted from the perspective of the NHS, focusing on the direct costs associated with disease management. Results: The implementation of the proposed policies demonstrated potential significant savings in direct healthcare costs. The first policy, focused on increasing therapeutic adherence, generated an estimated savings of 202 million €. The second, concerning the wider use of triple therapies, led to savings of about 142 million €. Finally, the third policy, aimed at reducing the delay in prescribing appropriate therapies, contributed to an additional saving of over 175 million € in the time horizon considered in the analysis. Overall, these results suggest a substantial improvement opportunity in COPD management, with significant economic benefits for the Italian NHS. Conclusion: The study confirms the importance of targeted policies in the management of COPD, highlighting how strategic interventions can lead to significant resource savings while simultaneously improving patient care. These results provide a solid foundation for further research and serve as a useful guide for decision-makers in planning effective intervention strategies, aimed at optimizing resources and enhancing disease management in the Italian healthcare context.

Health impacts of takeaway management zones around schools in six different local authorities across England: a public health modelling study using PRIMEtime.

In England, the number of takeaway food outlets ('takeaways') has been increasing for over two decades. Takeaway management zones around schools are an effective way to restrict the growth of new takeaways but their impacts on population health have not been estimated. To model the impact of takeaway management zones on health, we used estimates of change in and exposure to takeaways (across home, work, and commuting buffers) based on a previous evaluation suggesting that 50% of new outlets were prevented from opening because of management zones. Based on previous cross-sectional findings, we estimated changes in body mass index (BMI) from changes in takeaway exposure, from 2018 to 2040. We used PRIMEtime, a proportional multistate lifetable model, and BMI change to estimate the impact of the intervention, in a closed-cohort of adults (25-64years), on incidence of 12 non-communicable diseases, obesity prevalence, quality-adjusted life years (QALYs), and healthcare costs saved by 2040 in six local authorities (LAs) across the rural-urban spectrum in England (Wandsworth, Manchester, Blackburn with Darwen, Sheffield, North Somerset, and Fenland). By 2031, compared to no intervention, reductions in outlet exposure ranged from 3 outlets/person in Fenland to 28 outlets/person in Manchester. This corresponded to mean per person reductions in BMI of 0.08 and 0.68kg/m2, respectively. Relative to no intervention, obesity prevalence was estimated to be reduced in both sexes in all LAs, including by 2.3 percentage points (PP) (95% uncertainty interval:2.9PP, 1.7PP) to 1.5PP (95%UI:1.9PP, 1.1PP) in males living in Manchester and Wandsworth by 2040, respectively. Model estimates showed reductions in incidence of disease, including type II diabetes (e.g. 964 (95% UI: 1565, 870) fewer cases/100,000 population for males in Manchester)), cardiovascular diseases, asthma, certain cancers, and low back pain. Savings in healthcare costs (millions) ranged from £1.65 (95% UI: £1.17, £2.25)/100,000 population in North Somerset to £2.02 (95% UI: £1.39, £2.83)/100,000 population in Wandsworth. Gains in QALYs/100,000 person were broadly similar across LAs. Takeaway management zones in England have the potential to meaningfully contribute towards reducing obesity prevalence and associated healthcare burden in the adult population, at the local level and across the rural-urban spectrum.

Abstract 4134796: Safety of over 1000 consecutive, selected low risk patients with accelerated discharge from a chest pain unit with early generation cardiac troponin use, no cardiac functional or anatomic testing and no clinical risk scores

Introduction: Over 6 million patients (pts) present to US emergency departments annually with chest pain (CP), of which the majority are found to have no serious disease. Evaluation of these pts results in substantial costs for unnecessary hospitalization and extensive testing. We evaluated the utility of early discharge of selected low-risk (LR) CP pts from a chest pain unit (CPU) in which no predischarge testing or risk scores were used. Methods: This retrospective study analyzed 1,037 consecutive LR CP pts from a prospectively recorded database. LR was based on normal examination, stable hemodynamics, normal electrocardiograms (ECG), and negative cardiac troponin I, without pre-discharge functional or anatomic cardiac testing or risk scores. We assessed demographics, comorbidities, medications, and major cardiac events at 30 d and 6 mos post-discharge. Results: The study group of 1037 pts comprised 26% of the 4010 pts admitted to the CPU during the study interval from May 2005 to March 2015. Mean patient age was 55 yrs, 56% (n=575) were women, and comorbid conditions were frequent: hypertension (64.1%), dyslipidemia (46.1%), diabetes (25.7%), documented coronary artery disease (19.3%), previous revascularization (20.6%), previous myocardial infarction (10.1%). Length of stay (LOS) in the CPU to discharge was 10.4 hrs. Women received more discharge cardiac medications than men: antiplatelet agents, statins, beta blockers, ACE inhibitors, angiotensin II blockers, calcium channel blockers, and nitrates (p=0.0002 - 0.04). Follow-up (F/U) at 30 d was 91% (n=948) complete and revealed 0.3% (n=3) cardiac deaths, 0.6% (n=6) acute coronary syndromes (ACS), and 6.2% (n= 64) receiving revascularization. F/U at 6 mos was 90% (n=936) complete and total cumulative cardiac deaths were 0.9% (n=9), 0.7% (n=7) ACS and 6.3% (n=65) revascularization. Discussion: Cardiac events at both 30 d and 6 mos were very low and did not differ in men and women (P=0.8). LOS in CPU was minimized and patient safety was maintained. These selected LR pts remained at reduced risk for cardiac events despite a high rate of comorbidities. Early discharge of selected LR CP pts based on history, examination, ECG, and biomarker evaluation was safe and effective. Conclusion: This approach in selected LR pts has the potential to reduce unnecessary diagnostic testing and CPU LOS. This strategy could lead to substantial savings in healthcare costs without compromising patient safety.

The case for investment in nutritional interventions to prevent and reduce childhood and adolescent overweight and obesity in Peru: a modelling study

BackgroundBetween 2006 and 2016 the prevalence of overweight and obesity among children and adolescents aged 5–19 years in Peru increased from 22.7 to 27.0%. This investment case quantifies the economic impacts of childhood and adolescent overweight and obesity in Peru. It identifies and quantifies the potential impact of a set of new or expanded interventions that can strengthen current national efforts to prevent and reduce child and adolescent overweight and obesity.MethodsA deterministic Markov cohort model with a societal cost perspective estimated reductions in mortality and morbidity from implementing interventions to prevent and reduce child and adolescent overweight and obesity and the impact in savings in healthcare costs and gains in wages and productivity. Interventions identified through a review of published literature includes a school-based social marketing campaign, exclusive breastfeeding promotion and support, a healthy food and drink policy for school premises, and a 20% subsidy on fruits and vegetables for people living below the national poverty line. The return on investment (ROI) was calculated along with the estimated cost savings associated with the interventions. Analysis was conducted to test ROI sensitivity to changes in the key parameters and assumptions.ResultsBetween 2025 and 2092, the expected combined direct and indirect healthcare costs attributable to child and adolescent overweight and obesity in Peru are 210.6 billion USD. The direct healthcare costs are 1.8 billion USD, and the indirect costs are 208.8 billion USD. Expected savings for all interventions combined is 13.9 billion USD with a per-person savings of 12,089.8 USD. The expected ROI of the four interventions combined is 39.3 USD (30-years), 64.6 USD (50-years), and 164.1 USD (66-years) per one USD invested.ConclusionsThe overweight and obesity epidemic among children and adolescents in Peru requires wide-ranging and expanded implementation of policies to achieve long-term reductions in prevalence. This study’s findings show that the four priority interventions have high ROIs and can be used to guide policy to address the complex interplay of factors that contribute to the obesogenic environment.

Health outcomes reported by healthcare providers and clients of a community-based medically tailored meal program

BackgroundMedically tailored meal (MTM) programs provide home-delivered meals to people living with serious illness and poor nutritional status. Client outcome studies have found evidence of decreased healthcare utilization and cost savings associated with MTM program participation, and inconclusive evidence of change in health measures. The purpose of this study was to use a novel observational framework to describe the client profile and change in health outcomes using routinely collected health and program data from a community-based MTM program at MANNA (Philadelphia, PA).MethodsClients reported their self-rated health and experiences of food insecurity and malnutrition. Healthcare providers reported clients’ body mass index, systolic blood pressure, and hemoglobin A1C. These health outcomes, measured at program intake and 3–6 months later, were linked with administrative data for 1,959 clients who completed at least two months of MTM services in 2020, 2021, and 2022.ResultsClients exhibited substantial heterogeneity in demographics and health status at intake. Self-reported malnutrition risk decreased significantly over program duration (p < .001). Nearly one-third of clients with poor health reported improvement over time. Over 60% of clients with obesity experienced stable BMI. Clients with hypertension experienced significant improvements in systolic blood pressure (p < .001). Clients with diabetes and available data (n = 45) demonstrated significant reduction in hemoglobin A1C (p = .005).ConclusionWe found evidence that participation in MANNA’s MTM program was associated with favorable health outcomes for clients with serious illness and nutritional risk. Community-based organizations can maximize the completeness of their data by focusing on routinely collected internal data like validated health screeners and surveys.

Impact of a clinical pharmacist-led, artificial intelligence–supported medication adherence program on medication adherence performance, chronic disease control measures, and cost savings

BackgroundChronic diseases are the leading cause of disability and death in the United States. Clinical pharmacists have been shown to optimize health outcomes and reduce health care expenditures in patients with chronic diseases through improving medication adherence. ObjectiveThe primary objective of this study was to evaluate a pharmacist-led, artificial intelligence (AI)–supported medication adherence program on medication adherence, select disease control measures, and health care expenditures. MethodsThis was a multicenter, retrospective, quasi-experimental evaluation from January 2019 to December 2019 (preimplementation) and January 2021 to December 2021 (postimplementation). This pharmacy-driven service focuses on improving medication adherence and patient outcomes through AI-supported analytics, individual patient case review, and pharmacist-led individual patient outreach. The primary end point was to determine whether implementation improved medication adherence in 3 medication-related measures: medication adherence for hypertension (MAH), medication adherence for cholesterol (MAC), and medication adherence for diabetes (MAD). Secondary outcomes were to evaluate reductions in select chronic diseases control measures and cost savings of this service after implementation of this service. ResultsThis medication adherence service was deployed across 10,477 patients: 60.6% of patients were in at least 1 medication-related measure, generating 2762 actionable medication adherence gaps. After the implementation of this pharmacist-led program, medication adherence improved in all 3 disease state measures (MAH 5.9% improvement, MAC 7.9% improvement, MAD, 6.4% improvement), and Medicare Star ratings also improved. The percentage of patients with diabetes who reached their A1c goal also increased (75.5%-81.7%). Furthermore, reductions in overall health care expenditures were seen per member per month in patients who were adherent in comparison with those who were nonadherent (hypertension 31% cost savings, hyperlipidemia 25% cost savings, diabetes 32% cost savings). ConclusionThis clinical pharmacist–driven service leveraged technology and patient connection to increase medication adherence in patients with chronic disease states and led to improvement in select disease control measures and substantial health care cost savings.

Unlocking Cost Savings in Healthcare: How Difference-in-Differences (DID) Can Measure the Impact of Interventions

Unlocking Cost Savings in Healthcare: How Difference-in-Differences (DID) Can Measure the Impact of Interventions

Cost savings from an mHealth tool for improving medication adherence.

To determine the health care cost savings from the Wellth app, a mobile health intervention that uses financial incentives to increase medication adherence. An observational study of members in one of Arizona's Medicaid managed care plans, part of Arizona Health Care Cost Containment System (AHCCCS), using the Wellth app from March 28, 2020, to January 12, 2021. One-to-one matching was used to identify comparable nonparticipants, and a difference-in-differences approach was used to estimate the impact of the Wellth intervention on outcomes defined over the 9 months before and after using Wellth. An AHCCCS managed care health plan provided claims data that contained drug prescription, health care utilization, and health care cost information for all participants, and Wellth provided app usage data and contextual information about the Wellth intervention. On average, the Wellth intervention increased medication adherence by 5.0 percentage points (95% CI, 2.9-7.1; P = .008) and reduced emergency department (-0.02; 95% CI, -0.03 to -0.01; P = .002), inpatient (-0.04; 95% CI, -0.06 to -0.02; P = .001), and mental health clinic (-0.06; 95%CI, -0.10 to -0.01; P = .013) visits relative to nonparticipants over 9 months. Short-term reductions in utilization had an estimated mean cost savings over 9months of $88.15 (95% CI, $31.07-$136.40), with greater reductions for those with chronic obstructive pulmonary disease, schizophrenia, or major depression. Given the relatively low cost of the Wellth intervention, our findings provide preliminary evidence of cost savings from implementing Wellth among adults with several common chronicconditions.

Waiting for surgery after hip fracture-Health and/or economic risk?

Waiting for surgery is a disconcerting experience. It can have a negative impact on patients' outcomes and length of stay (LOS) as driver for treatment costs. Process-optimisation may be a strategy to improve quality and cost-efficacy. The study investigates the correlation between waiting for hip fracture surgery and patient characteristics, organisational variables, outcomes, LOS, and the distribution of waiting times and LOS over time, including cost estimates. Thereby the study aims to identify the potential for organisational improvements with respect to managing the waiting time. Ten-year routine health data (patient characteristics and follow-up information) and process-indicators that is, waiting time and LOS from a Swiss trauma-centre were analysed retrospectively. Cost-estimates were calculated based on Swiss diagnosis related groups and daily costs to evaluate hospital revenues. In total, 2572 patients aged ≥60years with low-energy hip fractures were included. Waiting times >48h were associated with sub-optimal outcomes. Over the years long waiting times decreased. This reduction was not reflected by a reduction in LOS which remained stable around 10days, primarily driven by late discharge to in-patient rehabilitation. Reimbursement persisted at an average revenue in the low 4-5-digit range, depending on implant costs. While there has been a reduction of waiting times, this has not translated into a reduction of LOS or potential savings in health care costs, due to the various dependencies along the patient journey. Managing waiting times may be an area for improvement, increasing cost-efficacy, especially since long waiting times are still associated with inferior outcomes and LOS.

An economic evaluation on sub-optimal breastfeeding in Hong Kong: Infant health outcomes and costs.

This study estimated the healthcare cost savings for the government due to the prevention of gastroenteritis (GE) infections and lower respiratory tract infections (LRTI) in the first year of life, attributed to an increase in the exclusive breastfeeding rate at 4 months in Hong Kong. The model used the best available data inputs, with uncertainty considered using probabilistic sensitivity analysis. We additionally assessed the impact of neonatal jaundice (NNJ) on the economic benefits of increasing exclusive breastfeeding rates. During 2010-2019, five admissions for GE and three admissions for LRTI per 1000 births would have been prevented in the first year of life if the exclusive breastfeeding rate at 4 months increased from the actual levels (~15-30%) to 50%, resulting in annual healthcare cost savings of USD1.05 (95% CI 1.03-1.07) million/year. The cost saving would reach USD1.89 (95% CI 1.86-1.92) million/year if the exclusive breastfeeding rate at 4 months increase to 70%. However, if higher NNJ admissions during 7-90 days related to more exclusive breastfeeding are considered, the cost saving would reduce by 60%. Our findings can guide policymakers in allocating budget and resources for breastfeeding promotion in Hong Kong. The prevention of unnecessary NNJ admissions would maximise the economic benefits of exclusive breastfeeding at 4 months.

Binding-induced activation of CRISPR-Cas12a using PAM-engineered toehold switch and DNA tile architectures for enhanced detection of thrombin

This study presents a novel biosensor that integrates CRISPR-Cas12a technology with DNA tile-based architectures to enhance thrombin detection. Utilizing PAM-engineered toehold switches, the biosensor dynamically activates the CRISPR-Cas12a system upon thrombin recognition, significantly improving both sensitivity and specificity. The label-free electrochemical detection method offers rapid, cost-effective analysis, making it ideal for real-time clinical applications. The biosensor achieved an impressive detection limit of 103 aM, surpassing traditional methods and setting a new standard for thrombin assays. The biosensor's robust performance in complex biological samples, such as diluted human serum, demonstrates its reliability for clinical diagnostics. This is particularly important for the early diagnosis and management of thrombotic and coagulation-related disorders. By combining advanced genetic engineering with traditional electrochemical techniques, the biosensor not only optimizes detection but also expands its potential applications across various biomedical fields. Overall, this biosensor provides a powerful and innovative tool for thrombin detection, offering enhanced diagnostic accuracy, faster patient management, and potential cost savings in healthcare. Its superior performance and adaptability highlight its promise for broader adoption in clinical diagnostics and other biosensing applications.

Administrative Analysis of the Home-Based Older Persons Upstreaming Prevention Physical Therapy Program: A Pilot Observational Study.

Introduction Traditionally, physical therapist (PT) services do not commence until an injury, fall, or health issue has already occurred although there is increasing evidence that preventative programs administered by PTs may decrease the fall risk among elderly individuals.The purpose of this study was to examine billing, reimbursement, and administrative outcomes of the previously established and investigated prevention-based screening and intervention HOP-UP-PT (Home-based Older Persons Upstreaming Prevention-Physical Therapy) program delivered by a physical therapist in the home of older adults after being referred by a community partner. A randomized controlled trial of the HOP-UP-PT program demonstrated an 8-fold reduction in falls for participants at moderate and high fall risk compared to those who did not participate in the program. Methods Aprospective observational study was performed to examine administrative and payment outcomes of HOP-UP-PT participation. Participants were referred into the HOP-UP-PT program via a local community center. Physician authorization for physical therapy participation was obtained for each participant as required for payment under United States' Center for Medicare and Medicaid Services (CMS)guidelines. The HOP-UP-PT program is preventative physical therapy delivered in the person's home with five in person visits (approximately one per month) followed by a monthly telehealth visit and a final in-person visit.Interventions included a balance program, home safety recommendations, health coaching, and addressing individual risks of falling or becoming homebound. A retrospective analysis was performed on the administrative andinsurance payment data from this study which was then analyzed descriptively. Results Six participants with four different insurances completed the 7-month program (mean age=77 years) in 2021. The physical therapy visits were submitted to the participants' Medicare Part B plan. One participant's physical therapy visits were not submitted for payment as the health system did not have an active agreement with that health insurer. Due to the unclear status of telehealth visits in 2021, these services were not submitted to the insurance company for payment.All other PT visits were paid by the insurance companies. The mean amount paid for the initial evaluation code was $102.83 and the mean payment for the ~15 minute treatment codes was $25.90 per unit. Initial pilot data demonstrated a potential for a4.2% positive operating margin when considering salary costs and travel.The mean delay from the initial referral into the HOP-UP-PT program until the physician provided written authorization for physical therapy was 69.7 days. Conclusion This study demonstrated initial evidence that payment for prevention-focused outpatient physical therapist services delivered in the home was feasible, however delays and costsin procuring physician authorization was a substantial barrier to prevention-focused physical therapy. A 4.2% operating margin demonstrated that, when efficiently operated, similar programs are likely to be viable. Furthermore, if telehealth services would have been paid, the operating margin was estimated to increase to 32%. Physical therapists are highly qualified to deliver efficient, effective preventative services which has the potential to reduce falls and institutionalization and subsequent healthcare cost savings.

Estimating the Potential Health Care Cost-Savings from a Flax-Based Treatment for Hypertension.

Hypertension contributes to the increase in health care spending in Canada through two primary mechanisms. First, it directly increases costs, as individuals with hypertension require medical care to manage the condition. Second, it indirectly raises expenses by serving as a risk factor for numerous chronic diseases, leading to increased health care utilization among those affected. Therefore, reducing hypertension prevalence could alleviate its resulting strain on the Canadian health care system. Clinical trials have demonstrated that daily flaxseed consumption effectively lowers both systolic and diastolic blood pressure. This study employs a four-step cost-of-illness analysis to estimate the potential health care cost-savings from a flaxseed-based treatment for hypertension. The analysis begins by assessing the proportion of individuals with hypertension likely to adopt the flaxseed regimen. It then evaluates the impact of flaxseed consumption on systolic and diastolic blood pressure. Next, data from the Canadian Health Measures Survey, Cycles 5 and 6, are used to estimate the prevalence of hypertension and the expected reduction in prevalence due to the flaxseed treatment. Finally, the potential reduction in health care spending is calculated. To incorporate uncertainty, partial sensitivity analysis and Monte Carlo simulations were utilized, varying the intake success rate and other model parameters, respectively. The most conservative estimate suggests a potential health care cost-savings of CAD 96,284,344 in Canada for the year 2020.

Colonic stenting: is the bridge to surgery worth its cost? A cost-effectiveness analysis at a single Asian institution.

In patients with acute left-sided colonic obstruction, stenting can convert an emergency operation into a semi-elective procedure. However, its use continues to be debated. We performed a cost-effective analysis using our institution's experiences. Endoscopic, surgical, and financial details were prospectively collected for patients who presented with acute colonic obstruction and underwent stenting between 2019 and 2022. Outcomes were defined as technical/clinical success and successful surgical resection. The financial cost of stenting was compared with the expected cost without stenting. Forty patients were included, with 29 undergoing definitive resection. The most common pathology was primary colon cancer (27 patients, 93%). Endoscopic stenting had high technical (90%) and clinical (83%) success rates, with low rates of complications such as perforation (2 patients, 7%) and migration (0 patients, 0%). As a bridge to surgery, the median procedure time was 226 minutes and the surgical outcomes also showed a low rate of complications (3 patients, 11%), such as anastomotic leakage (0 patients, 0%), intraabdominal abscesses (2 patients, 7%), and 30-day postoperative mortality (0 patients, 0%). The cumulative costs with colonic stenting were $32,900, while the expected costs with emergency surgery, including stoma reversal, were $40,700 (healthcare cost-savings of $7,800 per person). The difference was mainly due to the avoidance of upfront emergency surgery. The incremental cost-effectiveness ratio was 0.81, favoring colonic stenting over upfront emergency surgery. Colonic stenting as a bridge to surgery is safe and cost-effective for treating left-sided colonic obstruction with high success rates and low complication rates.

The Risk Of Perpetuating Health Disparities Through Cost-Effectiveness Analyses.

Cost-effectiveness analyses are commonly used to inform health care and public health policy decisions. However, standard approaches may systematically disadvantage marginalized groups by incorporating assumptions of persisting health inequities. We examined how competing risks, baseline health care costs, and indirect costs can differentially affect cost-effectiveness analyses for racial and ethnic minority populations. We illustrate that these structural factors can reduce estimated quality-adjusted life-years and cost savings for disadvantaged groups, making interventions focused on disadvantaged populations appear less cost-effective. For example, analyses of a sugar-sweetened beverage tax may estimate higher costs per quality-adjusted life-year gained for Black versus White populations because of differences in competing risks and insurance status that manifest in higher health care cost savings from averted disease among White people. To ensure that cost-effectiveness assessments do not perpetuate inequities, alternative approaches are needed that account for the impact of structural factors on different groups and that consider scenarios in which health inequities are reduced. Sensitivity analyses focusing on health equity could help advance interventions that disproportionately benefit disadvantaged communities.

The Modeled Cost-Effectiveness of a Prevention Program Targeting Both Eating Disorders and High BMI.

Prevention programs for eating disorders (EDs) and high body index mass (BMI) have the potential to reduce the onset of these interconnected public health concerns. However, it remains unclear whether routine implementation of such programs would be cost-effective. This study aims to determine the cost-effectiveness of an intervention that aims to prevent both ED and high BMI. A Markov model was developed to evaluate the incremental cost-effectiveness of a targeted school-based program, Healthy Weight, that aims to prevent both EDs and high BMI among Australian adolescents with body image concerns (aged 15-18 years), versus a "no intervention" comparator. A cost-utility analysis was conducted from a "healthcare and education" sector perspective with costs (measured in 2019 Australian dollars) and health impacts modeled over the lifetime of the target population. An incremental cost-effectiveness ratio (ICER), expressed as cost per health-adjusted life year (HALY) gained, was calculated. Sensitivity analyses were done to test model assumptions. The mean intervention cost and HALYs gained were AUD$2.13 million (95% CI, AUD$1.83-2.43 million) and 146 (95% CI, 90-209), respectively. With healthcare cost-savings (AUD$3.97 million) included, the intervention was predicted to be cost-saving (AUD$1.83 million; 95% CI, AUD$0.51-3.21 million). Primary findings were robust to extensive sensitivity analyses. The Healthy Weight intervention is likely to represent good value-for-money. To ensure the successful implementation of this program at the population level, further research on its feasibility and acceptability among schools and the wider community is required.

Cross-sectional and longitudinal associations among healthcare costs and deficit accumulation.

Type 2 diabetes mellitus and overweight/obesity increase healthcare costs. Both are also associated with accelerated aging. However, the contributions of this accelerated aging to increased healthcare costs are unknown. We use data from a 8-year longitudinal cohort followed at 16 U.S. clinical research sites. Participants were adults aged 45-76 years with established type 2 diabetes and overweight or obesity who had enrolled in the Action for Health in Diabetes clinical trial. They were randomly (1:1) assigned to either an intensive lifestyle intervention focused on weight loss versus a comparator of diabetes support and education. A validated deficit accumulation frailty index (FI) was used to characterize biological aging. Discounted annual healthcare costs were estimated using national databases in 2012 dollars. Descriptive characteristics were collected by trained and certified staff. Compared with participants in the lowest tertile (least frail) of baseline FI, those in the highest tertile (most frail) at Year 1 averaged $714 (42%) higher medication costs, $244 (22%) higher outpatient costs, and $800 (134%) higher hospitalization costs (p < 0.001). At Years 4 and 8, relatively greater increases in FI (third vs. first tertile) were associated with an approximate doubling of total healthcare costs (p < 0.001). Mean (95% confidence interval) relative annual savings in healthcare costs associated with randomization to the intensive lifestyle intervention were $437 ($195, $579) per year during Years 1-4 and $461 ($232, $690) per year during Years 1-8. These were attenuated and the 95% confidence interval no longer excluded $0 after adjustment for the annual FI differences from baseline. Deficit accumulation frailty tracks well with healthcare costs among adults with type 2 diabetes and overweight or obesity. It may serve as a useful marker to project healthcare needs and as an intermediate outcome in clinical trials.

Global Challenges and Economic Feasibility in Achieving 100% Renewable Energy

Abstract: This study aims to investigate the global transition towards 100% renewable energy (RE) grids while analyzing associated challenges and economic prospects. The scientific aim of the work is to examine national and regional plans, revealing shared research challenges such as neglect of system stability, reliance on specific RE sources, and limitations on capacity share growth. The subject of the research was to obtain insights into the economic feasibility of this transition, underscored by projections of creating 24.3 million new jobs by 2050 and substantial annual savings in air pollution and environmental costs. This study extends the existing research by analyzing promising examples from countries like Norway and Costa Rica, demonstrating diverse approaches with hydropower playing a pivotal role, while Canada and New Zealand showcase adaptability based on local resources. Addressing key research challenges, from technological uncertainties to socio-economic considerations, the paper emphasizes the need for robust policies and infrastructure development. Despite challenges, the transition promises economic benefits, with estimated annual savings in healthcare and global warming costs. The literature and global examples affirm the technical and financial feasibility of transitioning to 100% RE. In conclusion, this paper contributes to understanding the intricate economic and technological landscape of achieving a sustainable global energy transition.

Tobacco Exposures are Associated With Healthcare Utilization and Healthcare Costs in Pregnant Persons and Their Newborn Babies.

Identifying healthcare utilization and costs associated with active and passive smoking during pregnancy could help improve health management strategies. Data are from the Newborn Epigenetics STudy (NEST), a birth cohort enrolled from 2005 to 2011 in Durham and adjacent counties in North Carolina, United States. Participants included those for whom prenatal serum samples were assayed and for whom administrative data were obtainable (N = 1045). Zero-inflated poisson regression models were used to assess associations between cotinine, adjusted for covariates (eg, race and ethnicity, age at delivery, cohabitation status, and education), and health care utilization outcomes. Generalized linear regression models were used to estimate average total charges. Simulation models were conducted to determine the economic benefits of reducing secondhand smoke and smoking during pregnancy. Increasing levels of cotinine were positively associated with parent's number of emergency department (ED) visits (coefficient[b] = 0.0012, standard error [SE] = 0.0002; p < .001), the number of ICU hours (b = 0.0079, SE = 0.0025; p = .002), time spent in the ICU (b = 0.0238, SE = 0.0020, p < .001), and the number of OP visits (b = 0.0003, SE = 0.0001; p < .001). For infants, higher cotinine levels were associated with higher number of ED (b = 0.0012, SE = 0.0004; p = .005), ICU (b = 0.0050, SE = 0.001; p < .001), and OP (b = 0.0006, SE = 0.0002; p < .001) visits and longer time spent in the ED (b = 0.0025, SE = 0.0003; p < .001), ICU (b = 0.0005, SE = 0.0001; p < .001), and IP (b = 0.0020, SE = 0.0002; p < .001). Simulation results showed that a 5% reduction in smoking would correspond to a potential median cost savings of $150 533 from ED visits of parents and infants. Our findings highlight the importance of smoke exposure cessation during pregnancy to reduce health care utilization and costs for both parents and infants. This study reinforces the importance of reducing smoking and secondhand smoke exposure during pregnancy. Focusing on expanding cessation services to this group could help reduce morbidities observed within this population. Furthermore, there is the potential for healthcare cost savings to healthcare systems, especially for those with high delivery numbers. These cost savings are represented by potential reductions in ED, OP, and ICU hours and visits.