Increase In Cost Research Articles

Hyperuricemia and acute decompensation of heart failure: is there a causative link? A review

The relevance and importance of the problem of acute decompensation of heart failure for the health care system not only in Russia, but also in the whole world is caused by a significant increase in the number of hospitalizations, associated increase in financial costs and extremely unfavorable prognosis in this group of patients. The article is devoted to the pathogenesis of acute decompensation of heart failure and the place of asymptomatic hyperuricemia in the development of this condition. Hyperuricemia is considered as a prognostic marker of unfavorable prognosis in patients with both cardiovascular diseases in general and acute decompensation of heart failure in particular. Special emphasis is made on approaches to drug therapy, tactics of xanthine oxidase inhibitor allopurinol use, doses are analyzed in terms of efficacy, influence on prognosis, methods of achieving and controlling target values of hyperuricemia are discussed.

Hospitalization expenses of coronary heart disease inpatients in China: evidence from two hospitals in Ningxia Hui autonomous region.

The increasing morbidity from coronary health disease (CHD) has imposed a significant social and economic burden in China. We analyzed the factors affecting hospitalization expenses of CHD patients. From 2012 to 2018, data on 16,726 CHD patients were collected from the hospital information system in Ningxia Hui Autonomous Region. A multiple ordered logistic regression model was used to analyze the factors affecting hospitalization expenses. The average hospitalization expense was RMB30998.26 ± 29890.03. Hospital materials expenses accounted for roughly 60% of total hospitalization costs. The older adult, patients who were male, in critical health status, with longer hospital stays, unemployed, using antibiotics and undergoing an operation without incision had significantly raised hospital expenses, while those with fewer complications, no operations and self-paying for health care had reduced hospitalization costs (p < 0.05). The length of hospital stay played a partial mediator role (p < 0.05). Controlling the increase of medical materials costs and preventing over-consumption of hospital services by insured patients are recommended.

The rising global economic costs of invasive Aedes mosquitoes and Aedes-borne diseases

Invasive Aedes aegypti and Aedes albopictus mosquitoes transmit viruses such as dengue, chikungunya and Zika, posing a huge public health burden as well as having a less well understood economic impact. We present a comprehensive, global-scale synthesis of studies reporting these economic costs, spanning 166 countries and territories over 45 years. The minimum cumulative reported cost estimate expressed in 2022 US$ was 94.7 billion, although this figure reflects considerable underreporting and underestimation. The analysis suggests a 14-fold increase in costs, with an average annual expenditure of US$ 3.1 billion, and a maximum of US$ 20.3 billion in 2013. Damage and losses were an order of magnitude higher than investment in management, with only a modest portion allocated to prevention. Effective control measures are urgently needed to safeguard global health and well-being, and to reduce the economic burden on human societies. This study fills a critical gap by addressing the increasing economic costs of Aedes and Aedes-borne diseases and offers insights to inform evidence-based policy.

Cost of disease progression among US patients with human epidermal growth factor receptor 2-positive metastatic breast cancer.

Aim: The objectives were to investigate the differences in per patient per month (PPPM) healthcare resource utilization (HCRU) and costs among commercially insured and Medicare Advantage patients with human epidermal growth factor receptor 2 positive (HER2+) metastatic breast cancer (mBC) who experience disease progression in 12months compared with those who don't investigate the impact of progression timing on cumulative healthcare costs. Patients & methods: This claims-based study included patients diagnosed with mBC between 1January 2013 and 30April 2020 and received HER2-targeted therapy. Patients were categorized as progressed or nonprogressed. For objective one, monthly HCRU and costs were assessed for up to two lines of therapy (LOTs). Data were summarized descriptively and compared using a generalized linear model (GLM). For objective two, patients with at least 6 months of follow-up were assessed and cumulative healthcare costs were estimated in the 3 years following the start of LOT1 or LOT2 using a GLM and Kaplan-Meier weighting. Results: Among the 4113 patients in the study sample, 3406 had at least 12 months of follow-up (or less if due to death). Compared with nonprogressed patients, progressed patients had higher mean PPPM healthcare costs (LOT1: $22,014 vs $18,372, p<0.001; LOT2: $19,643 vs $16,863, p=0.001), and HCRU, including number of emergency room visits and inpatient stays (both p<0.001) in the 12 months following LOT start. Progressed patients had higher 3-year mean cumulative healthcare costs than nonprogressed patients following LOT1 and LOT2 and this difference was greater for patients who progressed earlier. Conclusion: Disease progression was associated with significant increases in HCRU and costs. Delays in progression were associated with lower cumulative healthcare costs. Earlier use of more clinically effective treatments to delay progression may reduce the economic burden among these patients.

Association of severe obesity with risk of conversion to open in laparoscopic cholecystectomy for acute cholecystitis

BackgroundObesity is a known risk factor for cholecystitis and is associated with technical complications during laparoscopic procedures. The present study seeks to assess the association between obesity class and conversion to open (CTO) during laparoscopic cholecystectomy (LC). MethodsAdult acute cholecystitis patients with obesity undergoing non-elective LC were identified in the 2017–2020 Nationwide Readmissions Database. Patients were stratified by obesity class; class 1 (Body Mass Index [BMI] = 30.0–34.9), class 2 (BMI = 35.0–39.9), and class 3 (BMI ≥ 40.0). Multivariable regression models were developed to assess factors associated with CTO and its association with perioperative complications and resource utilization. ResultsOf 89,476 patients undergoing LC, 40.6 % had BMI ≥ 40.0. Before adjustment, class 3 obesity was associated with increased rates of CTO compared to class 1–2 (4.6 vs 3.8 %; p < 0.001). Following adjustment, class 3 remained associated with an increased likelihood of CTO (Adjusted Odds Ratio [AOR] 1.45, 95 % Confidence Interval [CI] 1.31–1.61; ref.: class 1–2). Patients undergoing CTO had increased risk of blood transfusion (AOR 3.27, 95 % CI 2.54–4.22) and respiratory complications (AOR 1.36, 95 % CI 1.01–1.85). Finally, CTO was associated with incremental increases in hospitalization costs (β + $719, 95 % CI 538–899) and length of stay (LOS; β +2.20 days, 95 % CI 2.05–2.34). ConclusionsClass 3 obesity is a significant risk factor for CTO. Moreover, CTO is associated with increased hospitalization costs and LOS. As the prevalence of obesity grows, improved understanding of operative risk by approach is required to optimize clinical outcomes. Our findings are relevant to shared decision-making and informed consent.

Cost-effectiveness analysis of once-weekly semaglutide vs. once-daily liraglutide administered subcutaneously in patients with overweight and obesity: a decision analysis.

Obesity presents an enduring and multifaceted dilemma that impacts individuals, society, economies, and healthcare systems alike. Glucagon-like peptide-1 (GLP-1) receptor agonists, including liraglutide and semaglutide, have received FDA approval for obesity treatment. This study aims to present a cost-effectiveness analysis to compare the cost and clinical outcomes of semaglutide vs. liraglutide on weight loss in people with overweight and obesity. A cost-effectiveness analysis was conducted to compare the cost and the clinical outcomes of adding weekly 2.4 mg SC semaglutide vs. daily 3.0 mg SC liraglutide or placebo to physical activity and diet control in overweight and obese patients. A clinical outcome of achieving ≥15% weight loss was chosen. A simple decision analysis model from a third-payer perspective was applied. Drug costs were based on the retail price of the USA market. One-way sensitivity analyses were performed. Results showed that 2.4 mg weekly semaglutide, when added to physical activity and diet control, was the most cost-effective choice in terms of ≥15% weight loss (ICER: $ 7,056/patient/68 weeks). The model was robust against the 50% increase in the unit cost of semaglutide and the 50% decrease in the unit cost of liraglutide, as well as the changes in probabilities by the corresponding 95% confidence intervals across the model. This cost-effectiveness analysis suggests that employing once-weekly 2.4 mg semaglutide emerges as a remarkably cost-effective option when contrasted with once-daily 3.0 mg liraglutide in patients with overweight and obesity when added to physical activity and diet control.

Feasibility of zero emission freight zones: scenario analysis and risk assessment

To further incentivize the adoption of zero-emission trucks (ZETs), Chinese cities would need more proactive policies like zero-emission freight zones (ZEFZs). However, the design of the policy should avoid the disruption of goods supply, increase of logistic costs, and ensure inclusive transition of small carriers and financial sustainability for city governments. To this end, this study employs Beijing as a case: Based on ZEFZ case studies, policy document and literature review, and data analysis of freight demand distribution and truck movements in Beijing, this study constructs four scenarios with different spatial coverages, restricted truck segments, and roll-out years of ZEFZs. The impacts of different ZEFZ scenarios on emissions reduction potentials, goods supply and vehicle fleet replacement, and public and private expenditure are evaluated. The most cost-efficient and easy-to-implement scenario is recommended as the initial phase of the ZEFZ scheme, with risk assessment and risk mitigation measures.

Analysis of the Effect of Time and Cost Performance Risk of Toll Road Project Based on the Principle of Project Management Body of Knowledge

Toll road facilities are needed by the community to improve economic standards with adequate mobility. Toll Road Projects often have delays in the implementation schedule which results in increased project costs. This study aims to determine the effect of the risk of increasing costs on toll road projects caused by delays in project implementation time based on PMBOK guidelines. This research is based on the object of the Japek II Selatan Package III Toll Road project and studies journal literature, surveys, and questionnaires using the SEM Smart PLS program. The effect of risk on cost performance is variable due to the lack of project land readiness. Based on project data from the contract, it was supposed to be completed in December 2020 but was pushed back to mid-2024 estimates. The effect is due to an increase in costs, with a percentage of 2%; in this study, the factor of implementing K3 Projects is in the form of work accident costs. The analysis of SEM PLS shows the effect of time and cost performance on the Planning and Implementation of land readiness indicators, unit price increase, project K3 implementation, and risk management implementation. The study concludes that the risk of increasing costs includes poor planning, which is hampered by land readiness and results in delays in implementation time and year differences that cause changes in material unit prices, resulting in an increase in project costs. Risk Management, as stated in the PMBOK guidelines on Toll Road Projects, must be implemented to reduce the impact of the risk of increasing project costs.

Bi-objective model for tactical planning in corn supply chain considering CO2 balance

This paper addresses the Brazilian corn production logistic supply chain with an optimisation model considering carbon emission from transportation and carbon sequestration from corn production. The focus is on the higher-level decision planning, which includes the best regions for corn cultivation, location and sizing of silos to store grains, transportation modes with intermodality, considering several resource constraints to meet the demands of domestic market and export. Two conflicting objectives are considered: the logistics costs of the supply chain and the balance of CO 2 . Accurate data are used to evaluate the model and the Pareto optimal solutions are produced in scenarios potentially feasible in practice. The solutions showed relevant information to guide decisions about investment in logistic infrastructure. We demonstrated that cleaner transportation routes lead to solutions that have larger carbon stocks with 3–5% increase in costs by only choosing more suitable regions for corn cultivation and transportation modes.

Evaluation of Composite Structural Materials for Heliostat Cost Reduction

Abstract Structures manufactured from steel comprise up to 40% of a CSP heliostat's cost. Composite struc-tures represent a potential opportunity to reduce this cost. A reference heliostat structural model has been created with a reflector area of 25m2. The design, constructed of low-carbon steel, pro-vides baseline deflection and stiffness under a 21 m/s operating wind speeds. Wind loads on the tracker structure are determined for both operating and stow conditions. An established roster of suitable metal alternative materials is considered including: glass, basalt, and carbon reinforced polymer (GFRP, BFRP, and CFRP respectively). Three heliostat components are investigated: the pylon, torque tube, and the purlin-strut assembly. Composite material properties are substituted for those of steel, and the beams are re-sized to match the original steel components' deflection under given wind loads. Weight and cost changes resulting from this resizing are evaluated. It is found that GFRP and BFRP represent a 3X–6X cost premium for the same operating deflection character-istics as steel across all three investigated component classes; with weight reduction only achieved for the purlin-strut assembly. While CFRP components can achieve approximately 25–75% weight savings depending on the application, this comes with a 9X–14X cost increase over the steel base-line for tube-type structures and roughly 5X cost increase when replacing c-channel structures. This work does not rule out the possibility of cost savings when the heliostat design and kinematics to take advantage of composites' specific properties.

SOCIAL MINIMUM LEVELS IN POLAND IN THE THIRD QUARTER OF 2023

The article provides a summary of the social minimum estimates for the third quarter of 2023.Although modelled household spending still appears to be rising on an annual basis, on a quarterly basis it fell for the first time this year. In relation to the third quarter of 2022, the CPI stood at 9.7% (cf. GUS, 2023). During this time, the social minimum values increased from 9.7% in the household of two pensioners to 14.5% in the household of a single person of working age. Compared to the data from the previous survey (2nd quarter, 2023), with a negative CPI (-0.3%), the values of the social minimum also fell. The decrease was smallest in the pensioner household of a single person (-0.6%) and largest in households with dependent children (-1.1%). The reduction in the value of the social minimum during the period under review was most influenced by the fall in the value of the food basket. This was a result of the autumn reduction in prices, mainly of vegetables and fruit. The decline in the value of the social minimum was partly prevented by an increase in the model costs of housing and energy carriers. With a low CPI for this group (0.1%), these costs rose from 1.2% in 1-person households to 1.4% in 4- and 5-person households.

Pre-operative pulmonary risk assessment in surgery patients

Aims: Postoperative pulmonary complications (PPC) that may develop after surgery are important causes of morbidity and mortality. PPCs cause a prolongation of hospital stays and an increase in hospitalization costs. The study aims to determine factors associated with PPCs to predict PPCs in surgical patients undergoing preoperative evaluation. Methods: A retrospective cohort study was conducted at Şişli Hamidiye Etfal Training and Research Hospital using data from 200 patients referred for preoperative pulmonary evaluation from anesthesia and surgery clinics. This study analyzed the characteristics and outcomes of patients with PPC and those without PPC. The Canet pulmonary risk scores are used for PPC in all preoperative surgery patients. The study’s primary endpoints are to determine the development of respiratory failure, bronchospasm/asthma, COPD exacerbation, atelectasis, pleural effusion, or pneumonia. The study also analyzed the effective respiratory function parameters for PPC development using a logistic regression model. Results: The total study population included 200 patients with a median age of 53.5 years (aged between 19-88), 103 (51.5%) of whom were female. PPCs were observed in 38% (n=76) of the study group. There was a statistically significant difference between the patients in terms of the development of postoperative pulmonary complications according to gender (higher in males, p=0.001) and smoking (p=0.0001). Preoperative oxygen saturation (SpO2) and FEV1/FVC ratio were significant predictors of PPC development, and complications were more frequent in low-saturated patients (p=0.0001, p=0.013 respectively). The relationship between SpO2 and PPC was confirmed via logistic regression analysis. A one-unit increase in saturation reduced the occurrence of postoperative respiratory complications by 0.645-fold. The cut-off value for the saturation value was 97.5%, with a sensitivity of 46.8% and a specificity of 71.1% [p=0.0001, 95% CI, (0.521-0.798)]. Conclusion: In this study, the Canet (ARISCAT) score, a preoperative evaluation scale validated in Turkey that predicts postoperative pulmonary complications and mortality, was used. The Canet risk score is a simple risk score with moderate discriminatory performance for predicting PPCs. It may be useful in identifying individual patients at high risk of PPC and in the design of future studies to evaluate interventions to prevent these complications. However, a customized preoperative risk assessment system is needed for each patient.

Beneficial Effects of PIN1 Inhibition on Diabetes Mellitus: A Concise Review.

Type 2 diabetes mellitus is a long-term medical illness in which the body either becomes resistant to insulin or fails to produce it sufficiently. Mostly, combinatorial therapy is required to control blood glucose levels. However, combinatorial therapy has detrimental side effects. The prevalence of the cases and subsequent increases in medical costs of the same intimidate human health globally. While there have been a lot of studies focused on developing diabetic regimens that work to lower blood glucose levels, their effectiveness is short-lived because of unfavorable side effects, such as weight gain and hypoglycemia. In recent years, the PIN1 (protein interacting with NIMA) enzyme has attracted the attention of researchers. Previous studies suggested that PIN1 may act on the various substrates that are involved in the progression of T2DM and also help in the management of diabetes-related disorders. Thus, the focus of the current review is to examine the correlation between PIN1, T2DM and its related disorders and explore the possibility of developing novel therapeutic targets through PIN1 inhibition.

Accelerating the transition to zero-emissions ferries

This study investigates how the authorities in Norway have managed to reduce greenhouse gas (GHG) emissions from the ferry sector by implementing a strategic tendering process for domestic ferry services. The study was conducted using interviews and document analysis. The authorities used competitive dialogue to implement zero-emissions technology in the procurement process, rendering the tender process and contract period longer than traditional tenders. The authorities’ first competitive environmental bid process was announced in 2011, and all new ferry tenders are now based on hybrid or zero-emissions technology. The authorities employed push and pull strategies to advance a successful green transition in ferry operations. These measures have led to a significant reduction in GHG emissions from this transport sector but an increase in investment costs compared with traditional diesel ferries. How the authorities used the tender system to make ferry transport more environmentally friendly is useful knowledge for others with similar objectives.

Electrical Energy Audit in Pratama Tapan Hospital

Hospitals, as large energy consumers, must adopt efficient energy-saving measures due to cost increases, regulations, and climate change concerns. In this study, an electrical energy audit was conducted at Pratama Tapan Hospital to identify energy-saving opportunities and recommend equipment replacements or technology upgrades. The primary objective was to determine the Energy Consumption Intensity (ECI) and analyze the potential for energy savings. The audit re-vealed an ECI value of 10.33 kWh/m²/year, highly efficient by ASEAN-USAID standards. However, 100% of rooms didn't meet the SNI 03-6197-2000 light intensity standard, causing discomfort. The study recommends installing specific light fixtures and adjusting lamp power to comply with the standard. These findings offer valuable insights for healthcare institutions striv-ing to achieve sustainability goals.

Economic and financial analysis in the pea production system (Pisum sativumL.) in Nariño, Colombia

The pea production system in the Department of Nariño, Colombia, constitutes an important pillar within the life strategies of Nariño families, representing a good portion of the high Andean landscape. However, despite its importance, there remains a notable lack of information in aspects such as direct and indirect costs, profitability, and other key economic variables, for the development of this productive system and for decision making, particularly in the Nariño context. current. Therefore, the purpose of this study is to carry out a detailed economic and financial analysis, focused on the producers participating in the AGROSAVIA Social Balance project, to facilitate a deep understanding of the dynamics of this productive system. To this end, 38 semi-structured interviews were carried out with producers adopting Agrosavia Obonuco Andina and Agrosavia San Isidro varieties between the years 2019 to 2022. Producers were identified through the snowball strategy and references from key territorial actors. The analysis involved calculations of economic and financial ratios, production costs and the application of an econometric model based on the Cobb-Douglas function, using ordinary least squares to evaluate the efficiency and inefficiency of the crop. The findings reveal an annual increase in production costs of 9.5 %, a financial profitability of 35 % according to the internal rate of return (IRR), and a technical efficiency of 1.67. Factors such as seed and labour exerted a predominant influence on productivity, while aspects such as production area and age showed inefficiencies, which is why more efficient management strategies for available physical resources, more active involvement of the family and management strategies and appropriation of knowledge and technologies with an intergenerational approach.

ECONOMIC FEASIBILITY OF ON-GRID PHOTOVOLTAIC SYSTEMS IN A SINGLE-FAMILY HOUSE IN RIO DE JANEIRO CITY

Brazil is a tropical country with favorable conditions for the generation and utilization of solar energy. This energy source becomes even more attractive when considering the dry periods that impact hydroelectric power generation in the country, resulting in an increase in energy costs reflected monthly in consumers' bills through tariff flags. In order to enhance residential architectural designs and promote energy efficiency, a feasibility study of photovoltaic systems was conducted, considering key economic indicators and the current tariff flags. To accomplish this, research was conducted in collaboration with Mounting Companies for a case study located in the city of Rio de Janeiro, adopting technical assumptions commonly used for residential photovoltaic system sizing. For the graphical sizing of the case study, factors such as the environment and summer and winter solstices were taken into account, and a shadow study was conducted to assess the potential loss of power generation by the photovoltaic system throughout the year. The shadow study revealed that, during both solstices, the optimal time for power generation by photovoltaic systems is between 9 a.m. and 6 p.m. Essentially, the calculated values of NPV (Net Present Value) and IRR (Internal Rate of Return) indicate that the project is economically viable and particularly advantageous during the yellow and red tariff flags, situations in which energy costs tend to be higher for consumers.

Does the introduction of an infliximab biosimilar always result in savings for hospitals? A descriptive study using real-world data

BackgroundBiosimilars are biologic drugs that have the potential to increase the efficiency of healthcare spending and curb drug-related cost increases. However, their introduction into hospital formularies through initiatives such as non-medical switching must be carefully orchestrated so as not to cause treatment discontinuation or result in increased health resource utilization, such as additional visits or laboratory tests, among others. This retrospective cohort study aims to assess the impact of the introduction of CT-P13 on the healthcare expenditures of patients who were treated with originator infliximab or CT-P13.MethodsGastroenterology, immunoallergology and rheumatology patients treated between September 2017 and December 2020 at a university hospital in Western Switzerland were included and divided into seven cohorts, based on their treatment pathway (i.e., use and discontinuation of CT-P13 and/or originator infliximab). Costs in Swiss francs were obtained from the hospital's cost accounting department and length of stay was extracted from inpatient records. Comparisons of costs and length of stay between cohorts were calculated by bootstrapping.ResultsSixty immunoallergology, 84 rheumatology and 114 gastroenterology patients were included. Inpatient and outpatient costs averaged (sd) CHF 1,611 (1,020) per hospital day and CHF 4,991 (6,931) per infusion, respectively. The mean (sd) length of stay was 20 (28) days. Although immunoallergology and rheumatology patients had higher average costs than gastroenterology patients, differences in costs and length of stay were not formally explained by treatment pathway. Differences in health resource utilization were marginal.ConclusionsThe introduction of CT-P13 and the disruption of patient treatment management were not associated with differences in average outpatient and inpatient costs and length of stay, in contrast to the results reported in the rest of the literature. Future research should focus on the cost-effectiveness of non-medical switching policies and the potential benefits for patients.

A multi-stage optimization of battery electric bus transit with battery degradation

Battery electric buses (BEBs) are appealing to transit operators for their elevated comfort, low noise, and zero tailpipe emissions. However, the degradation of BEB batteries over time challenges their performance and necessitates infrastructure adjustments. This study develops a generic multi-stage optimization model for BEB systems. The model addresses the dynamic influence of BEB battery degradation rates on the optimal BEB system configuration and operation, including component sizing, charging infrastructure allocation, BEB charging schedule, and battery replacement throughout the BEB usage lifecycle. A surrogate model-based space mapping (SMSM) algorithm is employed to address the inherent nonlinearity of incorporating battery degradation rates within the developed model. The model is tested on a real-world, multi-hub transit network, and the results highlight significant implications of battery degradation on the optimal spatiotemporal allocation of charging infrastructure, charging schedules, and battery replacement decisions throughout the 12-year BEB usage lifecycle. Sensitivity analysis highlights the influence of operational conditions on total system cost, indicating a 16.3 % increase in cost with a 50 % rise in both energy consumption rates and time-of-use (ToU) tariffs. Overall, the proposed model is a valuable decision-making tool for transit operators navigating BEB transit system planning.

Improving Speed Characteristics of High-Torque-Density Motors for Physical Human–Robot Interaction Using an Independent Three-Phase Winding Structure

Recently, due to the decrease in labor force, increase in labor costs, and the desire for improved quality of life, research on robots has been actively conducted to address these issues. However, it is currently difficult to find robots that physically interact with humans. The reason is that the actuators of robots do not have a high torque density on their own. To solve this problem, high-torque-density motors, such as proprioceptive actuators, are being researched. However, the torque density is still insufficient for physical interaction with humans, so a motor with higher torque density has been developed. However, high-torque-density motors have the disadvantage of lower speed characteristics due to increased Back EMF levels. Therefore, to address the deterioration of speed characteristics in the developed motor, we applied the independent three-phase winding structure to improve the speed characteristics. Consequently, through comparison with the Y-Connection and D-Connection, we propose the most suitable winding structure for high-torque-density motors intended for physical interaction with humans.