Key Cost Drivers Research Articles

The costs of implementing anaemia reduction interventions among women fish processors in Ghana

BackgroundAnaemia among women of reproductive age (WRA) remains persistently high in Ghana, affecting 41% in 2022. Women in low-income communities in Ghana engaged in fish processing activities are at increased risk of anaemia due to inadequate diets, exposure to infectious pathogens, and pollutants. The Invisible Fishers (IFs) project was implemented among women fish processors in their reproductive age in Central and Volta regions of Ghana to mitigate anaemia. Despite the efficacy, feasibility and scalability of the intervention, the cost of implementing the intervention is unknown. The objective of this study was to estimate the costs of implementing the IFs project in Ghana.MethodsWe used micro-costing approach to analyse the costs of implementing the IFs project. Data were collected as part of a pilot randomized control trial with three interventions: Behaviour Change Communication (BCC), Strengthening Market Engagement of fish processors plus Behaviour Change Communication (SME + BCC), and Fish Smoking Technology and Practices plus Behaviour Change Communication (FST + BCC). The interventions were delivered to 60 women fish processors in the Central region and 60 in Volta region. The cost of the intervention was estimated from the societal perspective. Economic costs were categorized as direct costs (i.e. personnel, transportation, meetings, training, and monitoring) and indirect cost (i.e. value of productive time lost due to women and community volunteers’ participation in the activities of the IFs project).ResultsThe FST + BCC had the highest average cost per beneficiary (US$11898.62), followed by the SME + BCC (US8962.93). The least expensive was the BCC (US$4651.93) over the intervention period of 18 months. Recurrent costs constituted the largest component of economic costs (98%). Key drivers of direct costs were personnel (58%), administrative expenses (14%), and transportation (7%).ConclusionThere is a high cost for implementing interventions included in the IFs project. Planning and scaling -up of the interventions across larger populations could bring about economies of scale to reduce the average cost of the interventions.

Predicting costs of local public bus transport services through machine learning methods

The present study developed several machine learning-based cost models to predict an efficient total economic cost per vehicle revenue-mile of urban public bus transport. The models were trained on a built-in dataset from 269 transit agencies providing urban services in the United States from 2015 to 2019. A feature selection strategy was implemented, finding that, for each proposed model, a subset of features determined a large impact on unit cost. These “core” features included commercial speed, average salary expenses per employee, vehicle productivity, and fleet ownership cost per vehicle. Machine learning techniques outperformed the linear regression method in terms of predictive power and robustness (understood as the dispersion of predictive power measures over the training sets). Based on SHAP values, the sensitivity analyses showed that the proposed models could be used to predict the impact of changes in some critical features on corresponding unit costs. The results may be useful for: (i) introducing regulatory constraints to the allocation of national public resources to local public bus transport services, aimed at minimizing the resources needed to provide a given level of service; (ii) defining the maximum economic compensation required by firms involved in competitive tendering for the allotment of service concessions, or firms with monopoly rights (by political choice and/or local public ownership); and (iii) improving service contract management and design by identifying key cost drivers of transit services.

Pricing drinking water testing in northern Haiti: Financial sensitivity to operating costs, user demand, and economic conditions

Safe drinking water availability is a concern in Haiti. Public systems have limited coverage and reliability. Private wells and local water sources are often of unknown or poor quality. Public health events, such as the 2010 cholera outbreak, demonstrate vulnerability to water contamination. To address these concerns, a drinking water laboratory was established at the Campus Henri Christophe in Limonade, a branch of the State University of Haiti, to meet water testing demands from local clients such as for-profit kiosks, institutions, industries, and municipal water systems. This study assessed the financial viability of a university-based drinking water laboratory in Haiti by calculating Internal Rate of Return and Net Present Value. Sensitivity analysis was used to identify the range of conditions under which laboratory revenues would cover operating costs. To achieve an acceptable profitability level, the laboratory must perform microbiological testing for routine monitoring samples and test an average of five samples per day. Price-based incentives for new clients have relatively small impacts on profitability. Finally, international and Haitian inflation cause some variation in profitability. These economic factors will be among the key drivers of laboratory operation costs. The results underscore the main factors that must be considered to make the laboratory successful and the importance of strategic marketing for laboratory managers to encourage clients to regularly test drinking water and emphasize microbiological testing.

Review of Cost Control Research in Prefabricated Construction under EPC Mode

Aims: Amidst the accelerating global urbanization and growing demand for sustainable development, prefabricated construction emerges as a pivotal transformational force in the construction industry due to its efficiency and environmental friendliness. This paper comprehensively reviews cost control research in prefabricated construction under the EPC (Engineering, Procurement, Construction) model. Study Design: The study adopts a literature-based approach, incorporating findings from domestic and international scholars, to uncover the critical issues and challenges in cost control within the EPC framework. Additionally, it analyzes the application of technological innovations such as BIM (Building Information Modeling) and DEMATEL (Decision Making Trial and Evaluation Laboratory) in cost control, offering a theoretical foundation and practical guidance for prefabricated construction under EPC. Place and Duration of Study: The research spans various regions globally, examining recent practices and theoretical advancements in cost control for prefabricated construction projects under EPC over the past decade to ensure timeliness and comprehensiveness. Methodology: The methodology encompasses a systematic literature review to construct a theoretical framework, coupled with an analysis of case studies showcasing effective cost control measures. Furthermore, the study explores the utilization of BIM and DEMATEL to enhance cost prediction accuracy, process monitoring, and decision-making support. Results: The findings reveal that the EPC model facilitates more systematic and efficient cost control in prefabricated construction. The application of BIM significantly improves cost forecasting precision and process transparency, enabling timely cost deviation identification and correction. DEMATEL effectively identifies key cost drivers and their interrelationships, informing targeted cost control strategies. Conclusion: This paper underscores the significance of cost control in prefabricated construction under the EPC model and highlights the pivotal role of BIM and DEMATEL in enhancing cost control effectiveness. It concludes by advocating for deeper integration of prefabricated construction with the EPC model to propel the green, intelligent transformation and sustainable development of the construction industry.

The Impact of the COVID-19 Pandemic on the Cost of the Urology Application Process

ObjectiveTo review the self-reported costs of urology residency applications from 2019 to 2023 and examine the impact of Society of Academic Urologists (SAU) policy changes made during the COVID-19 pandemic on these costs. MethodsData from the Texas Seeking Transparency in Applications to Residency (STAR) survey was used to evaluate costs incurred by fourth-year urology residency applicants from U.S. medical schools. Outcomes included median total cost (mTC), interview costs, application fees, and other associated costs, alongside the number of interviews offered and match outcomes. Cost comparisons among surgical specialties were made. Simple linear regression was used to identify cost drivers and cost-outcome correlations. ResultsBetween 2019 and 2023, 522 urology residency applicants responded to the survey. The adoption of virtual interviews and discontinuation of in-person away rotations in the 2020-21 cycle led to a 79% reduction in mTC and a 92% reduction in interview costs. Key cost drivers were the number of away rotations and number of applications submitted. Each incremental away rotation is associated increased cost of $1,490. In the 2020-21 cycle, urology applicants spent on average $2,000 more than their general surgery counterparts. Urology shared the position of most expensive surgical specialty with thoracic surgery and ophthalmology in the 2021-22 match cycle. ConclusionPandemic-related policy changes significantly reduced the costs of urology residency applications, helping to reduce socio-economic barriers. The critical role of away rotations in securing match success, along with their associated costs, highlights equity concerns for students from institutions without home urology programs.

The role of economic factors in shaping and constituting the household burden of neglected tropical diseases of the skin: Qualitative findings from Ghana and Ethiopia

Tracers of health system equity, neglected tropical diseases (NTDs) disproportionately affect marginalized populations. NTDs that manifest on the skin – “skin NTDs” – are associated with scarring, disfigurement, physical disability, social exclusion, psychological distress, and economic hardship. To support development and evaluation of appropriate intervention strategies, we aimed to improve understanding of the role of economic factors in shaping and constituting the burden that skin NTDs place on households. We collected data in 2021 in two predominantly rural districts: Atwima Mponua in Ghana (where Buruli ulcer, yaws, and leprosy are endemic) and Kalu in Ethiopia (where cutaneous leishmaniasis and leprosy are endemic). We conducted interviews (n = 50) and focus group discussions (n = 14) that explored economic themes with affected individuals, caregivers, and community members and analysed the data thematically using a pre-defined framework. We found remarkable commonalities across countries and diseases. We developed a conceptual framework which illustrates skin NTDs' negative economic impact, including financial costs of care-seeking and reductions in work and schooling; categorises coping strategies by their degree of risk-pooling; and clarifies the mechanisms through which skin NTDs disproportionately affect the poorest. Despite health insurance schemes in both countries, wide-ranging, often harmful coping strategies were reported. Traditional healers were often described as more accessible, affordable and offering more flexible payment terms than formal health services, except for Ethiopia's well-established leprosy programme. Our findings are important in informing strategies to mitigate the skin NTD burden and identifying key drivers of household costs to measure in future evaluations. To reduce skin NTDs' impact on households' physical, mental, and economic wellbeing, intervention strategies should address economic constraints to prompt and effective care-seeking. While financial support and incentives for referrals and promotion of insurance enrolment may mitigate some constraints, structural interventions that decentralise care may offer more equitable and sustainable access to skin NTD care.

Association of risk assessment at diagnosis with healthcare resource utilization and health-related quality of life outcomes in pulmonary arterial hypertension.

We aimed to describe the clinical characteristics, healthcare resource utilization (HCRU) and costs, health-related quality of life (HRQoL), and survival for patients with pulmonary arterial hypertension (PAH), stratified by 1-year mortality risk at diagnosis. Adults diagnosed with PAH at the Sheffield Pulmonary Vascular Disease Unit between 2012 and 2019 were included. Patients were categorized as low, intermediate, or high risk for 1-year mortality at diagnosis. Demographics, clinical characteristics, comorbidities, HCRU, costs, HRQoL, and survival were analyzed. Overall, 1717 patients were included: 72 (5%) at low risk, 941 (62%) at intermediate risk, and 496 (33%) at high risk. Low-risk patients had lower HCRU prediagnosis and 1-year postdiagnosis than intermediate- or high-risk patients. Postdiagnosis, there were significant changes in HCRU, particularly inpatient hospitalizations and accident and emergency (A&E) visits among high-risk patients. At 3 years postdiagnosis, HCRU for all measures was similar across risk groups. Low-risk patients had lower EmPHasis-10 scores (indicating better HRQoL) at diagnosis and at 1-year follow-up compared with intermediate- and high-risk patients; only the score in the high-risk group improved. Median overall survival decreased as risk category increased in analyzed subgroups. Low-risk status was associated with better 1-year survival and HRQoL compared with intermediate- and high-risk patients. HCRU decreased in high-risk patients postdiagnosis, with the most marked reduction in A&E admissions. The pattern of decreased per-patient inpatient hospitalizations and A&E visits at 3 years postdiagnosis suggests that a diagnosis of PAH helps to decrease HCRU in areas that are key drivers of costs.

Varying Estimates of Social Workers in the United States: Which Data Source to Use?

Behavioral health needs continue rise in the United States and constitute a key driver of health care utilization, costs, and outcomes. Social workers provide a wide range of services across health, behavioral health, and community settings, and while this heterogeneity in practice benefits care delivery, it complicates health workforce analyses. This analysis compares five commonly used national data sources and details similarities and differences in their estimates of the number, type, and practice characteristics of social workers. The analysis suggests that estimates vary significantly between data sets ranging from 282,425 to 1,022,859 social workers; as well as yield different findings of types of social workers in the United States, depending on the data set used. These differences have the potential to shape how researchers and policy makers assess the adequacy of the social work workforce and identify solutions to address the nation's behavioral health and social care needs.

Increased Time Interval of Postoperative Flap Monitoring After Autologous Breast Reconstruction

Background Hourly flap checks are the most common means of flap monitoring during the first 24 hours following autologous breast reconstruction (ABR). This practice often requires intensive care unit (ICU) admission, which is a key driver of health care costs and decreased patient satisfaction. This study addresses these issues by demonstrating decreased cost and length of admission associated with a 4-hour interval between flap checks during the first 24 hours following ABR. Methods This is a retrospective review of ABR surgeries performed by multiple surgeons from 2017 to 2020. Two cohorts were identified, one that underwent flap checks every hour in the ICU (Q1 cohort) and the other that underwent flap checks every 4 hours on the hospital floor (Q4 cohort). Our primary outcome measures were length of stay (LOS), flap takebacks, flap loss, and encounter cost. Results Rates of flap takeback and loss did not differ between cohorts (P = 0.18, P = 0.21). The Q4 cohort's average LOS was shorter than the Q1 cohort (P = 0.002). The Q4 cohort's average cost was also $25,554.80 less than the Q1 cohort (P < 0.001). This association persisted after controlling for LOS, operating room takeback, timing and laterality of reconstruction, and flap configuration (hazard ratio = 0.65, P = 0.0007). Conclusion This study demonstrates the benefits of lengthened flap check intervals during the first 24 hours following ABR. These intervals decrease the cost of ABR while also maintaining safety, making ABR a more accessible option for breast reconstruction patients.

Green hydrogen prospects in Peninsular Malaysia: a techno-economic analysis via Monte Carlo simulations

According to Malaysia's National Energy Transition Roadmap, hydrogen is a critical component of the country's energy transition. However, there is a scarcity of hydrogen studies for Peninsular Malaysian states, which limits discussions on green hydrogen production. This study employs a Monte Carlo model to assess the economic and technical factors influencing the success of green hydrogen in Peninsular Malaysia. The study focuses on three target years: 2023, 2030, and 2050, representing various stages of technological development and market adoption. The levelized cost of hydrogen (LCOH) of a 1-MW Proton Exchange Membrane (PEM) electrolyzer system ranges from $5.39 to $10.97 per kg in 2023, highlighting early-stage challenges and uncertainties. A 6-MW PEM electrolyzer system could achieve an LCOH of $3.50 to $4.72 per kg by 2030, indicating better prospects. Because of technological advancements and cost reductions, a 20-MW PEM electrolyzer system could achieve an LCOH of $3.12 to $3.64 per kg in 2050. The findings indicate that the northern regions of Peninsular Malaysia have consistently low LCOH values due to favorable geographical conditions. Due to minor variations in solar capacity factors, uncertainty distributions in LCOH remain stable across different regions. Some states may face increased uncertainty, emphasizing the need for additional policy support mechanisms to mitigate risks associated with green hydrogen investments. The sensitivity analysis shows that key cost drivers are shifting, with early-stage electrolyzer investments dominating in 2023 and electricity prices becoming more important in 2030 and 2050. Future research could focus on optimizing green hydrogen systems for areas with underdeveloped green hydrogen industries. This study contributes to informed discussions about green hydrogen production by emphasizing the importance of tailored strategies that consider local conditions and highlighting the role of Peninsular Malaysia in the energy transition.

Predicting healthcare expenditure based on Adjusted Morbidity Groups to implement a needs-based capitation financing system

BackgroundDue to population aging, healthcare expenditure is projected to increase substantially in developed countries like Spain. However, prior research indicates that health status, not merely age, is a key driver of healthcare costs. This study analyzed data from over 1.25 million residents of Spain's Murcia region to develop a capitation-based healthcare financing model incorporating health status via Adjusted Morbidity Groups (AMGs). The goal was to simulate an equitable area-based healthcare budget allocation reflecting population needs.MethodsUsing 2017 data on residents' age, sex, AMG designation, and individual healthcare costs, generalized linear models were built to predict healthcare expenditure based on health status indicators. Multiple link functions and distribution families were tested, with model selection guided by information criteria, residual analysis, and goodness-of-fit statistics. The selected model was used to estimate adjusted populations and simulate capitated budgets for the 9 healthcare districts in Murcia.ResultsThe gamma distribution with logarithmic link function provided the best model fit. Comparisons of predicted and actual average costs revealed underfunded and overfunded areas within Murcia. If implemented, the capitation model would decrease funding for most districts (up to 15.5%) while increasing it for two high-need areas, emphasizing allocation based on health status and standardized utilization rather than historical spending alone.ConclusionsAMG-based capitated budgeting could improve equity in healthcare financing across regions in Spain. By explicitly incorporating multimorbidity burden into allocation formulas, resources can be reallocated towards areas with poorer overall population health. Further policy analysis and adjustment is needed before full-scale implementation of such need-based global budgets.

Healthcare utilisation and economic burden of migraines among bank employees in China: a probabilistic modelling study.

Despite the recognised high prevalence of migraines among bank employees, yet their healthcare utilisation patterns and the economic burden of migraines remain underexplored. To examine migraine-related healthcare utilisation among bank employees in China, and to estimate the economic burden of migraines. A cross-sectional survey was conducted in Guizhou province, China between May and October 2022. The HARDSHIP questionnaire was used to identify migraine-positive individuals and enquire about their healthcare utilisation and productivity losses. A probabilistic decision-analytic model with a micro-costing approach was used to estimate the economic burden from the perspectives of the healthcare system, employers, and society. All costs were expressed in 2022 United States dollars. One-way and probabilistic sensitivity analyses were performed. Nearly half of individuals with migraines reported not seeking medical care. Only 21.8% reported seeking outpatient consultations, 52.5% reported taking medicines, and 27.1% reported using complementary therapies. Chronic migraine patients had significantly higher healthcare utilisation than episodic migraine patients. Among individuals with a monthly migraine frequency of 15 days or more, 63.6% took inappropriate treatments by excessively using acute medications. Migraines in the banking sector in Guizhou cost the healthcare system a median of $7,578.0 thousand (25th to 75th percentile $4,509.2-$16,434.9 thousand) per year, employers $89,750.3 thousand (25th to 75th percentile $53,211.6-$151,162.2 thousand), and society $108,850.3 thousand (25th to 75th percentile $67,370.1-$181,048.6 thousand). The median societal cost per patient-year is $3,078.1. Migraine prevalence and productivity losses were identified as key cost drivers. The study points to the need to raise awareness of migraines across all stakeholders and to improve the organisation of the migraine care system. A substantial economic burden of migraines on the healthcare system, employers, and society at large was highlighted. These cost estimates offer evidence-based benchmarks for assessing economic savings from improved migraine management, and can also draw the attention of Chinese policymakers to prioritise migraine policies within the banking and other office-based occupations.

Costing of a Combination Intervention (Kyaterekera) Addressing Sexual Risk-Taking Behaviors among Vulnerable Women in Southern Uganda.

In Uganda, women engaged in sex work (WESW) are a marginalized population at the intersection of multiple vulnerabilities. The Kyaterekera intervention is targeted at WESW in Rakai and the greater Masaka regions in Uganda and combines a traditional HIV risk-reduction approach with a savings-led economic empowerment intervention and financial literacy training. We estimated the economic costs of the Kyaterekera intervention from a program provider perspective using a prospective activity-based micro-costing method. All program activities and resource uses were measured and valued across the control arm receiving a traditional HIV risk-reduction intervention and the treatment arm receiving a matched individual development savings account and financial literacy training on top of HIV risk reduction. The total per-participant cost by arm was adjusted for inflation and discounted at an annual rate of 3% and presented in 2019 US dollars. The total per-participant costs of the control and intervention arms were estimated at $323 and $1,435, respectively, using the per-protocol sample. When calculated based on the intent-to-treat sample, the per-participant costs were reduced to $183 and $588, respectively. The key cost drivers were the capital invested in individual development accounts and personnel and transportation costs for program operations, linked to WESW's higher mobility and the dispersed pattern of hot spot locations. The findings provide evidence of the economic costs of implementing a targeted intervention for this marginalized population in resource-constrained settings and shed light on the scale of potential investment needed to better achieve the health equity goal of HIV prevention strategies.

Cost of SARS-CoV-2 self-test distribution programmes by different modalities: a micro-costing study in five countries (Brazil, Georgia, Malaysia, Ethiopia and the Philippines)

ObjectiveDiagnostic testing is an important tool to combat the COVID-19 pandemic, yet access to and uptake of testing vary widely 3 years into the pandemic. The WHO recommends the use...

Evaluating the Economic Burden of Acute Myeloid Leukemia in Canada

Introduction: Acute myeloid leukemia (AML) represents a significant burden for patients and their families, and to the healthcare system. This study estimated the total cost of illness associated with newly diagnosed AML patients in Canada. Methods: The economic burden of AML was estimated using an incidence-based model, analyzing different types of AML cases in Canada. Direct and indirect costs were calculated using scientific literature and Canadian clinical experts’ inputs. Patients were categorized depending on their eligibility for intensive chemotherapy (fit and unfit patients) as well as according to age and cytogenetic markers. Results: The total average cost of AML per patient is estimated to be CAD 178,073 with a cost of CAD 210,983 and CAD 145,163 for fit and unfit patients, respectively. The costs related to treatment represent half of the total average cost (52%), followed by hematopoietic stem cell transplant (23%), best supportive care (16%), productivity loss (6%), and wastage (4%). Conclusion: For patients with AML, the costs associated with fit patients are higher than unfit patients. Hospitalization and best supportive care costs are key cost drivers for the total costs of fit and unfit patients, respectively. This study highlights that AML is associated with a significant economic burden in Canada.

The economic burden of difficult intravenous access in the emergency department from a United States' provider perspective.

Peripheral intravenous catheter placement is one of the most common invasive procedures that nurses will perform, especially in emergency departments. This early analysis aimed to quantify the economic burden associated with intravenous therapy in patients presenting in emergency departments with difficult intravenous access, receiving traditional peripheral intravenous catheters. This may inform the opportunity for improvement for investment in nursing tools and services regarding difficult venous access burden reduction. Model parameter data were obtained from published literature where possible via a targeted literature review for the terms including relative variations of 'Difficult Venous Access', 'burden', and 'costs', or elicited from expert clinical opinion. A simple decision tree model was developed in Microsoft® Excel 2016. Results included number of insertion attempts, number of patients requiring escalation, catheter failures due to complications, healthcare professional (e.g. nurse) time, and total costs (including/excluding health care professional time). Sensitivity analyses were performed. The model considers 64,000 individuals presenting in the emergency department annually, of which 75% (48,000) require a peripheral intravenous catheter; of these 22% (10,560) are estimated to have difficult venous access. The total cost burden of difficult venous access is estimated to be $890,095 per year/$84.29 per patient with difficult venous access, including the cost of clinician time. Key total cost drivers include the population size treated in the emergency department annually, the proportion of midlines placed by a specialist IV (intravenous access) nurse and the percentage of patients with difficult venous access. This is the first formal analysis estimating the significant economic burden of difficult venous access in emergency departments via peripheral intravenous catheter placement, a task frequently performed by nurses. Further studies are needed to evaluate nursing-centric strategies for reducing this burden. Additionally, adoption of a concise definition is needed, as is routine use of reliable assessment tools so that future cost analyses can be better contextualised.

Transitioning patients from intravenous to subcutaneous infliximab and vedolizumab for inflammatory bowel disease: what is the opportunity cost of improving access to healthcare?

Biologic drugs are highly effective for inflammatory bowel disease (IBD) management but are key drivers of costs of care especially when administered intravenously (i.v.). Availability of subcutaneous (SC) formulations has increased convenience for patients and improved access to care, but at the cost of revenue to health services. To evaluate the economic impact of transitioning a tertiary centre IBD cohort from i.v. to SC biologic administration and assess the implications for key stakeholders. A retrospective analysis of all patients who received i.v. infliximab or vedolizumab in the outpatient infusion centre of a tertiary IBD centre between July 2019 and June 2021 was undertaken. Data were collated from electronic medical records, pharmacy dispensing systems and the hospital business intelligence unit. An economic analysis and theoretical financial/capacity impact analysis of a transition to an SC model were estimated under two scenarios using a random 10% and 30% of the patient cohort. Transitioning our IBD cohort from i.v. to SC administration would result in a loss to our health service of AU$2 732 123.75, composed of AU$1 463 003.75 in Weighted Inlier Equivalent Separation (WIES) and AU$1 269 120 in drug procurement revenue. However, it would ease capacity in the infusion centre by up to 5256 h. Transitioning patients to SC administration results in improved access to infusion centres and substantial savings to state governments; however, switching results in a loss of i.v. biologic-generated WIES to health services. Alternative funding models are required to achieve sustainability in IBD care and reduce reliance on i.v. biologic-generated income.

Standardising workforce cost estimates across Australian jurisdictions: genomic testing as a use case.

IntroductionLabour costs are a key driver of healthcare costs and a key component of economic evaluations in healthcare. We undertook the current study to collect information about workforce costs related to clinical genomic testing in Australia, identifying key components of pay scales and contracts, and incorporating these into a matrix to enable modelling of disaggregated costs.MethodsWe undertook a microcosting study of health workforce labour costs in Australia, from a health services perspective. We mapped the genomic testing processes, identifying the relevant workforce. Data was collected on the identified workforce from publicly available pay scales. Estimates were used to model the total cost from a public health services employer perspective, undertaking deterministic and probabilistic sensitivity analyses.ResultsWe identified significant variability in the way in which pay scales and related conditions are both structured and the levels between jurisdictions. The total costs (2023-2024 Australian dollars) ranged from 160,794 (113,848-233,350) for administrative staff to 703,206 (548,011-923,661) for pathology staff (full-time equivalent). Deterministic sensitivity analysis identified that the base salary accounts for the greatest source of uncertainty, from 24.8% (20.0-32.9%) for laboratory technicians to 53.6% (52.8-54.4%) for medical scientists.ConclusionVariations in remuneration levels and conditions between Australian jurisdictions account for considerable variation in the estimated cost of labour and may contribute significantly to the uncertainty of economic assessments of genomic testing and other labour-intensive health technologies. We outline an approach to standardise the collection and estimation of uncertainty for Australian health workforce costs and provide current estimates for labour costs.

Price prediction of residential buildings using random forest and artificial neural network

ABSTRACT Inaccurate cost estimates significantly affect the ultimate cost of construction projects and reduce revenues. This study compares the accuracy of two algorithm models in estimating construction project prices during the early conceptual stage of project development. The construction prices of residential projects are forecasted in this study using two modeling methods, artificial neural networks (ANN) and random forest (RF), based on the project data from the actual projects. The datasets have been collected from 220 residential buildings implemented in various cities in Egypt. Python was used to build the model during the training and testing phases. To evaluate the performance of the models generated by each algorithm, five key statistical metrics were employed. The findings revealed that both ANN and RF managed to predict the price per meter square of the construction projects, attaining model score accuracies of 96.6% and 93.05%, respectively. The best training for RF was acquired with 110 trees and a maximum decision tree depth of 20. The outcomes of this research could assist stakeholders in the building sector estimate construction project costs during the conceptual stage, enabling more informed decisions by examining key cost drivers for building projects and utilizing appropriate machine learning techniques for analysis.

The economic burden of households affected by tuberculosis in Brazil: First national survey results, 2019-2021.

One of the three main targets of the World Health Organization (WHO) End TB Strategy (2015-2035) is that no tuberculosis (TB) patients or their households face catastrophic costs (defined as exceeding 20% of the annual household income) because of the disease. Our study seeks to determine, as a baseline, the magnitude and main drivers of the costs associated with TB disease for patients and their households and to monitor the proportion of households experiencing catastrophic costs in Brazil. A national cross-sectional cluster-based survey was conducted in Brazil in 2019-2021 following WHO methodology. TB patients of all ages and types of TB were eligible for the survey. Adult TB patients and guardians of minors (<18 years old) were interviewed once about costs, time loss, coping measures, income, household expenses, and asset ownership. Total costs, including indirect costs measured as reported household income change, were expressed as a percentage of annual household income. We used descriptive statistics to analyze the cost drivers and multivariate logistic regression to determine factors associated with catastrophic costs. We interviewed 603 patients, including 538 (89%) with drug-sensitive (DS) and 65 (11%) with drug-resistant (DR) TB. Of 603 affected households, 48.1% (95%CI: 43-53.2) experienced costs above 20% of their annual household income during their TB episode. The proportion was 44.4% and 78.5% among patients with DS- and DR-TB, respectively. On average, patients incurred costs of US$1573 (95%CI: 1361.8-1785.0) per TB episode, including pre-diagnosis and post-diagnosis expenses. Key cost drivers were post-diagnosis nutritional supplements (US$317.6, 95%CI: 232.7-402.6) followed by medical costs (US$85.5, 95%CI: 54.3-116.5) and costs of travel for clinic visits during treatment (US$79.2, 95%CI: 61.9-96.5). In multivariate analysis, predictors of catastrophic costs included positive HIV status (aOR = 3.0, 95%CI:1.1-8.6) and self-employment (aOR = 2.7, 95%CI:1.1-6.5); high education was a protective factor (aOR = 0.1, 95%CI:0.0-0.9). Although the services offered to patients with TB are free of charge in the Brazilian public health sector, the availability of free diagnosis and treatment services does not alleviate patients' financial burden related to accessing TB care. The study allowed us to identify the costs incurred by patients and suggest actions to mitigate their suffering. In addition, this study established a baseline for monitoring catastrophic costs and fostering a national policy to reduce the costs to patients for TB care in Brazil.