Key Cost Drivers Research Articles

Assessing the treatment pattern, health care resource utilisation, and economic burden of multiple myeloma in France using the Système National des Données de Santé (SNDS) database: a retrospective cohort study

BackgroundReal-world data on health care resource utilisation (HCRU) and costs for French patients with multiple myeloma (MM) are limited due to the quickly evolving MM treatment landscape. This retrospective, national-level study quantified the MM economic burden in France.MethodsThe study included patients with newly diagnosed MM from the Système National des Données de Santé coverage claims database between 2013 and 2018 who received active treatment within 30 days of diagnosis. HCRU included hospitalisations, drugs, consultations, procedures, tests, devices, transport, and sick leave. Costs were annualized to 2019 prices. Drug treatments, reported by line of therapy (LOT), were algorithmically defined using drug regimen, duration of therapy, and gaps between treatments. Analyses were stratified by stem cell transplantation status and LOT.ResultsAmong 6413 eligible patients, 6229 (97.1%) received ≥ 1 identifiable LOT; most received 1 (39.8%) or 2 LOT (27.5%) during follow-up. Average annual hospitalisation was 6.3 episodes/patient/year (median duration: 11.6 days). The average annual cost/patient was €58.3 K. Key cost drivers were treatment (€28.2 K; 39.5% of total HCRU within one year of MM diagnosis) and hospitalisations (€22.2 K; 48.6% of total HCRU costs in first year). Monthly treatment-related costs increased from LOT1 (€2.447 K) and LOT5 + (€7.026 K); only 9% of patients received LOT5 + . At LOT4 + , 37 distinct regimens were identified. Hospitalisation costs were higher in patients with stem cell transplantation than total population, particularly in the first year.ConclusionsThis study showed a high economic burden of MM in France (€72.37 K/patient/year in the first year) and the diversity of regimens used in late-line treatments.

Costing of a Multiple Family Group Strengthening Intervention (SMART Africa) to Improve Child and Adolescent Behavioral Health in Uganda.

Reliable cost estimates are key to assessing the feasibility, affordability, and cost-effectiveness of interventions. We estimated the economic costs of a multiple family group (MFG) intervention-child and adolescent mental health evidence-based practices (CAMH-EBP) implemented under the SMART Africa study, seeking to improve family functioning and reduce child and adolescent behavior problems-delivered through task-shifting by community health workers (CHWs) or parent peers (PPs) in school settings in Uganda. This prospective microcosting analysis was conducted from a provider perspective as part of a three-armed randomized controlled trial of the MFG intervention involving 2,391 participants aged 8-13 years and their caregivers in 26 primary schools. Activity-specific costs were estimated and summed, and divided by actual participant numbers in each study arm to conservatively calculate total per-child costs by arm. Total per-child costs of the MFG-PP and MFG-CHW arms were estimated at US$346 and US$328, respectively. The higher per-child cost of the MFG-PP arm was driven by lower than anticipated attendance by participants recruited to this arm. Personnel costs were the key cost driver, accounting for approximately 70% of total costs because of intensive supervision and support provided to MFG facilitators and intervention quality assurance efforts. This is the first study estimating the economic costs of an evidence-based MFG intervention provided through task-shifting strategies in a low-resource setting. Compared with the costs of other family-based interventions ranging between US$500 and US$900 in similar settings, the MFG intervention had a lower per-participant cost; however, few comparisons are available in the literature. More costing studies on CAMH-EBPs in low-resource settings are needed.

Replacement Method of Main Parts of Mining and Earth Moving Equipment: Current Situation and Prospect of Machinery Industry

The dynamic production budgets and the volatile metal prices in the current mining industry have stimulated and strengthened a continuous search for operating efficiency in all areas of the production process, with reliability of the earth moving equipment being one of the core aspects. Unpredicted breakdown of earth moving machine major components usually cause serious consequences such as loss of production, extra cost and deviation from mine plans. From a financial perspective, these components are one of the key cost drivers among the top Mine cost centers and success in managing them (achieving expected life cycle and operational cost) is essential in meeting maintenance and production cost (cost/ton) of the equipment. Whereas relatively small and frequent repairs largely affect availability, operational cost is directly affected by major component failure. In trying to maximize the operating efficiency of earth moving equipment, various maintenance strategies and methodologies have been tried, tested and initiated. However, the challenge in most, if not all operations, has been to find an accurate method to determine the exact expected replacement point of major components. This phenomenon has been challenging, though a number of operations engage in a time-based replaced strategy as recommended by most equipment manufacturers, replacement schedules are rarely executed as panned. The norm however, has been to draw up a calendar of parts to be replaced each year during budgeting time and scheduled intervals of replacement are set following the Original Equipment Manufacturers’ (OEM) recommendation. Nevertheless, these schedules have not conclusively determined the point at which the replacement is economically justified. This study therefore, highlights the challenges of the traditional time-based component replacement strategy and recommends an approachbased on condition assessment.The data used in this study are obtained from different Mines as well as the experience of the researcher(ethnological study in the industry). The study concludes that, to realize optimum utility from a component, a component management strategy must start right from equipment selection and purchase decisions. Thus, criticalcomponents, which require preventive replacement, need to be identified and monitored through condition monitoring. Condition inspections must bescheduled in such a way that they do not adversely affect the availability of the equipment.

Economic aspects of low-field magnetic resonance imaging : Acquisition, installation, and maintenance costs of 0.55 T systems

HintergrundNiederfeld-Magnetresonanztomographie(MRT)-Geräte bieten aufgrund niedrigerer Herstellungskosten und geringerer baulicher Anforderungen für Installation und Betrieb eine Chance zur Kostenreduktion.FragestellungMögliche Kostenreduktionen in Anschaffung, Einbringung und Unterhalt durch die Verwendung neuer Niederfeld-MRT-Systeme.Material und MethodenÜbersicht über die wichtigsten Kostenfaktoren und Evaluierung des Einsparpotenzials eines 0,55-T-Niederfeld-MRT der neuesten Generation im Vergleich zu 1,5‑ und 3‑T-MRT-Systemen in der klinischen Routine.ErgebnisseIm Anschaffungspreis liegt das Einsparpotenzial eines 0,55-T- im Vergleich zu einem 1,5-T-MRT-System bei etwa 40–50 %. Das um 25 % niedrigere Gewicht des Systems verringert die Transportkosten, die geringere Größe des Geräts erlaubt bei einem ebenerdigen Betriebsplatz die Einbringung mittels ferngesteuertem fahrbarem Robotersystem ohne Eröffnung der Außenfassade. Eine Quench-Leitung muss nicht installiert werden. Die Kosten für Einbringung und Installation sind insgesamt bis zu 70 % niedriger als bei Hochfeldsystemen. Die Wartungskosten eines 0,55-T-Geräts liegen etwa 45 % unter denen eines 1,5-T-Geräts bei vergleichbarem Servicevertrag. Weitere potenzielle Kostenreduktionen ergeben sich durch die geringere Raumgröße und einen potenziell geringeren Energieverbrauch für Untersuchungen und Kühlung.SchlussfolgerungDie Verwendung von MRT-Systemen mit niedrigerer Feldstärke bieten großes ökonomisches und ökologisches Potenzial für Kliniken und Praxisbetreiber.

The interaction between direct and indirect network externalities in the early diffusion of mobile social networking

The early diffusion of mobile social networking (MSN) reflected the interplay of different factors: the affordability of better Internet connectivity and the diffusion of Smartphones suitable for Social Networking Applications. These key technology and cost drivers facilitated both the direct and indirect network externalities, which are necessary to overtake critical adoption barriers and facilitate users' decisions. However, a key challenge in modeling MSN diffusion is in distinguishing among the impact of these two types of network externalities. This paper addresses such a challenge by adopting a two-stage estimation strategy. In the first stage, we focus on direct network externalities by estimating a set of country-specific adoptions peaks that allow differentiating between early and late adopters. In the second stage, we estimate the impact of indirect network externalities on MSN diffusion while also considering the role of pricing strategies. Our results provide significant evidence that indirect network externalities can exert opposite effects on adoption between early adopters and followers, depending on whether they adopt before or after a country's MSN diffusion peak.

Direct and indirect costs of systemic sclerosis and associated interstitial lung disease: A nationwide population-based cohort study.

Background and objectiveThe study aimed to evaluate the direct and indirect costs of systemic sclerosis (SSc) in cases with and without interstitial lung disease (ILD).MethodsCases diagnosed with SSc (2002–2015) were identified in the Danish National Patient Registry. Cases were matched 1:4 with non‐SSc controls from the general population. Data on costs were obtained from national databases. Excess cost was estimated as the annual cost per case subtracting the costs of the control.ResultsWe identified 1869 cases and 7463 controls. Total excess cost (direct healthcare, elderly care and indirect costs) in the SSc‐ILD cohort was €29,725, and €17,905 in the non‐ILD SSc cohort. In‐ and out‐patient contacts and forgone earnings were the key drivers of costs in both cohorts. Healthcare costs were higher before and after the diagnosis compared with the controls. Men incurred higher excess healthcare costs than women. Hospitalization and outpatient services were the key drivers of the gender‐associated differences. Income from employment decreased more rapidly after diagnosis in the SSc‐ILD cohort than in the non‐ILD SSc cohort. Public transfer income increased after diagnosis, with the most pronounced difference in the SSc‐ILD cohort. Disability pension was the key driver of public transfer income.ConclusionSSc is associated with a significant individual and societal burden that is evident several years before and after the diagnosis. Total excess costs are higher in SSc‐ILD than in the non‐ILD SSc underlining the severity of pulmonary involvement. Initiatives to maintain work ability and to reduce hospital admissions may reduce the economic burden of SSc.

Patient-level costing analysis of paediatric short bowel syndrome care in a specialist tertiary centre

PurposeTo undertake a pilot study estimating patient-level costs of care for paediatric short bowel syndrome (SBS) from the healthcare provider perspective.MethodsA pilot group of patients with anatomical SBS was selected at a single specialist tertiary centre in the United Kingdom. The Patient Level Information and Costing System (PLICS) was used to extract costing data for all hospital-based activities related to SBS, from the implementation of PLICS in 2016 to April 2021. Patient-specific and pooled data were reported descriptively in per patient-year terms.ResultsFive patients had full PLICS data available for the 5-year study period and 2 patients had 4 years of data. The median cost for hospital care of SBS was £52,834 per patient-year (range £1804–£331,489). The key cost drivers were inpatient beds, pharmacy, and staffing costs, which made up > 60% of annual costs. In the first 3 years following index admission (n = 2), there was a steady decline in the annual cost of care to a level comparable with patients with established SBS.ConclusionPatient-level cost of care analysis for SBS is feasible using PLICS. Hospital-related costs vary widely between and within individual patients over time. Key drivers of cost are related to complications of SBS.

How Much Does an Infected Fracture Cost?

Though infection is a common and costly complication following fracture, there is a scarcity of literature focused on the additional cost of healthcare when a fracture becomes infected. This literature review compiles existing heterogenous data to evaluate the cost of infected fractures, yielding an estimate of a 1.2-fold to six-fold increase in healthcare costs associated with infection. The increases in cost were largely driven by an increased length of stay. Factors which affect this increase include the infectious agent, the depth of infection and the location of the fracture. In order to reduce healthcare costs, early soft tissue cover and prophylactic antibiotics are effective in that they reduce the infection rates. An alternative approach is to reduce the length of stay, the key driver of cost, for example by reducing the length of inpatient antibiotic therapy. Further cost-utility analyses which focus on the same aspects of the healthcare costs are required for a more accurate estimation of the cost.

Economic assessment of local solar module assembly in a global market

With increasingly competitive pricing and net-zero targets driving the growing demand for solar photovoltaics, new manufacturing supply-chain models are under consideration to increase local resilience and to ensure continuity of supply. We report a cost model that assesses the opportunity for local module assembly in a competitive global market context and extends techno-economic analysis to include important supply-chain aspects of trade and logistics costs. The initial analysis focuses on the economic viability of photovoltaic (PV) module assembly at different scales in Australia and then generalizes to include the global supply chain. The analysis shows that, with economies of scale and sufficient demand, local module assembly from imported materials can compete with the price of imported modules. Key cost drivers and their impact on profitability are discussed in the light of broader benefits and potential policy mechanisms that influence decision-making that can support investments in domestic solar module manufacturing. • A supply-chain model is proposed to assess the opportunity for local module assembly • CapEx, OpEx, trade, and logistic costs are optimized simultaneously • The impact of social factors and market size are modeled for local manufacturing • Economy of scale may significantly reduce the manufacturing cost To achieve terawatts of installation PV, a diverse range of business models are operating to deliver the lowest cost of solar PV. Here, Dehghanimadvar et al. examine local module assembly in the global market by extending techno-economic analysis to include the supply-chain aspects of trade and logistics costs.

GEOGRAPHIC DIFFERENCES IN THE RISK OF SURGERY IN INFLAMMATORY BOWEL DISEASE: A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract BACKGROUND The management of inflammatory bowel disease (IBD) is associated with considerable healthcare and societal cost. A key driver of direct medical cost, remains surgery. Although the cumulative risks of surgery have been well described in countries of the Western world, surgical risk data from Asia, where IBD is rapidly emerging, is lacking. OBJECTIVES The primary objective was to compare the cumulative risk of surgery at 1-year after a diagnosis of Crohn’s disease (CD) and ulcerative colitis (UC) between contemporary adult population-based cohorts from the Western world and Asia. Secondarily, we estimated 5- and 10-year risks of IBD-related surgery. METHODS MEDLINE and EMBASE were searched for population-based studies published on or after January 1, 2000, that reported 1-, 5-, and 10-year risks of IBD-related surgery. Authors were contacted to provide previously unpublished data. Random effects models were performed to analyze temporal and regional risks of surgery for cohorts diagnosed with IBD in the year 1998 and later. RESULTS The initial search yielded 10,358 citations. Of those, 37 studies were used in analyses. For UC, the 1-, 5-, and 10-year risk of surgery were 1.71% (95% confidence intervals [CI]: 1.13, 2.29), 3.77% (95% CI: 2.41, 5.13), and 8.33% (95% CI: 5.03, 11.63), respectively. For CD, the 1-, 5-, and 10-year risk of surgery were 7.17% (95% CI: 5.92, 8.42), 13.63% (95% CI: 11.26, 16.00), and 24.57% (95% CI: 19.21, 29.93), respectively (Table 1; Figure 1). For CD, the 1-year risk of surgery was 7.44% (95% CI: 6.07, 8.80) and 7.22% (95% CI: 2.65, 11.78) for countries in the Western world and countries in Asia, respectively (p= 0.93). The Western 5-year risk of CD surgery (13.52%, 95% CI: 10.85, 16.19) was similar to Asia (15.95%, 95% CI: 5.48, 26.43) (p=0.66). The 1-year risk of surgery for UC was not significantly different between Western world countries (1.87%, 95% CI: 1.27, 2.47) and Asia (0.74%, 95% CI: -0.48, 1.97) (p=0.13). The pooled 5-year risk of surgery was significantly higher in countries of the Western world (4.13%, 95% CI: 2.71, 5.55) as compared to Asia (2.11%, 95% CI: 1.88, 2.33) (p=0.02). Comparison of pooled 10-year risk between countries of the Western world and Asia was not possible as there was only one Asian study published on risk of surgery 10-years after CD and UC diagnosis each. CONCLUSIONS During the 21st century the risk of early surgery 1-year after the diagnosis for CD and UC was similar in countries of the Western world as compared to Asia. Long-term (10-year data) was lacking for Asian countries. Future studies are needed to generate more robust long-term estimates for risks of IBD-surgery in Asia.

GEOGRAPHIC DIFFERENCES IN THE RISK OF SURGERY IN INFLAMMATORY BOWEL DISEASE: A SYSTEMATIC REVIEW AND META-ANALYSIS

The management of inflammatory bowel disease (IBD) is associated with considerable healthcare and societal cost. A key driver of direct medical cost, remains surgery. Although the cumulative risks of surgery have been well described in countries of the Western world, surgical risk data from Asia, where IBD is rapidly emerging, is lacking.

Türkiye'de Alevlenme ile Yatırılan Kronik Obstrüktif Akciğer Hastalarının Yönetiminde Anahtar Maliyet Kalemleri ve Ekonomik Yük: Geri Ödeyici Perspektifinden Hastalık Maliyeti Çalışması

Objective: To estimate the economic burden and key cost drivers of managing exacerbated and hospitalized chronic obstructive pulmonary disease (COPD) patients in Türkiye. Material and Methods: This cost of illness study was based on an estimation of per patient annual direct medical costs for the management of exacerbated and hospitalized COPD patients in Türkiye from a payer perspective. The average per patient direct medical cost was calculated based on cost items related to outpatient visits, diagnostic laboratory and radiological tests, hospitalizations and interventions, training and rehabilitation, drug treatment and equipment, drug-related adverse events, and co-morbidities/complications. Results: Based on average annual per patient costs calculated for outpatient admission ($88.5), laboratory and radiological tests ($68.6), hospitalizations and interventions/training/rehabilitation ($1,181.3), drug treatment/equipment ($1,088.0), co-morbidities/complications ($1,291.7) and drug related adverse events ($11.8) cost items, per patient annual direct medical cost related to the management of exacerbated and hospitalized COPD patients was calculated to be $3,729.9 from the payer perspective. Co-morbidities/complications (34.6%), hospitalizations/interventions (31.7%) and drug treatment/equipment (29.2%) were the key cost driver. Results: In conclusion, our findings indicate that managing exacerbated and hospitalized COPD patients pose a considerable burden to health economics in Türkiye, with co-morbidities and hospitalizations estimated as the main cost drivers. Our findings emphasize the need for cost-effective prevention strategies and the likelihood of potential cost-savings by timely recognition and proper management of co-morbidities and by better disease control with reduced frequency of exacerbations and hospitalizations.

Towards standardized nuclear reactors: Seismic isolation and the cost impact of the earthquake load case

Nuclear energy has a key role to play in global decarbonization. Impediments to the widespread deployment of reactors are their projected high capital cost and levelized cost of energy, and time required to analyze, design, license, construct, and commission them. The earthquake load case is a key cost driver for a new build nuclear plant, because near-surface soils and seismic hazard are different at each site, requiring site-specific analysis, design, engineering, qualification, licensing, and regulatory review, essentially making every design First-of-a-Kind (FoaK). To enable deployment at the scale needed for deep decarbonization, the cost and time impact of the seismic load case must be significantly mitigated, and plants must be standardized. Seismic base isolation has been proven to considerably reduce the earthquake response of structures and equipment but has yet to be applied to a nuclear power plant in the United States, in part because the financial impacts, positive or negative, are not known. Because there are no recent non-proprietary data to characterize the influence of the seismic load case on capital cost, it is difficult to confidently quantify the financial benefits of seismic isolation.Scheme-level designs of two fundamentally different advanced reactor buildings were developed to assemble cost data on the influence of the seismic load case. Both buildings were equipped with three bespoke pieces of safety-related equipment and analyzed for incremented levels of earthquake shaking to quantify the seismic penalty on equipment, in terms of vessel weights and horizontal accelerations. Using analysis results, a questionnaire was developed and transmitted to nuclear utilities, reactor developers, engineers, and equipment suppliers to collect cost data on engineering and fabrication costs for these unique pieces of safety-class equipment. Synthesis of the cost data showed that the seismic load case significantly affects the capital cost (sum of engineering and fabrication cost) of safety-class equipment, with engineering costs being comparable to fabrication costs. Standardization of safety-class equipment is made possible by seismic isolation, that is, equipment designed for minimal seismic robustness can resist earthquake shaking at a site of much higher seismic hazard. The average reduction in the capital cost of the safety-related equipment, enabled by seismic isolation, is a factor of two for FoaK equipment and a factor of five for standardized equipment.

Estimating the economic impacts of percutaneous coronary intervention in Australia: a registry-based cost burden study

ObjectivesIn this study, we sought to evaluate the costs of percutaneous coronary intervention (PCI) across a variety of indications in Victoria, Australia, using a direct per-person approach, as well as...

Costing methodology and key drivers of healthcare costs within economic analyses in musculoskeletal community/primary care services: A systematic review

Purpose: Identifying variation in musculoskeletal (MSK) service costs requires the use of specific standardised metrics. There has been a large focus on costing, efficiency, and standardised metrics within the acute MSK setting, but far less attention in primary care and community settings. This data is necessary to improve efficiency and drive transformation of MSK pathways of care.

The budget impact of adding pralsetinib to a US health plan formulary for treatment of non-small cell lung cancer and thyroid cancer with RET alterations.

BACKGROUND: Lung cancer is the leading cause of cancer death in the United States. Non-small cell lung cancer (NSCLC) accounts for 80% to 85% of all lung cancers. Thyroid cancer, while generally not as lethal as lung cancer, has a large prevalent population and a rapidly increasing incidence in the United States. Pralsetinib is a highly potent, selective rearranged during transfection (RET) inhibitor indicated for the treatment of RET-positive NSCLC and thyroid cancer tumors. OBJECTIVE: To estimate the budget impact of adding pralsetinib to a 1 million-member US health plan formulary for the treatment of patients with metastatic RET fusion-positive NSCLC, advanced or metastatic RET-mutant medullary thyroid cancer (MTC), or advanced or metastatic RET fusion-positive thyroid cancer (non-MTC). METHODS: A budget impact model with a 3-year time horizon was developed in Microsoft Excel to estimate the number of eligible RET-positive NSCLC and thyroid cancer patients in a plan and quantify associated treatment costs (2020 USD). Comparators in the analyses included pralsetinib, selpercatinib, and cabozantinib, as well as indication-specific use of pembrolizumab, pemetrexed/carboplatin combination, vandetanib, lenvatinib, and sorafenib. Drug acquisition, molecular testing, treatment monitoring, and adverse event management costs were included to estimate total annual costs and per-member per-month (PMPM) costs in current (without pralsetinib) and potential future market scenarios, where pralsetinib is assumed to split the projected RET inhibitor market share with selpercatinib. The number of treated patients was based on age- and sex-adjusted incidence of disease, the proportion of patients diagnosed with advanced or metastatic disease, and projected RET testing rates. Treatment duration was based on progression-free survival or duration of response data from clinical trials. Medical resources were monetized using standardized sources such as Medicare reimbursement and wholesale acquisition cost (WAC). RESULTS: The model estimated that there would be approximately 6 new treatment-eligible patients in a 1 million-member plan annually. Monthly WAC is $19,243 for pralsetinib and $20,600 for selpercatinib at the recommended starting dose. Adoption of pralsetinib, with corresponding increases in pralsetinib market share, would be slightly cost saving to a payer, decreasing the overall budget impact to the health plan by $49,985 in year 3 (-$0.0042 PMPM; -$0.0030, -$0.0006, and -$0.0005 for NSCLC, MTC, and thyroid cancer [non-MTC], respectively). In year 3, drug costs were the key driver of total costs (~80%-98%) and cost savings. All other medical resource categories were cost-neutral or nominally cost saving or additive in the budget impact analysis. CONCLUSIONS: Quantifying the budget impact associated with the adoption of new targeted precision therapies is an important consideration for payers. For eligible NSCLC and thyroid cancer patients, our analysis suggests that adoption of pralsetinib is expected to result in modest cost savings for US payers. DISCLOSURES: Support for this study was provided by Blueprint Medicines Corporation. This study was conducted by Veritas Health Economics Consulting, Inc., in collaboration with Blueprint Medicines, which was involved in the design of the study; collection, analysis, and interpretation of the data; writing of the report; and the decision to submit the report for publication. Duff is an employee of Veritas Health Economics Consulting, which received research funding from Blueprint Medicines to develop the budget impact model. Norregaard and Sullivan are employees of Blueprint Medicines. Bargiacchi and Brener were employees of Blueprint Medicines at the time of the research study. This study was presented as a poster at the AMCP Virtual Learning Event, April 2021.

The Impact of Extubation Setting on Operating Room Efficiency, Hospital Costs, and Patient Safety in a Children's Hospital

Introduction: Operating room (OR) throughput and efficiency is a key driver of hospital costs. We sought to evaluate the efficacy, safety, and cost implications of a practice of post-anesthesia care unit (PACU) extubation for 4 common pediatric surgical operations. Methods: The records of 6,956 children who underwent inguinal hernia repair, laparoscopic appendectomy, pyloromyotomy, and tonsillectomy/adenoidectomy at a free-standing children’s hospital between July 2018 and June 2020 were reviewed. OR flow time metrics and postoperative airway interventions were assessed. Based on a 2014 study, 1 minute of operative time was assessed at $37. Exclusion criteria included PACU holds and direct transfers from the OR to an inpatient unit. Results: There were 5,245 procedures analyzed. All patients were extubated in the PACU except during periods of elevated COVID-19 transmission risk or when the PACU was understaffed. The mean time from procedure completion to leaving the OR was between 3.7 and 4.8 minutes for patients extubated in the PACU and 10.0 and 13.0 minutes for those extubated in the OR. PACU respiratory events were minor, infrequent, and of similar incidence after PACU or OR extubation. Conclusion: We found PACU extubation to be safe and effective in reducing patient time in the OR by up to 13 minutes. We project that our hospital has saved more than $1 million in 2 years due to the time savings associated with only these 4 common operations. In a time of limited resources, a policy of PACU extubation could have a substantial impact on the financial viability of children’s hospitals.

(Invited) Material Considerations for Li-Ion Battery Recycling R&D at the ReCell Center

The ReCell Center was established by the US Department of Energy’s Vehicle Technologies Office to develop a practical process for recycling of lithium-ion batteries. But if a recycling process is actually going to be adopted by industry, it must be economical. Analysis of costs for production or recycling of batteries instantly reveals that purchased materials are the key cost driver. The quantity and composition of materials to be recycled, whether post-consumer material or manufacturing scrap, are also very important. Therefore, ReCell processes are subjected to careful technical and economic analysis, using our publicly available and award-winning EverBatt model, to determine which unit processes will be most economical and environmentally friendly for different conditions. This presentation will use processes under development to highlight the role of materials in comparing the technical and economic feasibility of alternative processes.

Developing Strategies for Onchocerciasis Elimination Mapping and Surveillance Through The Diagnostic Network Optimization Approach

BackgroundOnchocerciasis (river blindness) is a filarial disease targeted for elimination of transmission. However, challenges exist to the implementation of effective diagnostic and surveillance strategies at various stages of elimination programs. To address these challenges, we used a network data analytics approach to identify optimal diagnostic scenarios for onchocerciasis elimination mapping (OEM).MethodsThe diagnostic network optimization (DNO) method was used to model the implementation of the old Ov16 rapid diagnostic test (RDT) and of new RDTs in development for OEM under different testing strategy scenarios with varying testing locations, test performance and disease prevalence. Environmental suitability scores (ESS) based on machine learning algorithms were developed to identify areas at risk of transmission and used to select sites for OEM in Bandundu region in the Democratic Republic of Congo (DRC) and Uige province in Angola. Test sensitivity and specificity ranges were obtained from the literature for the existing RDT, and from characteristics defined in the target product profile for the new RDTs. Sourcing and transportation policies were defined, and costing information was obtained from onchocerciasis programs. Various scenarios were created to test various state configurations. The actual demand scenarios represented the disease prevalence at IUs according to the ESS, while the counterfactual scenarios (conducted only in the DRC) are based on adapted prevalence estimates to generate prevalence close to the statistical decision thresholds (5% and 2%), to account for variability in field observations. The number of correctly classified implementation units (IUs) per scenario were estimated and key cost drivers were identified.ResultsIn both Bandundu and Uige, the sites selected based on ESS had high predicted onchocerciasis prevalence >10%. Thus, in the actual demand scenarios in both Bandundu and Uige, the old Ov16 RDT correctly classified all 13 and 11 IUs, respectively, as requiring CDTi. In the counterfactual scenarios in Bandundu, the new RDTs with higher specificity correctly classified IUs more cost effectively. The new RDT with highest specificity (99.8%) correctly classified all 13 IUs. However, very high specificity (e.g., 99.8%) when coupled with imperfect sensitivity, can result in many false negative results (missing decisions to start MDA) at the 5% statistical decision threshold (the decision rule to start MDA). This effect can be negated by reducing the statistical decision threshold to 2%. Across all scenarios, the need for second stage sampling significantly drove program costs upwards. The best performing testing strategies with new RDTs were more expensive than testing with existing tests due to need for second stage sampling, but this was offset by the cost of incorrect classification of IUs.ConclusionThe new RDTs modelled added most value in areas with variable disease prevalence, with most benefit in IUs that are near the statistical decision thresholds. Based on the evaluations in this study, DNO could be used to guide the development of new RDTs based on defined sensitivities and specificities. While test sensitivity is a minor driver of whether an IU is identified as positive, higher specificities are essential. Further, these models could be used to explore the development and optimization of new tools for other neglected tropical diseases.

A scenario discovery approach to least-cost electrification modelling in Burkina Faso

This paper presents the first application of the scenario discovery approach in geospatial electrification modelling. 1944 electrification simulations were constructed for Burkina Faso from a combination seven input levers, including four grid-extension strategies. The scenario discovery analysis identifies a scenario described by a high grid electricity generation cost in combination with an intensification strategy for grid-extension, as most likely to lead to a high cost of electricity in Burkina Faso. Thus, to avoid such a high cost, decisions in the country could be targeted either at lowering grid electricity generation costs or to choose one of the other two grid-extension strategies, or both. For each of the grid-extension strategies, a number of drivers causing a high LCOE were identified. Common drivers for all strategies were the grid electricity generation cost and discount rate. The scenario discovery approach was used to identify the key drivers of high electrification costs and their interactions, providing useful information that might not be gained from a traditional scenario-axes approach. This approach provided a structured way to analyze more parameters than found in previous electrification studies for Burkina Faso. The paper discusses on the pros compared to a traditional scenario-axes approach, such as reduced risk of perceived bias and improved ability to deal with multiple uncertain parameters, but also notes the additional computational requirements.