Largest Cost Component Research Articles

Fixed Manpower Reduction Analysis to Reduce Indirect Cost of Ship Production

In the shipping industry, especially shipyards which are used for building and repairing ships, a lot of labor is required. Due to a lot of labor, of course, makes the salary component to be a fairly large cost component in the company. Nowadays, many shipyards have turned to outsourcing-based shipyards, to reduce indirect costs. However, other shipyards have not yet become outsourcing-based shipyards, so the number of workers is still relatively large. The high number of permanent workers in a company indicates the effectiveness and efficiency of the workforce in the company is still lacking, so that the company will experience losses because the workload received by each workforce does not match the salary received by the worker. The research was conducted using the Full-Time Equivalent (FTE) method, which the components required for this method are the effective working days in 1 year and the effective working time in 1 year. After the analysis was carried out, the percentage of reduction in labor remained at 55%, and the percentage reduction in indirect costs is 38%.

Measuring the Total Cost of Ankle Fractures: A Prospective Analysis

Category:Trauma; AnkleIntroduction/Purpose:Ankle fractures (AFx) are the most common foot and ankle fracture seen at hospitals in the United States, and are undoubtedly costly to patients. Quantification of the costs of fractures and their associated treatments has garnered increased attention in orthopedics in recent years through cost-effectiveness analysis. However, literature pertaining to AFx’s almost never reports on the indirect costs of AFx’s, and thus fails to accurately assess the true value of treatments. The purpose of this study was to prospectively assess the direct and indirect costs of AFx’s in operatively and nonoperatively treated patients. Secondary analysis included evaluation of the composition of indirect cost, the duration these costs are endured, and the factors that influence their magnitude.Methods:A prospective observational single-center study was performed. Adult patients presenting for initial consult for an AFx that could speak English or Spanish were enrolled. Polytrauma patients and those unable to provide complete indirect cost data were excluded. Patients completed a cost form that asked the money they had spent in the last week on transportation, household chores, and self-care due to their AFx. Patients were considered to have complete indirect cost data if they returned for follow-up visits until they reported no recurring indirect costs and had returned to work. Direct cost data was obtained directly from the hospital billing department. Amount collected was utilized. Direct costs included any costs incurred from staff treating the patient, supplies required for treatment, and the use of healthcare facilities. A descriptive analysis of the entire cohort and stratification by operative status was performed for the primary comparative analysis.Results:60 patients were ultimately analyzed. Average age was 46.5 years. 55% were female. 10% of patients were diabetic. 17% smoked cigarettes actively. Weber A, B, and C fractures composed 12%, 72%, and 18% of fractures, respectively. Operatively treated patients (n=37) had a significantly higher total and direct cost than non-operative patients (P<0.01). Average salary of the 39 employed patients was $61,416 and return to work period was 11.2 weeks. In all patients, lost income accounted for the largest portion of total and indirect cost, averaging 38% of total cost. Longer periods of return to work were significantly associated with undergoing surgery and having less than a college-level education (P<0.05). Average number of weeks for indirect costs to amount to zero was 19.1.Conclusion:In patients treated operatively and nonoperatively, the largest cost component was an indirect cost: missed wages at 28.6% and 63.3%, respectively. While the majority of the direct costs of AFx’s are accrued in the period immediately following the injury, indirect cost components will regularly be incurred for nearly 5 months and often longer. The degree and duration to which these indirect costs accumulate are novel findings. Future research should no longer neglect reporting on an intervention’s impact on the indirect costs of AFx’s.

PGI16 BREAKDOWN OF COSTS ATTRIBUTABLE TO CLOSTRIDIOIDES DIFFICILE INFECTION IN THE US: RESULTS FROM A SYSTEMATIC LITERATURE REVIEW

A previous systematic literature review (SLR) of Clostridioides difficile infection (CDI) global economic burden, conducted up to 2014, showed considerable costs of CDI. This SLR summarizes CDI-attributable economic burden literature in the United States (US) published since 2014. An SLR using terms for CDI, costs, and/or healthcare resource use was conducted across relevant databases from 1 January 2014 to 15 August 2018 without language or geographical restrictions, and supplemented by conference and HTA website searches. Costs attributed to CDI by study authors and differences in regression-adjusted or matched costs between CDI and non-CDI cohorts were extracted, including components of total costs (e.g., inpatient-, outpatient- and indirect costs, etc.) where available. Of 2,342 sources screened, 7 articles included CDI-attributable costs for US patients. Overall CDI-attributable cost ranged from 1.2-3.3 times that of non-CDI patients (incremental $1,700-$80,178), although study methods varied. Three studies presented detailed breakdown of direct costs; none included indirect costs. Two were retrospective database studies with one using insurance claims data. One study in primary CDI patients reported that 87% ($21,096) of the $24,205 overall CDI-attributable costs over 6 months was due to inpatient services, followed by outpatient ($1,520) and emergency services ($555). Another study found inpatient costs represented 91% ($73,045) of total CDI-attributable costs ($80,178). The third study, conducted in nursing homes over two months of follow-up, also found inpatient services were the predominant driver (55% [$8,243]) of total CDI-attributable costs ($14,977), with skilled nursing facility ($3,487) the next largest cost component. Consistent with the prior SLR, recent US studies demonstrate substantial direct medical costs attributable to CDI, with inpatient costs representing the largest proportion (55%-91%). However, non-inpatient services still account for $555-$7,133 in CDI-attributable costs. Future research should incorporate CDI-attributable indirect costs to more completely describe the economic burden of CDI.

Costs and Resource Use Associated with Community-Dwelling Patients with Alzheimer's Disease in Japan: Baseline Results from the Prospective Observational GERAS-J Study.

Background:As the Japanese population ages, caring for people with Alzheimer’s disease (AD) dementia is becoming a major socioeconomic issue.Objective:To determine the contribution of patient and caregiver costs to total societal costs associated with AD dementia.Methods:Baseline data was used from the longitudinal, observational GERAS-J study. Using the Mini-Mental State Examination (MMSE) score, patients routinely visiting memory clinics were stratified into three groups based on AD severity. Health care resource utilizationwas recorded using the Resource Utilization in Dementia questionnaire. Total monthly societal costs were estimated using Japan-specific unit costs of services and products (patient direct health care use, patient social care use, and informal caregiving time). Uncertainty around mean costs was estimated using bootstrapping methods.Results:Overall, 553 community-dwelling patients withADdementia (28.3% mild[MMSE21-26], 37.8% moderate[MMSE 15-20], and 34.0% moderately severe/severe [MMSE < 14]) and their caregivers were enrolled. Patient characteristics were: mean age 80.3 years, 72.7% female, and 13.6% living alone. Caregiver characteristics were: mean age 62.1 years, 70.7% female, 78.8% living with patient, 49.0% child of patient, and 39.2% sole caregiver. Total monthly societal costs of AD dementia (Japanese yen) were: 158,454 (mild), 211,301 (moderate), and 294,224 (moderately severe/severe). Informal caregiving costs comprised over 50% of total costs.Conclusion:Baseline results of GERAS-J showed that total monthly societal costs associated with AD dementia increased with AD severity. Caregiver-related costs were the largest cost component. Interventions are needed to decrease informal costs and decrease caregiver burden.

Standardized framework for evaluating costs of active case-finding programs: An analysis of two programs in Cambodia and Tajikistan.

IntroductionOver the years, technological and process innovations enabled active case finding (ACF) programs to expand their capacities and scope to have evolved to close gaps in missing TB patients globally. However, with increased ACF program’s operational complexity and a need for significant resource commitments, a comprehensive, transparent, and standardized approach in evaluating costs of ACF programs is needed to properly determine costs and value of ACF programs.MethodsBased on reviews of program activity and financial reports, multiple interviews with program managers of two TB REACH funded ACF programs deployed in Cambodia and Tajikistan, we first identified common program components, which formed the basis of the cost data collection, analysis, reporting framework. Within each program component and sub-activity group, cost data were collected and organized by relevant resource types (human resource, capital, recurrent, and overhead costs). Total shared, indirect and overhead costs were apportioned into each activity category based on direct human resource contribution (e.g. a number of staff and their relative level of effort dedicated to each program component). Capital assets were assessed specific to program components and were annualized based on their expected useful life and a 3% discount rate. All costs were assessed based on the service provider perspective and expressed in 2015 USD.ResultsOver the two program years (April 2013 to December 2015), the Cambodia and Tajikistan ACF programs cumulated a total cost of $336,951 and $771,429 to screen 68,846 and 1,980,516 target population, bacteriologically test 4,589 and 19,764 presumptive TB, diagnose 731 and 2,246 TB patients in the respective programs. Recurrent costs were the largest cost components (54% and 34%) of the total costs for the respective programs and Xpert MTB/RIF (Xpert) testing incurred largest program component/activity cost for both programs. Cost per screening was $0.63 and $0.10 and cost per Xpert test was $25 and $18; Cost per TB case detected (Xpert) was $373 and $343 in Cambodia and Tajikistan.ConclusionsResults from two contextually and programmatically different multi-component ACF programs demonstrate that our tool is fully capable of comprehensively and transparently evaluating and comparing costs of various ACF programs.

A hybrid simulation model approach to examine bacterial genome sequencing during a hospital outbreak

BackgroundHospital infection control requires timely detection and identification of organisms, and their antimicrobial susceptibility. We describe a hybrid modeling approach to evaluate whole genome sequencing of pathogens for improving clinical decisions during a 2017 hospital outbreak of OXA-181 carbapenemase-producing Escherichia coli and the associated economic effects.MethodsCombining agent-based and discrete-event paradigms, we built a hybrid simulation model to assess hospital ward dynamics, pathogen transmission and colonizations. The model was calibrated to exactly replicate the real-life outcomes of the outbreak at the ward-level. Seven scenarios were assessed including genome sequencing (early or late) and no sequencing (usual care). Model inputs included extent of microbiology and sequencing tests, patient-level data on length of stay, hospital ward movement, cost data and local clinical knowledge. The main outcomes were outbreak size and hospital costs. Model validation and sensitivity analyses were performed to address uncertainty around data inputs and calibration.ResultsAn estimated 197 patients were colonized during the outbreak with 75 patients detected. The total outbreak cost was US$318,654 with 6.1% of total costs spent on sequencing. Without sequencing, the outbreak was estimated to result in 352 colonized patients costing US$531,109. Microbiology tests were the largest cost component across all scenarios.ConclusionA hybrid simulation approach using the advantages of both agent-based and discrete-event modeling successfully replicated a real-life bacterial hospital outbreak as a foundation for evaluating clinical outcomes and efficiency of outbreak management. Whole genome sequencing of a potentially serious pathogen appears effective in containing an outbreak and minimizing hospital costs.

Cost of hospitalisation and length of stay due to hypoglycaemia in patients with diabetes mellitus: a cross-sectional study

Objective:This study aims to estimate the length of stay and hospitalisation cost of hypoglycaemia, and to identify determinants of variation in the length of stay and hospitalisation cost among individual patients with type 1 or 2 diabetes mellitus.Methods:A cross-sectional study was conducted using inpatients records for patients with diabetes mellitus who had been hospitalised due to hypoglycaemic events in two private hospitals in Amman, Jordan between January 2009 and May 2017. All hospitalisation costs were inflated to the equivalent costs in 2017. Hospitalisation cost was estimated from the patient’s perspective in Jordanian dinars (JOD). Descriptive analyses and correlation between sociodemographic or clinical characteristics with the cost and length of stay were explored. Predictors of hypoglycaemic hospitalisation cost and length of stay were determined using logistic regression.Results:During the study period a total of 126 patients with diabetes mellitus were hospitalised due to an incident of hypoglycaemia. The mean patient age was 64.2 (SD=19.6) years; half were male. Patients admitted for hypoglycaemia stayed in hospital for a median duration of two days (IQR=2 days). The median cost of hospitalisation for hypoglycaemia was 163.2 JOD (USD 230.1) (IQR=216.3 JOD). We found that the Glasgow coma score was positively associated with length of stay (0.345, p=0.008), and older age was correlated with higher hospitalisation cost (0.207, p=0.02). Patients with a family history of diabetes had higher hospitalisation costs and longer duration of stay (0.306 and 0.275, p<0.05). In addition, being a male patient (0.394, p<0.05) and with an absence of smoking history was associated with longer duration of stay (0.456, p<0.01), but not with higher hospitalisation cost.Conclusions:Costs associated with the incidence of hypoglycaemic events are not low and constitute a large cost component of managing and treating diabetes mellitus. Male patients and patients having a family history of diabetes should receive extra care and education on the prevention of hypoglycaemic events, and a treatment de-intensification approach should be considered if necessary, so we can prevent its associated hospitalisation costs and length of stay.

Costs per Treatment Phase for AML Patients Receiving High-Dose Chemoterapy in Sweden

Introduction: AML affects all ages with an incidence rate of 5 per 100,000, but is much more frequent in older population. The overall lifetime risk of AML is estimated to be 0.5-1%. Long-term overall survival in younger (age &lt; 60 years) is about 50%, but much worse among older population. Although AML therapy is one of the most resource-intensive cancer treatments, there are few estimates of the resource use and economic burden by treatment phase. Methods: This study was a retrospective database study performed on Swedish national data. Adult patients (age ≥18 years) diagnosed with AML in Sweden between 2007 and 2015 were identified in the Swedish Cancer Registry, along with vital status. Data on resource use were collected from national registers for inpatient- and outpatient specialized care and prescribed drugs. Information on diagnostics and treatment was accessed from the Swedish national AML Registry (SwAMLR). Data on sick leave (SL) and early retirement (ER) came from the Swedish Social Insurance Agency (absent days costed with the mean salary in Sweden). Hospital care resource use was costed using diagnosis-related group (DRG) remunerations, and include cost of inpatient drugs. The mean cost from the defined start of the treatment phase until the end of the treatment phase was divided by the mean number of days for the corresponding treatment phase to estimate the mean cost per day. The defined treatment phases were restricted to a maximum of 5 years. All costs are represented in US$. Results: Of the 2,954 patients identified in the Swedish Cancer Registry, 1,772 patients with a median age of 64 years were identified in the SwAMLR as fit for receiving high-dose chemotherapy . Of these, 1,243 were recorded with both curative intent of treatment and dates for achieving complete remission. Mean costs from the first AML-related hospital admission until the date of complete remission amount to $27,244. The mean number of days for the corresponding period were 45.16, resulting in a mean cost per day of $603 from first admission to first complete remission. The corresponding cost per day for patients recorded with curative intent but no complete remission (n=428) are $494. Time was counted from first AML-related admission until 90 days after first admission, or SCT or death, whichever occurred first. Costs after complete remission to either relapse, SCT, death or re-induction (n=1,237) amount to $50,793 for a mean of 438.63 days ($116/day). This treatment phase includes long-term survivors, whereas the costs from SCT, relapse or re-induction are not included. From relapse to death, the total cost is almost twofold for patients with re-induction (n=350) compared to palliative treatment (n=254). Cost per day amount to $179 for patients with palliative treatment and $256 for patients with re-induction treatment, respectively. The cost per day from date of SCT to death (n=511) is estimated to $192, incurred over a long period of time (mean number of days 844.02). The age of transplant recipients ranged between 18-71 years, with a median of 52 years. Conclusions: Costs of AML up to remission are feasible to estimate through DRG-costing methods, and studies have shown these costs are intense. Indeed this study shows that the highest cost per day is observed from first admission to complete remission. In addition results from our study show that there are high costs incurred also in the long-term, i.e. after remission. Of the included treatment phases the total cost from date of SCT to death is the largest, amounting to over $160,000. Approximately 20% are due to SL/ER, which is the second largest cost component after inpatient costs accounting for 60% of the total costs. Table. Disclosures Hernlund: ICON: Employment. Redig:ICON: Employment. Paulsson:Novartis: Employment. Vertuani:Novartis: Employment.

Vertical Sterilizer Design of Building Palm Oil Processing Plant to Cost Efficiency

Research is carried out in the Palm Oil Processing Plant is being built. The establishment of a factory experienced cost problem due to the increasing price of products import. This study describes the application of value engineering to find the highest cost components and alternative designs are able to replace the initial design and the building cost in the factory can be reduced. Vertical sterilizer is known to be the largest cost component followed by the cost of the Valves and Hydraulic System Control Unit. The company is currently designing to replace 4 units vertical sterilizer capacity 10 tons fresh fruit bunches with 3 units vertical sterilizer capacity 15 tons fresh fruit bunches. The change in the quantity and capacity of the vertical sterilizer is followed by a reduction quantity of Control Units c / w Valves and Hydraulic Systems used. As a result of this design change, the initial life cycle cost is IDR 7.531.154.360,- decrease to IDR 6.642.162.754,-. By using value engineering, it is able to make the cost efficiency in a factory about 11,8%.

Study of Temperature Effects on Economic Performance of CO2 Enhanced Shale Gas Recovery

Abstract CO2 displacement has been proposed to enhance shale gas recovery and unlock a big potential market for CO2 beneficial utilization. Theoretically, gas adsorption is inversely related to the temperature, so gas can be desorbed by elevating the temperature. This paper investigates the economic performance of enhancing shale gas recovery by injecting CO2 at high temperatures through displacement as well as desorption by rising temperatures. Influences of operation temperature and injection pressure were studied for three potential shale plays in China. Study results show that both factors exerted obvious impacts, and CO2 procurement was the largest cost component. It is found that the net revenue was not always proportional to the operation temperature, but more controlled by the injection–production ratio. This is because of the different temperature impacts to the various patterns of adsorbed CH4 and CO2 contents. Consequently, in some cases, more CO2 is needed to displace CH4 when operation temperature is raised, resulting a higher cost. The modeling results demonstrate that based on the adsorption characters of reservoirs, the productivity and profitability of CO2 enhanced gas recovery can be further improved by choosing appropriate operation temperatures.

Analisis Biaya Penyakit Stroke Pasien Jaminan Kesehatan Nasional di RSUD Blambangan Banyuwangi

Cost analysis of chronic diseases in health care facilities during JKN is needed as quality and cost control. Stroke is a high cost, volume, and risk, catastrophic disease that can cause an increase in medical expenses, which requires special attention. The purpose of this study is to provide an overview of real costs and cost components, providing an overview of the direct medical costs and tariff packages of INA-CBGs based on the type of stroke, and the factors that affect direct medical costs. This study is a descriptive-analytic observational study according to the hospital perspective. Data was taken retrospectively. The subjects of the study were adult JKN patients who were aged ≥18 years old with a stroke diagnosis that entered the inclusion criteria. The research variables included age, gender, type of stroke, comorbidity, hospitalization class, length of stay (LOS), and real costs. Data analysis used univariate, bivariate and multivariate analysis. The research results obtained total real costs of Rp. 1,525,236,503 with an average cost of Rp. 4,872,960, the largest cost component was the cost of drugs and BMHP Rp. 402,248,555 (27.21%). The real cost of hemorrhagic strokes is Rp. 572,969,865 and the INA-CBGs tariff package is Rp. 483,804,000, the real cost of ischemic stroke is Rp. 1,107,055,700. There were significant differences in real cost from class factors and length of stay (p-value &lt;0.005). The concluded that the INA-CBGs tariff package is insufficient to finance hospitalized patients with hemorrhagic strokes (-Rp89.165,865), but sufficient for ischemic stroke (+Rp.154,789,069).

Vegetable Market Performance in Smallholders Production System: The Case of Lake Tana Basin, Ethiopia

Lake Tana basin is one of the most potential vegetable production areas in Ethiopia. However, production in this region has been carried out at smallholders’ level with poor marketing infrastructure. Hence, this study was aimed to examine the structure and performance of vegetable marketing in the Lake Tana basin. Multistage random sampling mixed with non probability sampling techniques were employed to collect data from 385 smallholder vegetable producing farmers and 107 vegetable traders from three districts and two major town markets. Data were analyzed using market structure and performance indicators. The result of the analysis showed that market structure in the study area could be characterized by weak oligopolistic market with little chance of market participants to influence market price. Storage loss and transport cost were found the two largest cost components of vegetable marketing in the study area. Net marketing margin and producers’ share of the consumers’ price could be improved by shortening the distance between the producer and urban consumer or reducing the intermediaries involved. Establishing farmers’ group marketing with communication access together with least cost storage and transport technologies should be encouraged to improve vegetable marketing performance.

Voluntary medical male circumcision service delivery in South Africa: The economic costs and potential opportunity for private sector involvement.

BackgroundIn 2010, the South African Government initiated a voluntary medical male circumcision (VMMC) program as a part of the country’s HIV prevention strategy based on compelling evidence that VMMC reduces men’s risk of becoming HIV infected by approximately 60%. A previous VMMC costing study at Government and PEPFAR-supported facilities noted that the lack of sufficient data from the private sector represented a gap in knowledge concerning the overall cost of scaling up VMMC services. This study, conducted in mid-2016, focused on surgical circumcision and aims to address this limitation.MethodsVMMC service delivery cost data were collected at 13 private facilities in three provinces in South Africa: Gauteng, KwaZulu-Natal, and Mpumalanga. Unit costs were calculated using a bottom-up approach by cost components, and then disaggregated by facility type and urbanization level. VMMC demand creation, and higher-level management and program support costs were not collected. The unit cost of VMMC service delivery at private facilities in South Africa was calculated as a weighted average of the unit costs at the 13 facilities.Key findingsAt the average annual exchange rate of R10.83 = $1, the unit cost including training and cost of continuous quality improvement (CQI) to provide VMMC at private facilities was $137. The largest cost components were consumables (40%) and direct labor (35%). Eleven out of the 13 surveyed private sector facilities were fixed sites (with a unit cost of $142), while one was a fixed site with outreach services (with a unit cost of $156), and the last one provided services at a combination of fixed, outreach and mobile sites (with a unit cost per circumcision performed of $123). The unit cost was not substantially different based on the level of urbanization: $141, $129, and $143 at urban, peri-urban, and rural facilities, respectively.ConclusionsThe private sector VMMC unit cost ($137) did not differ substantially from that at government and PEPFAR-supported facilities ($132 based on results from a similar study conducted in 2014 in South Africa at 33 sites across eight of the countries nine provinces). The two largest cost drivers, consumables and direct labor, were comparable across the two studies (75% in private facilities and 67% in public/PEPFAR-supported facilities). Results from this study provide VMMC unit cost data that had been missing and makes an important contribution to a better understanding of the costs of VMMC service delivery, enabling VMMC programs to make informed decisions regarding funding levels and scale-up strategies for VMMC in South Africa.

PRM149 - OPEN-SOURCE DISCRETE EVENT SIMULATION MODEL FOR MAJOR DEPRESSION DISORDER (MDD): AN UPDATE SUITABLE FOR NEW GENERATION TREATMENT?

In 2014, an open-source discrete event simulations (DES) model was developed for major depressive disorder (MDD) to estimate health and cost outcomes associated with alternative treatment strategies. The DES has been updated in order to provide a freely available up-to-date cost-effectiveness analysis taking into account potential gene therapy. This model simulated short-and long term clinical events (partial response, remission, relapse, recovery, and recurrence), adverse events, and treatment changes (titration change, switch, addition, and discontinuation) over up to 5 years. Several treatment pathways were defined by clinical experts considering classical therapy and gene therapy with three levels of efficacy, tolerability, and price (low, medium and high) from first line to third line. The possibility of a one-time cost was implemented and the model was updated with input data from the literature for the UK settings. Model outputs include time in different health states, quality adjusted life years (QALYs) and costs from National Health Service and societal perspectives. The model remains open source and is now available on GitHub. The largest cost components from the payer perspective were the price of the new drug followed by physician visits and hospitalisations. The predicted costs and QALYs were driven by utility values, effectiveness, and frequency of physician visits. Differences in QALYs and costs between strategies were dependent with the duration of the simulation: a shorter time horizon limited the capture of the long term health benefit, increasing the impact of the high one time-cost on the ICER. The discrete event simulation model can provide a comprehensive evaluation of different therapeutic options in MDD including potential gene therapy and can be used to compare a wide range of health care technologies in various groups of patients in MDD. The fact that the DES is open-source reinforced the credibility and the acceptability of the model.

Variability in hospital costs for carotid artery revascularization

ObjectiveThe objective of this study was to understand drivers of cost for carotid endarterectomy (CEA) and carotid artery stenting (CAS) and to compare variation in cost among cases performed by vascular surgery (VS) with other services (OSs). MethodsWe collected internal hospital claims data for CEA and CAS between September 2013 and August 2015 and performed a financial analysis of all hospital costs including room accommodations, medications, medical and surgical supplies, imaging, and laboratory tests. Cases were stratified by presence of symptoms and procedure type, and costs of procedures performed by VS were compared with those performed by OSs. ResultsThe cohort comprised 144 patients (78 asymptomatic, 66 symptomatic; 44 CAS, 100 CEA) receiving unilateral revascularization. VS (24 CAS, 70 CEA) and neurosurgery and neurointerventional radiology services (20 CAS, 30 CEA) performed all procedures. Age (71 ± 9 years vs 70 ± 11 years; P = .8) and length of stay (1.7 ± 2.1 days vs 2.2 ± 2.4 days; P = .73) were similar for VS and OSs. Symptoms were present before revascularization for 46% and were more commonly treated by OSs (78% vs 29%; P < .001). Case mix index was similar after stratifying by symptoms (asymptomatic, 1.28 ± 0.35 vs 1.39 ± 0.42 [P = .5]; symptomatic, 1.66 ± 0.73 vs 1.82 ± 0.81 [P = .9]). The largest cost components were operating room (OR)-related costs, beds, and supplies, together accounting for 76% of costs. Asymptomatic patients had 37% lower average hospital costs. For asymptomatic CAS, average index hospitalization cost was 17% less for VS compared with OSs because of 78% lower intensive care unit costs, 44% lower OR-related costs, 40% lower medication costs, and 24% lower cardiac testing costs. VS had 22% higher supply costs. For asymptomatic CEA, average index hospitalization costs were 22% lower for VS, driven by lower OR-related costs (28%), medications (28%), imaging (62%), and neurointerventional monitoring (64%). Costs were 38% higher for CAS vs CEA. For symptomatic CAS, costs were similar for both groups. For symptomatic CEA, total costs were 14% lower for VS compared with OSs, driven by 25% lower OR-related costs, 62% lower neurointerventional monitoring, 20% step-down beds, and 28% lower supply costs (and counterbalanced by 117% higher intensive care unit costs). ConclusionsVS average hospital costs were lower for asymptomatic CAS and all CEAs compared with OSs. Drivers of higher cost appear to be attributed to variation in physicians' practice as well as patients' complexity, affording an opportunity to reduce cost by establishing standard practices when appropriate.

Vehicle Routing Problem (VRP) for courier service: A review

The internet development access is really very fast and change all aspects for life activities include buying and selling transactions of goods or services that can arrange online or also called e-commerce which courier service influence. The courier basic operational is logistics of a supply chain. Transportation is a vital component in logistics management because it becomes the largest cost component in its activities that is about 50-60% of the total logistics costs. The purpose of this study is to find out what kind of vehicle routing problem (VRP) is used for courier service so can be used as reference for further research. Collect and selection process found 40 science journals for analyse. There has been a lot of research about the shortest route problem for courier service or can also called city logistics with VRP which the optimum solution obtained with heuristic and metaheuristic algorithm. Result found VRP type often used for courier service are dynamic VRP (DVRP) and VRP with time window (VRPTW) or can merging both dynamic VRP with time window (DVRPTW).

Potential cost savings owing to the route of administration of oncology drugs: a microcosting study of intravenous and subcutaneous administration of trastuzumab and rituximab in the Netherlands.

There is little evidence on the costs associated with the route of administration of oncology drugs. We investigated time and resource use for hospitals and patients and compared healthcare and societal costs for intravenous (IV) and subcutaneous (SC) administration of trastuzumab and rituximab. Data for the preparation and administration of both drugs were collected at the hospital pharmacy and at the oncology day care unit. Patients completed a questionnaire for obtaining information on societal costs (productivity losses, informal care and traveling expenses). A total of 126 patients were recruited in six hospitals; 82 received trastuzumab (37 IV and 45 SC) and 44 received rituximab (23 IV and 21 SC). The costs per administration (including societal cost but excluding drug costs) were &OV0556;167 and &OV0556;264 for IV and &OV0556;76 and &OV0556;146 for SC trastuzumab and rituximab, respectively. The costs for SC administration were lower in all categories. The largest cost component was related to time spent at the day care unit (overhead costs). This resulted in savings of &OV0556;47 for SC trastuzumab and &OV0556;69 for SC rituximab. The costs related to time of healthcare professionals was &OV0556;9 lower for both drugs. The costs for consumables resulted in another &OV0556;12 savings. Societal costs were &OV0556;22 lower for SC trastuzumab and &OV0556;28 lower for SC rituximab. Although administration costs are relatively a small part of the total costs, important savings can be generated by switching to an SC route of administration especially because a large number of patients receive oncology drugs and patients receive more than one administration.

Understanding spread in the electronic futures markets: financial crisis perspective

ABSTRACTThis article analyses bid–ask spreads in U.S. electronic futures markets around the recent financial crisis. We decompose the bid–ask spread into three components – order processing, inventory holding and adverse selection costs – and show that adverse selection costs increased the most during the crisis while order processing costs are the largest cost component. Volume significantly affects inventory holding and order processing costs, whereas volatility only influences inventory holding costs. The crisis period had a significant effect on these relations. This study extends the existing literature on liquidity in equity to futures markets.

ANALYSIS OF TOTAL COSTS OF BREAST CANCER CEMOTHERAPY PATIENTS BASED ON USE OF CHEMOTHERAPY REGIMEN ON JKN PATIENTS IN SANGLAH RSUP

&lt;p&gt;&lt;em&gt;Breast cancer is the first sequence of most attacking women in Indonesia. The high cost of care and old services is a major problem in the prevention of breast cancer. This study aims to determine the relationship between the total cost of the Sanglah Denpasar hospital with the chemotherapy regimen of breast cancer of JKN patients at Sanglah Hospital Denpasar. Test homogeneity using Levene test method. Test normality using Kolmogorov-Smirnov. One way ANOVA test results showed a significant relationship between chemotherapy therapy regimen (FAC, FAC + PAXUS, FEC, AC, AC + PAXUS) with total real cost in breast cancer chemotherapy patients (p = 0.001). The total rill cost was greater in the group receiving FAC + PAXUS, FEC, and AC + PAXUS regimens than the group receiving FAC and AC therapy regimens. This can be caused by a large pharmaceutical cost component in the FAC + PAXUS, FEC, and AC + PAXUS groups. Pharmaceutical costs account for 76.84-85.80% of the total real cost of breast cancer patients receiving chemotherapy. More drug combination factors can lead to higher total rill costs in patients receiving FAC + PAXUS, FEC, and AC + PAXUS.&lt;/em&gt;&lt;/p&gt;

Cost effectiveness of vildagliptin versus glimepiride as add-on treatment to metformin for the treatment of diabetes mellitus type 2 patients in Greece

ObjectivesThis study was designed to assess the cost-effectiveness of vildagliptin versus glimepiride as add-on to metformin in the management of type 2 diabetes mellitus (T2DM) patients in the Greek healthcare setting.MethodsA cost-effectiveness model was designed, using MS Excel, to compare two treatment strategies. Strategy 1 consisted of first-line metformin, followed by metformin + vildagliptin in second-line, while strategy 2 consisted of first line metformin, followed by metformin + glimepiride in second line. Subsequent lines were the same in both strategies and consisted of metformin + basal insulin and metformin + basal + rapid insulin. Clinical data and utility decrements relating to diabetes complications were taken from the published literature. Only direct medical costs were included in the analysis (cost base year 2014), and consisted of drug, adverse events and comorbidity costs (taken from local officially published sources and the literature). The perspective adopted was that of the Social Insurance Fund. The time horizon was lifetime, and future costs and outcomes were discounted at 3.5% per annum.ResultsAdding vildagliptin to metformin increased drug costs compared with adding glimepiride to metformin (€2853 vs. €2427, respectively). However, this increase was offset by a decrease in the costs of associated comorbidities (€4393 vs. €4539) and adverse events (€2757 vs. €3111), resulting in a lower total cost of €74 in strategy 1 compared with strategy 2. Comorbidities were the largest cost component in both strategies, accounting for 43.9 and 45.0% in strategies 1 and 2, respectively. Strategy 1 was also associated with increased life-years (LYs, 0.11) and quality-adjusted life-years (QALYs, 0.11) compared with strategy 2. Strategy 1 is therefore dominant, as it is associated with both lower overall costs and increased effectiveness.ConclusionsVildagliptin as add-on treatment to metformin in the management of T2DM in Greece appears to be dominant versus. glimepiride in terms of both cost per LY and cost per QALY gained.