Long-term Savings Research Articles

Preferences of Young Polish Renters: Findings from the Mediation Analysis

The worsening housing problems of young adults in many countries have become a worldwide problem. Researchers point to a number of factors that influence young people’s decisions to own or rent their own apartments or houses. The term generation of renters or the lost generation has appeared in the literature in relation to the young adult generation. This article offers insights into the housing preferences of young adults aged 18 to 45 in Poland, with a particular focus on the renter cohort. Conclusions are drawn about whether young adults who are already renting prefer to buy an apartment or house rather than maintain their status quo, and what determines their decisions in this regard. The study identifies a number of socioeconomic factors that influence the housing decisions of young renters in Poland. It addresses some of the problems and challenges of today’s housing market and, in particular, examines what leads young Polish renters to switch from renting to buying their first home or, alternatively, to live in a rented apartment for years (thus showing indifference to homeownership). Some of the reasons for the change in attitude toward this issue are highlighted. The study is quantitative in nature, relying on an online survey and a mediation analysis that is particularly well suited to explaining the relationship between many different variables. Of the eight hypotheses tested in the study (using mediation analysis), only three could be proven, namely that the amount of rent payments and other costs for economic reasons influences the willingness to buy an apartment or a house, and also that the length of the rental period has a negative influence on the willingness to buy a house. Finally, the mediation model provides evidence that the higher a young renter’s tolerance threshold for mortgage interest compared to “rent payments”, the more inclined they are to buy an apartment or house. The study suggests that the housing finance subsystem has some shortcomings as far as financing young people is concerned. Strategically, there are two complementary solutions that could be implemented: (1) a long-term home savings plan or program and (2) innovative housing loan options tailored to the financial situation of young people.

Exploring acceptance on benefit of solar farm implementation in Malaysia

Exploring acceptance on benefits of solar farm implementation in Malaysia. Implementation of solar farms to generate electricity is still low in Malaysia, where only 1%, or 227.5 MW of the total installed electrical capacity in Malaysia was produced from solar PV installations in 2016. Renewable energies, e.g. solar energy, have been adopted in many countries to generate electricity as a response to global environment issues. The aim of this study is to determine financial opportunities and benefits of solar farm implementation towards the society and the environment. Data were acquired through a literature review and questionnaire survey that was conducted among the respondents that are directly involved in the solar energy. Long-term financial savings constitute the most identified financial opportunities for the implementation of solar farms in generating clean electricity. Implementation of solar farms will encourage more businesses related to solar energy to be established in the country and will lead to new business opportunities. Solar farms are far better than conventional fossil fuel power plants in terms of the environmental effect and also reduce the health effects on the society during the electric generating process.

Cost-Effectiveness and Long-Term Savings of the Bright Bodies Intervention for Childhood Obesity

ObjectivesTo estimate the cost and cost-effectiveness of Bright Bodies, a high-intensity, family-based intervention that has been demonstrated to improve body mass index (BMI) among children with obesity in a randomized controlled trial. MethodsWe developed a microsimulation model to project 10-year BMI trajectories of 8 to 16-year-old children with obesity, using data from the National Longitudinal Surveys and Centers for Disease Control and Prevention growth charts, and we validated the model using data from the Bright Bodies trial and a follow-up study. We used the trial data to estimate the average reduction in BMI per person-year over 10 years and the incremental costs of Bright Bodies, compared with the traditional clinical weight management (control), from a health system’s perspective in 2020 US dollars. Using results from studies of Medical Expenditure Panel Survey data, we projected the long-term obesity-related medical expenditure. ResultsIn the primary analysis, assuming depreciating effects postintervention, Bright Bodies is expected to reduce a participant's BMI by 1.67 kg/m2 (95% uncertainty interval 1.43-1.94) per year over 10 years as compared with control. The incremental intervention cost of Bright Bodies was $360 ($292-$421) per person compared with the clinical control. Nevertheless, savings in obesity-related healthcare expenditure offset these costs and the expected cost-savings of Bright Bodies is $1126 ($689-$1693) per person over 10-years. The projected time to achieve cost-savings compared with clinical control was 3.58 (2.63-5.17) years. ConclusionsAlthough resource-intensive, our findings suggest that Bright Bodies is cost-saving compared to the clinical control by averting future obesity-related healthcare costs among children with obesity.

Achieving cardiac rehabilitation uptake targets: What is the value case for commissioners? A UK case-study

Cardiac Rehabilitation (CR) has become an established intervention to support patient recovery after a cardiac event, with evidence supporting its effectiveness and cost-effectiveness in improving patient health and reducing future burden on healthcare systems. However, this evidence has focussed on the national value case for CR rather than at the point at which it is commissioned. This analysis uses the UK as a case-study to explore variation in current CR engagement and disassemble the value case from a commissioner perspective.Using data collected by the National Audit of CR (NACR), and an existing model of cost-effectiveness, we present details on the current level of CR uptake by commissioning region (Specialist Clinical Networks) in light of the current UK target of achieving 85% uptake. We then interrogate the value case for achieving the target at a commissioner level, highlighting the expected profile of health benefits and healthcare system costs over the long-term. Importantly we consider where this may differ from the national value case.Each commissioning region has a unique level of CR uptake and sociodemographic profile. Concurrently, the value case for commissioning CR relies on the upfront cost of the service being offset by long-term healthcare savings, and health improvements.The shift in the UK and internationally to more localised commissioning necessitates evidence of cost-effectiveness that better reflects the realities of those decision makers. This paper provides vital additional data to facilitate such commissioners to understand the value case in increasing CR uptake in line with national policy.

Perinatal psychiatric practitioner consultation program delivers rapid response to OB/GYN practitioners.

Screening and treatment initiation for perinatal psychiatric conditions is a recommended competency in OB/GYN practitioners, yet perinatal psychiatry is rapidly evolving. Practitioner-to-psychiatrist consultation programs have the potential to improve the management of psychiatric conditions in perinatal women. This study describes utilization of a statewide perinatal psychiatric consultation service by OB/GYN practitioners through examination of the volume, responsivity, content and outcomes of clinical inquiries, and satisfaction. This quality improvement study describes the 460 telephone or e-mail consultations requested by OB/GYN practitioners over 2 years and housed within a REDCap database. Data include the characteristics of consult users, month-over-month and total utilization, the patient's perinatal status, the reason for contact, current symptoms and medications, and the consulting psychiatrist recommendations. Practitioner satisfaction with consultation is also described. After completion of triage, the psychiatrist returned the practitioner's call ≤5min in 59% of consultations. The most common inquiries were for pregnant (64%) women for depressive (51%) or anxiety (46%) symptoms with 47% of inquiries reporting the patient was currently taking a psychiatric medication. Had consultation not been available, referral to mental health (41%) or starting a medication (15%) were most often reported. This perinatal psychiatric consultation service rapidly and effectively met the needs of practitioners practicing in OB/GYN settings across a state having a critical psychiatry shortage and varying urban and rural geography. Future recommendations include the assessment of direct patient outcomes, practitioner skill attainment, and long-term cost savings of this perinatal psychiatric consultation model.

A computationally efficient heuristic approach for solving a new sophisticated arrangement of cogeneration combined heat and power cycle

Cogeneration combined heat and power cycle components are continually optimized using new methods and solutions. Due to the interconnection of two different power generation cycles, the design of the cogeneration cycle is extremely complex and any changes in the structure directly affect the power, efficiency, costs, and other variables. To address this issue, a new arrangement of the cogeneration combined heat and power cycle is presented in this study, as well as a suitable fit function for exergy analysis and evolutionary algorithms used for model optimization. Several objectives are considered when optimizing, such as reducing costs, increasing profitability, etc. Optimization algorithms increased energy efficiency by 2.7% and exergy efficiency by 8.6%, indicating substantial long-term energy savings. A significant improvement was made in all desired parameters as well. Therefore, we can conclude that the upgraded algorithm considered in this study is effective in designing power generation cycles due to the particular importance of optimal design in power generation cycles.

Assessment of Health Care Costs and Total Baclofen Use Associated With Targeted Drug Delivery for Spasticity

BackgroundChronic spasticity causes significant impairment and financial burden. Oral baclofen, the first-line therapy, can have intolerable, dose-dependent side effects. Targeted drug delivery (TDD) through intrathecal baclofen delivers smaller amounts of baclofen into the thecal sac via an implanted infusion system. However, the health care resource utilization of patients with spasticity receiving TDD has not been studied extensively. Materials and MethodsAdult patients who received TDD for spasticity between 2009 and 2017 were identified using the IBM MarketScan® data bases. Patients’ use of oral baclofen and health care costs were examined at baseline (one year before implantation) and three years after implantation. A multivariable regression model using the generalized estimating equations method and a log link function was used to compare postimplantation costs with those at baseline. ResultsThe study identified 771 patients with TDD for medication analysis and 576 for cost analysis. At baseline, the median costs were $39,326 (interquartile range [IQR]: $19,526–$80,679), which increased to $75,728 (IQR: $44,199–$122,676) in year 1, decreased to $27,160 (IQR: $11,896–$62,427) in year 2, and increased slightly to $28,008 (IQR: $11,771–$61,885) in year 3. In multivariable analysis, the cost was 47% higher than at baseline (cost ratio [CR] 1.47, 95% CI: 1.32–1.63) in year 1 but was 25% lower (CR 0.75, 95% CI: 0.66–0.86) in year 2 and 32% lower (CR 0.68, 95% CI: 0.59–0.79) in year 3. Before implant, 58% of patients took oral baclofen, which decreased to 24% by year 3. The median daily baclofen dose decreased from 61.8 mg (IQR: 40–86.4) before TDD to 32.8 mg (IQR: 30–65.7) three years later. ConclusionsOur findings indicate that patients who undergo TDD use less oral baclofen, potentially reducing the risk of side effects. Although total health care costs increased immediately after TDD, most likely owing to device and implantation costs, they decreased below baseline after one year. The costs of TDD reach cost neutrality approximately three years after implant, indicating its potential for long-term cost savings.

A two-stage stochastic model for intermodal terminal location and freight distribution under facility disruptions

ABSTRACT A two-stage stochastic model is developed for intermodal facility location and freight distribution under random disruptions at shipper facilities and/or intermodal terminals (IMTs). The magnitude of the disruption and the impacted locations are uncertain parameters. A two-stage stochastic programming model is used to address supply uncertainty at shippers and throughput capacity uncertainty at IMTs. A level-method based decomposition approach and the L-shaped method are used to solve the model. The state of South Carolina in the U.S.A. is used as a case study with the goal of determining the set of IMT locations that minimise the total long-run network costs due to hurricane disruptions. A methodology is developed to generate realistic scenarios. The Freight Analysis Framework Version 4.5 data set is used to generate demands and supply, and k-means clustering is used with the Hurricane database (HURDAT2) to generate hurricane disruption scenarios. Sensitivity analyses are performed by varying the disruption probabilities, disruption duration, and direct shipping cost parameters. The results indicate that as disruptions increase, less disrupted intermodal facilities are opened. Also, as direct shipping costs increase, the long-term savings increase non-linearly for all magnitudes of disruptions.

An Economic Model to Establish the Costs Associated With Routes to Presentation for Patients With Multiple Myeloma in the United Kingdom

ObjectivesPatients with myeloma often face significant diagnostic delay, with up to one-third of UK patients diagnosed after an emergency presentation (EP). Compared with other routes, patients presenting as an emergency have more advanced disease, increased complications, and poorer prognosis. MethodsAn economic model was developed using a decision-tree framework and lifetime time horizon to estimate costs related to different presentation routes (EP, general practitioner [GP] 2-week wait, GP urgent, GP routine, and consultant to consultant) for UK patients diagnosed as having myeloma. After diagnosis, patients received one of 3 first-line management options (observation, active treatment, or end-of-life care). Inputs were derived from UK health technology assessments and targeted literature reviews, or based on authors’ clinical experience where data were unavailable. Active treatment, complication, and end-of-life care costs were included. ResultsThe average per-patient cost of treating myeloma (across all routes) was estimated at £146 261. The average per-patient cost associated with EP (£152 677) was the highest; differences were minimal compared with GP 2-week wait (£149 631) and consultant to consultant (£147 237). GP urgent (£140 025) and GP routine (£130 212) were associated with marginally lower costs. Complication (£42 252) and end-of-life care (£11 273) costs were numerically higher for EP than other routes (£25 021-£38 170 and £9772-£10 458, respectively). ConclusionsAn economic benefit may be associated with earlier diagnosis, gained via reduced complication and end-of-life care costs. Strategies to expedite myeloma diagnosis and minimize EPs have the potential to improve patient outcomes and may result in long-term savings that could offset any upfront costs associated with their implementation.

Characteristics and short- and long-term direct medical costs among adults with timely and delayed presentation for HIV care in the Netherlands.

In Europe, half of people living with HIV (PLWH) present late to care, with associated higher morbidity and mortality. This study aims to assess short- and long-term costs of HIV-care based on time of presentation and identify other factors contributing to higher costs in the first and fifth year after antiretroviral therapy (ART) initiation. We included ATHENA cohort data which prospectively includes 98% of PLWH in the Netherlands. PLWH who initiated ART in 2013 were included and followed over five years. PLWH were divided in three categories based on CD4 cell-count at time of ART initiation: timely presentation (CD4>350cells/μL), late presentation (CD4 200-350cells/μL or >350cells/μL with AIDS-defining illness) and very late presentation (CD4<200cells/μL). The total HIV-care cost was calculated distinguishing ART medication and non-ART medication costs (hospitalization, outpatient clinic visits, co-medications, and HIV-laboratory tests). From 1,296 PLWH, 273 (21%) presented late and 179 (14%) very late. Nearly half of those who entered HIV-care in a very late stage were of non-Dutch origin, with 21% originating from sub-Saharan Africa. The mean cost per patient in the first year was €12,902 (SD€11,098), of which about two-thirds due to ART (€8,250 (SD€3,142)). ART costs in the first and fifth year were comparable regardless of time of presentation. During the first year on treatment, non-ART medication costs were substantially higher among those with late presentation (€4,749 (SD€8,009)) and very late presentation (€15,886 (SD€ 21,834)), compared with timely presentation (€2,407(SD€4,511)). Higher non-ART costs were attributable to hospitalization and co-medication. The total non-ART costs incurred across five years on treatment were 56% and 246% higher for late and very late presentation respectively as compared to timely presentation. Very late presentation is associated with substantial costs, with non-ART costs nearly seven times higher than for those presenting timely. Hospitalization and co-medication costs are likely to continue to drive higher costs for individuals with late presentation into the future. Programs that identify individuals earlier will therefore likely provide significant short- and long-term health cost savings.

SG-APSIC1129: Long-term effect of a bundled care program in reducing central-line–associated bloodstream infections

Objectives: Central-line–associated bloodstream infection (CLABSI) has been the leading cause of healthcare-associated infections (HAIs) in the intensive care unit (ICU) setting. Previous studies have shown that a care bundle is effective in reducing CLABSI rates; however, the data on long-term sustainability and cost savings of bundled care are limited. Methods: From January 2011 to December 2020, a prospective surveillance was performed to monitor CLABSI at a university hospital in northern Taiwan. To reduce the CLABSI rate, a hospital-wide bundled care program for CLABSI prevention was implemented in 2013. We evaluated the long-term effect of the care bundle on CLABSI incidence and length of stay in the ICU. Results: During the study period, the overall CLABSI incidence decreased from 8.22 per 1,000 catheter days before the care bundle was implemented to 6.33 per 1,000 catheter days in 2020 (P for trend &lt;.01). The most common pathogens causing CLABSI were gut organisms (1,420 of 2,363, 60.1%), followed by environmental organisms (734 of 2,363, 31.1%) and skin organisms (177 of 2,363, 7.5%). The decreasing trend was statistically significant in the incidence of CLABSI caused by skin organisms (P for trend &lt; .01), but not in the incidence of CLABSI caused by environmental organisms (P for trend = .86) or gut organisms (P for trend = .06). In the multivariable analysis, implementation of this care bundle was independently associated with a decrease in the CLABSI rate (RR, 0.77; 95% CI, 0.66–0.88). Compared with patients without CLABSI, patients with CLABSI had a longer average ICU length of stay (27 vs 17 days). Conclusions: A sustainable reduction in the incidence of CLABSI caused by common commensals could be achieved through a cost-saving bundled care program.

Clinical and Cost Benefits of Anti-Obesity Medication for US Veterans Participating in the MOVE! Weight Management Program.

Abstract This study investigated the clinical and economic impact of anti-obesity medications (AOMs; orlistat, liraglutide, phentermine/topiramate extended-release [ER], naltrexone ER/bupropion ER) among United States Veterans with obesity participating in Motivating Overweight/Obese Veterans Everywhere! (MOVE!), a government-initiated weight management program. The study population was identified from electronic medical records of the Veterans Health Administration (2010-2020). Clinical indices of obesity and health care resource utilization and costs were evaluated at 6, 12, and 24 months after the initial dispensing of an AOM in the AOM+MOVE! cohort (N = 3732, mean age 57 years, 79% male) or on the corresponding date of an inpatient or outpatient encounter in the MOVE! cohort (N = 7883, mean age 58 years, 81% male). At 6 months postindex, the AOM+MOVE! cohort had better cardiometabolic indices (eg, systolic blood pressure, diastolic blood pressure, total cholesterol, low-density lipoprotein cholesterol, hemoglobin A1c) than the MOVE! cohort, with the trends persisting at 12 and 24 months. The AOM+MOVE! cohort was significantly more likely than the MOVE! cohort to have weight decreases of 5%-10%, 10%-15%, and >15% and lower body mass index at 6, 12, and 24 months. The AOM+MOVE! cohort also had fewer inpatient and emergency department visits than the MOVE! cohort, which was associated with lower mean total medical costs including inpatient costs. These results suggest that combining AOM treatment with the MOVE! program could yield long-term cost savings for the Veterans Affairs network and meaningful clinical improvements for Veterans with obesity.

Investigating Associations Between Access to Rheumatology Care, Treatment, Continuous Care, and Healthcare Utilization and Costs Among Older Individuals With Rheumatoid Arthritis.

To examine the association between rheumatologist access, early treatment, and ongoing care of older-onset rheumatoid arthritis (RA) and healthcare utilization and costs following diagnosis. We analyzed data from a population-based inception cohort of individuals aged > 65 years with RA in Ontario, Canada, diagnosed between 2002 and 2014 with follow-up to 2019. We assessed 4 performance measures in the first 4 years following diagnosis, including access to rheumatology care, yearly follow-up, timely treatment, and ongoing treatment with a disease-modifying antirheumatic drug. We examined annual healthcare utilization, mean direct healthcare costs, and whether the performance measures were associated with costs in year 5. A total of 13,293 individuals met inclusion criteria. The mean age was 73.7 (SD 5.7) years and 68% were female. Total mean direct healthcare cost per individual increased annually and was CAD $13,929 in year 5. All 4 performance measures were met for 35% of individuals. In multivariable analyses, costs for not meeting access to rheumatology care and timely treatment performance measures were 20% (95% CI 8-32) and 6% (95% CI 1-12) higher, respectively, than where those measures were met. The main driver of cost savings among individuals meeting all 4 performance measures were from lower complex continuing care, home care, and long-term care costs, as well as fewer hospitalizations and emergency visits. Access to rheumatologists for RA diagnosis, timely treatment, and ongoing care are associated with lower total healthcare costs at 5 years. Investments in improving access to care may be associated with long-term health system savings.

Cost and Benefit Analysis of Solar Panels at Home

Due to the high utility costs in Cabanatuan City, the solar panel system is rapidly approaching. People in the middle and lower income classes of the country particularly feel the effects of inflation. In order to address the ongoing rise in oil prices and pollution, the government has made the development of renewable energy one of its top priorities. In order to help consumers reduce their utility costs, save money, and produce greener energy, a study on the installation of a solar panel system at home was carried out. The researchers gathered some data from consumers to be utilized as the basis for the contractors' computations, where the adoption of a 3kw on-grid solar panel system was recommended to those respondents with power bills under ₱2,400. The project costs approximately ₱150,000 in total, including installation and permits, and can save approximately ₱2,300 monthly. This investment has a 5.4-year payback period and a total savings of ₱402,000 over a 20-year period. The consumption analysis revealed a sensitive effect on savings and investment payback periods. The study proved that the project's long-term savings can be more than double the initial investment. A SWOT analysis was also performed to highlight the advantages and disadvantages of having an on-grid solar panel, as well as the benefits of clean energy and gas reduction in our environment that future generations could benefit from. The project's cost-benefit is a win-win investment for everyone who wants to save money while also enjoying cleaner air in the long run.

Long Term Energy Savings Through User Behavior Modeling in Smart Homes

The Internet of Things (IoT) has enabled real-time monitoring of energy consumption in smart homes through sensors embedded in the surrounding environment. In the post-pandemic world, domestic energy management has gained importance due to increased work-from-home consumption, making data collection in a smart home a relevant IoT application with many potential energy savings. However, this information is difficult for most users to understand, and existing monitoring systems’ savings results degrade over time. To address these challenges, this study presents a novel approach for domestic energy consumption, production, and comfort perception using color-based dashboards enhanced for user feedback interaction. The approach includes the management of in-home appliances and comfort levels according to user preferences to attain long-term energy savings. The approach includes multiple appealing strategies such as 3D representation, mobile connectivity, utility integration, and dynamic information, to increase long-term engagement and provides quantitative data on energy savings achieved for one year, where the average energy consumption was reduced by 19%. It was found that the approach sustained user engagement over time, with users actively participating in energy conservation efforts. A community survey with 208 participants was also developed and studied where 69% of the enquired considered our approach more attractive than existing market solutions, and 79% considered it more useful than existing solutions. Regarding the real-time information presented on our approach, 81% of the participants strongly or totally agree that it can change users’ behaviors.

Component Reusability for Long-term Emission Savings

Component Reusability for Long-term Emission Savings

Comparative preference of loans provided by SBI and ICICI with reference to Coimbatore district

The need for home loans arises not because property prices are heading upwards all the time but because home loans make great sense from a long-term savings perspective. The study is about comparison of service of SBI and ICICI. The main objective of the study is that to know about the socio-economic profile of the respondents availing home loan in SBI and ICICI Bank in Coimbatore city and to study on the customer opinion about services and the problems faced by them. The study was analyzed with descriptive research with 125 samples from ICICI and 125 samples from SBI were percentage analysis, chi square, descriptive statistics and factor analysis were used as tools for analyzing the data. The conclusion is that the service provided by ICICI is better than SBI based on the interest rate and both the banks have to implement new technology to reduce the process time of loans which leads to satisfaction of customers in future period of time.

The equitable housing workshop. Mapping and improving stakeholders’ decision-making process for circular equitable housing projects.

A growing housing crisis in Western Europe increases the pressure on conventional support measures and further reduces the accessibility to equitable housing. Yet, the necessary transition to a sustainable and circular construction economy could be an opportunity to meet this social challenge. Research on the long-term costs and savings of circular strategies in housing projects demonstrates that applying specific circular strategies to specific projects can improve the long-term affordability of housing. Little research mentions circular building’s relation to housing quality nor the decision mechanism behind the design process of housing projects. Since these decisions are not only based on costs, but also social factors and practical considerations, it is important to take these into account. Introducing systems thinking in the design process could lead to more inclusive, and mindful decision making in the design process of housing projects. This paper proposes a methodology to encourage stakeholders in a housing project to think systemically and to have an open discussion about housing dimensions. The equitable housing workshop allows us to visually display rather complex networks of decisions and influences present in a project. The workshop continues by challenging the participants to find solutions that fit within the equitable housing model. These solutions are then linked to circular building strategies to encourage participants to look for sustainable and circular solutions. This also shows them how circular building design can make housing more equitable, and therefore, give them the tools to tailor a circular strategy specifically to their project. For researchers, analysing the participant’s discussions, held throughout the workshop, can bring new insights into the relationship between equitable housing and circular building.

An Evaluation of a Care Coaching and Provider Referral Intervention for Behavioral Health Needs

To evaluate changes in health care spending and utilization associated with a telehealth-based care coach-supported and behavioral health (BH) provider referral intervention in the United States. Observational retrospective cohort study with propensity score matching of treated and control groups. Difference-in-differences (DID) analysis was used to calculate per-member per-month (PMPM) savings and changes in utilization in a treated group relative to matched controls over 36 months. The study included 1800 adults with substance use disorder (SUD), anxiety, or depression who were eligible for the intervention. Treated members (n = 900) graduated from the program. Matched control members (n = 900) were eligible but never enrolled. Primary outcomes included all-cause and disease-attributable health care cost and utilization PMPM, categorized by place of service. There were statistically significant reductions in total all-cause medical costs of $485 PMPM (P < .001) and a 66% pre-post reduction in inpatient encounters, with $488 PMPM DID savings for inpatient admissions (P < .001) among the treated cohort compared with the control cohort over 36 months. Conversely, there were statistically significant cost increases ($110 PMPM; P < .001) for all-cause office visits in the treated cohort compared with the control cohort. Similar results were seen in SUD-attributable and BH-attributablecosts. Although the results could be affected by unmeasured confounding, they suggest that care coaching interventions that offer BH provider referrals may produce long-term savings, reductions in avoidable utilization, and increases in targeted services to treat BH conditions. Rigorous evaluations are needed to confirm these findings.

Simulation of Pathways toward Low-Carbon Electricity Generation in the Arctic

This paper examines the various pathways toward energy transition available to remote Arctic communities. Inhabitants of Arctic communities often face significant cost burdens due to high energy prices. Electricity costs are particularly high, due in part to the predominant use of diesel for electricity generation in over 80% of remote Arctic communities. This study examines the different approaches for integrating renewable energy sources, with a focus on the different strategies that might be implemented to finance the energy transition toward greater use of such renewable sources. The high costs associated with project realization in the remote Arctic present special challenges. This study uses a system dynamics model to evaluate the various financing tools available to facilitate the energy transition. The model results indicate that the integration of renewable energy sources has the potential to yield long-term electricity cost savings for the remote Arctic communities in question.