Lower Total Costs Research Articles

Environmental and Economic Assessment of Membrane Capacitive Deionization (MCDI) and Low-Pressure Reverse Osmosis (LPRO) for Sustainable Irrigation in the Mediterranean Region

Ensuring the sustainability of a product or a system requires a thorough evaluation of its environmental and socioeconomic impacts. In this context, one of the objectives of the EU-PRIMA SmaCuMed project is to evaluate the socioeconomic and environmental impacts of the Smart Cube system. The Smart Cube was developed for the PV-powered desalination of brackish groundwater with membrane capacitive deionization (MCDI) and low-pressure reverse osmosis (LPRO); it additionally uses smart sensors for controlled irrigation in remote agricultural areas in Morocco, as an example for the North African region. Based on the Life Cycle Sustainability Assessment approach, this paper aims to assess the environmental and economic impacts of the Smart Cube, using Life Cycle Costing (LCC) and Life Cycle Assessment (LCA) analyses for environmental evaluation. Various scenarios have been defined for both environmental and economic assessments. Based on 1 m3 of produced desalinated water, the LCC results showed that, when using the desalination technologies directly connected to the grid, the prices are lower than those obtained when it was supplied by the PV system. This is only due to the very low energy prices from the Moroccan grid (EUR 0.10/kWh). The LCC results showed that LPRO is a more cost-effective option for producing desalinated water, with a lower total cost compared to MCDI. However, LCA results indicated that LPRO has a higher environmental impact compared to MCDI. If higher water production capacity is a priority, MCDI connected to PV is the best choice, with lower carbon emission but higher overall water costs.

Comparison of health care costs following sleeve gastrectomy versus Roux-en-Y gastric bypass among patients with type 2 diabetes.

The objective of this study was to compare the impact of sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) on overall and diabetes-specific health care costs among patients with type 2 diabetes. This retrospective cohort study examined patients with type 2 diabetes after SG and RYGB using data from Optum's deidentified Clinformatics® Data Mart database. The matched study group included 9608 patients who underwent SG or RYGB and were enrolled between 2007 and 2019. The primary outcomes assessed were overall and diabetes-specific health care costs. Health care costs associated with type 2 diabetes declined substantially in the first few years following both SG and RYGB. RYGB was associated with a larger decrease in pharmacy costs, as well as type 2 diabetes-specific office and laboratory costs. SG was associated with lower total health care costs in the first three follow-up periods and lower acute care costs in the first 2 years after surgery. In this nationwide study, patients with type 2 diabetes at baseline undergoing RYGB appear to experience a reduced need for ambulatory type 2 diabetes monitoring and reduced requirements for antidiabetes medication but, despite this, did not experience an overall medical cost-benefit in the first few years after RYGB versus SG.

Examining different cost ratio frameworks for decision rule machine learning algorithms in diagnostic application.

Artificial Intelligence (AI) plays a pivotal role in the diagnosis of health conditions ranging from general well-being to critical health issues. In the realm of health diagnostics, an often overlooked but critical aspect is the consideration of cost-sensitive learning, a facet that this study prioritizes over the non-invasive nature of the diagnostic process whereas the other standard metrics such as accuracy and sensitivity reflect weakness in error profile. This research aims to investigate the total cost of misclassification (Total Cost) by decision rule Machine Learning (ML) algorithms implemented in Java platforms such as DecisionTable, JRip, OneR, and PART. An augmented dataset with conjunctiva images along candidates' demographic and anthropometric features under supervised learning is considered with a specific emphasis on cost-sensitive classification. The opted decision rule classifiers use the text features, additionally the image feature 'a* value of CIELAB color space' extracted from the conjunctiva digital images as input attributes. The pre-processing consists of amalgamating text and image features on a uniform scale, normalizing. Then the 10-fold cross-validation enables the classification of samples into two categories: the presence or absence of the anemia. This study utilizes the Cost Ratio (ρ) extracted from the cost matrix to meticulously monitor the Total Cost in four different cost ratio methodologies namely Uniform (U), Uniform Inverted (UI), Non-Uniform (NU), and Non-Uniform Inverted (NUI). It has been established that the PART classifier stands out as the top performer in this binary classification task, yielding the lowest mean total cost of 629.9 compared to other selected classifiers. Moreover, it demonstrates a comparatively lower standard deviation 335.9, and lower total cost across all four different cost ratio methodologies. The ranking of algorithm performance goes as follows: PART, JRIP, DecisionTable, and OneR. The significance of adopting a cost-sensitive learning approach is emphasized showing the PART classifier's consistent performance within the proposed framework for learning the anemia dataset. This emphasis on cost-sensitive learning not only enhances the recommendations in diagnosis but also holds the potential for substantial cost savings and makes it a noteworthy focal point in the advancement of AI-driven health care.

Techno-Economic Planning of a Fully Renewable Energy-Based Autonomous Microgrid with Both Single and Hybrid Energy Storage Systems

This paper presents both the techno-economic planning and a comprehensive sensitivity analysis of an off-grid fully renewable energy-based microgrid (MG) intended to be used as an electric vehicle (EV) charging station. Different possible plans are compared using technical, economic, and techno-economic characteristics for different numbers of wind turbines and solar panels, and both single and hybrid energy storage systems (ESSs) composed of new Li-ion, second-life Li-ion, and new lead–acid batteries. A modified cost of energy (MCOE) index including EVs’ unmet energy penalties and present values of ESSs is proposed, which can combine both important technical and economic criteria together to enable a techno-economic decision to be made. Bi-objective and multi-objective decision-making are provided using the MCOE, total met load, and total costs in which different plans are introduced as the best plans from different aspects. The number of wind turbines and solar panels required for the case study is obtained with respect to the ESS capacity using weather data and assuming EV demand according to the EV population data, which can be generalized to other case studies according to the presented modelling. Through studies on hybrid-ESS-supported MGs, the impact of two different global energy management systems (EMSs) on techno-economic characteristics is investigated, including a power-sharing-based and a priority-based EMS. Single Li-ion battery ESSs in both forms, new and second-life, show the best plans according to the MCOE and total met load; however, the second-life Li-ion shows lower total costs. The hybrid ESSs of both the new and second-life Li-ion battery ESSs show the advantages of both the new and second-life types, i.e., deeper depths of discharge and cheaper plans.

The downtrending cost of robotic bariatric surgery: a cost analysis of 47,788 bariatric patients.

The surgical robot is assumed to be a fixed, indirect cost. We hypothesized rising volume of robotic bariatric procedures would decrease cost per patient over time. Patients who underwent elective, initial gastric bypass (GB) or sleeve gastrectomy (SG) for morbid obesity were selected from Florida Agency for Health Care Administration database from 2017 to 2021. Inflation-adjusted cost per patient was collected. Cost-over-time ($/patientyear) and change in cost-over-time were calculated for open, laparoscopic, and robotic cases. Linear regression on cost generated predictive parameters. Density plots utilizing area under the curve demonstrated cost overlap. Among 76 hospitals, 11,472 bypasses (223 open, 6885 laparoscopic, 4364 robotic) and 36,316 sleeves (26,596 laparoscopic, 9724 robotic) were included. Total cost for robotic was approximately 1.5-fold higher (p<0.001) than laparoscopic for both procedures. For GB, laparoscopic had lower total ($15,520) and operative ($6497) average cost compared to open (total $17,779; operative $9273) and robotic (total $21,756; operative $10,896). For SG, laparoscopic total cost was significantly less than robotic ($10,691 vs. $16,393). Robotic GB cost-over-time increased until 2021, when there was a large decrease in cost (-$944, compared with 2020). Robotic SG total cost-over time fluctuated, but decreased significantly in 2021 (-$490 compared with 2020). While surgical costs rose significantly in 2020 for bariatric procedures, our study suggests a possible downward trend in robotic bariatric surgery as total and operative costs are decreasing at a higher rate than laparoscopic costs.

Cost-effectiveness analysis of dupilumab versus omalizumab, mepolizumab, and benralizumab added to the standard of care in adults with severe asthma in Colombia

ABSTRACT Background Cost-effectiveness studies evaluate health technologies and help choose treatments. The current study compared dupilumab to omalizumab, mepolizumab, and benralizumab in Colombian adults with severe uncontrolled type 2 asthma. Methods Over a 5-year period, a Markov model was utilized to assess the costs of biological treatments and management of exacerbations, comparing various doses of exacerbations, comparing various doses of dupilumab, omalizumab, mepolizumab, and benralizumab as add-on treatments. It included a 5% annual discount rate per local HTA, and set willingness-to-pay at three times GDP per capita per quality-adjusted life year (QALY) in Colombia. Results Dupilumab (200 mg) exhibited greater QALYs and reduced overall costs compared to mepolizumab (100 mg), benralizumab (30 mg), and omalizumab (450 mg and 600 mg), with the incremental cost-effectiveness ratio (ICER) per QALYgained being -$5.429, -$6.269, -$196.567 and -$991.007, respectively. Dupilumab had greater QALYs and costs versus omalizumab 300 mg (ICERof $200.653 per QALY, above the willingness-to-pay threshold of 3 × GDP per capita). Sensitivity analyses were consistent with base case results. Conclusions Dupilumab 200 mg was strongly dominant versus omalizumab 450 mg and 600 mg, mepolizumab 100 mg, and benralizumab 30 mg; however, cost-effectiveness was not demonstrated versus omalizumab 300 mg. These results could assist healthcare professionals in choosing an appropriate biologic for treating severe type 2 asthma.

Comparison of clinical data between the proximal femoral bionic nail (PFBN) and hip replacement for the treatment of femoral intertrochanteric fracture.

The aim of this study was to compare the difference between proximal femoral bionic nail (PFBN) and hip replacement (HR) for femoral intertrochanteric fracture. A retrospective analysis of the differences in operative time, length of stay, postoperative Harris score, and postoperative mortality between patients with femoral intertrochanteric fracture treated by PFBN and HR admitted to Jinzhai County People's Hospital from October 2020 to September 2022 was performed. A total of 56 patients with femoral intertrochanteric fracture, 26 with PFBN and 30 with HR, were included in the study. There were no differences in the length of surgery, pre- and post-operative hemoglobin, or post-operative Harris score at 3 months between the two groups. Compared to the HR group, the PFBN group had a lower total cost, shorter hospital stays, and lower mortality but a longer ambulation time, with a difference of 3.36 weeks. PFBN may be a promising new treatment for femoral intertrochanteric fracture.

COST-EFFECTIVENESS ANALYSIS OF MIRIKIZUMAB VERSUS USTEKINUMAB IN ADVANCED THERAPY EXPERIENCED PATIENTS WITH MODERATELY TO SEVERELY ACTIVE ULCERATIVE COLITIS IN THE US

Abstract BACKGROUND Mirikizumab, an interleukin (IL)-23p19 inhibitor, demonstrated efficacy compared to placebo in clinical trials in adult patients with moderately to severely active ulcerative colitis (UC). Mirikizumab is expected to receive approval from the United States (US) Food and Drug Administration in 2023. Ustekinumab, an IL12/23 antagonist, is the preferred option in advanced therapy (AT; biologics, novel targeted systemics) experienced patients. OBJECTIVES To evaluate the cost effectiveness of mirikizumab compared to ustekinumab in the US among patients diagnosed with moderately to severely active UC who have been previously treated with AT. METHODS A Markov model was developed in MS Excel, comprising an AT layer, a second line (2L) AT layer, a conventional treatment (CT) layer, and a surgery layer. Following initial induction (2-week cycle length), responders transition to maintenance, while non-responders transition to induction in 2L, consisting of a weighted mix of ATs used in clinical practice according to market shares, or CT. During the maintenance phase (12-week cycle length), the AT layers include remission and non-remission response health states; patients who lose response transition to the 2L, CT or surgery layer, comprising surgery and post-surgery health states. Death is possible from all health states, as per US 2020 national life tables. Probabilities for remission, non-remission response at the end of induction, and transition probabilities during maintenance were derived from a network meta-analysis and published literature, as were health state utilities. The analysis from a US payer's perspective over a lifetime horizon considered only direct medical costs in 2023 US dollars (USD). Costs and outcomes were discounted at 3%. Sensitivity analyses were performed; scenario analyses explored the impact of re-induction, dose escalation, and including societal costs. RESULTS Mirikizumab resulted in lower total costs (USD 1,232,582) and more quality-adjusted life-years (QALYs) (10.352) when compared to ustekinumab at standard doses (USD 1,279,620; 10.247 QALYs). Key drivers of cost savings (USD -47,038) and higher QALYs (0.105) for mirikizumab were assumptions on loss of response, the efficacy of mirikizumab at induction and the price of mirikizumab. The probability that mirikizumab is cost-effective at a willingness to pay threshold of USD 100,000 per QALY gained was 74.9%. Adopting an escalated dose for ustekinumab and re-induction for mirikizumab considerably increased savings. CONCLUSIONS The analyses provided insights into the cost-effectiveness of mirikizumab compared to ustekinumab in the US for patients with moderately to severely active UC previously treated with AT. Results demonstrated that adopting mirikizumab can be considered cost-effective compared to ustekinumab, contributing to decision-making in healthcare management.

Clinical outcomes and economic evaluation of patient-centered care system versus routine-service system for patients with type 2 diabetes in Thailand

IntroductionPatient-centered care in diabetes is another approach for outcome improvement, yet the supporting economic and clinical evidence remains limited in Thailand. ObjectivesThis study compared health outcomes and cost-utility of implementing Patient-Centered Care Systems (PCCS) in a primary care setting vs. the Routine Service System (RSS) in a hospital setting. MethodsThe economic evaluation was performed using a randomized controlled study design. The participants aged ≥18 were enrolled from Phimai City in Nakhon Ratchasima Province, Thailand from June 2022 to February 2023. Totally, 309 well-controlled patients with initial care in a hospital were referred to receive the PCCS at the primary care setting or remained receiving the RSS in the hospital. Outcomes of different approaches such as fasting blood sugar, Hemoglobin A1c (HbA1c), direct medical costs, direct nonmedical costs and utility were prospectively collected at months 0, 3 and 6. Fisher's exact test, t-test or Wilcoxon signed-rank test were used to analyze data, whichever was appropriate. An incremental cost-effectiveness ratio was calculated, and various sensitivity analyses were performed. ResultsThe PCCS showed significantly reduced HbA1c (p < 0.001) and a greater number of patients with improved HbA1c (p < 0.001). The PCCS were a cost-saving strategy due to incurring lower total costs (60.15 vs. 73.42 USD) and gaining more quality-adjusted life-years (QALY)(0.340 vs. 0.330) compared with the RSS. With a ceiling ratio of 4,659 USD/QALY, the PCCS had a 94.6 % probability of being cost-effective. ConclusionThis finding indicated that the PCCS in a primary care setting was a cost-saving strategy by lowering cost, providing a higher quality of life and improving glycemic control compared with the RSS in a hospital setting. However, generalizing the findings in a country as a whole, the economic evaluation of PCCS and RSS should be conducted among different levels of hospitals from all regions in Thailand.

A novel reactive-extractive distillation process for separation of water/methanol/tetrahydrofuran mixtures

The design of separation systems for the purification of azeotropic mixtures is of great importance in the chemical industries from economic and environmental points of view. Two novel reactive-extractive distillation (RED) processes, new design (I) and new design (II), were proposed for separating the azeotropic mixture of water/methanol/tetrahydrofuran (THF). These processes were compared to a conventional extractive distillation (ED) process. New design (I) employs dimethyl sulfoxide as a solvent, while new design (II) utilizes ethylene glycol. Ethylene oxide was introduced to the first column in both designs, enabling the in-situ production of ethylene glycol, a valuable byproduct. This is a novel solution to separate water from the azeotropic mixture by reaction between ethylene oxide and water. Aspen Plus software was used to simulate and design the processes. Both suggested designs were compared economically with the base design which is an ED process. According to the results, the new design (I) is more cost-effective and environmentally friendly alternative to the base design and the new design (II). It has a lower total capital cost and produces less carbon dioxide. Additionally, it generates a valuable by-product, ethylene glycol, which can be sold for substantial revenue. As a result, the new design (I) is the preferred choice for replacing the conventional extractive distillation method.

Multi-source multicast service chaining model guaranteeing reliability of network services

Service chaining provides network services to users by processing packets with a series of virtualized network functions (VNFs). Multicast communication can suppress the network load compared to unicast communication when the same service is provided to multiple users simultaneously. Network providers need to ensure that services are provided to users under reliability requirements. Existing service chaining models can cause failure-intolerant or cost-inefficient resource allocation for multicast services. This paper proposes a multi-source multicast service chaining model that guarantees the reliability of network services with flexible routing and VNF placement. The proposed model determines the routing and VNF placement for each service chain request with redundancy so as to minimize the total resource utilization cost while satisfying the reliability requirement. In order to obtain cost-efficient feasible solutions, we introduce two heuristic algorithms. One is an algorithm that iteratively solves an integer linear programming problem until the reliability requirements are satisfied for all requests. The other is an algorithm that determines the VNF placement by using a metric based on the betweenness centrality and server failure rate. Numerical results show that the proposed model allocates the network and computation resources for services with lower total cost compared to the existing model. We also show illustrative examples of the resource allocation to compare the characteristics of two heuristic algorithms.

An investigation of an athlete injury likelihood monitoring system using the random forest algorithm and DWT.

The main goal of sports science is to monitor sports injuries. Nevertheless, the existing sports injury monitoring projects have many expensive instruments and excessively extended monitoring periods, which makes it difficult to expand sports injury monitoring on a large scale. The advancement of machine learning algorithms opens up new avenues for the tracking of sports injuries. A training set of sports injuries was created using the Discrete Wavelet Transform (DWT) and Random Forest algorithms. Next, a basic analytic framework was created based on the lower-body movement of runners, and an athlete's injury likelihood monitoring system was established. First off, the wearable gyroscope device can efficiently plot the motion displacement curve and monitor the three-dimensional mechanics of the athlete's hips, thighs, and calves. Secondly, the system has a higher computational efficiency and an advantage over other classifier-based systems in terms of testing and training times. The suggested system framework identifies athletes' injury propensity, providing preventive recommendations based on displacement curves, and offering a low total cost and high testing accuracy, making it easy to implement and cost-effective. All things considered, the sports injury monitoring device is very accurate and reasonably priced, making it appropriate for widespread use.

Benefits of Preservation, Green and Quality Improvement Investment for Waste Management in Sustainable Supply Chain under Fuzzy Learning and Inflation

In the modern world, waste management, incorporating the quality of the products, energy consumption, and environmental concern have become significant challenges for supply chain managers. Also, smart devices are essential for daily life in the current socioeconomic environment, and customers primarily contemplate a smart product’s price and energy usage before purchasing that. In this situation, to maintain a balance between the selling price, energy consumption, and carbon emission from supply chain operations becomes necessary. So this study develops a twoechelon sustainable inventory model for deteriorating items with an imperfect production process under energy consumption and selling price dependent demand. The producer makes a rework process and quality improvement investment to mitigate defective products and enhance the quality of the products. The present model develops under the influence of inflation. Also, preservation and green technologies are used to mitigate the rate of deterioration and carbon emission, respectively. Firstly, the model is created in a crisp sense, and then expanded into a fuzzy learning model to examine the impact of the learning effect in an imprecise environment. A numerical analysis is performed to validate the proposed model, and the cost function’s convexity is shown graphically using mathematica software. The result of the proposed model provides significant insights to decision-makers on how to efficiently reduce waste while still minimizing the total cost of the system by investing in high efficiency preservation, quality improvement and green techniques. Also, due to learning in fuzziness, the fuzzy learning model gives the lowest total cost, followed by the fuzzy and crisp model. Finally, for various parameters, a sensitivity analysis is performed to gather valuable observations and management insights.

Impact of a Pharmacy Care Management Service on Medically Complex Medicare Advantage Members

Summary Medicare Advantage (MA) programs have grown rapidly, and a shift toward more medically complex beneficiaries has implications for health care utilization, costs, and quality in the MA program. Ensuring safe and effective medication use in this population has been identified as a priority, yet there is limited evidence to guide MA plans’ pharmacy care management (PCM) efforts. The goal of this study was to investigate the impact of an integrated PCM program for MA beneficiaries taking multiple chronic medications, including a subset with high predicted cost savings from improved medication adherence, assessed using the Value of Future Adherence (VFA) score. Using adjudicated administrative claims data from a regional Medicare Advantage and Part D (MAPD) plan, a retrospective matched cohort study was designed. A total of 724 members receiving PCM services were matched to 3,620 control members who received usual pharmacy care. From these two cohorts, 196 of 724 PCM participant members and 980 of 3,620 control group members were defined as having a high VFA score. PCM program enrollees underwent monthly medication reviews, reconciliation, and synchronization of refills, which were dispensed and delivered to the home in adherence packaging by a specially equipped pharmacy. Members were contacted monthly and received, as needed, education, referral to health care providers, consultation with prescribers on changes to medication regimens, and referral to social support or case management programs. Primary outcomes of interest were per enrollee per month (PEPM) costs, resource utilization, and medication adherence for three MAPD Star Ratings measures — Medication Adherence for Diabetes Medications, Medication Adherence for Hypertension (renin-angiotensin system antagonists [RASAs]), and Medication Adherence for Cholesterol (statins) — over 12 months for all members and for the subgroup with a high VFA score. The authors found that among all PCM program enrollees, there was a $50 (95% confidence interval [CI], $15 to $86; P = 0.005) PEPM increase in average pharmacy spending compared with control members and an offsetting $158 (95% CI, −$265 to −$51; P = 0.004) PEPM decrease in medical spending, resulting in PCM participants having $108 (95% CI, −$221 to $5; P = 0.062) lower PEPM total cost of care. Compared with the control group, PCM enrollees had 15% (P = 0.008) fewer inpatient stays and improvements in medication adherence of 7.3% among members taking oral antidiabetic agents, 9.4% among members taking statins, and 12.9% among members taking RASA antihypertensive agents (P < .001 for all three measures). These effects were driven by the patients in the subgroup with a high VFA score, for whom PEPM total cost of care was $406 (95% CI, −$645 to −$161; P < 0.001) lower than control members. These findings support the potential value of an integrated PCM program for MAPD beneficiaries on multiple medications, particularly when targeted to those members predicted to benefit most.

Telemedicine management of obstructive sleep apnea disorder in China: a randomized, controlled, non-inferiority trial.

Previous studies assessed different components of telemedicine management pathway for OSA instead of the whole pathway. This randomized, controlled, and non-inferiority trial aimed to assess whether telemedicine management is clinically inferior to in-person care in China. Adults suspected of OSA were randomized to telemedicine (web-based questionnaires, self-administered home sleep apnea test [HSAT], automatically adjusting positive airway pressure [APAP], and video-conference visits) or in-person management (paper questionnaires, in-person HSAT set-up, APAP, and face-to-face visits). Participants with an apnea-hypopnea index (AHI) ≥ 15 events/hour received APAP for 3months. The non-inferiority analysis was based on the change in Functional Outcomes of Sleep Questionnaire (FOSQ) score and APAP adherence. Cost-effectiveness analysis was performed. In the modified intent-to-treat analysis set (n = 111 telemedicine, 111 in-person), FOSQ scores improved 1.73 (95% confidence interval [CI], 1.31-2.14) points with telemedicine and 2.05 (1.64-2.46) points with in-person care. The lower bound of the one-sided 95% non-inferiority CI for the difference in change between groups of - 0.812 was larger than the non-inferiority threshold of - 1. APAP adherence at 3months was 243.3 (223.1-263.5) minutes/night for telemedicine and 241.6 (221.3-261.8) minutes/night for in-person care. The lower bound of the one-sided 95% non-inferiority CI of - 22.2min/night was higher than the non-inferiority delta of - 45min/night. Telemedicine had lower total costs than in-person management (CNY 1482.7 ± 377.2 vs. 1912.6 ± 681.3; p < 0.0001), driven by patient costs, but no significant difference in QALYs. Functional outcomes and adherence were not clinically inferior in patients managed by a comprehensive telemedicine approach compared to those receiving in-person care in China. https://www.chictr.org.cn , Registration number ChiCTR2000030546. Retrospectively registered on March 06, 2020.

Long term cost outcomes among commercially insured patients undergoing bariatric surgical procedures.

Bariatric procedures have become safer in recent years, warranting new data on long-term costs. This study examined the impact of bariatric procedures on a person's long-term healthcare costs up to 10years and if it differed by socio-economic status (SES). This retrospective observational study compared the downstream health care cost of patients with obesity who had undergone bariatric surgery (BS) between 2009 and 2018 to a 1:1 matched group of members with obesity but no surgery. 167,764 individuals from administrative claims data with an obesity diagnosis were included; 83,882 in the BS group and 83,882 in the non-surgical group. In follow-up years 2-10, the BS group was associated with lower total medical healthcare cost compared to the non-surgical group (cost ratios ranged 0.85-0.93, p values<0.05). When stratifying the BS group by SES quartiles, there were no significant cost differences by SES (cost ratios ranged from 0.96 to 1.05, most p values>0.05). BS was associated with lower long-term follow-up medical cost and cost savings appeared similar among the SES quartiles in the BS group. The study results may help policy makers and employers in designing benefits and extending coverage for bariatric surgical procedures.

Impact of the Home-Based Medical Integrated Program on Health Outcomes and Medical Resource Utilization in Home Healthcare Patients in Taiwan.

The home-based medical integrated program (HMIP) is a novel model for home healthcare (HHC) in Taiwan, initiated in 2016 to enhance care quality. However, the outcomes of this program on health outcomes and medical resource utilization in HHC patients remain unclear. Thus, we conducted this study to clarify it. The authors utilized the Taiwan National Health Insurance Research Database to identify HHC patients who received HMIP and those who did not between January 2015 and December 2017. A retrospective cohort study design was used. Convenience sampling was employed to select patients who met the inclusion criteria: being part of the HHC program and having complete data for analysis. A total of 4982 HHC patients in the HMIP group and 10,447 patients in the non-HMIP group were identified for this study. The mean age in the HMIP group and non-HMIP group was 77.6 years and 76.1 years, respectively. Compared with the non-HMIP group, the HMIP group had lower total medical costs for HHC, fewer outpatient department visits and lower medical costs, lower medical costs for emergency department visits, fewer hospitalizations, and a lower mortality rate (34.6% vs 41.2%, p<0.001). The HMIP is a promising model for improving care quality and reducing medical resource utilization in HHC patients. While this suggests that the non-HMIP model should be replaced, it's important to note that both non-HMIP and HMIP models currently coexist. The HMIP may serve as an important reference for other nations seeking to improve care quality and reduce medical resource utilization in their own HHC systems.

Integrating Demand Response with Unit Commitment in Insular Microgrid considering Forecasting Errors and Battery Storage

In this paper, DR programs are integrated with the unit commitment economic dispatch model for a single day to lower total operating costs for an insular microgrid. The proposed model takes into account the forecasting errors associated with wind, solar, and load demands. A new combined DR program is presented to enhance microgrid operation and financial effectiveness, benefiting microgrid consumers. The price elasticity and consumer profit are the foundation for DR modeling. The optimization problem is developed as mixed‐integer nonlinear programming (MINLP) and solved using GAMS software. For the case study, an insular microgrid consisting of two microturbines, a wind turbine, solar photovoltaic, and battery storage is considered. Optimization is carried out under both with and without the DR program. The outcomes show that by implementing TOU and DLC DR programs, the operating cost is reduced by 13.55% and 9.68%, respectively. While consumers experience a financial loss in TOU‐DR, they earn profit in DLC‐DR. Therefore, a combination of the two, i.e., TOU + DLC DR, is proposed, reducing operating costs by 10.73% while increasing profit for users. The suggested approach benefits the microgrid operator as well as its users, encouraging the construction and operation of insular microgrids in rural or isolated areas.

Efficacy of immediate versus delayed renal replacement therapy in septic patients undergoing continuous renal replacement therapy.

To compare the therapeutic efficacy of immediate versus delayed renal replacement therapy (RRT) in septic patients undergoing continuous RRT. We retrospectively analyzed 98 septic patients who received continuous RRT between August 2021 and January 2023. Patients were divided into two groups: RRT group (n=50, immediate RRT) and delayed RRT group (n=48), where RRT was delayed by 48 hours in the absence of renal function recovery. Demographic data, comorbidities, vital signs, laboratory results, Acute Physiology and Chronic Health Evaluation (APACHE) II scores, Sequential Organ Failure Assessment (SOFA) scores, and follow-up details were compared between the two groups. The RRT group showed significantly lower serum interleukin-6 and creatinine levels at 1, 3, and 5 days of treatment (P=0.006, P=0.021, P=0.007; P=0.016, P=0.006, P=0.021, respectively) compared with the delayed RRT group. Additionally, the RRT group had shorter ICU stays, reduced duration of mechanical ventilation, and lower total treatment costs (P=0.016, P=0.003, P=0.029). Post-treatment, the RRT group exhibited significantly lower APACHE II and SOFA scores (P=0.031, P=0.018), a shorter average ICU stay (P=0.009), and a lower mortality rate (P=0.018) than the delayed RRT group. Immediate RRT in septic patients undergoing continuous RRT significantly reduces inflammatory markers, accelerates patient outcome, and decreases short-term mortality compared to delayed treatment.

Comparative efficacy of laparoscopic choledocholithotomy with T-tube insertion vs. primary suture in the management of cholecystolithiasis complicated by choledocholithiasis.

To evaluate the efficacy of laparoscopic choledocholithotomy with either an indwelling T-tube or primary suture in treating cholecystolithiasis complicated by choledocholithiasis. We conducted a retrospective analysis of 133 patients with cholecystolithiasis complicated by choledocholithiasis treated at Inner Mongolia Aerospace Medical Baogang Hospital from March 2020 to March 2023. Patients were divided into a control group (laparoscopic choledocholithotomy with T-tube placement) and an observation group (laparoscopic choledocholithotomy with primary suture). We compared general and surgery-related data between groups. Factors correlated with favorable postoperative outcomes were identified using univariate and multivariate logistic regression analyses. The observation group exhibited significantly shorter surgical times, faster intestinal function recovery, reduced postoperative hospital stays, and lower total hospitalization costs compared to the control group (all P < 0.05). No significant differences were observed in postoperative total bilirubin (TBIL), aspartate aminotransferase (AST), or alanine aminotransferase (ALT) levels between the groups (all P > 0.05). Both primary suture technique and the absence of postoperative complications were independent predictors of favorable outcomes. Laparoscopic choledocholithotomy with primary suture is associated with shorter operation times, reduced medical costs, decreased hospitalization duration, and quicker gastrointestinal recovery compared to the traditional T-tube approach. This method is safe and feasible, provided clinicians are well-versed in its indications.