Net Savings Research Articles

Financial impact of medication reviews by clinical pharmacists to reduce in-hospital adverse drug events: a return-on-investment analysis

BackgroundAdverse drug events contribute to rising health care costs. Clinical pharmacists can reduce their risks by identifying and solving drug-related problems (DRPs) through medication review.AimTo develop an economic model to determine whether medication reviews performed by clinical pharmacists could lead to a reduction in health care costs associated with the prevention of potential adverse drug events.MethodTwo pharmacists performed medication reviews during ward rounds in an internal medicine setting over one year. Avoided costs were estimated by monetizing five categories of DRPs (improper drug selection, drug interactions, untreated indications, inadequate dosages, and drug use without an indication). An expert panel assessed potential adverse drug events and their probabilities of occurrence for 20 randomly selected DRPs in each category. The costs of adverse drug events were extracted from internal hospital financial data. A partial economic study from a hospital perspective then estimated the annual costs avoided by resolving DRPs identified by 3 part-time clinical pharmacists (0.9 full-time equivalent) from 2019 to 2020. The return on investment (ROI) of medication review was calculated.ResultsThe estimated annual avoided costs associated with the potential adverse drug events induced by 676 DRPs detected was € 304,170. The cost of a 0.9 full-time equivalent clinical pharmacist was € 112,408. Extrapolated to 1 full-time equivalent, the annual net savings was € 213,069 or an ROI of 1–1.71. Sensitivity analyses showed that the economic model was robust.ConclusionThis economic model revealed the positive financial impact and favorable return on investment of a medication review intervention performed by clinical pharmacists. These findings should encourage the future deployment of a pharmacist-led adverse drug events prevention program.

Net saving improvement of capacitor banks in power distribution systems by increasing daily size switching number: A comparative result analysis by artificial intelligence

AbstractThis paper studies the effect of the number of switching (NOS) per day of capacitor banks on loss reduction in radial distribution systems. To this aim, the daytime (more precisely, 24 h) is divided into different numbers of time segments (equal to the same NOS) for capacitors’ size switching. The resulting non‐linear programming with discontinuous derivatives (called DNLP) model is solved subject to related constraints. The results reveal the impact of hourly switching of capacitor banks on further loss reduction (namely 118.4435, 83.7856, and 101.738 MWh for three IEEE systems) and higher net savings (i.e. k$5.6067, k$4.2772, and k$5.3542 for the same systems) of radial distribution systems compared to daily switching. Then, the hyper‐tuned Random Forest model is trained based on the IEEE 69‐bus network, fine‐tuned by the IEEE 10‐bus network, and fitted by the IEEE 33‐bus network to have an intelligent multi‐classification task with the highest accuracy. Numerical simulation, in both classic and intelligent parts, is presented to demonstrate the performance of DeepOptaCap. For the final step, DeepOptaCast is compared to other intelligent models of Light Gradient Boosting Method (LGBM), Decision Tree, and XGBoost, regarding KPIs of mean absolute percentage error, root mean squared percentage error, mean absolute error, root mean squared error, and coefficient of determination to demonstrate the model's superiority.

A Business Case for Climate Neutrality in Pasture-Based Dairy Production Systems in Ireland: Evidence from Farm Zero C

Agriculture in Ireland is responsible for producing and exporting healthy, nutritional food pivotal for meeting the Sustainable Development Goals (SDGs) such as global food security, economic development and sustainable communities. However, the agricultural sector, dominated by a large bovine population, faces the challenge of reducing greenhouse gas (GHG) emissions to reach climate neutrality by 2050. The objective of the current study was to model the environmental and economic impact of simultaneously applying farm-level climate change mitigation strategies for a conventional grass-based dairy farm in Ireland. An average farm of 52 ha with a spring-calving herd of 93 was used as a reference scenario to create a business case. Partial budgeting was used to calculate the annual net benefit. A cradle-to-grave life cycle assessment (LCA) was used to model the reduction in GHG emissions, which was expressed as kg of carbon dioxide equivalent per kilogram of fat- and protein-corrected milk (kg CO2-eq/kg FPCM). The baseline for average emissions was 0.960 kg CO2-eq/kg FPCM. An average farm would reduce its annual emissions by 12% to 0.847 kg CO2-eq/kg FPCM in Scenario 1, where climate change mitigation strategies were applied on a minimal scale. For Scenario 2, the emissions are reduced by 36% to 0.614 kg CO2-eq/kg FPCM. In terms of annual savings on cash income, an increase of EUR 6634 and EUR 18,045 in net savings for the farm are realised in Scenarios 1 and 2, respectively. The business case provides evidence that farms can move towards climate neutrality while still remaining economically sustainable.

Relative comparison of the benefits of wall envelope insulation materials in the South African energy zones, subject to the new national building energy efficiency standards

Introduction: South Africa is ranked among the 20 highest greenhouse gas (GHG) emitters worldwide, mainly due to its heavy reliance on coal for energy. The residential building industry can play a significant role towards the minimization of both GHG emissions and energy consumption. This research assesses the beneficial impacts of utilizing wall envelope insulation measures using five insulation materials, for a detached residential building, within the seven energy zones of South Africa in accordance with the South African National code for Building energy efficiency (SANS10400-XA).Methods: Lifecycle analysis (for 50 years), regression methods and sequential search techniques of building energy modelling were used to determine both the energy saving implications of adopting the insulation materials (at various levels of thickness), and their corresponding energy payback periods. The study area consisted of eight selected locations representing all the seven energy zones in South Africa (Welkom, Witbank, Thohoyandou, Cape Town, Pretoria, Ixopo, Sutherland, and Fraserburg).Results: Sutherland (zone 6), Cape Town (zone 4) and Fraserburg (zone 7) benefitted most from energy savings due to application of insulation measures. Witbank (Zone 2), Thohoyandou (zone 3) and Pretoria (zone 5) never benefitted from application of wall envelope insulation (in terms of energy savings). Cellulose and straw yielded the lowest payback periods. Generally, polyurethane yielded the highest net energy savings at lower insulation thickness levels, while cellulose was preferable at higher insulation thickness levels in Welkom (zone1) Cape Town (zone 4), Ixopo (zone 5H), Sutherland (zone 6) and Fraserburg (zone 7).Discussion: Lower optimal wall envelope insulation thicknesses (that maximized energy savings) appeared to correspond to locations with higher annual temperature ranges. Higher temperature ranges (hence, higher degree days) would ensure that more energy is saved in order to keep the indoor temperatures within the acceptable comfort limits, due to application of insulation. However, the selection of insulation material is also influenced by other factors such as resistance to insect and mould attack (which easily affect bio-insulation materials), fire retardancy, durability (which affects cellulose), sound proofing, structural strength, and resistance to water vapour.

Relative Comparison of Benefits of Floor Slab Insulation Methods, Using Polyiso and Extruded Polystyrene Materials in South Africa, Subject to the New National Building Energy Efficiency Standards

This article aims to assess the benefits of floor slab insulation measures using extruded polystyrene (XPS) and polyisocyanurate (also referred to as polyiso or PIR) insulation materials at various levels of insulation thicknesses for a detached residential building. An EnergyPlus simulation analysis was carried out within the seven energy zones (represented by eight locations) of South Africa in accordance with the South African national code for building energy efficiency (SANS10400-XA). The energy savings and payback periods related to the use of the insulation over a lifecycle period of 50 years were assessed. Cape Town (zone 4) behaved differently from other locations and hardly benefited from the application of floor slab insulation measures. Generally, polyiso (PIR) insulation performed better than XPS for vertical gap insulation, and lower insulation thicknesses required higher insulation depths to maximize energy savings. Similarly, lower insulation thicknesses (25 mm and 50 mm) required higher perimeter insulation widths to maximize energy savings for horizontal perimeter insulation, especially in Sutherland (zone 6) and Cape Town. The maximization of energy savings was also achieved at low insulation thickness for the full floor slab insulation method, except for Sutherland and Fraserburg (zone 7). The locations that benefitted most from the floor slab insulation methods were Pretoria (zone 5), Thohoyandou (zone 3), Sutherland (zone 6), Fraserburg (zone 7), Welkom (zone 1), Ixopo (zone 5H), Witbank (zone 2), and Cape Town (zone 4), in that order. Generally, higher net energy savings are achieved in areas with lower humidity levels and areas with greater annual sums of both cooling and heating degree days.

Do energy transition and environmental taxation contribute to sustainable development? Evidence from OECD countries

PurposeIn this study, the author intend to investigate the impacts of renewable energy use and environmental taxation on sustainable development measured by the adjusted net savings (ANS).Design/methodology/approachThis study employs the quantile regression (QR) for a set of 24 Organization for Cooperation and Economic Development (OECD) countries over the period 1994–2018.FindingsThe main empirical findings of estimates show that access to renewable energy and environmental taxation generate positive and significant effects in increasing the ANS for most quantiles. Hence, they are practical tools for achieving sustainable development goals (SDGs).Practical implicationsThis study has important implications for governments and policymakers of the OECD countries. Therefore, governments can use subsidies and incentives to promote the adoption of renewable energy sources, energy-efficient technologies and sustainable practices. Similarly, by imposing taxes on pollution and resource use, governments can encourage the adoption of cleaner technologies and practices toward more sustainable behavior.Originality/valueThis paper is based on a novel measure of sustainable development (ANS) and a novel econometric method (QR).

Détermination des facteurs d’émission de GES à travers l’ACV dans les unités d’enfouissement, de compostage et de recyclage du CTVD de Ouagadougou

This study is a contribution to the quantification of greenhouse gas emissions in the waste sector in developing countries, especially through the determination of specific emission factors. The purpose is to determine the greenhouse gas emission factors of the various waste treatment units at the waste treatment and recovery centre in Ouagadougou (Burkina Faso) using the Life Cycle Analysis method. The emission factors were evaluated and then reduced to an equivalent CO2 emission per tonne of waste. The results show that landfill has the highest emission factors, with values ranging from 751.19 to 1,818.6 kg CO2 eq/tonne of waste for direct emissions, depending on whether or not sequestered carbon is taken into account, and from 7.24 to 1.31 kg CO2 eq/tonne for indirect emissions. Composting and plastic recovery units have negative EFs over their entire life cycle (-69.69 and -1736.65 Kg CO2 eq/tonne), thus contributing to net greenhouse gas savings. This study is the first of its kind to provide data that can be used for national accounting of greenhouse gas emissions in the waste sector

Optimum insulation thickness and exergy savings of building walls in Bamenda: a comparative analysis

The goal of this study is to examine the energetic, entransy, and exergetic methodologies employed to estimate the ideal insulation thickness for construction walls in terms of cost and ecological impact. To achieve these goals, the life cycle cost analysis-based insulating thicknesses of the various methods are evaluated along with the overall costs, yearly cost reductions, and total expenses. The fuel consumption, CO2 emissions, and ecological effects are then compared using an environmental analysis based on the three methodologies. The savings of hollow concrete brick (HCB), compressed stabilized earth brick (CSEB), and sundried earth brick (SEB) walls are evaluated along with the insulation thicknesses in terms of cost and ecological impact. As a result, it is determined that the exergetic technique is better suited for optimizing insulating thickness. For CSEB, SEB, and HCB walls, the economic ideal insulation thicknesses are 0.01 m, 0.016 m, and 0.02 m, with yearly financial savings of 5 $·m−2, 7.5 $·m−2, and 9 $·m−2. For CSEB, SEB, and HCB walls, accordingly, the ecological optimal insulation thicknesses are 0.023 m, 0.032 m, and 0.040 m, with net savings of exergetic ecological impact equal to 59 mPts·m−2, 55 mPts·m−2, and 51 mPts·m−2.

Sustainability and life cycle analyzes of different biofuel from municipal solid waste processes: an effective environmental guidance

Abstract The refining of biowaste into biofuels, particularly focusing on the organic fraction-municipal solid waste (OF-MSW), remains nascent and is influenced by factors such as energy requirements, microbial effectiveness, and structural design. This article presents a sustainable and thorough framework for evaluating the environmental behavior associated with diverse biofuel from OF-MSW conversion methodologies. The evaluation considers three different pre-treatment methods (acetone organosolv, hot water, and acidic pre-treatment), several fermentation techniques (including ethanol fermentation and ABE-F (acetone/butanol/ethanol fermentation)), and acidic or enzymatic hydrolysis approaches. Furthermore, the environmental analysis utilizes the life cycle analysis (LCA) approach. Within this framework, a consequential LCA is implemented, which includes process development to address the issue of multi-functionality and the use of marginal processes for designing foundational processes. The biofuels produced, ethanol and butanol, are analyzed for their environmental impact. To discern the varying and combined effects, methodologies for sensitivity analysis and single score evaluations have been established. Research outcomes suggest that the acetone–ethanol–butanol fermentation scenario does not provide an optimal environmental outcome due to its inability to offset the environmental impacts through the benefits derived from the byproducts. Among the scenarios examined, Scenario SC-IV emerged as the most environmentally beneficial, showing significant net environmental savings including decrements of −854.55 PDF m−2 (potentially disappeared fraction, annually), −253.74 kg CO2.eq per 1000 kg of OF-MSW, and − 3290 MJ per 1000 kg of OF-MSW treated.

Trimming the Plate: A Comprehensive Case Study on Effective Food Waste Reduction Strategies in Corporate Canteens

This case study analyses food waste reduction measures in a corporate canteen, addressing environmental, economic, and social sustainability dimensions. By implementing seven actions such as raising awareness among kitchen staff, providing smaller portions and preparing soup from overproduction, food waste was reduced by 46% in two canteens serving up to 1800 people daily over the time period of six months. This preserved 343 kg of food waste, conserving over 450,000 kcal in nutritional value and yielding net economic savings of over 15,500 Euros, as well as environmental savings of over 31 tonnes CO2 eq. and 213 mPt PEF. The Benefit-to-Cost Ratio (BCR) of 0.03 kg of food waste saved per 1 Euro invested, along with the associated savings of 40.78 kcal, 2.74 kg CO2 eq., 0.02 mPt PEF, and 2.37 Euros, exemplifies the overall success of these actions. Therefore, this business case offers valuable insights into how (corporate) canteens can enhance sustainability and resource conservation by reducing food waste.

A Cost and Waste-Savings Comparison Between Single-Use and Reusable Pulse Oximetry Sensors Across US Operating Rooms.

Operating room (OR) expenditures and waste generation are a priority, with several professional societies recommending the use of reprocessed or reusable equipment where feasible. The aim of this analysis was to compare single-use pulse oximetry sensor stickers ("single-use stickers") versus reusable pulse oximetry sensor clips ("reusable clips") in terms of annual cost savings and waste generation across all ORs nationally. This study did not involve patient data or research on human subjects. As such, it did not meet the requirements for institutional review board approval. An economic model was used to compare the relative costs and waste generation from using single-use stickers versus reusable clips. This model took into account: (1) the relative prices of single-use stickers and reusable clips, (2) the number of surgeries and ORs nationwide, (3) the workload burden of cleaning the reusable clips, and (4) the costs of capital for single-use stickers and reusable clips. In addition, we also estimated differences in waste production based on the raw weight plus unit packaging of single-use stickers and reusable clips that would be disposed of over the course of the year, without any recycling interventions. Estimated savings were rounded to the nearest $0.1 million. The national net annual savings of transitioning from single-use stickers to reusable clips in all ORs ranged from $510.5 million (conservative state) to $519.3 million (favorable state). Variability in savings estimates is driven by scenario planning for replacement rate of reusable clips, workload burden of cleaning (ranging from an additional expense of $618k versus a cost savings of $309k), and cost of capital-interest gained on investment of capital that is freed up by the monetary savings of a transition to reusable clips contributes between $541k (low-interest rates of 2.85%) and $1.3 million (high-interest rates of 7.08%). The annual waste that could be diverted from landfill by transitioning to reusable clips was found to be between 587 tons (conservative state) up to 589 tons (favorable state). If institutions need to purchase new vendor monitors or cables to make the transition, that may increase the 1-time capital disbursement. Using reusable clips versus single-use stickers across all ORs nationally would result in appreciable annual cost savings and waste generation reduction impact. As both single-use stickers and reusable clips are equally accurate and reliable, this cost and waste savings could be instituted without a compromise in clinical care.

Techno-economic analysis of renewable energy generation at the South Pole

Transitioning from fossil-fuel power generation to renewable energy generation and energy storage in remote locations has the potential to reduce both carbon emissions and cost. This study presents a techno-economic analysis for implementation of a hybrid renewable energy system at the South Pole in Antarctica, which currently hosts several high-energy physics experiments with nontrivial power needs. A tailored model of resource availability and economics for solar photovoltaics, wind turbine generators, lithium-ion energy storage, and long-duration energy storage at this site is explored in different combinations with and without existing diesel energy generation. The Renewable Energy Integration and Optimization (REopt) platform is used to determine the optimal system component sizing and the associated system economics and environmental benefit. We find that the least-cost system includes all three energy generation sources and lithium-ion energy storage. For an example steady-state load of 170 kW, this hybrid system includes 180 kW-DC of photovoltaic panels, 570 kW of wind turbines, and a 3.4 MWh lithium-ion battery energy storage system. This system reduces diesel consumption by 95% compared to an all-diesel configuration, resulting in approximately 1200 metric tons of carbon footprint avoided annually. Over the course of a 15-year analysis period the reduced diesel usage leads to a net savings of 57 million United States dollars, with a time to payback of approximately two years. All the scenarios modeled show that the transition to renewables is highly cost effective under the unique economics and constraints of this extremely remote site.

Optimal antiseptic skin preparation agents for minimizing surgical site infection following surgery: cost and cost-effectiveness analysis.

The application of antiseptic skin agents prior to incision minimizes the rate of surgical site infection. Despite their ubiquity, the optimal skin preparation agent remains uncertain. A retrospective economic analysis was conducted to complement the results from the NEWSkin Prep trial which prospectively compared three preparation agents. A cost and cost-effectiveness analysis was performed from a healthcare service perspective to compare chlorhexidine with 70% ethanol, and aqueous povidone-iodine, against povidone-iodine with 70% ethanol. Resource use estimates accounted for hospital admissions, readmissions associated with surgical site infection, outpatient and general practitioner attendances, visits from community nurses and therapeutic consumables. The measure of effectiveness comprised the net difference in number of patients with surgical site infections per 1000 patients. Costs were compared using a two-sample Welch's t-test. Deterministic and probabilistic sensitivity analyses were performed to evaluate the incremental cost-effectiveness ratio. The null hypothesis that the mean costs for the trial arms were significantly different was not rejected (Welch's t-test P value: 0.771 for chlorhexidine with 70% ethanol against povidone-iodine with 70% ethanol; and 0.955 for aqueous povidone-iodine against povidone-iodine with 70% ethanol). Based on bootstrap averages, the chlorhexidine with 70% ethanol intervention generated 8.0 fewer surgical site infections per 1000 patients and net cost savings of €151,698 (Euros) per 1000 patients compared with povidone-iodine with 70% ethanol, and aqueous povidone-iodine produced a net cost saving of €37,494 per 1000 patients but generated an additional 11.6 surgical site infections per 1000 patients compared with povidone-iodine with 70% ethanol. The comparison of chlorhexidine with 70% ethanol to povidone-iodine with 70% ethanol was sensitive to the inclusion of cost outliers, while the comparison of aqueous povidone-iodine to povidone-iodine with 70% ethanol was sensitive to the estimated cost per surgical site infection. Based on the outcomes from the NEWSkin Prep study, this economic analysis found no definitive evidence in favour of any one of the study comparators. Future model-based economic analyses of alternative skin preparations should critically address the quality of evidence and integrate the results from the NEWSkin Prep study.

Cost-effectiveness of 20-valent pneumococcal conjugate vaccine in US infants

BackgroundAs of June 2023, two pneumococcal conjugate vaccines, 20- (PCV20) and 15- (PCV15) valent formulations, are recommended for US infants under a 3 + 1 schedule. This study evaluated the health and economic impact of vaccinating US infants with a new expanded valency PCV20 formulation. MethodsA population-based, multi cohort, decision-analytic Markov model was developed to estimate the public health impact and cost-effectiveness of PCV20 from both societal and healthcare system perspectives over 10 years. Epidemiological data were based on published studies and unpublished Active Bacterial Core Surveillance System (ABCs) data. Vaccine effectiveness was based on PCV13 effectiveness and PCV7 efficacy studies. Indirect impact was based on observational studies. Costs and disutilities were based on published data. PCV20 was compared to both PCV13 and PCV15 in separate scenarios. ResultsReplacing PCV13 with PCV20 in infants has the potential to avert over 55,000 invasive pneumococcal disease (IPD) cases, 2.5 million pneumonia cases, 5.4 million otitis media (OM) cases, and 19,000 deaths across all ages over a 10-year time horizon, corresponding to net gains of 515,000 life years and 271,000 QALYs. Acquisition costs of PCV20 were offset by monetary savings from averted cases resulting in net savings of $20.6 billion. The same trend was observed when comparing PCV20 versus PCV15, with a net gain of 146,000 QALYs and $9.9 billion in net savings. A large proportion of the avoided costs and cases were attributable to indirect effects in unvaccinated adults and elderly. From a health-care perspective, PCV20 was also the dominant strategy compared to both PCV13 and PCV15. ConclusionsInfant vaccination with PCV20 is estimated to further reduce pneumococcal disease and associated healthcare system and societal costs compared to both PCV13 and PCV15.

Using a ledger to facilitate autonomous peer-to-peer virtual net metering of solar photovoltaic distributed generation

To assist electric utilities to overcome limitations of centralized billing and encourage distributed production of solar photovoltaic (PV) electricity, this study designs and assesses a novel open-source autonomous virtual utility to monitor users and enable peer-to-peer trading. This study provides system design and software implementation of the concept using blockchain technology written in Solidity and Truffle. A set of smart contracts adds users to a system and monitors their demand, PV generation, and facilitates transactions between users on an hourly basis when one user has PV-generated excess electricity, and another has demand. Unit tests for each of the contracts’ methods are developed in Solidity, and data on gas usage and costs is collected. Once the contracts have been written and evaluated, a JavaScript simulation is developed to use the contracts on real load and PV generation data for one year on an hourly basis. The results of two case studies are quantified: 1) true peers, where all houses are prosumers with rooftop PV, and 2) intermittent transition case, where PV deployment and demand are more varied. The results found that with ten users in the system, the true peers case study resulted in an uneconomic number of exchanges, but the intermittent transition case study resulted in more than a factor of twenty increases in exchanges and net cost savings. The savings more than doubles for both cases when time of use pricing is in effect. The system utility increases with more variability of PV production across participating users and is recommended for utilities targeting increases in distributed generation during the energy transition.

Manufacturing cost reduction techniques for automobile crankcase mould inserts

The manufacturing of automobile moulds is itself a challenging job and very tedious task requiring high accuracy of component profiles. The required complicated and complex profiles are generated when the mould inserts are relinquished from several numbers of workstations, which run for a longer process time. As the accuracy needed for the component area is very high and it (insert) has to pass through several bottleneck workstations, the production time and increased buffer time are observed. This chapter focuses on providing economical methods for manufacturing hot die steel inserts. These techniques are implemented on a pressure die-casting insert component. The present solution is derived for manufacturing time reduction and minimisation of the die-casting inserts (moving and fixed die) at every stage. Implementing combined electrodes, assembly machining and cluster plate machining/sparking techniques are critical development advancements in the research. In the combined electrode concept, one electrode is designed in the same area to cover multiple areas that were initially covered by separate individual electrodes. Furthermore, this concept is outstretched by the cluster plate concept. Those electrodes that cannot be covered by a single electrode are machined together to act as a single electrode and later separated while individual sparking. Combined electrode design, assembly machining and cluster machining/sparking of the electrodes reduce the total machining time of the die and the machining centre. Reducing the machine run time will reduce the production cost and increase profit. The results achieved show that the combined electrode design setup shows 75% savings in the combined sparking setup, whereas the cluster plate machining setup shows 35% savings in the tool list generation (from software used) of the net savings. The proposed solution opens up new avenues for similar automobile components by setting benchmarks to decrease the rope length associated with manufacturing and increase profit.

A Feasible Proposal for Energy-Efficient Roof Retrofitting in Southern European Obsolete Residential Neighborhoods

1960s Europe saw a large number of residential neighborhoods built to house those migrating from the countryside. Today, more than 50 years later, these neighborhoods suffer high levels of functional, social, and technical obsolescence. In response to this, the University of Seville developed the Aura Strategy as an intervention methodology to find global solutions to issues in outdated neighborhoods. To provide visibility to this aspect of the Aura Strategy, the retrofit proposal presented in this article provides a solution to improve the roofing of buildings in a case study neighborhood (Polígono de San Pablo, Seville) and an analysis of the results in terms of energy and financial savings for local residents. The results show that for a population of roughly 18,000 (in 2018), net savings, including energy and retrofitting costs, ranging from nearly €6.5 to over €8.6 million can be made over the 20-year life-cycle span. Likewise, the results obtained on the reduction of thermal loads indicate a 72% decrease in energy consumption, equivalent to a saving of close to 4500 tons of greenhouse gas emissions for the district and the entire life-cycle time period, with the consequent benefits on the impact on air quality and the fight against climate change.

A cost-effectiveness analysis of intrauterine spacers used to prevent the formation of intrauterine adhesions following endometrial cavity surgery

Aim To assess, from a United States (US) payer’s perspective, the cost-effectiveness of gels designed to separate the endometrial surfaces (intrauterine spacers) placed immediately following intrauterine surgery. Materials and Methods A decision tree model was developed to estimate the cost-effectiveness of intrauterine spacers used to facilitate endometrial repair and prevent the formation (primary prevention) and reformation (secondary prevention) of intrauterine adhesions (IUAs) and associated pregnancy- and birth-related adverse outcomes. Event rates and costs were extrapolated from data available in the existing literature. Sensitivity analyses were conducted to corroborate the base case results. Results In this model, using intrauterine spacers for adhesion prevention led to net cost savings for US payers of $2,905 per patient over a 3.5-year time horizon. These savings were driven by the direct benefit of preventing procedures associated with IUA formation ($2,162 net savings) and the indirect benefit of preventing pregnancy-related complications often associated with IUA formation ($3,002). These factors offset the incremental cost of intrauterine spacer use of $1,539 based on an assumed price of $1,800 and the related increase in normal deliveries of $931. Model outcomes were sensitive to the probability of preterm and normal deliveries. Budget impact analyses show overall cost savings of ‍$19.96 per initial member within a US healthcare plan, translating to $20 million over a 5-year time horizon for a one-million-member plan. Limitations There are no available data on the effects of intrauterine spacers or IUAs on patients’ quality of life. Resultingly, the model could not evaluate patients’ utility related to treatment with or without intrauterine spacers and instead focused on costs and events avoided. Conclusion This analysis robustly demonstrated that intrauterine spacers would be cost-saving to healthcare payers, including both per-patient and per-plan member, through a reduction in IUAs and improvements to patients’ pregnancy-related outcomes.

Energy and cost savings of cool coatings for multifamily buildings in U.S. climate zones

While cool coatings have recently received much attention for building applications, their impact on building energy consumption strongly depends upon climatic conditions. Herein we evaluate the energy, cost, carbon, and interior comfort impact of cool coatings applied to a residential multifamily building across 32 climate zones in the United States by applying advanced cool coating properties to established building energy models. The model not only considers promising cool coating properties based upon recent experiments but also an ideal cool coating. Our calculations show that the ideal cool coating can achieve annual cooling energy savings of up to 6.64 kWh/m2 (Phoenix, AZ), annual net utility cost savings up to $1.16/m2 (Brawley, CA), and net annual carbon emission savings up to 7.7 % (Phoenix, AZ). We also estimate the change in interior temperature for buildings without space cooling systems and show that cool coatings make buildings in the warmest climate zones in the U.S. without space cooling more comfortable by 30 % to 50 % on a cooling degree days basis. Using analysis of variance, we examine the statistical relationships between building performance metrics and climatic parameters. The presented methodology enables evaluation of cool coating application to buildings in various climate zones across the world.

PP101 Clinical And Economic Impact Of Flushing Vascular Access Devices With Pre-filled versus Manually-Prepared Saline Flush Syringes In Korea

IntroductionAround 90 percent of hospitalized patients require vascular access devices (VADs) during hospitalization to administer fluids, medications and facilitate blood transfusions. After insertion, it is essential to maintain VADs to achieve optimal dwell time and reduce complications. Flushing of VADs is an integral part of catheter maintenance practices. With increasing cost burden on healthcare systems and nursing shortages, it is crucial to use time-and cost-saving technologies such as pre-filled flush syringes for common procedures namely VAD maintenance. This study aims to compare the clinical and economic impact of using pre-filled saline syringes versus manually-prepared saline syringes for flushing VADs in Korea.MethodsA budget impact analysis was developed using Microsoft Excel to estimate the annual clinical and economic impact of pre-filled saline syringes and a base case scenario of flushing 100,000 VADs was modeled. Clinical impact was estimated for peripheral intravenous catheter (PIVC) failure, central line-associated bloodstream infections (CLABSIs), central line occlusion and nurse time. Economic impact was estimated for costs associated with flushing materials, additional length of stay (LOS) due to CLABSI, VAD replacement, and nurse-time. Global and local data sources were used for inputs. Assumptions include: (i) Distribution of 95 percent peripheral and 5 percent central VADs; (ii) 50 percent peripheral and 50 percent central VADs on intermittent therapy; and (iii) 3 flushes/catheter-day.ResultsOver a one-year timeframe, the model estimated 3,344 fewer PIVC failures, 15 fewer CLABSIs and 157 fewer occlusions with adoption of pre-filled saline syringes. Nurse time was reduced by 3,465 hours. Potential net annual savings from lower device cost, reduced complications, shortened LOS and increased nurse efficiency were estimated to be KRW23.7 million (USD178,957).ConclusionsUsing pre-filled saline syringes instead of manually-prepared syringes for flushing VADs may result in fewer complications, lower VAD utilization, nurse time saving and cost savings in Korea. This can potentially help improve patient outcomes, relieve nurses’ stress to some extent and help healthcare decision-makers to reallocate these cost savings to other life-saving technologies.