Potential Cost Benefits Research Articles

Flexural behavior of bonded post-tensioned concrete beams with steel or GFRP bars

Post-tensioned concrete beams with GFRP reinforcement have gained attention in recent years due to their unique flexural behavior and potential cost benefits. Because of the absence of comprehensive guidelines in international codes and limited application in constructions, this hybrid system is adopted in the current paper as a pioneering solution for sustainable and eco-friendly construction practices. Particularly noteworthy is the corrosion resistance of GFRP bars, which significantly enhances the durability of structures. The influence of using GFRP with bonded post-tension concrete beam is experimentally investigated compared to concrete beams with prestressing and non-prestressing reinforcement. Eight concrete beams with different reinforcement types and ratios were cast and tested under three-point load. Flexural resistance, crack pattern, deflections, and strains of the beams were compared with a reference beam with prestressing and non-prestressing reinforcement. Experimental load capacities of the tested beams were compared to those obtained from various international codes. The experimental results revealed that the beams with GFRP bars had smaller failure load and larger deflection compared to those with non-prestressing steel by up to 25 % and 37 %, respectively. A 3D finite element model (FEM) was developed and validated by comparing the numerical results with those obtained from the experiments. A sensitivity analysis was performed, using the validated FEM, by changing the concrete strength, steel yield stress, and GFRP ultimate strength by ± 20 %. The sensitivity analysis included seventy-two beams which had the same dimensions, loading, and boundary conditions of the tested beams. Changing the concrete strength only led to varying the beam capacities by −7 % ∼ + 4 %. Changing the steel yield stress only led to changing of the beam capacities by −13 % ∼ + 11 %. No change was observed when the GFRP ultimate stress was varied by 20 %.

Rapid review: effectiveness of the Wolbachia strategy for arbovirus controlRevisión sistemática rápida: efectividad de la estrategia de control con Wolbachia en la lucha contra las arbovirosis

To identify and synthesize evidence of the effectiveness and cost-effectiveness of the Wolbachia-Aedes methodology for reducing cases of arboviral infection. Rapid systematic review. A search of five online portals and bibliographic databases was conducted in February 2022. Two reviewers conducted the selection stages, with any disagreements resolved by a third investigator. Data were extracted by one reviewer and subsequently checked by another. The inclusion criteria were studies describing the cost-effectiveness and effectiveness of the Wolbachia-Aedes methodology, based on field interventions, published in Portuguese, English, and Spanish, with no restrictions on date of publication. Four studies were included: one cluster randomized trial, two quasi-experimental studies, and one pre-post study, published between 2019 and 2021 in four countries. The included studies reported effectiveness for some of the outcomes of interest, such as a reduction in the incidence of dengue, Zika, and chikungunya cases. Although no experimental studies addressing the cost-effectiveness of the Wolbachia-Aedes strategy were identified, some modeling studies have demonstrated potential cost-benefit of this methodology. Considering the results of the included studies, Wolbachia has the potential to be an economically effective strategy that leads to reductions in the incidence of dengue, Zika, and chikungunya. Nevertheless, this strategy cannot yet be recommended as a public policy; additional large-scale studies with high methodological quality are still needed to inform political decision-making.

Inclusion of water age in conjunctive optimal operation of water and power networks

ABSTRACT Water distribution systems (WDSs) are vital infrastructures designed to deliver water safely to consumers. This complex system necessitates continuous operational decisions, often optimized for efficiency. WDSs rely on power grids (PGs) to operate pumps and treatment facilities. PGs, likewise crucial, require strategic management to meet demand and environmental standards. Integrating the operation of both systems has garnered attention for its potential cost, energy, and environmental benefits. By leveraging the interconnection, trade-offs can be assessed, leading to improved solutions. Past research primarily focused on cost or carbon emissions as well as on hydraulic and voltage constraints. However, this study examines the impact of power systems on water quality, particularly water age, a key operational concern. Incorporating PGs into the optimal operation problem may alter flow directions, thereby influencing water age. Through mathematical modelling, this study evaluates these effects and applies them to simple case studies, demonstrating the influence of PG operation on water quality. Results demonstrate how tank constraints affect water age and show that a conjunctive operation approach, although beneficial for reduction of cost and energy consumption, can be damaging for water quality.

Effect of CYP3A5*3, ABCC2 C-24T, and ABCC2 C3972T Genetic Polymorphisms on Direct Cost of Kidney Transplant Recipients.

Introduction Genetic variations can influence how kidney transplant recipients (KTRs) respond to immunosuppressive drugs. However, limited resources necessitate a cost-benefit analysis of pharmacogenetic testing to determine its role in routine practice. This study investigated the cost-effectiveness of three genetic polymorphisms (CYP3A5*3, ABCC2 -24C>T,andABCC2 3972C>T) in KTRs. Methods This was a multicenter, prospective observational cohort study that included patients on tacrolimus-mycophenolate-prednisolone treatment. Ethnically diverse adult KTRs who had undergone kidney transplantation between 2020 and 2021 and consented were enrolled in the study. Deoxyribonucleic acid(DNA) was extracted from the collected blood samples using a commercially available kit.CYP3A5*3,ABCC2 -24C>T,andABCC2 3972C>Tsingle nucleotide polymorphisms (SNPs) were determined by polymerase chain reaction (PCR). Results Data was analyzed from 39 KTRs with an average age of 32.2 ± 7.0 years. The median annual healthcare cost per patient was MYR 52,700 (laboratory tests and immunosuppressants being the highest expenses). Notably, the annual cost was significantly higher in patients with theCYP3A5*3variant compared to the wildtype (p < 0.001). Furthermore, an incremental cost-effectiveness analysis revealed that carriers of theCYP3A5*1wildtype allele, theABCC2 -24C>T Tvariant allele, and theABCC2 3972C>T Tvariant allele were associated with a more cost-effective approach to kidney transplantation management, potentially reducing the risk of graft rejection and acute tubular necrosis (ATN). Conclusion While these findings suggest potential cost benefits for specific genotypes, further research with larger and more diverse patient populations is necessary to definitively establish the role of pharmacogenetic testing in optimizing cost-effectiveness for KTRs.

Measurement of the distal bile duct density on computed tomography can differentiate choledocholithiasis from a control population.

Hounsfield unit density of biliary fluid on CT may be a useful clinical marker that has not been described in the literature. This method has been used to differentiate pyonephrosis from hydronephrosis in obstructed collecting systems of the kidney. We aimed to create a user-friendly technique to measure the density of the distal bile duct using CT. The bile duct density of cases with proven choledocholithiasis at ERCP were compared with those of a control group (no biliary pathology). A total of 106 patients with proven choledocholithiasis at ERCP and 50 control patients were analysed. The distal bile duct density was calculated using the 4-point and max ellipse methods. Two blinded, independent investigators calculated the bile duct density. The HU is significantly higher in the presence of choledocholithiasis (P < 0.0001). Using the Youden index a cut-off value of 28.6 HU for the 4-point technique is useful to predict the presence of choledocholithiasis (Sensitivity 58%, Specificity 86%). Calculation of the distal bile duct density can differentiate choledocholithiasis from a control population. It may be useful alone or as a component of a scoring system to select patients more effectively for intervention. The improved use of CT may also decrease use of MRCP and reduce time to ERCP, which have potential cost benefits.

Modeling the Moisture Content and Dry Matter Loss in Dynamic Woody Biomass Storage Piles with Variable Extraction

The urgent need to mitigate climate change has spurred significant interest in renewable energy sources. This paper explores the storage and processing of woody biomass for biofuel production, considering the dynamic nature of biomass piles in real-world scenarios. A model has been developed to analyze moisture content changes and dry matter loss in woody biomass stored in piles prior to processing, taking into account varying extraction methods and environmental conditions. Case studies that examine the effects of different unpiling methods (FIFO, LIFO, and homogeneous) on moisture content and dry matter loss under various feedstock arrival rates and weather conditions are presented. Results indicate that unpiling methods significantly impact moisture content, with LIFO typically resulting in higher moisture content due to the utilization of fresher feedstock. Dry matter loss increases with pile size and time, emphasizing the importance of accurate modeling for assessing carbon emissions and feedstock quality. Furthermore, the model highlights the importance of process loading order and extraction methods in biomass storage, suggesting potential cost benefits associated with decreased moisture content. The difference between different extraction methods could vary the moisture content in the feedstock reaching the biofuel process by as much as 37.6%, however dry matter loss varies minimally for realistic pile changes. Overall, this research contributes to a better understanding of biomass storage dynamics and informs sustainable biofuel production practices.

Motor improvement of remote programming in patients with Parkinson's disease after deep brain stimulation: a 1-year follow-up.

Remote programming (RP) is an emerging technology that enables the adjustment of implantable pulse generators (IPGs) via the Internet for people with Parkinson's disease (PwPD) who have undergone deep brain stimulation (DBS). Previous studies have not comprehensively explored the effectiveness of RP in managing motor symptoms, often omitting assessments such as the rigidity and retropulsion tests during the follow-up. This study evaluates the comprehensive improvements in motor performance and the potential cost benefits of RP for PwPD with DBS. A retrospective analysis was conducted on two groups of patients-those who received RP and those who received standard programming (SP). Clinical outcomes including motor improvement, quality of life, and daily levodopa dosage were compared between the groups during a 12 (± 3)-month in-clinic follow-up. A total of 44 patients were included in the study, with 18 in the RP group and 26 in the SP group. No significant differences were observed in the frequency of programming sessions or clinical outcomes between the groups (p > 0.05). However, the RP group experienced significantly lower costs per programming session than the SP group (p < 0.05), despite patients in the former group living further from our center (p < 0.05). Our findings suggest that RP could significantly reduce the costs of programming for PwPD with DBS, especially without compromising the effectiveness of treatment across all motor symptoms in the short term.

Arthroscopic Management of Anterior Shoulder Instability: A Study of Functional Outcome and Analysis.

Background The remarkable range of motion of the shoulder comes at the cost of increased instability, especially anterior instability. Arthroscopic Bankart repairwith or without remplissage, which is a minimally invasive surgery, is the preferred treatment for recurrent anterior instability. This study investigated the effectiveness of Bankart repair, with or without remplissage, in restoring function, preventing redislocation, and improving patient satisfaction. Methods A prospective observational study examined 40 patients (19-50years old) with recurrent anterior instability and MRI-confirmed Bankart or Bankartwith Hill-Sachs lesions. Patients underwent arthroscopic Bankart repair with or without remplissage based on the inclusioncriteria of this study. Preoperative assessments included demographics, history, physical examination, American Shoulder and Elbow Surgeons (ASES) score, Quick Disabilities of the Arm, Shoulder, and Hand (DASH) score, ROWE score,and plain MRIof the shoulder joint. Post-operative radiographs and rehabilitation were advised. Functional recovery was evaluated at three months and six months after surgery. Results All patients underwent Bankart repair. Among them, 22 with engaging Hill-Sachs lesions received an additional remplissage procedure. Both groups showed significant improvements in their functional scores (p<0.05) and returned to their prior activities. However, the additional remplissage group had a slightly reduced meanexternal rotation (86.59°) compared with the Bankart repair-onlygroup (90°). Notably, the recurrence rate was very low, with only one patient (2.5%) experiencing instability. Conclusion Our study emphasizes the importance of propercapsulolabraltissue elevationto achieve a sufficient labral bump during Bankart repair. This technique allowed us to efficiently use only two suture anchors in 35 cases (87.5%). Additionally, remplissage was performed on all identified engaging Hill-Sachs lesions. We found that proper anchor placement and suturing techniques were crucial for successful Bankart repair.The emphasis on the potential cost benefits of a two-anchor approach is a valuable contribution to the field.

Business case for psychosocial interventions in clinics: potential for decrease in treatment discontinuation and costs

Research questionFrom a value-based healthcare (VBHC) perspective, does an assessment of clinical outcomes and intervention costs indicate that providing cognitive behavioural therapy (CBT) or mindfulness to women seeking fertility treatment add value compared with no such intervention? DesignProof-of-concept business case based on a VBHC perspective that considers clinical outcomes and costs. Potential effects on psychological and fertility outcomes were based on existing research. Cost outcomes were estimated with a costing model for the Dutch fertility treatment setting. ResultsThirty-two studies were identified; 13 were included. Women who received CBT had 12% lower anxiety, 40% lower depression and 6% higher fertility quality of life; difference in clinical pregnancy rates was six percentage points (CBT [30.2%]; control [24.2%]); difference in fertility discontinuation rates was 10 percentage points (CBT [5.5%]; control [15.2%]). Women who received training in mindfulness had 8% lower anxiety, 45% lower depression and 21% higher fertility quality of life; difference in mean clinical pregnancy rate was 19 percentage points (mindfulness [44.8%]; control [26.0%]). Potential total cost savings was about €1.2 million per year if CBT was provided and €11 million if mindfulness was provided. Corresponding return on investment for CBT was 30.7%, and for mindfulness 288%. Potential cost benefits are influenced by the assumed clinical pregnancy rates; such data related to mindfulness were limited to one study. ConclusionsThe provision of CBT or mindfulness to women seeking fertility treatment could add value. Higher quality primary studies are needed on the effect of mindfulness on clinical pregnancy rates.

51 Application of an energy and nutrient matrix to a mixed cereals-based diet supplemented with a novel phytase and xylanase–β-glucanase achieved a production benefit from wean-to-finish in pigs

Abstract The effect of a novel consensus bacterial 6-phytase variant (PhyG) without or with a xylanase–β-glucanase (XB) when added to an energy and nutrient-reduced diet on growth performance and production benefit was evaluated in pigs from wean-to-finish. A total of 192 weaned pigs [DanBred x Pi; initial body weight (BW) 7.18 ± 0.38 kg] were randomized to 4 treatments with 12 (4 piglets/pen) and 24 pens (2 pigs/pen) per treatment (1:1 male to female) for nursery and grow-finish phases, respectively. Diets were wheat-corn-barley-rye-soybean meal-based and fed in 5 phases (pre-starter, 7–11 kg, starter, 11–25 kg, grower I, 25–55 kg, grower II, 55–85 kg and finisher, 85–110 kg BW). Treatments comprised: 1) a nutritionally adequate positive control (PC); 2) a negative control (NC1) without added inorganic phosphate, reduced (based on specific PhyG dose) in net energy (NE), calcium (Ca), digestible amino acids (AA) and sodium (Na) vs. PC, supplemented with PhyG at 1,000, 1000, 750, 500 and 500 FTU/kg during pre-starter, starter, grower I, II and finisher phase, respectively (NC1+PhyG ‘low’); 3) a negative control (NC2) without added inorganic phosphate, supplemented with PhyG at 2,000, 2,000, 1,000, 750 and 750 FTU/kg in each phase with reduction in NE, Ca, dig AA and Na vs. PC based on the specific PhyG dose (NC2+PhyG ‘high’); and 4) a negative control (NC3) that was similar to 2) but supplemented with XB to provide 2,400 U/kg xylanase and 304 U/kg β-glucanase, with additional reduction in NE and dig AA based on the contribution of XB vs NC1 (NC3+PhyG ‘low’+XB). Data were analyzed by ANOVA, and means separation was by Tukey’s HSD test. Growth performance in all enzyme-supplemented diets was maintained or improved compared with PC. The NC3+PhyG ‘low’+XB treatment significantly improved performance vs. PC; average daily gain (ADG) and BW were greater vs. PC in starter (620 g and 28.2 kg vs. 557 g and 26.4 kg) and grower I (859 g and 65.1 kg vs. 777 g and 60.0 kg) respectively; feed conversion ratio (FCR) was reduced in grower II vs. PC (2.10 vs. 2.25; P &amp;lt; 0.05). The final BW was 114.5, 114.8, 115.6 and 116.7 kg in PC, NC1+PhyG ‘low’, NC2+PhyG ‘high’ and NC3+PhyG ‘low’+XB, respectively (P &amp;gt; 0.05). Carcass parameters were unaffected by treatments. Compared with PC, NC1+PhyG ‘low’, NC2+PhyG ‘high’ and NC3+PhyG ‘low’+XB conferred a 3.8 to 5.8% reduction in total feed cost (ingredients price, October 2023)/kg BWG and 4.4 to 6.8% reduction in the total carbon footprint (FeedPrint, WUR, The Netherland, CO2 eq., g)/kg BWG. The results confirm the appropriacy of the applied matrix values with PhyG supplementation, with or without XB, in mixed cereal diets from wean-to-finish and highlight the potential feed cost and sustainability benefit of using the phytase alone or in combination with the carbohydrase enzymes.

Telemetric ICP monitoring in children: a national questionnaire-based study.

Telemetric monitoring of intracranial pressure (ICP) facilitates long-term measurements and home monitoring, thus potentially reducing diagnostic imaging and acute hospital admissions in favour of outpatient appointments. Especially in paediatric patients, telemetric ICP monitoring requires a high level of collaboration and compliance from patients and parents. In this study, we aim to systematically investigate (1) patient and parent perception of telemetric ICP system utility and (2) hospital contact history and thus the potential cost-benefit of telemetric ICP monitoring in paediatric patients with a cerebrospinal fluid disorder. We conducted a nationwide questionnaire study, including paediatric patients with either a current or previous telemetric ICP sensor and their parents. Additionally, a retrospective review of electronic health records for all included children was performed. We included 16 children (age range 3-16 years), with a total of 41 telemetric ICP sensors implanted. Following sensor implantation, the frequency of telephone contacts and outpatient visits increased. No corresponding decrease in hospital admissions or total length of stay was found.The telemetric ICP sensor provided most parents with an improved sense of security and was seen as a necessary and valuable tool in treatment guidance. The size and shape of the sensor itself were reported as disadvantages, while the external monitoring equipment was reported as easy to use but too large and heavy for a child to carry. Though, in quantitative terms, there was no cost-benefit of the telemetric ICP sensor, it contributed to extended parental involvement and a sense of improved safety.

Investigating the Role of β-Disodium Glycerophosphate and Urea in Promoting Growth of Streptococcus thermophilus from Omics-Integrated Genome-Scale Models.

This study investigates the impact of urea and β-GP on the growth of Streptococcus thermophilus S-3, a bacterium commonly used in industrial fermentation processes. Through a series of growth experiments, transcriptome, metabolome, and omics-based analyses, the research demonstrates that both urea and β-GP can enhance the biomass of S. thermophilus, with urea showing a more significant effect. The optimal urea concentration for growth was determined to be 3 g/L in M17 medium. The study also highlights the metabolic pathways influenced by urea and β-GP, particularly the galactose metabolism pathway, which is crucial for cell growth when lactose is the substrate. The integration of omics data into the genome-scale metabolic model of S. thermophilus, iCH502, allowed for a more accurate prediction of metabolic fluxes and growth rates. The study concludes that urea can serve as a viable substitute for β-GP in the cultivation of S. thermophilus, offering potential cost and efficiency benefits in industrial fermentation processes. The findings are supported by validation experiments with 11 additional strains of S. thermophilus, which showed increased biomass in UM17 medium.

Mathematical model for assessing glycemic control in type 2 diabetes mellitus.

Glycated hemoglobin (HbA1c) and glycated albumin (GA) are vital markers for assessing glucose control in diabetes. This cross-sectional study involving 901 diagnosed type 2 diabetics aimed to compare calculated HbA1c, using the formula HbA1c = 2.6 + 0.03 x FBS (mg/dL), with directly measured HbA1c. Simultaneously, the study assessed the agreement between the two methods through regression analysis and explored correlations with various measures of glycemic control. The non-parametric Kolmogorov-Smirnov test indicated a non-normal data distribution, prompting appropriate statistical tests. Spearman's correlation coefficient revealed a strong correlation of calculated HbA1c, calculated GA, and estimated average glucose with measured parameters. Wilcoxon rank sum test indicated a significant difference between directly measured and calculated HbA1c (Z -9.487033, p < 0.0001). Passing Bablok regression analysis showed a significant deviation from linearity. Despite the potential cost benefits in resource-poor settings, caution is advised regarding interchangeable use of calculated and directly measured HbA1c in clinical decision-making. Data shows the importance of robust analytical methods in glycemic control assessment, offering insights for managing type 2 diabetes mellitus.

Eltrombopag in the Treatment of Post Allogeneic Hematopoietic Stem Cell Transplantation Cytopenia: Efficacy, Response Durability and Potential Cost Benefit of Early Drug Tapering.

Eltrombopag in the Treatment of Post Allogeneic Hematopoietic Stem Cell Transplantation Cytopenia: Efficacy, Response Durability and Potential Cost Benefit of Early Drug Tapering.

HDE-Array: Development and Validation of a New Dry Electrode Array Design to Acquire HD-sEMG for Hand Position Estimation.

This paper aims to introduce HDE-Array (High-Density Electrode Array), a novel dry electrode array for acquiring High-Density surface electromyography (HD-sEMG) for hand position estimation through RPC-Net (Recursive Prosthetic Control Network), a neural network defined in a previous study. We aim to demonstrate the hypothesis that the position estimates returned by RPC-Net using HD-sEMG signals acquired with HDE-Array are as accurate as those obtained from signals acquired with gel electrodes. We compared the results, in terms of precision of hand position estimation by RPC-Net, using signals acquired by traditional gel electrodes and by HDE-Array. As additional validation, we performed a variance analysis to confirm that the presence of only two rows of electrodes does not result in an excessive loss of information, and we characterized the electrode-skin impedance to assess the effects of the voltage divider effect and power line interference. Performance tests indicated that RPC-Net, used with HDE-Array, achieved comparable or superior results to those observed when used with the gel electrode setup. The dry electrodes demonstrated effective performance even with a simplified setup, highlighting potential cost and usability benefits. These results suggest improvements in the accessibility and user-friendliness of upper-limb rehabilitation devices and underscore the potential of HDE-Array and RPC-Net to revolutionize control for medical and non-medical applications.

Towards a low-cost sustainable broadband solution in rural areas of low and middle-income countries: Tanzania’s backhaul perspective

Although broadband internet has proven to accelerate the fulfilment of the information and communication for development (ICT4D) agenda, connectivity issues persist in some regions of the world, particularly in rural areas of Low and Middle-Income Countries (LMICs) which host 93% of the unconnected global population. Due to the lack of economic feasibility in these locations for service providers, International Telecommunication Union (ITU) has been advocating for low-cost sustainable solutions in such areas. Among the challenging broadband infrastructure segment seems to be the backhaul (middle-mile) as rural areas are remotely located from the backbone end-points. With Tanzania exemplifying LMICs, this paper presents a Techno-Economic Analysis (TEA) to compare the widely utilized backhaul (Microwave) and the promising Broadband over Power Line (BPL) towards achieving low-cost broadband solutions. To demonstrate technical viability in terms of capacity, Pathloss and MATLAB were utilized from which both technologies demonstrated the broadband-suitably capacity (161Mbps for Microwave and 168.99Mbs for BPL). From economic perspective, the Total Cost of Ownership (TCOs) for both technologies were determined using a Cost Model; BPL fared better as the cost of establishing one microwave link could have established almost 6 BPL links. Apart from adding to the body of knowledge on TEAs involving backhauls, this paper informs policymakers and other related stakeholders on the potential cost-benefit of BPL towards curbing the existing broadband connectivity gap.

Radiation based satellite attitude and thermal parameters estimation considering conduction effect

Accurate attitude information of satellites is a prerequisite for many space missions requiring some pointing capabilities. A radiation-based (RB) thermopile measurement package has recently been proposed for satellite attitude estimation with potential cost and power benefits. However, previous related researches have not considered all modes of the thermal communication, and have specifically neglected the conduction effect on and between the satellite surfaces as a simplifying assumption to initially develop the innovative measurement equation. As this assumption is practically difficult to implement for contemporary satellites operating in near Earth space environment, the present work complements the effect of conduction terms both in the measurement model as well as in relations pertaining to the solar RB attitude knowledge. In addition, another simplifying assumption of constant Earth albedo factor (AF) is also removed. Moreover, the present study simultaneously estimates the satellite attitude as well as its surface’s thermal characteristics (TC). The stochastic estimation algorithm used in the current study is based on the unscented Kalman filter (UKF) for attitude estimation via the new proposed sensor pack and measurement model. Finally, the study is augmented with a thorough sensitivity analysis against satellite internal heat radiation, environmental and initial conditions that have been verified via Monte Carlo simulations (MCS) to assess the merits of the proposed modified thermal model for RB concurrent satellite attitude and TC estimations.

Healthcare costs, resource utilization, and productivity loss associated with colorectal cancer screening.

To evaluate healthcare costs, resource utilization, associated costs, and lost productivity for colorectal cancer (CRC) screening in an average-risk population. This retrospective cohort study identified average-risk individuals (50-75 years) with claims in the Optum Research Database for CRC screening test between 1 January 2014 to 31 December 2018. Index date was defined as the first date of a claim for colonoscopy, fecal immunochemical test (FIT), guaiac-based fecal occult blood test (FOBT) or multi-target stool DNA test (mt-sDNA). Screening costs were evaluated with descriptive statistics and multivariable analyses, adjusting for patient characteristics and index screening costs. In total, 903,831 individuals were identified by test groups: mt-sDNA (n = 29,614), FIT (n = 254,002), guaiac-based FOBT (n = 112,757) and colonoscopy (n = 507,458). Adjusted costs for index screening were, colonoscopy ($3,029), mt-sDNA ($752), FIT ($45), and (FOBT ($153). Adjusted costs across the six months following the index screening were $146 for colonoscopy, $329 for mt-sDNA, $306 for FIT, and $412 for FOBT. Colonoscopy had the highest costs for lost productivity. Screening colonoscopy had the highest productivity loss and healthcare costs up-front, suggesting potential cost benefits for noninvasive screening modalities. The more frequent screening interval required for FIT and FOBT resulted in a higher yearly cost than colonoscopy or mt-sDNA.

Cost–benefit analysis of partnership working between fire and rescue and health services across England and Wales during the COVID-19 pandemic

ObjectivesFire and rescue services undertook a range of additional activities to support the National Health Service (NHS) in managing extreme service demand during the COVID-19 pandemic. This study aims to...

Evaluation of potential cost savings through chemotherapy and biotherapy dose-rounding at a pediatric institution.

Rapidly increasing costs of medication acquisition can pose a challenge for health-system pharmacy budgets. The impact of dose-rounding in a pediatric oncology population has not previously been well documented and a retrospective review was undertaken to quantify the potential cost benefits. A retrospective chart review of patients with an oncologic diagnosis was performed for cytotoxic agents, asparaginase products, and biotherapy administered between January 1, 2014, and December 31, 2017. In the analysis, orders that could be rounded down to the nearest vial size by 5 or 10% were included. Medication pricing information was based on wholesale acquisition cost (WAC) and was provided by the Department of Pharmacy. Cost savings per medication were determined by multiplying the WAC of the medication by the number of vials saved. Over a 4-year span, 347 patients were evaluated and 552 out of a possible 3110 orders (17.7%) met criteria for a theoretical cost savings of approximately $1,126,000 (∼$3200 per patient). Rounding down doses by up to 5% resulted in a potential savings of about $529,000. When rounding was extended to 5-10% of the originally ordered dose, an additional $597,000 of approximate cost savings could have been realized. The medications with the largest impact on cost savings were rituximab, pegaspargase, and erwinia asparaginase. For pediatric oncology patients, there exists a unique potential cost savings opportunity if doses are rounded down within 5 or 10% of the originally ordered weight-based or body surface area-calculated dose.