Potential Cost Benefits Research Articles

A micro-costing analysis of outpatient flexible cystoscopy: implications for adoption of single-use flexible cystoscopes.

To evaluate the total cost of outpatient flexible cystoscopy associated with reusable device purchase, maintenance, and reprocessing, and to assess potential cost benefits of single-use flexible cystoscopes. Cost data regarding the purchasing, maintaining, and reprocessing of reusable flexible cystoscopes were collected using a micro-costing approach at a high-volume outpatient urology clinic. We estimated the costs to facilities with a range of annual procedure volumes (1000-3000) performed with a fleet of cystoscopes ranging from 10 to 25. We also compared the total cost per double-J ureteral stent removal procedure performed using single-use flexible cystoscopes versus reusable devices. The cost associated with reusable flexible cystoscopes ranged from $105 to $224 per procedure depending on the annual procedure volume and cystoscopes available. As a practice became more efficient by increasing the ratio of procedures performed to cystoscopes in the fleet, the proportion of the total cost due to cystoscope reprocessing increased from 22 to 46%. For ureteral stent removal procedures, the total cost per procedure using reusable cystoscopes (range $165-$1469) was higher than that using single-use devices ($244-$420), unless the annual procedure volume was sufficiently high relative to the number of reusable cystoscopes in the fleet (≥ 350 for a practice with ten reusable cystoscopes, ≥ 700 for one with 20 devices). The cost of reprocessing reusable cystoscopes represents a large fraction of the total cost per procedure, especially for high-volume facilities. It may be economical to adopt single-use cystoscopes specifically for stent removal procedures, especially for lower-volume facilities.

Cost Savings of HPV Testing Alone Versus Co-Testing for Cervical Cancer Screening at a Student-Run Free Clinic

Background: Primary high-risk human papillomavirus (hrHPV) testing is an approved alternative method of cervical cancer screening by the United States Preventative Services Task Force. The University of South Florida BRIDGE (Building Relationships and Initiatives Dedicated to Gaining Equality) Clinic is a student-run free clinic with limited screening resources, serving patients below the poverty line. This study aimed to determine the potential cost benefit of primary hrHPV testing in this population.
 Methods: A retrospective observational study of clinic invoices and patient charts from January 2014 to December 2018 of women receiving cervical cancer screening by co-testing was performed. 
 Results: BRIDGE spent $29,122.37 on screening over the five-year period for 128 patients. By elimi-nating cervical cytology, the clinic would have saved $11,594.34. Fifteen patients had abnormal results, ten of which were hrHPV-positive.
 Conclusions: The $11,594 saved would allow BRIDGE to screen 110 more patients by primary hrHPV testing and another three by eliminating follow-up for atypical squamous cells of undetermined significance, hrHPV-negative results. One patient with low-grade squamous intraepithelial lesion and negative hrHPV represents a 0.8% risk of missing precancerous lesions the clinic would assume by adopting primary hrHPV testing.

AdaTrust: Combinational Hardware Trojan Detection Through Adaptive Test Pattern Construction

As society becomes increasingly reliant on products and systems that make use of integrated circuits, the defense against potential hardware Trojan attacks by an untrusted foundry becomes an important part of any certification flow for critical components. The slew of recent proposals notwithstanding, a satisfactory solution is still wanting as the solutions offered heretofore either require impractical design/test pattern cost or deliver insufficient detection capabilities, primarily challenged by the noise induced by process variation. The methodology put forth by this proposal aims to remedy this, leveraging an adaptive approach that applies superposition to perform a fine-grained circuit analysis and expose any extant Trojan circuitry. Iterative test pattern modifications, circuit response analysis, and adaptive decision-making are deployed, all embedded within the design-for-test and test pattern cost paradigms of a common industrial circuit. We demonstrate the efficacy of this technique on standard Trust-Hub benchmark circuits with combinational Trojans inserted in sequential designs, showing significant improvement over prior techniques. We also explore the potential cost–benefit tradeoffs that exist within such a methodology, with the intent to provide an efficient solution for an array of potential product markets. This methodology provides a reliable and effective means for Trojan detection, addressing an important piece of the overall circuit certification puzzle.

Progress Report: Next-Generation Sequencing, Multiplex Polymerase Chain Reaction, and Broad-Range Molecular Assays as Diagnostic Tools for Fever of Unknown Origin Investigations in Adults.

Even well into the 21st century, infectious diseases still account for most causes of fever of unknown origin (FUO). Advances in molecular technologies, including broad-range polymerase chain reaction (PCR) of the 16S ribosomal RNA gene followed by Sanger sequencing, multiplex PCR assays, and more recently, next-generation sequencing applications, have transitioned from research methods to more commonplace in some clinical microbiology laboratories. They have the potential to supplant traditional microbial identification methods and antimicrobial susceptibility testing. Despite the remaining challenges with these technologies, publications in the past decade justify excitement about the potential to transform FUO investigations. We discuss available evidence using these molecular methods for FUO evaluations, including potential cost-benefits and future directions.

Increased Health Care Resource Utilization and Costs Associated with Herpes Zoster Among Patients Aged ≥50 Years with Chronic Obstructive Pulmonary Disease in the United States.

Patients with chronic obstructive pulmonary disease (COPD) are potentially at increased risk of herpes zoster (HZ). Little is known about the impact of an HZ episode on health care resource utilization (HRU) and costs among patients with COPD. This retrospective cohort study of individuals aged ≥50 years in the United States (US) used administrative claims data from Optum's de-identified Clinformatics Data Mart Database for commercially insured and Medicare Advantage members (2013-2018). Two cohorts of patients with COPD, with HZ (COPD+/HZ+) and without HZ (COPD+/HZ-), were identified. All-cause and COPD-related HRU rates and costs (2018 US dollars) were compared between cohorts for up to 12 months of follow-up. Comparisons were controlled for baseline differences through propensity score adjustment. A total of 3415 COPD+/HZ+ and 35,360 COPD+/HZ- patients (mean ages 73.2 ± 9.0 and 72.4 ± 9.4 years, respectively) were identified. Patients in the COPD+/HZ+ versus COPD+/HZ- cohort had increased use of all-cause (adjusted incidence rate ratio [aIRR] 1.17; 95% confidence interval [CI] 1.14, 1.21) and COPD-related (aIRR 1.27; 95% CI 1.21, 1.34) medical services (both P<0.001) and higher mean total all-cause ($4140 versus $3749 per person per month [PPPM]; adjusted cost difference +$313 PPPM) and COPD-related ($1541 versus $1231 PPPM; +$152 PPPM) costs (both P<0.004) in the year after HZ. HRU and cost burden is higher in patients with COPD with vs without HZ. These results could help to estimate the potential cost benefits of HZ vaccination among patients with COPD.

Change in 12‐month health care utilization patterns among persons living with dementia who received a comprehensive home‐based dementia care coordination program: Mind at home

AbstractBackgroundMIND at Home, a value‐based innovation, is a comprehensive, home‐based care coordination program for people with dementia and their carers to identify and address a broad set of health determinants to improve health, clinical outcomes, and reduce costs. We present pooled trial data evaluate change in 12‐month health care utilization patterns among a racially and cognitively diverse group of persons living with dementia who received MIND at Home.MethodPre‐post, adjusted Poisson regression models were used to evaluate health care utilization patterns for a pooled sample of persons with dementia receiving MIND at Home (n=391) in the 12 month period after enrollment in the program with the 12 month period prior to enrollment. Hospitalizations, ED visits, outpatient visits, home and community‐based services (HCBS) were ascertained via proxy‐report from carers.ResultThe mean number of hospital admissions decreased by 27% in the one year period after baseline (95% CI: 6%, 44%, p=0.01) compared with the year prior. Adjusted rates of one or more hospitalizations declined from 36.8% to 32.5%, with a crude rate reduction of 11.6% (unadjusted) between pre‐and post‐periods. Mean number of HCBS services used increased by 70% (95% CI: 54%, 88%, p&lt;0.01) and mean number of outpatient specialties seen in the post period increased by 52% (95% CI: 43%, 62%, p&lt;0.01) compared with the year before baseline. Average number of outpatient provider visits remained the same (p=0.76). Mean number of ER visits decreased by 16% (95% CI: ‐8%, 34%) but was not statistically significant (p=0.18).ConclusionResults provide compelling new quasi‐experimental data that supports the impact of the MIND at Home program on changing health care utilization patterns and is in line with our prior findings. Persons who received MIND at Home were less likely to use high cost acute health services (inpatient) and more likely to use more cost‐efficient services like home and community based services and physician services in the year after enrollment compared to the year prior. These data imply a potential cost benefit of the MIND at Home dementia care coordination program.

CAPACITY UTILIZATION ANALYSIS OF HPLC INSTRUMENTS FROM THE ASPECT OF HUNGARIAN FOR- AND NON-PROFIT SECTOR

This study focuses on the development of a method in order to measure and evaluate the capacity utilization of forty laboratory instruments in the analytical field of chromatography in the two major sectors, namely non-profit and for-profit. The procurement of the laboratory instruments was either from own institution’s budget or European Union projects funded. The primary objective of this survey is to identify appropriate laboratory capacity utilization and productivity measures and analyze the potential cost benefit. The measurements were carried out by idle-time indicators for a 12-months/ a year period of time to determine the efficient utilization of the laboratory devices. The analyzed data were gathered from the Hungarian laboratory market as an own research. The significant difference was found between the classifications and periods of idle times for an HPLC instrument for non-profit and profit-oriented institutes and thus capacity utilization is slightly different in these two cases. Based on the results, at last it was stated that a number of effect of EU resources on R&amp;D development and their significance is still unsolved and so a more complex survey has to be carried out in future in the major sectors of the laboratory B2B market. In this work only the most important aspects based on the Research and Development activities were examined for sustainable economic development. Naturally, the conceptual scope and extent of this study do not permit all the possible issues to be examined from every aspect, thus it will be endeavored to point out merely the most relevant considerations.

Abstract 16898: Clinical Implementation of Pharmacogenomics Testing to Guide P2Y12 Inhibitor Use in Older Adults With Acute Coronary Syndrome: Insights From a Prospective Pilot Study

Introduction: CYP2C19 testing is a known pharmacogenomics application to identify patients who can activate clopidogrel. Evidence-based guidelines now support second generation P2Y12 inhibitors over clopidogrel for the management of acute coronary syndrome (ACS). However, continued broad use of clopidogrel within our health-system indicated the potential value of pharmacogenomic testing to guide P2Y12 inhibitor prescribing. This study aimed to evaluate the clinical application of pharmacogenomic testing within a cardiovascular population and identify optimizations to the implementation process. Methods: This was a prospective, descriptive cohort pilot study at a large academic health-system. A high-impact pilot population included patients 65 years and older admitted for ACS who underwent percutaneous coronary intervention (PCI). Pharmacists identified eligible patients and made genomic-guided P2Y12 inhibitor recommendations for each patient. Surrogate markers of clinical impact included clopidogrel prescribing rates and quantification of active medication-gene interactions. Process indicators included acceptance rate of recommendations. Results: A total of 151 patients were included. At the time of result return, 46% of patients were on clopidogrel. Of these patients, 27% were identified as poor or intermediate metabolizers and were indicated for a change in therapy. The acceptance rate of genomic-guided recommendations was 42%. Identified barriers to uptake included result turnaround time limiting application of findings and unclear responsibility of follow-up. Conclusions: Results from this real-world study support implementation of CYP2C19 testing to guide P2Y12 inhibitor use. Identifying candidates for clopidogrel use through testing has potential clinical and cost benefits, but further studies are needed. Process optimizations are required to address implementation barriers and increase follow-up on actionable results.

Pilot Project to Assess the Potential Cost-Benefit of a Bronchoscopy Program for the Diagnosis of TB in Uganda

Flexible bronchoscopy is considered an essential diagnostic and therapeutic procedure in pulmonary medicine in high-income countries. TB is the leading infectious killer worldwide, with over 10 million new cases and nearly 1.5 million deaths in 2018.1 Diagnosis of TB requires detection of Mycobacterium TB bacilli, or its DNA, from sputum. However, TB is often difficult to diagnose with conventional sputum-based testing in children and patients with paucibacillary disease. In high-income countries, bronchoscopy is recommended for prompt diagnosis of patients with presumed TB where induced sputum is negative or not available.

Assessing the Automation Potentials of Management Reporting Processes

Digitalization is driving the automation of accounting processes. It is estimated that up to 70% of administrative activities could be carried out by automated, i.e. rule-based sequences, which promises a considerable increase in productivity and efficiency for repetitive, standardized processes. In recent years, Robotic Process Automation (RPA) has been increasingly and successfully used for such purposes. However, before implementing a RPA solution, it is essential to evaluate the automation potentials. In the literature, such evaluations are based almost exclusively on process-oriented factors, such as the frequency and duration of processes or the degree of standardization. The assessment of potential cost benefits is often carried out secondarily and on the basis of cost estimates at a higher level. In order to close this gap and to make the cost-based assessment of automation potentials more soundly assessable, this article demonstrates a corresponding approach using Time-Driven Activity-Based Costing (TD ABC). For this purpose, a typical example from accounting is used for a demonstration with a management reporting process.

Unsedated Colonoscopy: Impact on Quality Indicators.

In the USA, sedation is commonly used for colonoscopies; though colonoscopy can be successfully performed without sedation, outcomes data in this setting are scarce. To determine patient characteristics associated with undergoing unsedated colonoscopy and whether adenoma detection rate (ADR) and cecal intubation rate (CIR) differ between sedated and unsedated colonoscopy. Using a single-center electronic endoscopy database, we identified patients who underwent outpatient colonoscopy between 2011 and 2018 with or without sedation. We used multivariable logistic regression to determine factors associated with unsedated colonoscopy, CIR, and ADR. We identified 24,795 patients who underwent colonoscopy during the study period. Of these, 179 patients (0.7%) underwent unsedated colonoscopy. ADR was 27.4% in sedated and 21.2% in unsedated colonoscopies (p = 0.06); CIR was 95.8% in sedated and 85.5% in unsedated patients (p < 0.01). On multivariable analysis, male sex (OR 2.06, CI 1.52-2.79) and suboptimal bowel preparation (OR 1.75, CI 1.24-2.45) were associated with undergoing unsedated colonoscopy, while higher BMI was inversely associated with unsedated colonoscopy (BMI 25-29.9: OR 0.44, CI 0.25-0.77). On multivariable analysis, colonoscopy with sedation was associated with CIR (OR 3.79, CI 2.39-6.00) and ADR (OR 1.45, OR 1.00-2.10). We found that undergoing outpatient colonoscopy with sedation as opposed to no sedation was significantly associated with a higher CIR and ADR. Our findings suggest sedation is necessary to meet current CIR and ADR guidelines; however, given the potential cost and safety benefits of unsedated colonoscopy, further investigation into methods to improve patient selection and colonoscopy quality indicators is warranted.

Should we reinforce the grid? Cost and emission optimization of electric vehicle charging under different transformer limits

With high electric vehicle (EV) adoption, optimization of the charging process of EVs is becoming increasingly important. Although the CO2 emission impact of EVs is heavily dependent on the generation mix at the moment of charging, emission minimization of EV charging receives limited attention. Generally, studies neglect the fact that cost and emission savings potential for EV charging can be constrained by the capacity limits of the low-voltage (LV) grid. Grid reinforcements provide EVs more freedom in minimizing charging costs and/or emissions, but also result in additional costs and emissions due to reinforcement of the grid. The first aim of this study is to present the trade-off between cost and emission minimization of EV charging. Second, to compare the costs and emissions of grid reinforcements with the potential cost and emission benefits of EV charging with grid reinforcements. This study proposes a method for multi-objective optimization of EV charging costs and/or emissions at low computational costs by aggregating individual EV batteries characteristics in a single EV charging model, considering vehicle-to-grid (V2G), EV battery degradation and the transformer capacity. The proposed method is applied to a case study grid in Utrecht, the Netherlands, using highly-detailed EV charging transaction data as input. The results of the analysis indicate that even when considering the current transformer capacity, cost savings up to 32.4% compared to uncontrolled EV charging are possible when using V2G. Emission minimization can reduce emissions by 23.6% while simultaneously reducing EV charging costs by 13.2%. This study also shows that in most cases, the extra cost or emission benefits of EV charging under a higher transformer capacity limit do not outweigh the cost and emissions for upgrading that transformer.

P0321OUR EXPERIENCE OF PATIROMER (VELTASSA) USE AND POTENTIAL COST-BENEFITS AT SOUTH TYNESIDE AND SUNDERLAND NHS FT, U.K

Abstract Background and Aims Patiromer is a new medication used to manage hyperkalaemia and acts as a bowel cation-exchange polymer with a simpler dosing and more favourable side effect profile than existing agents. In May 2018, South Tyneside and Sunderland NHS Foundation Trust (STSFT) implemented a protocol for the use of Patiromer in managing chronic hyperkalaemia to enhance options for managing cardio-renal patients in clinic. Conditional on our successful formulary application, was an audit against the protocol aiming to understand utility. Our second aim was to identify potential cost-benefits of patiromer. In particular, we were interested in preventing hospital admissions, bed days saved, temporary venous lines and dialysis sessions. It is important to note this analysis is subject to interpretation based on likely outcome should patiromer not have been given. Method To be eligible, patients had to have eGFR &amp;lt;30 and either a potassium &amp;gt;5.5 precluding the use of RAASi/MRAs or a recurrent potassium &amp;gt;6. Using electronic patient record system, we investigated 49 patients commenced on patiromer between October 2018 and October 2019. Results Only 14% of the incident prescriptions were in clinic with over half starting at a higher than UK licensed dose (once daily). The distribution of hyperkalaemia was varied as defining hyperkalaemia onset is challenging and what we found as more emergency use. We also identified the following clinical savings: 12 fewer bed days, 15 temporary lines and a minimum of 25 dialysis sessions avoided. Interestingly, we also found that in 2 cases, physicians utilised patiromer and avoided a referral to the renal team. Furthermore, we identified 11 uses of patiromer in the conservative/palliative setting allowing patients to withdraw from dialysis and to prevent discussions on commencing renal replacement therapy for concerns around hyperkalaemia. It would also provide a quality of life benefit avoiding recurrent cannulation to facilitate the standardised medical management of hyperkalaemia. Conclusion In conclusion, whilst this may not demonstrate an objective cost benefit, it does show the versatility of patiromer use in clinical practice. We have found an emphasis on usage in the inpatient setting to avoid dialysis and its attendant costs, rather than where its evidence base originates: as a renin-aldosterone blockade enabler in the outpatient setting. We have demonstrated awareness of adhering to the protocol criteria, whilst understanding the pitfalls of the protocol and why the medication has been administered out with of it, especially with regards to dosing. We wish to share our experience with clinicians and raise awareness of their growing armamentarium.

A reduced-tillering trait shows small but important yield gains in dryland wheat production.

Reducing the number of tillers per plant using a tiller inhibition (tin) gene has been considered as an important trait for wheat production in dryland environments. We used a spatial analysis approach with a daily time-step coupled radiation and transpiration efficiency model to simulate the impact of the reduced-tillering trait on wheat yield under different climate change scenarios across Australia's arable land. Our results show a small but consistent yield advantage of the reduced-tillering trait in the most water-limited environments both under current and likely future conditions. Our climate scenarios show that whilst elevated [CO2 ] (e[CO2 ]) alone might limit the area where the reduced-tillering trait is advantageous, the most likely climate scenario of e[CO2 ] combined with increased temperature and reduced rainfall consistently increased the area where restricted tillering has an advantage. Whilst long-term average yield advantages were small (ranged from 31 to 51kgha-1 year-1 ), across large dryland areas the value is large (potential cost-benefits ranged from Australian dollar 23 to 60 MIL/year). It seems therefore worthwhile to further explore this reduced-tillering trait in relation to a range of different environments and climates, because its benefits are likely to grow in future dry environments where wheat is grown around the world.

Revisiting thin silicon for photovoltaics: a technoeconomic perspective

This technoeconomic analysis revisits the concept of thin silicon wafer for its potential cost benefits and technological challenges.

Cost of adverse events (AEs) with second-line (2L) immuno-oncology agents (IO) and chemotherapy (CHEMO) in advanced non-small cell lung cancer (aNSCLC) in the real-world

Abstract Background Randomized clinical trials in aNSCLC demonstrated that 2L IO prolonged overall survival and lowered AE rates compared with 2L CHEMO. However, real-world (RW) evidence from clinical practice is limited, and the potential cost benefits of lower AE rates have not been examined. Here, we report average costs per patient (pt) associated with grade 3-4 AEs during 2L treatment with IO and CHEMO in aNSCLC from a US payer perspective. Methods AEs in pts treated with 2L IO or CHEMO for aNSCLC (Mar 2015-Dec 2017) were abstracted from US electronic health records in COTA’s database. Hospitalization costs for each ICD-10 code associated with the management of a grade 3-4 AE during treatment were estimated using the Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample 2017 dataset. Results Of 596 pts in the analysis, 276 received IO (199 nivolumab) and 320 received CHEMO. The proportion of IO- vs CHEMO-treated pts was higher for pts aged Table . 74P Average cost of grade 3-4 AEs per patient (Pt) IO (n = 276) CHEMO (n = 320) n Average Cost per Pt n Average Cost per Pt 107 $6,877 114 $17,203 ≥65 y 169 $11,033 206 $14,832 Male 150 $4,417 150 $10,460 Female 126 $15,379 170 $20,279 White 176 $9,265 233 $17,547 Former/current smoker 255 $7,973 265 $17,292 History of brain metastasis 101 $9,760 117 $20,219 No history of brain metastasis 175 $9,226 203 $13,059 Squamous 43 $3,096 53 $18,749 Nonsquamous 233 $10,634 267 $15,181 Conclusion In this RW analysis in pts with aNSCLC, 2L IO was associated with lower costs for the management of grade 3-4 AEs than 2L CHEMO. Editorial acknowledgement Writing assistance was provided by Roland Tacke, PhD, of Evidence Scientific Solutions Inc, funded by Bristol-Myers Squibb. Legal entity responsible for the study Bristol-Myers Squibb. Funding Bristol-Myers Squibb. Disclosure C.K. Wang: Shareholder / Stockholder / Stock options, Full / Part-time employment: COTA. K. Gupte-Singh: Full / Part-time employment: Bristol-Myers Squibb. A.J. Belli: Shareholder / Stockholder / Stock options, Full / Part-time employment: COTA. D.C. Lane: Shareholder / Stockholder / Stock options, Was an employee at Bristol-Myers Squibb while this work was done and recently joined COTA: Bristol-Myers Squibb. A. Lakshmanan: Shareholder / Stockholder / Stock options, Full / Part-time employment: COTA. A.D. Norden: Shareholder / Stockholder / Stock options, Full / Part-time employment: COTA.

ADVANCING PROGRAM REACH BY TAKING TRAINING ONLINE

The National Recreation and Park Association (NRPA) is one of four national organizations to receive funding from CDC to disseminate arthritis-appropriate evidence-based interventions (AAEBIs). NRPA has partnered with Fit & Strong!, a CDC-approved AAEBI and National Council on Aging falls prevention program, to disseminate through local park and recreation agencies across the country. To meet the needs of this dissemination effort, Fit & Strong! adapted its in-person instructor training into an online curriculum which became available March 2018. After initial pilot-testing, Fit & Strong! created a five-module training curriculum using Moodle teaching software. The training curriculum uses slides, graphics, videos, and interactive questions to assess mastery. After completing the training, fidelity checks are performed on all instructors by having them video record a class session and share it with the Fit & Strong! team for review. After evaluating the videos, the team meets with the instructors by phone to debrief and advise on any needed improvements. Through this partnership, Fit & Strong! trained an initial cohort of 39 instructors across 18 states within a month’s time. Training evaluation results have been positive. To date, over 900 participants have been reached. A second cohort of approximately 40 new instructors will be trained in Spring 2019. This presentation will review the processes of creating and executing the online training, potential cost and time-saving benefits to CBOs, instructor feedback, and the ease with which instructors can complete the training and offer the program anywhere across the country.

Potential direct secondary care cost benefits of HealthyWeightHub - Virtual Hospital 2.0 digital lifestyle intervention

HealthyWeighHub (HWH) is a 12-month coaching and education service designed to help patients with obesity make permanent life changes, launched and expanded gradually in Helsinki University Hospital (HUS) Healthvillage since 2016.&#x0D; We examined the direct secondary care cost benefits of HWH, measured with potential capacity freed (PCF) compared to conventional group coaching (CGC). Costs included health care, patient co-payments and travelling expenses. First, we evaluated the PCF actualized in the first two years from 2016 to 2018 in the HUS Specific Catchment Area (HUS ERVA). Then, we predicted the PCF at Finnish national level, if HWH was implemented gradually over the five years from 2018 to 2022, aimed at treating 1 % of adults with obesity annually in 2022.&#x0D; HWH’s actualized PCF was €2.69 million compared to CGC in the first two years in HUS ERVA. If the patients who received CGC had been treated with HWH instead, total PCF could have been €3.71 million. At Finnish national level, providing CGC to 1 % of adults with obesity was predicted to cost €28.0 million (€5.08 per capita) annually in 2022. With HWH predicted cost was €7.31 million (€1.33 per capita), meaning an annual PCF of €20.7 million (€3.75 per capita) in 2022 and cumulative five-year PCF of €57.5 million (€10.43 per capita). Compared to CGC, HWH is estimated to enable treatment of approximately 3.8-times more patients with obesity at the same cost.&#x0D; HWH can be more affordable than CGC and a potentially efficient tool to combat the obesity epidemic. Future evaluations should examine HWH’s effectiveness and impact on the indirect costs associated with weight loss and long-term illness.

Prospects of GTL Technology Use in the Oil and Gas Industry

Progress of the global energy industry as well as resources of natural gas of Russia were indicated in this article. The main region of their development over the years is Western Siberia, where more than 80% of gas reserves are explored. It is from here that the main stream of Russian gas flows to countries in Eastern and Western Europe. To date, good prospects have been opened for the preparation of gas reserves and production in eastern Russia with the launch of the Power of Siberia gas pipeline, which determined the high importance of this region, which is of strategic interest to the gas industry in Russia. The main resources of natural gas will be located in remote from the existing gas transmission system, inaccessible areas and areas with a harsh climate, where there are no large markets for the consumption of hydrocarbons. In connection with this, the search is underway for the transportation of natural gas, alternative to pipeline transportation, to the places of consumption. Three possible options are considered. According to the “General scheme for the development of the gas industry for the period up to 2030” , one of the promising options for the development of gas processing industries is the development and implementation of efficient technologies for the production of synthetic liquid fuels (GTL technology) aimed at solving the problems of developing small, mature and hard-to-reach natural gas fields. The special emphasize was made on one of the promising variants of gas-processing productions development - development and implementation of GTL (Gas to liquid) technology as a new method of production of synthetic liquid hydrocarbons from natural gas. Relevance, possible advantages, and prospects of GTL technology were also mentioned. The example of the Republic of Sakha (Yakutia) shown the possibility of using GTL technology, using as a raw material of natural gas of the Middle-Vilyusk gas condensate (gk) field. Also shown in this article are experimental details of the study of an individual hydrocarbon gas composition, which was determined using the gas chromatography method. The conclusion was made on the Republic's Oil and Gas Complex's overall potential cost-benefit in case of GTL technology implementation.

Cryptocurrency and Blockchains: Retail to Institutional

A reduction in cost of traditional financial intermediation was one of the main motivations cited by Satoshi Nakamoto in his/her/their 2008 proposal for: “… an electronic payment system based on cryptographic proof instead of trust.” We begin here with some back-of-the-envelope calculations of these potential cost savings and benefits from the customer perspective. We then discuss the public blockchain ledger and various solutions to two important problems that are constraints on the public blockchain’s trustless consensus, viz. “mining” costs in proof-of-work and governance issues. We speculate that foreseeable institutional implementations will often involve integration of permissioned blockchains with public blockchains. We then discuss exchanges for trading cryptocurrencies, the second component of the crypto blockchains, and in particular their “teething problems” along with the evolution of a subset of them into increasingly “industrial strength” entities. We suggest that with a more industrial strength infrastructure in place, self-executing smart contracts are virtually natural counterparts for more traditional passive investment products. We end with a discussion of Security Token Offerings (STOs) and the newer Initial Coin Offerings (ICOs): STOs are an interesting hybrid between the ICOs and traditional IPOs; they could conceivably pave the way to a long-time-coming “direct electronic IPO” market. TOPICS:Currency, exchanges/markets/clearinghouses, exchange-traded funds and applications Key Findings • A set of crypto exchanges are evolving into institutional-strength entities with law-of-one-price, clearing and settlement, custody services, and user algorithms to deal with fake inflated trade volumes. • Pure public blockchains with well-known “blockchain trilemma” problems like high energy consumption, low performance, governance shortcomings, and no clear “how-to-pay” mechanism for ledger-updating in non-crypto applications, are inexorably leading towards hybrid public/permissioned blockchain networks. • Despite their rocky start, STOs and ICOs are leading to direct or electronic IPO markets, while smart contracts running on blockchains with securities trading identifiers and data seem ideal vehicles for administering passive investment products.