Reduction In Total Cost Research Articles

Health Care Utilization in Functional Neurologic Disorders: Impact of Explaining the Diagnosis of Functional Seizures on Health Care Costs.

The objectives of this study were to investigate health care utilization costs of patients with video-electroencephalography (VEEG)-confirmed functional seizures (FS), determine whether patients who received a satisfactory functional neurologic disorder (FND) diagnosis explanation had reduced health care utilization compared with those with a poor explanation; and to quantify the overall health care costs 2 years prediagnosis and postdiagnosis for those receiving a different explanation. Patients with VEEG-confirmed pure FS (pFS) or mixed (functional seizure plus epileptic seizures) diagnosis between July 1, 2017, and July 1, 2019, were evaluated. Explanation of the diagnosis was determined "unsatisfactory" or "satisfactory" using self-developed criteria, and health care utilization data were collected using an itemized list. The subsequent costs 2 years post-FND diagnosis were compared with those 2 years before, and cost outcomes were compared between both groups. In patients who received a satisfactory explanation (n = 18), total health care costs were reduced from $169,803 to $117,133 USD (-31%). An increase in costs was found ($73,430 to $186,553 USD = +154%) in patients with pPNES after an unsatisfactory explanation (n = 7). On an individual level, 78% with a satisfactory explanation saw a reduction in total health care costs per year (mean $5,111 USD to $1,728 USD), and in 57%, an unsatisfactory explanation led to an increase (mean $4,425 to $20,524 USD). A similar effect was seen from explanation on patients with a dual diagnosis. The method of communicating an FND diagnosis has a significant impact on subsequent health care utilization. Those receiving satisfactory explanations demonstrated reduced health care utilization, whereas an unsatisfactory explanation resulted in additional expenses.

EFFICIENCY ANALYSIS OF OPEN FIELD TOMATO PRODUCTION IN PUNJAB: A NON PARAMETRIC DATA ENVELOPMENT ANALYSIS APPROACH


 
 
 This study was designed to calculate production efficiency (technical, economic and allocative) and determinants of inefficiency in open field tomato production in Punjab, Pakistan. Simple random sampling was used for primary data collection from 70 farmers in 2014. Data envelopment analysis explored the mean of technical (79.4%), allocative (58.1%) and economic (45.9%) efficiency. It showed the capability of 21.6 and 41.9% reduction in inputs and total cost, respectively with same output and technology. For sub groups, technical efficiency (92.1%) was more for medium farmer while allocative (74.2%) and economic efficiency (63.8%) was higher for large farmer. Tobit model explored the negative impact of education, experience, extension services and credit availability on inefficiency. Impact on inefficiency was positive for family size, area and vegetable market distance.
 
 

Incentive-Aware Blockchain-Assisted Intelligent Edge Caching and Computation Offloading for IoT

The rapid development of artificial intelligence has pushed the Internet of Things (IoT) into a new stage. Facing with the explosive growth of data and the higher quality of service required by users, edge computing and caching are regarded as promising solutions. However, the resources in edge nodes (ENs) are not inexhaustible. In this paper, we propose an incentive-aware blockchain-assisted intelligent edge caching and computation offloading scheme for IoT, which is dedicated to providing a secure and intelligent solution for collaborative ENs in resource optimization and controls. Specifically, we jointly optimize offloading and caching decisions as well as computing and communication resources allocation to minimize the total cost for tasks completion in the EN. Furthermore, a blockchain incentive and contribution co-aware federated deep reinforcement learning algorithm is designed to solve this optimization problem. In this algorithm, we construct an incentive-aware blockchain-assisted collaboration mechanism which operates during local training, with the aim to strengthen the willingness of ENs to participate in collaboration with security guarantee. Meanwhile, a contribution-based federated aggregation method is developed, in which the aggregation weights of EN gradients are based on their contributions, thereby improving the training effect. Finally, compared with other baseline schemes, the numerical results prove that our scheme has an efficient optimization utility of resources with significant advantages in total cost reduction and caching performance.

ПЛАНУВАННЯ ІНВЕСТИЦІЙНОЇ ДІЯЛЬНОСТІ ПІДПРИЄМСТВА

The article substantiates the necessity of developing an investment strategy of the enterprise. This is one of the conditions for the effective functioning of the enterprise, which is expressed in the improvement of product quality, reduction of total costs, expansion of the production base and, as a result, increase of competitiveness on the goods market. To achieve the above goals, it is necessary to carefully develop an investment strategy and constantly improve it. It is noted that the task of strategic planning is the development and substantiation of the company's development strategy in various markets, and the goal is to fix the source of obtaining financial resources, estimate the fee for use, taking into account the cost of their service. The stages of strategic planning of the enterprise's investment activity are defined and considered. The author points out that at the initial stage of strategic planning of the enterprise's investment activity, it is necessary to resolve the issue of the possibility of its implementation in general, at this enterprise, at this moment in time, in the near future. First of all, the success of the enterprise's activity, its profit, its capabilities, competitiveness, etc. depend on this. Having decided on the direction of investment activity and the necessary volume of investment resources, the identification and attraction of various sources of financing of real investments (investment projects) intended for implementation in both the short-term and long-term perspective is carried out. The next stage of strategic planning of the enterprise's investment activity is the rational choice of the form of capital attraction. That is, to use only equity capital or only loan capital for investment activities, or to find a rational ratio between the use of equity and loan capital. The main sources of investment financing are presented, the main groups of real investments are considered for the tasks to be solved. The advantages and disadvantages of various forms of financing the investment activities of the enterprise are determined. It is noted that a thorough assessment of the consequences of using various alternative schemes and forms of financing should be carried out during the strategic planning of investment activities.

Efekti implementacije digitalnog marketinga sa aspekta kupca u preduzećima tekstilne i odevne industrije

Being competitive today means, above all, increasing investment in research and fast and efficient implementation of new technologies (primarily ICT), which enable the automation of business processes and the reduction of total costs, as well as new products and new markets, along with the optimization of business processes and rationalization of costs. Otherwise, by implementing innovative ICT systems and e-business models, whose infrastructure is based on the implementation of ICT or internet technologies (web, cloud computing, internet of things, big data, ubiquitous computing, etc.), companies can achieve a significant competitive advantage and take the lead market positions. This means that e-business has a positive effect on the development of entrepreneurship, while from the customer's point of view it enables more efficient business, easier shopping and communication with sellers and service providers (regardless of time, place or context). One of the segments of efficient e-business and strengthening concurrency is the accelerated, high-quality and efficient implementation of information systems - IS, primarily production (CAD and CAM), but also service, such as IS marketing, sales or supply. The influence and effects of digital marketing have a double effect, so they are generally treated as dual in nature or two-way, and relevant research into the importance of digital marketing in the efficient operations of companies, implies an in-depth situational analysis from two aspects - from the aspect of the producer or service provider and from the aspect of the user or consumer.The work is an explanation of the types, ways and effects of the implementation of the digital marketing system, as well as its possibilities, advantages and disadvantages in the business of textile and clothing industry companies, but also an explanation of the analytical-synthetic perception through the prism of the results of the survey on digital marketing from the customer's point of view.

Modeling the impact of child vaccination (5-11y) on overall COVID-19 related hospitalizations and mortality in a context of omicron variant predominance and different vaccination coverage paces in Brazil.

Developing countries have experienced significant COVID-19 disease burden. With the emergence of new variants, particularly omicron, the disease burden in children has increased. When the first COVID-19 vaccine was approved for use in children aged 5-11 years of age, very few countries recommended vaccination due to limited risk-benefit evidence for vaccination of this population. In Brazil, ranking second in the global COVID-19 death toll, the childhood COVID-19 disease burden increased significantly in early 2022. This prompted a risk-benefit assessment of the introduction and scaling-up of COVID-19 vaccination of children. To estimate the potential impact of vaccinating children aged 5-11 years with mRNA-based COVID-19 vaccine in the context of omicron dominance, we developed a discrete-time SEIR-like model stratified in age groups, considering a three-month time horizon. We considered three scenarios: No vaccination, slow, and maximum vaccination paces. In each scenario, we estimated the potential reduction in total COVID-19 cases, hospitalizations, deaths, hospitalization costs, and potential years of life lost, considering the absence of vaccination as the base-case scenario. We estimated that vaccinating at a maximum pace could prevent, between mid-January and April 2022, about 26,000 COVID-19 hospitalizations, and 4200 deaths in all age groups; of which 5400 hospitalizations and 410 deaths in children aged 5-11 years. Continuing vaccination at a slow/current pace would prevent 1450 deaths and 9700 COVID-19 hospitalizations in all age groups in this same time period; of which 180 deaths and 2390 hospitalizations in children only. Maximum vaccination of children results in a significant reduction of COVID-19 hospitalizations and deaths and should be enforced in developing countries with significant disease incidence in children. This manuscript was funded by the Brazilian Council for Scientific and Technology Development (CNPq - Process # 402834/2020-8).

Deep Learning-Based Real Time Defect Detection for Optimization of Aircraft Manufacturing and Control Performance

Monitoring tool conditions and sub-assemblies before final integration is essential to reducing processing failures and improving production quality for manufacturing setups. This research study proposes a real-time deep learning-based framework for identifying faulty components due to malfunctioning at different manufacturing stages in the aerospace industry. It uses a convolutional neural network (CNN) to recognize and classify intermediate abnormal states in a single manufacturing process. The manufacturing process for aircraft factory products comprises different phases; analyzing the components after the integration is labor-intensive and time-consuming, which often puts the company’s stake at high risk. To overcome these challenges, the proposed AI-based system can perform inspection and defect detection and alleviate the probability of components’ needing to be re-manufacturing after being assembled. In addition, it analyses the impact value, i.e., rework delays and costs, of manufacturing processes using a statistical process control tool on real-time data for various manufactured components. Defects are detected and classified using the CNN and teachable machine in the single manufacturing process during the initial stage prior to assembling the components. The results show the significance of the proposed approach in improving operational cost management and reducing rework-induced delays. Ground tests are conducted to calculate the impact value followed by the air tests of the final assembled aircraft. The statistical results indicate a 52.88% and 34.32% reduction in time delays and total cost, respectively.

Integrated synthesis and control of heat exchanger networks with dynamic flexibility consideration

• Dynamic flexible aspect is taken into account in early integration stage. • A sequential iterative algorithm for the problem solution is devised. • Stream matches, heat transfer areas and bypass fractions are optimized. • Results indicate considerable cost (−14.95%) and control performances (+61.83%). • Major advantages found for case studies with multiple disturbances. Flexible synthesis and control which can be both used to reduce the influences of disturbances on heat exchanger networks are often considered as two separate issues assisting network development at different stages. A proper integration of these separate yet connected tasks carries the promise of achieving superior designs. Currently, the study of integration of heat exchanger networks is still towards a sequential procedure consisting of initial flexible synthesis based on steady-state economic calculations followed by a controller. To overcome this challenge, based on the stage-wise superstructure, an optimization framework in this work is presented to address dynamic flexible synthesis and advanced control simultaneously for maximizing performance in face of disturbances. The framework is based on a sequential iterative procedure that decomposes the overall problem into two stages. The first stage is performed by the dynamic flexibility analysis where the design variables are chosen. In the second stage, the optimization variables are adjusted during the discrete time intervals on the realizations of the control actions and the variation ranges of outlet stream temperatures. The sequential iterative is to map the temperature regulations to the network configuration retrofits. The application to two case studies indicates that the proposed framework returns solutions which are considerably better all in terms of dynamic flexibility, economics and control performance than those published in literature. Compared to previous literature studies, the optimized solutions feature a total annual cost reduction up to 14.95%, a decrease in control action up to 48.58% and an increase in control performance up to 61.83%. Moreover, the application to two case studies indicates that allows solving a real-world problem with up to 26 hot streams and 29 cold streams (leading to models with a size of 523 binary variables and 1655 equations).

Joint Production and Maintenance Scheduling for Total Cost and Machine Overload Reduction in Manufacturing: A Genetic Algorithm Approach

Joint Production and Maintenance Scheduling for Total Cost and Machine Overload Reduction in Manufacturing: A Genetic Algorithm Approach

New synthetic red- and orange-emitting luciferases to upgrade in vitro and 3D cell biosensing.

Bioluminescence (BL), i.e., the emission of light in living organisms, has become an indispensable tool for a plethora of applications including bioassays, biosensors, and in vivo imaging. Current efforts are focused on the obtainment of new luciferases having optimized properties, such as improved thermostability at 37 °C, pH-insensitive emission, high quantum yield, extended kinetics and red-shifted emission. To address these issues we have obtained two new synthetic luciferases, an orange and a red-emitting luciferase, which were designed to achieve high sensitivity (BoLuc) and multiplexing capability (BrLuc) for in vitro and in vivo biosensing using as a starting template a recently developed thermostable synthetic luciferase (BgLuc). Both luciferases were characterized in terms of emission behaviour and thermal and pH stability showing promising features as reporter proteins and BL probes. As proof-of-principle application, an inflammation assay based on Human Embryonic Kidney (HEK293T) 3D cell cultures was developed using either the orange or the red-emitting mutant. The assay provided good analytical performance, with limits of detection for Tumor Necrosis Factor (TNFα) of 0.06 and 0.12 ng mL-1 for BoLuc and BrLuc, respectively. Moreover, since these luciferases require the same substrate, D-luciferin, they can be easily implemented in dual-color assays with a significant reduction of total cost per assay.

A new multi-objective profit-driven micro-CHP planning model under participation in thermal and electrical markets

Recently, residential micro-combined heat and power (µCHP) systems have been increasingly used worldwide and simultaneously participated in thermal and electrical markets. To enhance practicality of µCHP system planning (MSP), this research proposes a new multi-objective optimization model for MSP considering investment costs and participation profits in thermal and electrical markets. A multi-objective optimization problem includes more than one objective and usually these objectives are competing which means that there is no single optimal solution that simultaneously optimizes all of them. Maximizing the participation profits along with minimizing investment costs can more effectively persuade investors to invest on MSP. Additionally, exergy efficiency and thermal discomfort level are considered in the proposed multi-objective model. Moreover, an improved lexicographic weighted Tchebycheff (ILWT) approach is developed for solving the proposed multi-objective MSP problem, which generates effective Pareto optimal solutions with a low computation burden. The proposed MSP model and ILWT solution approach are tested on a real-world µCHP system. It is shown that the proposed MSP model achieves a significant total cost reduction by the amount of 24.5% compared with conventional MSP model. Also, the proposed ILWT, compared with its nearest competitor, obtains about 3% higher preference with more than 39% lower computation time.

Отраслевой аспект расширения торговли в Западной макрозоне АТР: роль глобальных форматов

The purpose of this study was to assess the impact of countries participation in global trade formats on the turnover of commodity and industrial products in the Western macrozone of the Asia-Pacific Region (APR) in 1993–2021. It is shown that over the last three decades the Western macrozone of the APR, which includes the countries of East Asia, Oceania and Australia, has become the most dynamic economy in the world due to the reduction of restrictions in intra-regional trade. The estimation of border effects based on the gravity model confirmed the long-term total cost reduction for trade in commodity and industrial products in the Western macrozone of the APR. The estimates identified the crucial importance of global format mechanisms for trade expansion in the Western macrozone of the APR in the long run: by 113% for commodity products; by 101% for industrial products. The assessment of indirect trade effects revealed the key role of global formats in expanding trade in the Western macrozone of the APR by creating a common ‘benchmark’ for reducing trade barriers, including by extending such behavior to countries that have not acceded to the GATT and WTO. The discovered multiplication of direct and indirect trade effects of the GATT and WTO indicated the sufficiency of the mechanisms of global formats for the formation of a free market for commodities in the Western macrozone of the APR, which does not require the creation of free trade zones, in contrast to the market for industrial goods, which operates under conditions of monopolistic competition. The estimates obtained in the study complement the existing conclusions on the impact of integration formats on trade, indicating that the sectoral aspect of trade interactions is a key parameter for identifying rational motives explaining the use of specific integration instruments to expand trade within the Western macrozone of the APR. On the basis of the obtained assessments the motives of Russia’s long-term trade and economic positioning within the Western macrozone of the APR with reliance on the WTO mechanisms under the conditions of preserving the raw material model of the national economy are explained

가스히트펌프를 이용한 온실 난방 및 배가스 탄산시비 시스템의 경제성 및 온실가스 배출 영향 평가

The area of domestic horticulture continuously enlarged and the heating costs also increased to about 30 ~ 40% of the total operating expenses. To enhance the profitability of production, it is increasingly important to estimate the energy costs of greenhouses properly. This study aimed to compare the economic feasibility and the greenhouse gas emission of greenhouse energy systems according to heating methods with different fuel types. The annual power consumption was calculated by using TRNSYS, a commercial Building Energy Simulation(BES) tool. First, the model validation was performed using the experimental data obtained from the greenhouse that uses a gas engine drive heat pump. The results were compared with the reference kerosene heating case (CASE 1), which is widely used in domestic greenhouses. The analysis showed that gas heating case (CASE 2) has reduced total energy costs by 20% and greenhouse gas emissions by 10%. Whereas, the exhaust gas from gas engine driven heat pump can be used as a CO₂ source for enhancing photosynthesis. Lastly. the results from the GHP heating case (CASE 3) showed a 46% reduction in total cost and a 63% reduction in greenhouse gas emissions.

Efficient utilization of CO2 in power-to-liquids/power-to-gas hybrid processes: An economic-environmental assessment

Power-to-liquid (P2L) and Power-to-Gas (P2G) processes are considered as sustainable pathways to mitigate climate change. In both P2L and P2G processes, H2 production via water electrolysis has received widespread attentions, including PEM, AEM, SOEC and AWE technologies. Based on the preceding technical study on four P2L/P2G hybrid processes composed of above-mentioned water electrolysis technologies, a systematic study of P2L/P2G processes and economic analysis were conducted to quantitatively evaluate their economic performances in terms of total production cost (TPC) and net CO2 reduction cost (CRC). The P2L/P2G process coupled with SOEC technology has the lowest TPC of 204 M$/year, while that coupled with AEM technology has the lowest net CRC of 274 $/tonne CO2. Moreover, we further proposed nine process scenarios for P2L/P2G processes using grey, blue, and green H2, and compared their process performances in terms of TPC and global warming potential (GWP). The P2L/P2G process via water electrolysis using wind electricity reduces GWP by 61.50%, whereas its TPC is 1.39 times higher than that with coal gasification due to the relatively high production cost. It is anticipated that a significant cost saving in the water electrolysis units is possible in the future, which will definitely improve the profitability of P2L/P2G process.

Energy-effective and low-cost carbon capture from point-sources enabled by water-lean solvents

Aqueous amines, as the most mature carbon capture technology, are subject to high energy and cost penalties due to the large water content in their formulations. Emerging technologies are in demand to enable a transition to a low-carbon global economy. However, rigorous process modeling and techno-economic analyses are limited for emerging carbon capture technologies. Here, four CO2-Binding Organic Liquids (CO2BOLs), all water-lean solvents were presented as promising options towards energy-effective and low-cost carbon capture from point sources. Rigorous solvent property and process models were developed in Aspen Plus for a coal-fired power plant with CO2BOL-based carbon capture unit. Techno-economic analyses were conducted in 2018 US pricing basis. The results suggest that water-lean formulations can minimize water condensation and vaporization, leading to a 36% energy saving compared with aqueous amines. Indeed, these CO2BOLs can capture up to 97–99% CO2 from coal fired plant. The estimated carbon capture cost is about $40/tonne CO2 at 90–97% carbon capture rate, about 12–23% less expensive than the conventional aqueous amine technology. The comparison between these CO2BOLs showed that in addition to vapor liquid equilibrium and kinetics (key properties for aqueous solvents), viscosity, volatility, and hydrophobicity, also have strong impacts on the performance of water-lean solvents. The methods presented in this work can be used to evaluate other emerging carbon capture technologies, while the results linking costs and performance of carbon capture solvents with their properties. Further, this work identifies research directions and targets for further reductions in total costs of capture from either cost or energy perspectives for these leading water-lean solvents.

OGC P01 Cost utility analysis of a prehabilitation programme in patients undergoing treatment for oesophageal cancer

Abstract Background Treatment of oesophageal cancer is associated with significant morbidity which has an impact on longer term survival. Prehabilitation has been shown to reduce post-operative morbidity and mortality. The aim of this study was to undertake a cost-utility analysis to determine if, based on quality adjusted life-years, prehabilitation should be universally implemented in patients undergoing treatment for oesophageal cancer. Methods Patients with oesophageal cancer who were recruited to a randomised control trial were retrospectively analysed. Three-years follow-up was available for calculating overall survival. Costs were calculated based on network, staging, and treatment algorithms. QALYs were calculated as a matrix cost of treatment, quality of life, and overall survival. Overall survival was calculated from time of diagnosis to death or censorship at three-years follow up. Results Thirty-nine patients were randomised to prehabilitation (n=20, 51%) or standard care (n=19, 49%). The median cost per patient for treatment was £46,770.16 (Inter quartile range (IQR) 41,907.21–58,984.21). The overall cost per patient in the prehabilitation group was lower, £44,382.99 (IQR 42,022.86–54,068.23), when compared with standard care per patient £51,538.07 (IQR41,907.21–68,734.33). The mean survival was 24.7 months in the prehab group compared with 27.7 months in the control group (p=0.523). The cost per-QALY for the prehabilitation group was £24,899.06 compared with £25,781.71 in the standard care group. Conclusions In the setting of a randomised control trial, prehabilitation is clinically effective with observed reductions in total treatment costs and a cheaper cost per QALY.

Vehicle-to-ski: A V2G optimization-based cost and environmental analysis for a ski resort

Ski resorts are becoming perfect demonstrations for the integration of renewable sources. Moreover, the ever-growing global fleet of electric cars (EV) and the increase of battery capacities allow the vehicles to be used for purposes other than driving. This paper aims to study the implementation of a vehicle-to-grid (V2G) application and the development of an MPC-based energy management system (EMS) within a ski resort in the Trentino-Alto Adige Italian region. Using real data for load and production power estimation, the study analyses the economic and environmental impact in three different scenarios by considering the resort’s future trends. The results show that photovoltaic power generation has a significant impact on both cost and environmental aspects, leading to a reduction in total expenditure and CO2 of about 7%. However, assuming an increasing number of charging stations, the exploitation of V2G technology for energy arbitrage does not lead to significant total cost and CO2 reductions (≈2%) for the future scenarios. Conversely, self-consumption improves (≈100%) using different charging strategies. Despite this, a sensitivity analysis on PV production and a joint increase in EVs and energy price gap leads to a significant reduction in total costs of up to 7.7% and 15.2%, respectively.

HSD27 Constrained Optimization Model to Estimate Best Booster Allocation Strategy to Minimize Hospital Bed-Days Under a Fixed Healthcare Budget

COVID-19 vaccine boosters are available in many countries. Public health policymakers face difficult choices over which booster brand to recommend, given limited budgets and the need to maximize health gains. Here, we provide a conceptual model to identify the best booster strategies for age-identified subpopulations under different conditions. A constrained optimization model with an objective function to minimize bed-days was developed that varied population proportion receiving different booster options by age, to identify the best booster strategy that minimized bed-days with a constraint of maximum healthcare expenditure of US$2.10/person. It included a 3-month decision-tree model to calculate bed-days, with the following health states: healthy/asymptomatic; mild (not hospitalized); moderate (general ward); severe (intensive care unit [ICU], no mechanical ventilation); critical (requiring mechanical ventilation); and death. Medical resource utilization (MRU) costs and hospital bed-days were calculated for each health state. The base country was Brazil. Three booster options, B1 (US$1), B2 (US$2), and no-booster (NB, US$0) were considered. Based on real-world effectiveness estimates, B1 and B2 were assumed to be 55% and 75% effective against mild/moderate COVID-19, respectively. Both reduced severe/critical COVID-19 by 90%. The target population was adults eligible for boosters, stratified by age. The best booster strategy identified recommended 100% coverage of those eligible, with B1 for population <70 years and B2 for population ≥70 years. Compared with NB, bed-days were reduced by 75%, hospitalizations by 68%, and ICU admissions by 90% leading to a 60% reduction in total costs (81% reduction in MRU costs). Within individual age-groups, costs were reduced by 57%-66% based on the age-specific disease risk. A constrained optimization model identifies the best age-specific booster allocation strategy to minimize hospital bed-days across different age groups without exceeding a predefined budget. Decision-makers could use this method to achieve the best possible health outcomes when healthcare resources are limited.

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

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

Feasibility and Cost Analysis of Ambulatory Endovascular Aneurysm Repair

Purpose: We sought to compare the costs of ambulatory endovascular aneurysm repair (a-EVAR) and inpatient EVAR (i-EVAR) at up to 1-year of follow-up. Materials and Methods: A retrospective cohort study of consecutive patients undergoing elective EVAR between April 2016 and December 2018 at two academic centers. Patients planned for a-EVAR were compared with i-EVAR. Costs at 30 days and 1 year were extracted. These included operating room (OR) use, bed occupancy, laboratory and imaging, emergency department (ED) visits, readmissions, and reinterventions. Baseline characteristics were compared. Multiple regression model was used to identify predictors of increased EVAR costs. Repeated measures analysis of variance (ANOVA) was used to compare cost differences at 30 days and 1 year via an intention-to-treat analysis. Bonferroni post hoc test compared between-group differences. A p value<0.05 was considered statistically significant. Results: One hundred seventy patients were included. Most underwent percutaneous EVAR (>94%) under spinal anesthesia (>84%). Ambulatory endovascular aneurysm repair was successful in 84% (84/100). Ambulatory endovascular aneurysm repair patients (76±8 years) were younger than i-EVAR (78±9 years). They also had a smaller mean aneurysm diameter (56±6 mm) compared with i-EVAR (59±6 mm). Emergency department visits, readmissions, and reinterventions were similar up to 1 year (all p=NS). Ambulatory endovascular aneurysm repair costs showed a non-statistically significant reduction in total costs at 30 days and 1 year by 27% and 21%, respectively. Patients younger than 85 years and males had a 30-day cost reduction by 34% (p=0.027) and 33% (p=0.035), respectively with a-EVAR. Conclusions: Same-day discharge is feasible and successful in selected patients. Patients younger than 85 years and males have a short-term cost benefit with EVAR done in the ambulatory setting without increased complications or reinterventions. Clinical Impact This study shows the overall safety of ambulatory EVAR with proper patient selection. These patient had similar post-intervention complications to inpatients. Same day discharge also resulted in short-term reduction in costs in male patients and patients younger than 85 years.