Budget Savings Research Articles

Projected Savings to Canadian Provincial Budgets from Reduced Long-Term Care Home Utilization Due to a Disease-Modifying Alzheimer’s Treatment

BackgroundA disease-modifying Alzheimer’s treatment could provide budgetary savings to Canadian provinces from a reduction in long-term care home use, yet we do not know the magnitude of those potential savings.ObjectiveWe project savings to each Canadian province’s budget from 2023 to 2043.DesignAnnual savings are projected using a Markov model. We account for reduction in long-term care home use and in use of Alternative Level of Care (ALC) beds, which are hospital beds occupied by care home-eligible patients on the wait list for admission.ResultsA treatment that delays disease progression by 40% is projected to avoid 142,507 long-term care home and ALC years, resulting in $17.2 billion cumulative savings across all Canadian provinces, a 21% relative reduction among treatment eligible patients. Average per capita savings were $1,132, ranging from $734 (Alberta) to $2,895 (Prince Edward Island). Cumulative savings could increase to $22.7 billion with enhanced triage of patients in primary care stages and to $25.6 billion if all capacity constraints for diagnosis and treatment were removed.ConclusionA disease-modifying treatment could create budgetary savings from lower long-term care home use, offsetting part of the treatment cost. With the increasing demand for long-term care home beds and the high rates of patients being held in hospitals while wait-listed, such a treatment could additionally provide relief to the overburdened long-term care system in Canada.

Budget impact and transferability of cost-effectiveness of DPYD testing in metastatic breast cancer in three health systems.

The cost-effectiveness andbudget impact of introducing extended DPYD testing prior to fluoropyrimidine-based chemotherapy in metastatic breast cancer patients in the UK, The Netherlands and Hungary were examined. DPYD testing with ToxNav© was cost-effective in all three countries. In the UK and The Netherlands, the ToxNavstrategy led to more quality-adjusted life yearsand fewer costs to the health systems compared with no genetic testing and standard dosing of capecitabine/5-fluorouracil. In Hungary, the ToxNavstrategy produced more quality-adjusted life years at a higher costcompared with no testing and standard dose. The ToxNavstrategy was found to offer budget savings in the UK and in The Netherlands, while in Hungary it resulted in additional budget costs.

KOMPARASI MODEL COLLABORATIVE COLLECTION DEVELOPMENT DAN JUST-IN-TIME COLLECTION DEVELOPMENT PADA PERPUSTAKAAN PENDIDIKAN

This study aims to answer the question of how the application of collaborative and just-in-time model collection development and how the comparison of the two models that have been applied to educational libraries. The method used in this research is a critical review method with a literature study approach. The writer made comparation and analyze between two articles which adopted in different model of collection development. The research findings are as follows: 1) The collaborative collection development model utilizes library networks to save budgets and accelerate collection availability, while the just-in-time collection development model applies a responsive access-based collection development approach. This policy is to provide the right and fast collection and save funds. 2) The difference between these two models is that the collaborative model requires a network so as to facilitate the process of both procurement together in order to create budget savings, while the just-in-time collection development is a single model that does not really require a network so that it has absolute autonomy.

Creating an evidence-based economic model for prefilled parenteral medication delivery in the hospital setting

ObjectivesPrefilled syringes (PFS) may offer clinical and economic advantages over conventional parenteral medication delivery methods (vials and ampoules). The benefits of converting from vials and ampoules to PFS have been...

Budget impact analysis and treatment availability with biosimilar TNF inhibitors in rheumatic diseases in Poland: real-world evidence using a nationwide database

ObjectivesAlthough several years have passed since biologic disease modifying antirheumatic drugs were introduced to the market, considerable disparities in access still remain. Tumour necrosis factor inhibitors (TNFi) have proven to...

Doing more with less? Assessing the cost efficiency of US local police organizations

ABSTRACT We examine the cost efficiency of local police agencies in the US for 2016. We employ a multi-output translog stochastic frontier model and show that reductions in inefficiency would yield significant budgetary savings and improved performance in service delivery.

A ‘one-stop-shop’ point-of-care hepatitis C RNA testing intervention to enhance treatment uptake in a reception prison: The PIVOT study

Prisons are key venues for scaling-up hepatitis C virus (HCV) testing and treatment. Complex clinical pathways and frequent movements of people in prison remain barriers to HCV care. This study evaluated the impact of a 'one-stop-shop' point-of-care HCV RNA testing intervention on treatment uptake compared with standard of care among people recently incarcerated in Australia. PIVOT was a prospective, non-concurrent, controlled study comparing HCV treatment uptake during 'standard of care' (n= 239; November 2019-May 2020) and a 'one-stop-shop' intervention (n= 301; June 2020-April 2021) in one reception prison in Australia. The primary endpoint was uptake of direct-acting antiviral treatment at 12 weeks from enrolment. Secondary outcomes included the time taken from enrolment to each stage in the care cascade. A total of 540 male participants were enrolled. Median age (29 vs. 28 years) and history of injecting drug use (48% vs. 42%) were similar between standard of care and intervention phases. Among people diagnosed with current HCV infection (n= 18/63 in the standard of care phase vs. n= 30/298 in the intervention phase), the proportion initiating direct-acting antiviral treatment within 12 weeks from enrolment in the intervention phase was higher (93% [95% CI 0.78-0.99] vs. 22% [95% CI 0.64-0.48]; p <0.001), and the median time to treatment initiation was shorter (6 days [IQR 5-7] vs. 99 days [IQR 57-127]; p <0.001) compared to standard of care. The 'one-stop-shop' intervention enhanced treatment uptake and reduced time to treatment initiation among people recently incarcerated in Australia, thereby overcoming key barriers to treatment scale-up in the prison sector. This study provides important insights for policymakers regarding optimal HCV testing and treatment pathways for people newly incarcerated in prisons. The findings will improve health outcomes in people in prison with chronic HCV infection by increasing testing and treatment, thereby reducing infections, liver-related morbidity/mortality, and comorbidities. The findings will change clinical practice, clinical guidelines, and international guidance, and will inform future research and national and regional strategies, in particular regarding point-of-care testing, which is being rapidly scaled-up in various settings globally. The economic impact will likely include health budget savings resulting from reduced negative health outcomes relating to HCV, and health system efficiencies resulting from the introduction of simplified models of care. This study is registered at Clinicaltrials.gov (NCT04809246).

Updated clinical and economic analysis of using follitropin alfa in combination with assisted reproductive technologies in 2022

Objective: to perform a clinical and economic analysis of using drugs containing follitropin alfa as an active substance and to assess the impact of the studied drugs on the budget of the state healthcare system of the Russian Federation considering cost data for 2022 in the population of women with infertility and poor ovarian response who are undergoing treatment with the use of assisted reproductive technologies (ART).Material and methods. Clinical and economic evaluation of follitropin alfa use in patients with infertility and poor ovarian response was performed by a cost minimization method, using data from the Uniform Information System for Procurement for the period from July to December 2022 inclusive. The budget impact analysis model compared the costs required for ovarian stimulation of patients with poor ovarian response receiving only a fixed dose combination (FDC) of follitropin alfa + lutropin alfa with the expected practice of switching 25% of these patients to follitropin alfa with a modeling time horizon of 1 year.Results. A cost analysis of an ovarian stimulation course using biosimilar follitropin alfa showed cost savings of 17% compared with the cost of therapy using the original follitropin alfa. Also, cost minimization analysis per cycle of ovarian stimulation demonstrated that the use of the biosimilar follitropin alfa was characterized by cost savings of 24,420 rubles (32.37%) compared to FCD of follitropin alfa + lutropin alfa. Compared to the 2021 data, in the current study based on 2022 data and including only biosimilar follitropin alfa, there was a 103% increase in savings. Budget impact analysis determined that switching 25% of the population from FCD of follitropin alfa + lutropin alfa to follitropin alfa would reduce direct medical costs by 17.3 million rubles (8.1%) per year. Savings in direct medical costs in the current study compared to 2021 increased by 117%.Conclusion. The clinical and economic analysis, as well as the budget impact analysis of using biosimilar follitropin alfa for ovarian stimulation in a population of women with infertility and poor ovarian response, confirm the economic expediency revealed in 2021. Moreover, according to 2022 data, the use of biosimilar follitropin alfa results in additional budgetary savings.

Formulary Management of Biologics in Plaque Psoriasis

&#x0D; Unlike the new-generation biologics (interleukin [IL]-17 and IL-23 inhibitors), all old-generation biologics (anti–tumour necrosis factor [TNF] and anti–IL-12/23 biologics) for plaque psoriasis (PsO) have now lost their exclusivity status and most were launched prior to the pan-Canadian Pharmaceutical Alliance. In addition, biosimilar versions of the old-generation biologics have had limited uptake and delayed launches in Canada spanning multiple years, suggesting a significant opportunity cost paid for these drugs after loss of exclusivity.&#x0D; Modern clinical evidence, which is more rigorous than the evidence supporting the old-generation drugs and includes head-to-head trials comparing IL-17 and IL-23 inhibitors with anti-TNF and anti–IL-12/23 biologics, have demonstrated greater efficacy with the new-generation biologics.&#x0D; In Canada, despite access to newer and more efficacious treatments, physicians continue to prescribe old-generation drugs to patients newly initiating a biologic for PsO (25% of patients in 2020), and the new-generation biologics are also less costly on an average per patient basis at list price compared with the most utilized old-generation biologic (ustekinumab).&#x0D; Public payers have spent $28 million (at list price) on biologics initiated for PsO beyond their loss of exclusivity from 2016 to 2020 ($600 million for biologics initiated for any indication), and that figure is likely much higher today. Notably, some IL-17 biologics will lose data protection within the next 2 years, which will further increase this opportunity cost.&#x0D; It is prudent that decision-makers review the place in therapy of biologics for PsO. Based on the findings of this report, the policy recommendation is to assess the clinical and economic value of old-generation biologics in the context of current evidence standards in PsO. The promotion of the use of new-generation biologics should be considered by payers to support the appropriate use of biologics in PsO, which would improve patient outcomes with budget savings or neutrality (assuming no confidential pricing agreements with the old-generation biologics) versus the status quo.&#x0D;

Cost-Effectiveness of Fractional Exhaled Nitric Oxide Suppression Testing as an Adherence Screening Tool Among Patients With Difficult-to-Control Asthma

Approximately 50% of adults on long-term asthma medication are non-adherent. Current methods to detect non-adherence have had limited effect. Fractional exhaled nitric oxide suppression testing (FeNOSuppT) has demonstrated clinical effectiveness as an adherence screening tool to detect poor adherence to inhaled corticosteroids in difficult-to-control asthma prior to initiation of expensive biologic therapy. Estimate the cost-effectiveness and budget impact of FeNOSuppT as a screen prior to the initiation of biologic therapy among US adults with difficult-to-control asthma and high FeNO (≥45ppb). A decision tree simulated the progression of a cohort of patients over a one year time horizon into one of three states [discharged from (1) or remain in (2) specialist care; or progress to biologics (3)]. Two strategies, with and without FeNOSuppT, were examined and the incremental net monetary benefit (INMB) estimated using a discount rate of 3% and a willingness to pay (WTP) threshold of $100,000 per quality-adjusted life year (QALY). Sensitivity analysis and a budget impact analysis were also undertaken. In the baseline scenario, FeNOSuppT prior to the initiation of biologic therapy was associated with lower costs ($4,435/patient) and fewer QALYs (0.0023QALY/patient) compared to no-FeNOSuppT over one year and was considered cost-effective (INMB=$4,207). FeNOSuppT was consistently found to be cost-effective across a range of scenarios and in deterministic and probabilistic sensitivity analyses. Assuming differential levels of FeNOSuppT uptake (20%-100%), this was associated with budget savings ranging from USD $5m-$27m. FeNOSuppT is likely to be cost-effective as a protocol-driven, objective, biomarker-based tool for identifying non-adherence in difficult-to-control asthma. This cost-effectiveness is driven by cost-savings from patients not progressing to expensive biologic therapy.

Adapting international clinical trials during COVID-19 and beyond.

The COVID-19 pandemic and resulting restrictions, particularly travel restrictions, have had significant impact on the conduct of global clinical trials. Our clinical trials programme, which relied on in-person visits for training, monitoring and capacity building across nine low- and middle-income countries, had to adapt to those unprecedented operational challenges. We report the adaptation of our working model with a focus on the operational areas of training, monitoring and cross-site collaboration. Adaptations include changing training strategies from in-person site visits with three or four team members to a multi-pronged virtual approach, with generic online training for good clinical practice, the development of a library of study-specific training videos, and interactive virtual training sessions, including practical laboratory-focused training sessions. We also report changes from in-person monitoring to remote monitoring as well as the development of a more localized network of clinical trial monitors to support hybrid models with in-person and remote monitoring depending on identified risks at each site. We established a virtual network across different trial and study sites with the objective to further build capacity for good clinical practice-compliant antimalarial trials and foster cross-country and cross-study site collaboration. The forced adaptation of these new strategies has come with advantages that we did not envisage initially. This includes improved, more frequent engagement through the established network with opportunities for increased south-to-south support and a substantially reduced carbon footprint and budget savings. Our new approach is challenging for study sites with limited prior experience but this can be overcome with hybrid models. Capacity building for laboratory-based work remains difficult using a virtual environment. The changes to our working model are likely to last, even after the end of the pandemic, providing a more sustainable and equitable approach to our research.

Budgetary Impact of 20-Valent Pneumococcal Conjugate Vaccine Use for Adult Expatriates Living in Dubai

Dubai Health Authority currently recommends sequential administration of 13-valent pneumococcal conjugate vaccine (PCV13) followed by (→) 23-valent pneumococcal polysaccharide vaccine (PPV23) to prevent pneumococcal disease among adults at elevated risk of illness. Despite recommendations, disease burden and associated costs remain substantial. A new 20-valent pneumococcal conjugate vaccine (PCV20) recently received regulatory approval in the United Arab Emirates and has the potential to further reduce burden of pneumococcal disease. To evaluate budget impact of use of novel PCV20 compared with current recommendations (ie, PCV13→PPV23) among expatriates in Dubai aged 50 to 99 years and those aged 19 to 49 years with risk factors. A deterministic model depicted 5-year risks and costs of invasive pneumococcal disease and all-cause nonbacteremic pneumonia. Each year of the modeling horizon, persons could be vaccinated with either PCV20 or PCV13→PPV23 or remain unvaccinated; persons vaccinated during the modeling horizon were not eligible for vaccination in subsequent years. Annual vaccine uptake was assumed to be 5% in base cases analyses; higher uptake was considered in scenario analyses. Costs were discounted at 3.5% annually and reported in US dollars. In base case, use of PCV20 alone would prevent an additional 13 cases of invasive pneumococcal disease, 31 cases of inpatient all-cause nonbacteremic pneumonia, 139 cases of outpatient all-cause nonbacteremic pneumonia, and 5 disease-related deaths compared with PCV13→PPV23. Medical care costs would be reduced by $354,000, and total vaccination costs would decrease by $4.4 million. PCV20 would therefore yield net budgetary impact of -$4.8 million, resulting in savings of $2.47 per-person per-year over 5 years. In scenarios with higher vaccine uptake, PCV20 prevented more cases and deaths and yielded greater budget savings (vs PCV13→PPV23). PCV20 would reduce burden and economic costs of pneumococcal disease among expatriates in Dubai compared with PCV13→PPV23 and would therefore be budget saving for private health insurers who cover the majority of this population.

ВЫЗОВЫ И ПЕРСПЕКТИВЫ УКРУПНЕНИЯ МУНИЦИПАЛЬНЫХ ОБРАЗОВАНИЙ НА ПРИМЕРЕ МОСКОВСКОЙ ОБЛАСТИ

The article is devoted to the study of challenges and prospects of the reform of territorial organization of local self-government as the problem, which has become relevant in the context of the upcoming new law on local self-government regulation. Recently, some experts have been expressing concerns about the final transition to a homogenous system of local self-government in Russia, which will be expressed in the abolition of urban and rural settlements. The declared goals of the reform, among which there are an increase of budgetary independence and reduction in the cost of local administration maintenance, are criticized, but at the same time there is still a lack of thematical practice-oriented research. Therefore, the study examines actual results of transformation of territorial organization of local self-government in the Moscow region as an example of a region, where all municipalities were granted the status of urban districts before the end of 2019. The study is based on a theoretical framework, which is centered around public choice and economies of scale theories. A hypothesis is drawn that the spread of urban and municipal districts may lead to a decrease in the territorial accessibility of local self-government followed by no reduction in the cost of its maintenance. The pre- and post-reform values ​​of indicators, characterizing territorial accessibility of local self-governments and its services and the volume of expenses connected to local self-government maintenance are compared. Conclusions are drawn about the negative impact of the reform: the availability of local authorities and local services for citizens is declining, while there are no visible budgetary savings due to staff cuts.

Innovative methods of restoration by bac-teria, which secrete calcium, overgrowing microcracks

Innovative building materials are considered, allowing the use of new design solutions and the construction of durable structures that meet technical requirements and aesthetic requirements. The main properties, characteristics, objects and methods of application of hydraulic concrete and self-healing concrete are described. Self–healing concrete is a new stage in the development of building materials. The new self-healing concrete differs from classical recipes by adding fungi and bacterial spores to the composition, which can survive in alkaline conditions and give new properties to the building material. From the analysis of literary sources, we came to the conclusion that the long-term operation of various hydraulic structures is affected by water and the environment. All these factors lead to a decrease in the structural strength of hydraulic structures. A new self-healing material is needed in places where the production of minor repairs and regular inspection of the condition of structures is impossible: underground construction; underwater construction; high-rise buildings; bridge-type transport structures. Another advantage of new generation building materials is the possibility of budget savings, since there is no need for constant minor repairs of structures. The purpose of this work is the research and development of technology for the production of self-healing concrete modified with a micro-biological additive. In accordance with the goal, we analyzed the physical and mechanical properties of concrete and other cement composites, ways to improve them, studied damages and defects that reduce the durability of reinforced concrete structures, the process of structure formation, as well as ways to repair and restore them. Based on the analysis, a technology for creating industrial-scale concrete modified with a microbiological additive and self-healing structures is proposed. This area of research is very promising; the potential profit from the use of such concretes in hydraulic structures is huge.

Efektivitas Penerimaan CPNS dalam Memenuhi Kebutuhan Pegawai Pasca Moratorium Penerimaan CPNS di Pemkab Mojokerto

Moratorium of new recruitment of civil servant (CPNS) has been set by the government in the framework of budget savings and improving management of human resources (HR). The HR policies is carried out under the direction of policy in the grand design and road map of the national bureaucratic reforms. The aims of this article to analyze steps and the implications taken by the government in managing the re-organization of PNS and Its staff by issuing the moratorium policy. This policy, in addition to cut personnel expenditure budget, is also intended to restructure civil servants and their organization in order to optimize the bureaucratic reform agenda at the districts of Mojokerto.

The Financial Literacy of the Population as a Factor of Social Development

The proposed work examines financial literacy from the point of view of social awareness of the younger generation, reveals the essence of financial literacy as a system of knowledge, skills, skills and attitudes in the financial field, and defines the current tasks aimed at increasing financial literacy in Russia. The development of market relations, the trend of global globalization, the availability on the market of a wide range of previously unknown financial goods and services often lead Russians into confusion, posing problems for them, to which they are not properly prepared. All categories of citizens need financial education. A decent level of financial education allows adults to organize effective management of personal finances, optimize the ratio of savings to consumption, plan future pension provision, objectively assess possible risks and make reasonable decisions when investing own capital. The growing generation of financial education allows you to understand the value of money, serves as a basis for acquiring the basics of budget planning and savings, in general terms allows you to understand the essence of the financial market and products offered on it. Financial literacy is a complex of knowledge, skills, attitudes and behaviors in the financial field and personal socio-psychological characteristics, the formation of which determines the possibility and degree of a person's readiness to successfully perform a variety of socioeconomic roles, such as a householder, investor, borrower, taxpayer, e. Financial literacy makes it possible to determine at what level the student's financial relationships are with the society, in addition, it is an integral part of the student's social competence. Knowledge, skills, attitudes and attitudes in the financial sphere are cognitive, active and motivational-value elements of financial literacy. As a result of the given research we exmind summarized Russian Federation experience in propaganda of economic literacy.

Budget impact analysis of the subcutaneous infliximab (CT-P13 SC) for treating inflammatory bowel disease in the Big-5 European (E5) countries

BackgroundIn 2020, the European Medicines Agency approved infliximab subcutaneous (SC) for the treatment of inflammatory bowel disease. This new mode of infliximab administration will reduce outpatient visits and costs of intravenous (IV) administration. This article describes a budget impact analysis of introducing infliximab SC to the Big-5 European (E5) market (Germany, France, Italy, Spain and UK) for 5 years, from the healthcare payer’s perspective.MethodsA prevalence-based budget impact model was developed to examine the financial impact of infliximab SC. “World with” versus “world without” infliximab SC scenarios were compared, including the potential administration costs of IV administration.ResultsIntroducing infliximab SC in patients with Crohn’s disease (CD) for 5 years resulted in cost savings of €42.0 million in the UK, €59.4 million in Germany, and €46.4 million in France and Italy, but increased budget expenditure in Spain by €3.8 million. For ulcerative colitis (UC), cost savings of €42.7 million in the UK, €44.9 million in Germany, €44.3 million in France, and €53.0 million in Italy occurred, but with no savings in Spain for 5 years. Cost-savings per patient was calculated by diving the net budget saving by number of treatment eligible patients. Maximum and minimum saving per patient per year ranged between €38.25 and €575.74 in CD, both from Germany, and €105.06 (France) and €647.25 (Germany) in UC.ConclusionHealthcare payers in the UK, Germany, France, and Italy, but not in Spain, will make budget savings by using infliximab SC for the treatment of inflammatory bowel disease.

Similar costs and outcomes for differentiated service delivery models for HIV treatment in Uganda

This cost-outcome study estimated, from the perspective of the service provider, the total annual cost per client on antiretroviral therapy (ART) and total annual cost per client virally suppressed (defined as < 1000 copies/ml at the time of the study) in Uganda in five ART differentiated service delivery models (DSDMs). These included both facility- and community-based models and the standard of care (SOC), known as the facility-based individual management (FBIM) model. The Ministry of Health (MOH) adopted guidelines for DSDMs in 2017 and sought to measure their costs and outcomes, in order to effectively plan for their resourcing, implementation, and scale-up. In Uganda, the standard of care (FBIM) is considered as a DSDM option for clients requiring specialized treatment and support, or for those who select not to join an alternative DSDM. Note that clients on second-line regimes and considered as “established on treatment” can join a suitable DSDM.Using retrospective client record review of a cohort of clients over a two-year period, with bottom-up collection of clients’ resource utilization data, top-down collection of above-delivery level and delivery-level providers’ fixed operational costs, and local unit costs. Forty-seven DSDMs located at facilities or community-based points in the four regions of Uganda were included in the study, with 653 adults on ART (> 18 years old) enrolled in a DSDM. The study found that retention in care was 98% for the sample as a whole [96–100%], and viral suppression, 91% [86-93%]. The mean cost to the provider (MOH or NGO implementers) was $152 per annum per client treated, ranging from $141 to $166. Differences among the models’ costs were largely due to clients’ ARV regimens and the proportions of clients on second line regimens. Service delivery costs, excluding ARVs, other medicines and laboratory tests, were modest, ranging from $9.66–16.43 per client per year. We conclude that differentiated ART service delivery in Uganda achieved excellent treatment outcomes at a cost similar to the standard of care. While large budgetary savings might not be immediately realized, the reallocation of “saved” staff time could improve health system efficiency and with their equivalent or better outcomes and large benefits to clients, client-centred differentiated models would nevertheless add great societal value.

Analisis Kinerja Keuangan Badan Perencanaan Pembangunan Daerah, Penelitian dan Pengembangan (Bappedalitbang) Kabupaten Deli Serdang

The Regional Development Planning Agency, Research and Development (BAPPEDALITBANG) of Deli Serdang Regency is a regional technical institution in the field of regional development planning led by a head of the agency who is under and responsible to the Governor/Regent/Mayor through the regional secretariat. This study aims to assess the financial performance of Bappedalitbang Deli Serdang Regency for five fiscal years. In measuring financial performance, it is more focused on the Budget Realization Report (LRA). The measurement of financial performance is carried out to determine the absorption of the budget and the use of the budget during the five fiscal years on activities that exist in the agency itself. This research uses a qualitative approach with data collection techniques in the form of documentation. The analytical method used is descriptive method with the formula: compatibility analysis of spending which is divided into direct and indirect spending, effectiveness analysis, spending variance analysis, efficiency analysis and spending growth analysis. The results of the analysis show that the financial performance of the Deli Serdang Regency Bappedalitbang from 2019-2022 seen from the shopping compatibility analysis shows poor financial performance, because the total indirect spending is 51% and for direct spending 49%, so it can be said that the Bappedalitbang for the Regency Province Deli Serdang pays little attention to regional development. From the analysis of spending growth in 2019-2022 it is said to be good, because it can be seen that there has been a growth in spending for five years with a total of 1%, with a maximum value of 14% in 2019 and a minimum value of 3% in 2019. 2019-2022 can be said to be good, with a total comparison of 89%. However, judging from the effectiveness ratio of the use of the budget for five years, it can be said to be quite effective with the total ratio reaching 83%. Meanwhile, if viewed from the efficiency ratio, the Bappedalitbang Deli Serdang Regency is said to be quite efficient in using its budget from 2019-2022, with a total of 34 %, so in this case the Deli Serdang Regency Bappedalitbang has been able to make budget savings. &#x0D; &#x0D; Keywords: Financial Performance, shopping compatibility ratio, efficiency, effectiveness, and variance.

Projected Ontario budget savings from reduced long-term care utilization due to a disease-modifying Alzheimer’s treatment

Projected Ontario budget savings from reduced long-term care utilization due to a disease-modifying Alzheimer’s treatment Hankyung Jun PhD, Sol Price School of Public Policy, University of Southern California (USC) Zehao Shi, Center for Economic and Social Research,