Cost Savings Research Articles

A comprehensive outline towards conciliation in the contemporary world of E-commerce

Since the start of the millennial era, technical advancements have led to exponential growth in electronic commerce, or e-commerce. According to the United Nations Conference on Trade and Development (UNCTAD), e-commerce sales reached about US$25 trillion globally in 2021 [1] and are expected to grow at a compound annual growth rate of 9% through 2027, which is twice as fast as the 4% annual growth rate predicted for traditional in-person retail [2]. Online dispute resolution (ODR) techniques that aim to settle disagreements and lower the likelihood of expensive lawsuits are becoming more and more necessary as both individuals and corporations use online shopping platforms. Due of its legally binding nature, arbitration is the most formal method, as was briefly discussed [3]. Online arbitration is carried out using electronic methods, like email and digital tools designed to make the duties of arbitrators and parties to a dispute easier. It adheres to the same rules and processes as traditional arbitration. On the plus side of e-arbitration, advancements in technology allow for time and cost savings without sacrificing the ease of remote filing. The conclusion of e-arbitration agreements raises several negative issues, including privacy and data protection issues for the consumer signing the agreements and power imbalances between corporate entities and the consumer. The degree to which artificial intelligence (AI) is effectively and sufficiently analysing a dispute between parties is up for debate because it's unclear how new this adjudication process is.

Digital tools and AI: Using technology to monitor carbon emissions and waste at each stage of the supply chain, enabling real-time adjustments for sustainability improvements

The increasing urgency of addressing climate change has necessitated the adoption of innovative technologies to monitor and mitigate carbon emissions and waste throughout the supply chain. This paper explores the role of digital tools and artificial intelligence (AI) in enabling real-time tracking and analysis of environmental impact at each stage of the supply chain. By integrating IoT devices, big data analytics, and machine learning algorithms, organizations can gain comprehensive insights into their operations, identifying key areas where emissions and waste can be reduced. The use of AI-powered predictive analytics allows companies to model various scenarios, optimizing resource allocation and operational efficiency while minimizing environmental footprints. This research also highlights successful case studies where companies have implemented these technologies, resulting in significant sustainability improvements and cost savings. Furthermore, the paper discusses the challenges associated with data integration, system interoperability, and the need for industry-wide standards to ensure effective monitoring and reporting. The importance of stakeholder collaboration is emphasized, as engaging suppliers, customers, and regulatory bodies is essential for achieving comprehensive sustainability goals. Ultimately, this paper advocates for the strategic implementation of digital tools and AI as pivotal enablers of sustainable supply chain management, providing organizations with the capability to adapt to changing environmental regulations and consumer expectations. By leveraging technology to monitor and reduce carbon emissions and waste, businesses can enhance their competitiveness while contributing to a more sustainable future.

Enhancing HIV/AIDS and TB medication logistics: A comprehensive approach to global healthcare distribution

The distribution of HIV/AIDS and tuberculosis (TB) medications is critical to the success of global healthcare initiatives, particularly in regions with limited infrastructure and resources. This review examines the logistical challenges hindering the efficient delivery of these life-saving medications, including supply chain inefficiencies, poor infrastructure, and geographical barriers. It also explores innovative approaches to optimizing logistics, such as the use of blockchain, drones, and artificial intelligence (AI), alongside public-private partnerships (PPPs) and supportive policy frameworks. These emerging technologies have the potential to enhance the availability and effectiveness of HIV/AIDS and TB treatments by improving supply chain transparency, reducing stockouts, and overcoming transportation challenges in remote areas. The paper further assesses the impact of these logistical improvements on healthcare outcomes, demonstrating how they contribute to improved patient adherence, reduced disease transmission, and cost savings. Finally, recommendations are provided for policymakers, healthcare organizations, and stakeholders to adopt these innovations, and future research directions are proposed to expand these models to other medications and diseases.

Combating food waste in the agricultural supply chain: A systematic review of supply chain optimization strategies and their sustainability benefits

Food waste represents a significant global challenge, with approximately one-third of all food produced for human consumption lost or wasted annually, leading to severe environmental, economic, and social consequences. The issue not only exacerbates food insecurity but also contributes to greenhouse gas emissions, waste of resources, and economic losses estimated at over $1 trillion each year. This paper aims to systematically review the causes of food waste across agricultural supply chains and explore effective supply chain optimization strategies to mitigate these losses. Through a comprehensive analysis, the paper identifies critical drivers of food waste, including post-harvest losses, inefficient processing, and aesthetic standards, while proposing technological innovations such as the Internet of Things (IoT), blockchain, and artificial intelligence (AI) as solutions to enhance supply chain efficiency. Furthermore, it evaluates policy frameworks that support waste reduction, highlighting the role of government incentives and regulations in promoting sustainable practices. The findings underscore the importance of reducing food waste not only for environmental sustainability but also for economic profitability, as optimizing supply chains can lead to substantial cost savings and increased revenue for businesses. Ultimately, the paper emphasizes the necessity for collaboration among stakeholders—including governments, industries, and non-profit organizations—to create systemic change and effectively combat food waste on a global scale. By fostering innovative practices and policies, we can pave the way for a more sustainable agricultural future, ultimately contributing to the alleviation of food insecurity and the enhancement of economic resilience.

Sustainable bridge engineering: Cost reduction and durability enhancement in developing nations

This paper explores innovative approaches to sustainable bridge engineering, focusing on cost reduction and durability enhancement in developing nations. Drawing from my successful projects in Uganda and Guinea, where I reduced construction costs by 30% without compromising structural integrity, I will present detailed case studies that highlight the effective application of sustainable materials and techniques. In Uganda, through the use of locally sourced materials and optimized construction processes, I achieved significant cost savings while ensuring long-term durability in rural infrastructure. Similarly, in Guinea, I implemented advanced engineering practices that prioritized resource efficiency, leading to a reduction in project expenses and a strengthened bridge lifespan. The case studies demonstrate how sustainable engineering practices can be tailored to local conditions and still meet global standards for resilient infrastructure. By emphasizing cost-effective materials such as recycled aggregates and low-carbon concrete, and employing techniques such as modular construction and innovative foundation designs, my work offers a blueprint for reducing expenses while enhancing the longevity of infrastructure. The strategies I employed in Uganda and Guinea are adaptable to other developing nations and can be applied globally, including in the U.S., to build durable and sustainable bridges that address both budgetary constraints and environmental considerations. This paper aligns with the broader goals of sustainable infrastructure development by contributing to the global discourse on resource-efficient engineering solutions. The findings support national and international objectives to enhance infrastructure resilience while minimizing environmental impact and construction costs.

CYP3A5 pharmacogenetic testing for tacrolimus in pediatric heart transplant patients: a budget impact analysis.

Pharmacogenomic testing can optimize drug efficacy and minimize adverse effects. CYP3A5 polymorphisms affect the metabolism of tacrolimus. We sought to estimate the budget impact of preemptive pharmacogenomic testing for CYP3A5 in pediatric heart transplantation patients from an institutional perspective. A decision tree was constructed to estimate the budget impact of pediatric heart transplant patients (age ≤18 years) initiated on tacrolimus with and without CYP3A5 pharmacogenomic testing. The budget impact of preemptive pharmacogenomic testing versus no pharmacogenomic testing was calculated. One-way sensitivity analysis and alternative analyses were conducted to assess the robustness of results to changes in model parameters. CYP3A5 genotype-guided dosing provided savings of up to $17 225 per patient compared to standard dosing. These savings decreased to $11 759 when using another institution's data for the standard-dosing group. The time to achieve therapeutic concentration in the poor metabolizer genotype-guided dosing group had the largest impact on cost savings while the cost of the pharmacogenetic test had the smallest impact on cost savings. Implementing CYP3A5 testing could save $17 225 per pediatric heart transplant patient receiving tacrolimus. As pharmacogenomic testing becomes more widespread, institutions should track resource requirements and outcomes to determine the best implementation policies going forward.

Enhancing System Performance with Observability Data Analytics and Cost Savings

Modern applications are increasingly complex, built using microservices architectures, spread across cloud environments, and deployed globally. Maintaining system performance, reliability, and security is no easy task. Observability, powered by data analytics, helps engineers monitor, understand, and optimize these systems efficiently. Beyond operational benefits, observability leads to significant cost savings by reducing downtime, optimizing infrastructure, and improving development cycles. This article dives into how observability transforms system performance and how it results in real-world savings for businesses

Intraoperative Cost Comparison of Endoscopic Carpal Tunnel Release With WALANT Versus MAC Anesthesia.

The cost of endoscopic carpal tunnel release (ECTR) has historically been shown to be significantly higher than the cost of open carpal tunnel release (OCTR). Setting and anesthetic technique drive costs in hand surgery; ambulatory surgical center (ASC) settings demonstrate lower costs when compared to hospital-based settings and local-only anesthetic techniques demonstrate savings over general anesthesia. The purpose of this study is to compare wide awake local-only anesthesia technique (WALANT) to monitored anesthetic care (MAC) for ECTR performed in an ASC setting. This study includes 481 ECTR under WALANT and 405 ECTR under MAC, performed between January 2019 and December 2021 in an ASC. Utilizing previously reported direct operating room costs, overhead, and material costs, we calculated a final cost for each procedure. We also report our complication rates: intraoperative conversion to OCTR and late revision to OCTR. Intraoperative times were shortest for ECTR performed under WALANT (22 min) versus ECTR under MAC (25 min). The total cost for ECTR under WALANT was most cost-effective at $1341.28 versus ECTR under MAC at $1634.00. Both techniques demonstrated a low complication profile. Our intraoperative process flow, staffing model, and ASC setting resulted in cost savings making ECTR an economically feasible option.

Impact of bundled payments on healthcare use and costs for cardiovascular diseases in the Netherlands

Abstract Background Bundled payments for patients with cardiovascular diseases (CVD) aim to enhance primary care utilization in the Netherlands. This study assesses changes in healthcare utilization patterns and costs for CVD between 2015 and 2019, while investigating the potential association with bundled payment adoption. Methods We studied patients at very high risk for CVD using routinely recorded nationwide healthcare data. Multilevel logistic- and gamma regressions were conducted to assess healthcare utilizations patterns between 2015 and 2019, and the impact of bundled payments on the likelihood of receiving medical specialist care and the height of associated costs. Results The odds of medical specialist involvement declined over time for the 148,876 patients included in our study. This decline was significantly associated with practices’ use of bundled payments. Medical specialist costs did also significantly decrease between 2015 and 2019, and patients in practices with the highest level of bundled payments had significantly lower medical specialist costs. When general practice costs were included however, healthcare costs per patient stayed the same, both over time and stratified by use of bundled payments. Conclusions Our findings suggest an association between bundled payments and specialized healthcare use, potentially facilitating the transition to primary care. While we found no evidence for costs savings, our findings do support a reduction in spending growth. Key messages • We evaluated the impact of bundled payments as a means to facilitate integrated care, and found that bundled payments were associated with lower uptake of specialized medical care. • We found no cost savings were found, but findings do support reduced spending growth.

Cost-effectiveness analysis of implementing the Nagasaki Acute Myocardial Infarction (AMI) secondary prevention clinical pathway

Abstract Background/Introduction Because of the poor prognosis associated with acute coronary syndromes (ACS), intensive low-density lipoprotein cholesterol (LDL-C) management therapy is recommended as early as possible after the onset of ACS, with the goal of lowering plasma LDL-C to <70 mg/dL. In Nagasaki City, a council was formed comprising all hospitals performing percutaneous coronary intervention along with general physicians, and an initiative to manage LDL-C using a region-wide LDL-C management clinical pathway (Figure 1) was launched in July 2022. The rate of intensive statin therapy at discharge increased from 34.5% to 79.8%, and the rate of patients achieving LDL-C <70 mg/dL at discharge increased from 37.2% to 54.6% following the implementation of the clinical pathway. However, the cost-effectiveness of implementing the clinical pathway remains to be determined. Purpose: The purpose of this study was to evaluate the cost-effectiveness of implementing the Nagasaki AMI Secondary Prevention Clinical Pathway. Methods: To evaluate the cost-effectiveness of implementing the clinical pathway compared with no implementation, a lifetime simulation was performed using mathematical models. The models consisted of a decision tree model to model the flow of the clinical pathway (Figure 2) and a Markov model to consider the risks of developing cardiovascular disease (CVD) events. The quality-adjusted life year (QALY) was used as the outcome. Drug costs and treatment costs for each CVD event were included. Drug costs were calculated from actual prescriptions. Treatment costs and utility scores for each event were based on the literature. The risk of each CVD event was calculated using baseline risks estimated using commercial claims data (DeSC Healthcare, Inc.) and patients' LDL-C levels at discharge and 1 month after discharge. LDL-C levels at each time point were set separately for the groups that achieved or did not achieve a discharge LDL-C < 70 mg/dL, for patients with and without implementing the clinical pathway. Results: Implementing the clinical pathway was evaluated as dominant, with an incremental gain of 0.079 QALYs per person and expected cost savings of JPY 103,124 per person. Implementing the clinical pathway was shown to not only provide additional health benefits by preventing CVD, but also to reduce future health care costs. In the analysis with a 10-year time horizon, the result remained dominant, and the same level of cost savings was expected. Conclusions: Implementing the Nagasaki AMI Secondary Prevention Clinical Pathway can be expected to reduce costs, in addition to increasing QALYs by preventing CVD. Further clinical and economic evaluation of long-term follow-up with a collaborative pathway to the general physician after discharge from the hospital is expected.

The power of partnership: Strategies for pan-Canadian spread and scale of paramedics providing palliative care.

Paramedics and Palliative Care is an example of a promising practice ("pilot") that underwent successful spread and scale across Canada. Through the support of two pan-Canadian health organizations and concurrent evolution of the profession of paramedicine, this innovation has become integrated into practice. Evaluation of the innovation sites showed positive impact in all elements of the quintuple aim, and data from the expansion sites mirrors this success. Paramedic comfort and confidence is improved. Patient and family satisfaction is high. Quality indicators such as time spent at home, and home deaths, improved after program launch. There are time and cost savings with the program in place. The framework that enabled this spread and scale is presented and elaborated, to support further uptake of this innovation and provide a blueprint for successful expansion of other promising practices to support healthcare improvement across Canada.

Research on Intelligent Energy System and Power Metering Optimization Based on Multi-objective Optimization Decision Algorithm

In this paper, the intricate problem of optimizing power metering within an intelligent energy system, utilizing a multi-objective optimization decision-making algorithm, is thoroughly explored. Given the current energy landscape, achieving efficient energy utilization and environmental sustainability has become a focal point of research. As a pivotal aspect of future energy management, the precision and optimization of power metering in intelligent energy systems directly influence the effectiveness and cost of energy consumption. To begin, this paper delves into the fundamental principles and application backdrop of intelligent energy systems, highlighting the significance of power metering in such systems. Subsequently, addressing the multi-objective optimization challenges in power metering, a novel optimization method based on a multi-objective optimization decision algorithm is introduced. This algorithm achieves comprehensive optimization of power metering, encompassing multiple objectives such as power cost reduction, enhanced energy efficiency, and environmental protection. The experimental results underscore the remarkable performance of this algorithm, which not only elevates the precision of power metering but also achieves substantial savings in energy costs and significantly boosts energy efficiency. Furthermore, the algorithm exhibits robust adaptability, making it capable of addressing power metering optimization challenges across diverse scenarios. Finally, this paper discusses the practical application prospects of the optimization algorithm in intelligent energy systems, and points out the direction of future research. The research in this paper provides new ideas and methods for the optimization of power metering in intelligent energy systems, and has important theoretical and practical significance for promoting the intelligence and refinement of energy management.

Cost impact of the use of a universal cardiac implantable electronic devices remote monitoring solution: results of the Evidence RM study

Abstract Background Remote monitoring (RM) is considered the standard of care for patients with cardiac implantable electronic devices (CIED). In 2023 the HRS/EHRA/APHPRS/LAHRS expert consensus highlighted the potential interest of alert-based monitoring and the use of a third-party platform for RM management. By lightening the RM workload for clinical staff, valuable time and resources can be redirected towards patient care. Purpose This study aims to assess the impact on healthcare expenditures of the adoption of a Universal, vendor-neutral, and alert-focused remote monitoring (RM) platform for CIED in France, as opposed to the Conventional RM conducted via device specific manufacturers' platforms. Methods This study utilizes the French National Health Database (SNDS) to evaluate the effectiveness of RM solutions among patients with implantable cardioverter defibrillators (ICD), including cardiac resynchronization therapy defibrillators (CRT-D). All patients under RM were categorized based on the type of monitoring, either the Universal RM or the Conventional RM. The analysis was conducted on year 2019 and included only patients maintaining consistent RM solutions and device types throughout the entirety of the study period. To mitigate potential biases, costs were adjusted according to age, gender, device type, year of first implantation, year of RM initiation, medical center experience with RM, and Elixhauser score for comorbidities. Results Study cohort consisted of 36,401 patients (age 67.3 ± 13.0 years / male 78.4% / CRT-D 40.1%), 1,482 patients followed using the Universal RM platform and 34,419 patients monitored with the Conventional RM solutions. The study findings revealed a 4% decrease in corrected total costs and a notable 17.8% reduction in hospital costs among patients utilizing the Universal RM. Analysis further identified that this decrease in hospital expenses was primarily influenced by a reduction of the costs associated with cardiovascular diseases. Conversely, the group utilizing the Universal RM experienced a 7.9% increase in total outpatient costs compared to Conventional RM, while ambulatory visit costs remained unchanged. As costs incurred by patients were not included, total costs may however be underestimated. Patients under the Universal RM solution may benefit of more proactive preventive measures delivered through outpatient care. By addressing issues preemptively, critical conditions may be averted, enhancing overall patient management, and diminishing hospital costs. The adoption of a third-party Universal platform may thus yield to cost savings, exemplified by a negative Incremental Cost-Effectiveness Ratio (ICER) of -103€ per Day Alive and Out of Hospital (DAOH) as observed in this study. Conclusions The use of a third-party Universal RM platform showed a positive impact in terms of costs reduction for the French healthcare system on this ICD population.

Economic evaluation of fractional flow reserve-guided versus intravascular ultrasound-guided percutaneous coronary intervention

Abstract Background The randomized, controlled FLAVOUR trial demonstrated that the clinical outcomes of the fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) strategy were non-inferior to the intracoronary ultrasound (IVUS)-guided PCI strategy. Purpose This study aimed to compare the difference in economic implications and health-related quality of life between the two strategies. Methods A total of 890 patients with intermediate stenosis in 9 sites in China from the FLAVOUR trial were included. Direct medical costs were calculated using a combination of resource-based and event-based methods. Health utility was defined as quality-adjusted life years and assessed based on the 19-item Seattle Angina Questionnaire. The primary analysis was a cost-utility analysis. Probabilistic sensitivity, one-way sensitivity, and subgroup analyses were performed. Results At two years, the average total cost per patient was Chinese yuan (CNY) 36,287±19,531 in the IVUS-guided group and CNY 29,237±19,239 in the FFR-guided group (ΔIVUS-FFR=CNY 7,050, p<0.001). The difference was driven primarily by the cost of initial admission (ΔIVUS-FFR=CNY 6,284, p<0.001). Quality-adjusted life years gained showed no significant differences between the two groups (FFR vs. IVUS: 1.639±0.086 years vs. 1.638±0.128 years, p=0.872). The probabilistic sensitivity and one-way sensitivity analyses revealed robust results. The subgroup analysis found that the cost reductions attributed to FFR guidance decreased in several subgroups, including patients with diabetes and those with high anatomical complexity. Conclusions In patients with intermediate stenosis, FFR-guided PCI is associated with significant cost savings compared with IVUS-guided PCI at two years and shows no differences in health-related quality of life outcomes.Central Illustration

E-waste challenges of generative artificial intelligence.

Generative artificial intelligence (GAI) requires substantial computational resources for model training and inference, but the electronic-waste (e-waste) implications of GAI and its management strategies remain underexplored. Here we introduce a computational power-driven material flow analysis framework to quantify and explore ways of managing the e-waste generated by GAI, with a particular focus on large language models. Our findings indicate that this e-waste stream could increase, potentially reaching a total accumulation of 1.2-5.0 million tons during 2020-2030, under different future GAI development settings. This may be intensified in the context of geopolitical restrictions on semiconductor imports and the rapid server turnover for operational cost savings. Meanwhile, we show that the implementation of circular economy strategies along the GAI value chain could reduce e-waste generation by 16-86%. This underscores the importance of proactive e-waste management in the face of advancing GAI technologies.

Business AI for Oil and Gas: Unlocking Efficiency Across the Value Chain

This article explores the transformative impact of artificial intelligence (AI) on the oil and gas industry, focusing on its applications across the value chain from exploration to end-user delivery. It examines the potential of AI, particularly generative AI, to optimize various aspects of the sector, including exploration, development, production, transportation, refining, and sales. The article discusses specific AI applications in refinery processes. It highlights the significant benefits of AI implementation, such as improved operational efficiency, reduced downtime, enhanced decision-making, cost reduction, and increased safety. Drawing on industry studies and research, the article presents quantitative data on the potential cost savings, productivity improvements, and value creation that AI technologies can bring to the oil and gas sector.

Cost-Effectiveness of Salt Substitution and Antihypertensive Drug Treatment in Chinese Prehypertensive Adults.

Recent guidelines recommend antihypertensive drug treatment for prehypertensive individuals with blood pressure between 130/80 and 139/89 mm Hg. This study evaluates the cost-effectiveness of 3 interventions in Chinese prehypertensive adults: salt substitution, antihypertensive drug treatment, and their combination. We developed a Markov cohort model to estimate cardiovascular disease (CVD) events, costs, and quality-adjusted life years (QALYs) over a lifetime. Data from the China Kadoorie Biobank informed the simulation. Costs and utilities were drawn from published sources. We evaluated the cost-effectiveness of salt substitution alone, antihypertensive drug treatment alone, and a combination of the 2, focusing on the overall prehypertensive population, those at high CVD risk, and different starting ages (40, 50, 60, and 70 years). Incremental cost-effectiveness ratios (ICERs) were calculated per QALY gained. Salt substitution at age 40 years is the only cost-effective strategy for prehypertensive individuals, with an ICER of $6413.62/QALY. For those at high CVD risk, the combination intervention starting at age 40 years is most cost-effective, with an ICER of $2913.30/QALY. Interventions initiated at younger ages yielded greater CVD reductions and lower ICERs. For example, a combined intervention at age 40 years reduces CVD events by 5.3% with an ICER of $2913.30/QALY, compared with 4.9% and $32 635.33/QALY at age 70 years. These results were consistent across sensitivity analyses. In China, replacing usual salt with a salt substitute is more cost-effective than treating prehypertensive individuals over the age of 40 years with antihypertensive drugs. Furthermore, starting intervention at a younger age in prehypertensive adults can result in even greater cost savings.

Making integration happen: managers’ views on multidisciplinary work in Finnish health system

Abstract Background In Finland, a large-scale health and social service reform was implemented in 2023. The structural reform centralised the organising of health and social services from some 200 organisations to 22 wellbeing services counties (WBSC). One goal of the reform was to promote service integration between and within health and social services. The reform offers a unique opportunity for investigating how such change unfolds. This study addresses the integration aspirations of those who are responsible for implementing the change, that is middle managers in WBSCs. We focus on micro and meso levels and explore how the aim of multidisciplinary collaboration is interpreted as part of advancing service integration by middle managers in one newly formed WBSC. Methods The data for this qualitative study were derived from 11 semi-structured interviews with senior and middle managers responsible for various fields of health and social care services in a single WBSC between October 2022 and June 2023. Inductive thematic analysis was applied. Results The managers framed multidisciplinary collaboration very positively and easier to achieve in the new organisation with health and social services united under the same management. The managers acknowledged the need to form collaborative structures (e.g. meetings) and processes at all levels of organisation. Leadership plays a crucial role in creating space for the professionals to form an experience of a shared every-day work. However, previous structures and patterns of work still seemed to limit these endeavours. Tensions between, for example, professional groups or units were left essentially untouched. Multidisciplinary collaboration will serve especially persons with complex and multiple needs and was framed key to cost savings. Conclusions While the structural reform opens a window of opportunity to new collaborative patterns, competing logics and interests as well as power imbalances may hamper the development if not addressed. Key messages • Middle managers had high hopes for multidisciplinary work after the health system reform, including effects on the difficult issues concerning costs and health workforce availability. • While the managers were prepared to promote multidisciplinary work, the prior organisational boundaries and logics hindered integration. Different tensions between stakeholders need more attention.

Implementing dynamic atrioventricular delay optimization for cardiac resynchronization therapy: an economic analysis in the EU5 countries

Abstract Background Heart failure (HF) poses an escalating public health challenge, contributing significantly to patient morbidity, mortality and healthcare expenditures [1,2]. Cardiac resynchronization therapy (CRT) is a well-established intervention that improves functional capacity and enhances quality of life while mitigating symptoms, hospitalizations, and mortality in HF patients [3]. Nevertheless, the reaction to CRT varies among individuals; some experience positive responses and others show resistance to the therapy, with unfavourable outcomes and increased healthcare costs [4]. The introduction of the dynamic atrioventricular (AV) optimization algorithm aims to enhance CRT response by enabling dynamic optimization of the AV delay [4]. Purpose Despite the strong clinical evidence supporting the effectiveness of dynamic AV optimization algorithm, a comprehensive assessment of its economic implications is still lacking. This study aims to evaluate the economic impact of activating dynamic AV optimization algorithm in patients undergoing CRT treatment across the Big 5 European countries (EU5; France, Germany, Spain, Italy, and the UK). Methods The study examines two scenarios over a 3-year timeframe: a) current scenario, where dynamic AV optimization algorithm activation is limited to a small segment of the population, and b) future scenario, where dynamic AV optimization algorithm activation is progressively expanded per year from 15% to 50%. Treatment efficacy data, measured in terms of HF hospitalization and mortality rates, were sourced from Varma et al. studies [1,4]. Hospitalization and mortality costs were extracted from national DRG tariffs and relevant literature [5–14]. It is important to note that there is no additional cost for algorithm activation if the device is already equipped with it. Results In this hypothetical analysis of 1,000 patients, around 30% undergo CRT implantation compatible with dynamic AV optimization algorithm activation. The treatment cost of patients with the algorithm ON is reduced by -15% compared to patients with the algorithm OFF, considering a weighted average across the EU5 countries (France: -11%, Germany: -16%, Italy: -14%, Spain -17%, UK: -16%), as shown in Table 1. The steady increase in algorithm activation led to an annual expenditure reduction equal to €21,109, calculated on the weighted average across the EU5 countries (France: €15,549, Germany: €33,753, Italy: €13,844, Spain: €20,385, UK: £13,423). When compared to the current scenario, the future scenario saved €36,468 on average across the EU5 countries. Further country-specific cost savings are shown in Table 2. Conclusion The conducted economic analysis gives confidence in dynamic AV optimization algorithm, positioning it as a valuable and economically sustainable asset for enhancing CRT treatment outcomes in patients with HF.

Haemorrhoid artery ligation - recto anal repair (HAL-RAR) blind versus Doppler: a systematic review and meta-analysis.

Haemorrhoids remain a highly prevalent condition in Australia, affecting 39% of the adult Australian population. While haemorrhoidectomy remains the gold standard in the management of haemorrhoids, newer techniques such as haemorrhoid artery ligation-recto anal repair (HAL-RAR) are emerging as promising management modalities. We compare the efficacy of non-Doppler guided (non-DG) HAL-RAR versus Doppler-guided (DG) HAL-RAR in the management of haemorrhoids. This study was registered with PROSPERO (CRD42022353806) and adhered to PRISMA 2020 guidelines. We conducted a systematic review using Medline, Embase and Cochrane database for comparative studies between Doppler-guided HAL-RAR and non-Doppler-guided HAL-RAR in accordance with the PRISMA 2020 statement for reporting systematic reviews. Five studies were included in our systematic review and meta-analysis. There was no clinically significant difference in operative times (SMD 0.46, 9% CI -3.16 0 4.08, P = 0.804) or post-operative bleeding (P = 0.142) between the two groups. DG HAL-RAR patients were more likely to have post-operative urinary retention (P < 0.001). Non-DG patients were less likely to experience recurrence (OR 5.12, P < 0.001). Our review of non-DG HAL-RAR compared to DG HAL-RAR reflects the non-inferiority of the non-DG HALRAR procedure. We hope that these results would provide a guide to clinicians performing HAL-RAR, and would provide some cost savings for institutions who are unable to procure the necessary equipment for DG HAL-RAR.