Expenditure Savings Research Articles

Cost-effectiveness analysis of mHealth applications for depression in Germany using a Markov cohort simulation

AbstractRegulated mobile health applications are called digital health applications (“DiGA”) in Germany. To qualify for reimbursement by statutory health insurance companies, DiGA have to prove positive care effects in scientific studies. Since the empirical exploration of DiGA cost-effectiveness remains largely uncharted, this study pioneers the methodology of cohort-based state-transition Markov models to evaluate DiGA for depression. As health states, we define mild, moderate, severe depression, remission and death. Comparing a future scenario where 50% of patients receive supplementary DiGA access with the current standard of care reveals a gain of 0.02 quality-adjusted life years (QALYs) per patient, which comes at additional direct costs of ~1536 EUR per patient over a five-year timeframe. Influencing factors determining DiGA cost-effectiveness are the DiGA cost structure and individual DiGA effectiveness. Under Germany’s existing cost structure, DiGA for depression are yet to demonstrate the ability to generate overall savings in healthcare expenditures.

Modelling the potential impact of a tax on fruit juice in South Africa: implications for the primary prevention of type 2 diabetes and health financing

BackgroundSouth Africa is experiencing a persistent growth in non-communicable diseases. Diabetes is among the top ten causes of mortality, especially among women, which is partly driven by high levels of added sugar consumption and obesity. To reduce obesity rates and the incidence of diabetes, South Africa introduced a tax on sugar sweetened beverages (also known as the Health Promotion Levy (HPL)) in 2018. The tax is applicable to sugar-sweetened beverages but excludes 100% fruit juice. The government is currently considering extending the tax to include fruit juices. This study models the potential health and economic impact of taxing fruit juices at 20% of the retail price of one liter.MethodsTo analyze the distributional impact of the tax, this study uses extended cost-effectiveness analysis methodology. Data on price elasticities, healthcare cost, income, fruit juice consumption were sourced from the literature and representative national surveys. The potential impact of the tax on diabetes incidence, prevalence, mortality, and financial benefits were estimated for each income group (lowest, quintile 1 to highest, quintile 5).FindingsWe estimate that a 20% tax on fruit juice would avert 156,640 incident cases of type 2 diabetes mellitus over 20 years, with most disease averted occurring among the first- and fifth-income groups. Averted deaths from diabetes would average 2,000 deaths per quintile (for quintiles 1 to 4) and about 2,800 in quintile 5. The improved health resulting from averted incidence and deaths will reduce overall healthcare expenditure by R7.5 billion over 20 years, of which R2.3 billion will occur in the fifth quintile. The South African government will also save about R300 million in subsidizing diabetes-related healthcare cost as a result of prevention; and would raise R8.6 billion in tax revenues per annum. Out-of-pocket expenditure savings will be R303 million and a financial risk protection (money-metric value of insurance) of R4.6 billion over the 20-year period.ConclusionWe conclude that an HPL that significantly raises the retail price of fruit juices would reduce consumption and diabetes-related morbidity and mortality. The tax will also provide significant financial benefits in the form of reduced healthcare costs for both government and households as well as providing financial risk protection to individuals. Health taxes are win-win policies that improve population health and generate revenue for governments to fund public health services delivery and thus improve overall health financing activities of the government. Therefore, population level disease prevention measures such as health taxes are important for achieving universal health coverage.

Disparities in healthcare-seeking behaviors and associated costs between Venezuelan migrants and Colombians residing in Colombia

BackgroundColombia, which hosts over 3 million of the Venezuelan diaspora, is lauded for its progressive approach to social integration, including providing migrants access to its universal health coverage system. However, barriers to healthcare persist for both migrant and host populations, with poorly understood disparities in healthcare-seeking behaviors and associated costs. This is the first study to link healthcare-seeking behaviors with costs for Venezuelan migrants in Colombia, encompassing costs of missing work or usual activities due to healthcare events.MethodsWe use self-reported survey data from Venezuelan migrants and Colombians living in Colombia (September-November 2020) to compare healthcare-seeking behaviors and cost variables by nationality using two-sampled t-tests or Chi-square tests (X2). The International Classification of Diseases was used to compare reported household illnesses for both populations. Average health service direct costs were estimated using the Colombian Government’s Suficiencia database and self-reported out-of-pocket (OOP) payments for laboratory and pharmacy services. Indirect costs were calculated by multiplying self-reported days of missed work or usual activities with estimated income levels, derived by matching characteristics using the Gran Enquesta Integrada de Hogares database. We calculate economic burdens for both populations, combining self-reported healthcare-seeking behaviors and estimated healthcare service unit costs across six healthcare-seeking behavior categories.ResultsDespite similar disease profiles, Venezuelan migrants are 21.3% more likely to forego formal care than Colombians, with 746.3% more Venezuelans reporting lack of health insurance as their primary reason. Venezuelan women and uninsured report the greatest difficulties in accessing health services, with accessing medications becoming more difficult for Venezuelan women during the COVID-19 pandemic. Colombians cost the health system more per treated illness event (US$40) than Venezuelans (US$26) in our sample, over a thirty-day period. Venezuelans incur higher costs for emergency department visits (123.5% more) and laboratory/ pharmacy OOP payments (24.7% more).ConclusionsWhile Colombians and Venezuelans share similar disease burdens, significant differences exist in access, cost, and health-seeking behaviors. Increasing Venezuelan health insurance enrollment and tackling accessibility barriers are crucial for ensuring healthcare equity and effectively integrating the migrant population. Findings suggest that improving migrant access to primary healthcare would produce savings in Colombian healthcare expenditures.

Cost-effectiveness analysis of low-sodium potassium-rich salt substitutes in Indonesia: an equity modelling study

Evidence suggests low-sodium potassium-rich salt substitutes (LSSS) are effective in reducing blood pressure (BP). However, the health and economic impacts of LSSS in Indonesia are currently unknown. We developed a proportional multistate lifetable Markov model to assess a government-led strategy implementing the use of LSSS compared to current regular salt consumption. BP data were derived from the Indonesian Basic Health Research Survey (RISKESDAS 2018), while epidemiological data were from the Global Burden of Disease 2019 study. We estimated implementation costs and the impact of changes in BP on disease events and healthcare costs, and incremental cost-effectiveness ratios. Outcomes were simulated over different time horizons for the 2019 Indonesian population overall, and by income quintiles. Probabilistic sensitivity analysis was done to capture uncertainty. Over the first 10 years, LSSS could prevent 1.5 million non-fatal cardiovascular disease (CVD) events (8.3%-19.4% reduction) and 643,000 incident chronic kidney disease (CKD) cases (8.2% reduction), while averting over 200,000 CVD and CKD deaths (0.2%-5.2% reduction). This translated to over 24.6 million health-adjusted life years (HALYs) gained over the lifetime of the population, and reduced CVD-related health inequalities (concentration index,-0.075, 95% CI:-0.088 to-0.062). Implementation cost (US$ 1.2 billion [IDR 17.2 trillion] total; US$ 4.5 [IDR 63,665] per capita, as of July 2019) was outweighed by the net health expenditure savings (∼US$ 2 billion [IDR 27.7 trillion] total; US$ 7.3 [IDR 103,300] per capita) in the first 10 years. LSSS were cost-saving over the lifetime, and very cost-effective even with a high LSSS price. Scaling the use of LSSS nationally could be a cost-saving strategy to prevent substantial cardiovascular and kidney disease burden in Indonesia. Griffith University Postdoctoral Fellowship.

Modeling the economic value of cardiometabolic virtual-first care programs.

This study simulated the potential multiyear health and economic benefits of participation in 4 cardiometabolic virtual-first care (V1C) programs: prevention, hypertension, diabetes, and diabetes plus hypertension. Using nationally available data and existing clinical and demographic information from members participating in cardiometabolic V1C programs, a microsimulation approach was used to estimate potential reduction in onset of disease sequelae and associated gross savings (ie, excluding the cost of V1C programs) in health care costs. Members of each program were propensity matched to similar records in the combined 2012-2020 National Health and Nutrition Examination Survey files based on age, sex, race/ethnicity, body mass index, and diagnosis status of diabetes and/or hypertension. V1C program-attributed changes in clinical outcomes combined with baseline biometric levels and other risk factors were used as inputs to model disease onset and related gross health care costs. Across the V1C programs, sustained improvements in weight loss, hemoglobin A1c, and blood pressure levels were estimated to reduce incidence of modeled disease sequelae by 2% to 10% over the 5 years following enrollment. As a result of sustained improvement in biometrics and reduced disease onset, the estimated gross savings in medical expenditures across the programs would be $892 to $1342 after 1 year, and cumulative estimated gross medical savings would be $2963 to $4346 after 3 years and $5221 to $7756 after 5 years. In addition, high program engagement was associated with greater health and economic benefits. V1C programs for prevention and management of cardiometabolic chronic conditions have potential long-term health and financial implications.

Savings in social expenditures for work incapacity in patients with inflammatory bowel disease depend on access to innovative therapies in Poland.

Inflammatory bowel diseases (IBD) are an increasing burden for societies. We examined Polish Social Insurance Institution (ZUS) work incapacity expenditures for people with IBD compared with the general population. Aggregate data were obtained on ZUS expenditures between 2012 and 2021 in Polish zlotys (PLN). Annual work incapacity benefit expenditures were analyzed and IBD benefit expenditures were examined relative to innovative IBD drug utilization in individual provinces. Between 2012 and 2021, annual ZUS expenditures per person increased, while expenditures per IBD patient decreased. Proportionally, absenteeism was the largest ZUS expenditure in the general population, while disability pensions were the largest in the IBD population. ZUS expenditures due to absenteeism in the general population increased by PLN 282 per person; those due to disability pensions decreased by PLN 85. Disability pension spending due to Crohn's disease (CD) and ulcerative colitis (UC) decreased by PLN 371 and PLN 284, respectively, while absenteeism spending per person with CD and UC decreased (PLN 58 and PLN 35, respectively). Nationwide in 2021, 8.5% of people with CD and 1.9% of those with UC received innovative drugs. The percentage of people receiving innovative drugs and ZUS expenditure per person were inversely related in 9/16 provinces for CD and 5/16 for UC. Polish state spending on work incapacity benefits increased in the general population but decreased in people with IBD between 2012 and 2021. Use of innovative drugs was associated with reduced spending per person with IBD in some provinces.

Redesigning the Drugs Distribution Network: The Case of the Italian National Healthcare Service

Drug distribution performed through hospital pharmacies facilitates public expenditure savings but incurs higher social costs for patients and caregivers. The widespread presence of community pharmacies could support patient access while also improving drug distribution. The implementation of prescriptive data analyses as constrained optimization to achieve specific objectives, could be also applied with good results in the healthcare context. Assuming the perspective of the Italian National Healthcare Service, the present study, built upon existing research in this field, proposes a decision support tool that is able to define which self-administered drugs for chronic diseases should be distributed by community pharmacies, answering to critical challenges in the case of future pandemics and healthcare emergencies, while also providing suggestions for the institutional decision-making process. Moreover, the tool aids in determining the optimal setup of the drug distribution network, comparing centralized (hospital pharmacies) and decentralized (community pharmacies) approaches, as well as their economic and social implications.

An Efficient Hybrid Energy Smart System Using Lithium Ion Batteries Integrated with Battery Management System

The use of rechargeable batteries to store and distribute extra energy from photovoltaics (PV) improves the efficiency of solar energy generation. This study constructs a solar power plant system that is linked to the grid network and includes battery energy storage. The efficiency of a hybrid solar power plant with integrated batteries and grid energy storage is demonstrated and evaluated in this study. This study is based on real-time testing to determine battery utilization when different electrical loads for office use are combined. The workload profile during peak hours of use, which correspond to the peak time of sunshine, is used to evaluate the system. The collected findings show that the degree of effectiveness of this hybrid power plant fulfills the power simulation. During the peak irradiation time, the maximum power is 2100 watts, whereas the needed power simulation, which is 1900 watts in this case, so the power efficiency percentage is 110.52%. It means that PV can satisfy the charged power while also supplying extra power to the battery for usage at low periods. During the 8-hour test, the calculation of cost savings revealed a savings in electricity expenditure of Rp. 14,373. The energy storage system's real operational needs were met by battery storage and PV.

Analysis of PEM Membrane Electrode Assemblies Impact on the Levelized Cost of Hydrogen

Plug is building an end-to-end green hydrogen ecosystem to help its customers meet their business goals and decarbonize the economy. This hydrogen ecosystem is inclusive of production, storage, delivery, and energy generation. As the largest user of liquid hydrogen globally, Plug Power plans to build and operate green hydrogen production plants across North America and Europe. Plug’s hydrogen production plants are based on electrolyzer systems featuring internally developed proton exchange membrane (PEM) based water electrolysis membrane electrode assemblies (MEAs). This paper will review the state of commercial PEM water electrolysis MEAs and provide insight as to what advances in MEA technology are needed to produce hydrogen at a levelized cost of $1/kg.The cell polarization curves for two modeled PEM MEAs are shown in Figure 1. They represent the performance of both commercial and future PEM water electrolyzer technology. As the applied current density to the cell increases, so does the cell voltage, and thus the energy required to produce a kilogram of hydrogen. As the MEA technology in the stack matures, the applied current density, and thus, the hydrogen production rate can increase at a set efficiency. A 155 cell, 1,000 cm2 active area, electrolyzer stack featuring commercial MEAs would produce approximately 220 kg-H2/day at an efficiency of 49 kWh/kg-H2. With the future MEAs, this same stack, operating at the same efficiency, could produce as much as 1,200 kg-H2/day.A hydrogen plant with a production capability of 45 metric tons per day, featuring commercial MEAs, would produce hydrogen at a cost of approximately $6/kg when powered by energy at a price of $35/MWh. The MEA cost represents only a few percent of the total capital expenditure required to build a 45 metric ton hydrogen plant. Thus, MEAs would only contribute a few cents to the estimated $6/kg levelized cost of hydrogen (LCOH). They, however, are responsible for most of the energy consumed at a hydrogen plant. Therefore, the MEAs could account for 50%, or more, of the total cost to produce hydrogen. A savings of $328M to $410M can be realized or every $1/kg reduction in LCOH over the lifetime of a hydrogen plant. Thus, performance improvements in the MEA are paramount to making hydrogen production competitive with other energy carriers.The oxygen evolution catalyst featured in a future MEA would be required to achieve a greater than four-fold increase in activity. The PEM of the future MEA would also be required to support a substantial increase in proton transfer while maintaining its integrity for greater than 100,000 hours. These advances, as well as savings in hydrogen plant capital expenditures, are required to achieve a LCOH of approximately $1/kg at a fixed energy cost of $35/MWh. Even at the lowest projections for capital expenditures, most of the cost of hydrogen will be dominated by power consumption, further highlighting the importance of maturing PEM water electrolysis MEA technology. Figure 1

Cost-benefit Analysis and Financial Viability of Household Biogas Plant Investment in South Ethiopia

This study investigates the cost–benefit analysis and financial viability of biogas plant investment in South Ethiopia. A multi-stage sampling technique was employed to select sample households. A total of 105 adopter households were selected for household survey using a purposive sampling technique. All the households adopting biogas technology were considered. Besides, a biogas plant with 6 m3 and 8 m3 sizes were selected because they were the most commonly used size in the study area. Data were collected from the household survey, key informant interviews, focus group discussion and market price assessment. The installation cost took the largest share of the total cost of construction and was one of the main constraints that hindered adoption. The findings of the study indicate that the production of biogas increased household income by reducing the costs incurred for buying firewood, kerosene and chemical fertilizers. Relatively, lower plant size was more profitable than larger plant size. Installation under the subsidy scheme was more financially viable at 10% discount rate than its counterparts. Subsidy is important to enhance biogas plant investment, particularly for larger biogas plant sizes. Nevertheless, both plant sizes, installed without subsidy, had smaller NPV values and UDBP greater than 1 year, making this scenario financially less viable. Installation of low cost plants could more attract the engagement of a large number of rural households with low economic capacity. However, both plant sizes (6 m3 and 8 m3) are financially viable and profitable at 10% discount rate. Moreover, the profitability of biogas investment is highly sensitive to variation in discount rates, level of expenditure savings and input prices.

S109 Savings in Social Expenditures for Work Incapacity in Patients With Inflammatory Bowel Disease Depend on Access to Innovative Therapies in Poland

S109 Savings in Social Expenditures for Work Incapacity in Patients With Inflammatory Bowel Disease Depend on Access to Innovative Therapies in Poland

Farmers to urban citizens? Understanding resettled households' adaptation to urban life in Shaanxi, China

Rural to urban resettlement is a widely used poverty alleviation strategy in China's Shaanxi Province, with roughly 250,000 poor households being resettled between 2016 and 2020. This is a huge development intervention designed and implemented by the Chinese state that aims to fundamentally transform people's livelihoods, yet few studies have examined how rural people involved in these resettlements have adapted to their new urban life. This article aims to analyze this adaptation process. Based on a survey of 1285 poverty alleviation resettlement (PAR) households in Shaanxi, we examine the socioeconomic and identity transformations brought about by urbanizing poverty resettlements, paying particular attention to resettled households' heterogeneous experiences of adaptation. Our analysis complicates the picture of a managed, smooth transition from farmers to urban citizens, raising issues of identity, economic insecurity, employment opportunities, and rural land as security. Economically, in the face of increased expenditure and few savings, most households have mixed income sources, and most still retain ties to agricultural land. Different trajectories are evident among households, with uneven access to nearby off-farm employment. Socially, strong social relations are evident, but there is weak engagement in more formal community institutions. And in terms of identity, only a small proportion of households self- identified as “urban”. Our findings highlight how, in the face of rapid change, PAR households strategically float between the rural and the urban.

Demand response programs: Comparing price signals and direct load control

Canada's electric power system is responsible for approximately 9 % of national emissions, 53 % of which occur in the province of Alberta. Integrating new variable renewable energy resources is a key part of the supply-side decarbonization pathway, while end-use electrification unlocks further opportunities on the demand side. The inherent variability of variable renewable energy output necessitates network flexibility. Supply-side flexibility solutions require significant investment, but demand-side management programs have potential to deliver network flexibility at a lower cost. An integrated framework consisting of demand and supply models investigates the efficacy of demand response programs for improving network flexibility in Alberta's power system, as measured by multiple operational metrics. The framework is applied to two demand response programs: real-time pricing and direct load control. These programs are assessed for two generation capacity mixes derived from an expansion planning model. Results indicate that substantial network flexibility benefits are achievable in a zero-emission power system via both programs resulting in avoided wind curtailment by 7.7 %. Improvement in operational costs, up to 1.4 % of the base output, is also observed in all scenarios accompanied by savings in household power bill expenditure by up to 15 %. These improvements, however, are only achieved fully when sufficient flexible load is provided.

Artificial intelligence empowered digital platform to support patients with heart failure (AZIMUTH platform)

Abstract Background Despite continuous efforts, Heart Failure (HF) is the leading cause of hospital readmission in developed countries. Since this tendency worsens prognosis of patients and increases health care costs, it raises concerns about the sustainability of the overburdened traditional model of care. Contributing factors to readmission include inadequate treatment of risk factors and low adherence to medications. Purpose The AZIMUTH study aimed at evaluating the feasibility, patient acceptance and perceived value of a certified medical device class IIa, smartphone app-based model of care, designed to improve quality of care and clinical outcomes for HF patients. Methods The AZIMUTH-I multicentric trial enrolled 185 patients with a diagnosis of chronic HF. At enrollment, patients are supplied with the mobile application and IoT devices. Data were accessible through a clinical dashboard meant for the healthcare professionals to remotely monitor the individual patients. During the observational period of 12 months, the patients were asked to daily report their feelings and symptoms, to share vital parameters, to record medications and to answer questionnaires regarding quality of life (KCCQ) and medication adherence (MMAS-8). They were also allowed to digitally send medical reports and to address questions to a mutidisciplinary clinical staff. The user acceptance was recorded using the User Experience Questionnaire (UEQ-S) and the Friends and Family Test (FFT). Results Our ehealth-empowered approach was tested in a cohort of 185 chronic heart failure patients (mean age 74 ± 12 years, mean LVEF 47 ± 13 %, mean NYHA class 2 ± 0.5). After a median follow-up of 11 months, all patients completed the study. The engagement was very high: 75% of opened the app at least once a day, showing a remarkable willingness to share additional data, consisting in 8231 "patient-reported outcome measures" (PROM). The average adherence to mandatory tasks was 74.8% whereas the adherence to medication reporting was 84.2%. The median result of the UEQ was "excellent" and the FFT revealed an overall experience between "positive" and "very positive". A significant decrease in the rate of re-hospitalization was observed at 12 months when compared with the same period before the implementation of the AZIMUTH model of care (1±0.2 vs 3±0.3 p<0.01) and was accompanied with a significant increase in the perceived quality of life (KCCQ overall score 71.2±20.7vs78.5±23.5; clinical score 77.4±20.1vs82.6±21.5 p<0.05). Conclusion This trial proved that our ehealth-integrated HF care is feasibile, user-friendly, scalable with high adherence and perceived benefits. The preliminary clinical findings and the high number of interactions suggest that the adoption of similar digital platform may not only improve the quality of life but also generate savings in health expenditures. Further study is eagerly awaited to evaluate the clinical efficacy of this new model of care.

Key drivers for the adoption of circular economy practices in the tourist accommodation sector

PurposeThis article assesses the degree of adoption of the circular economy model in the tourist accommodation sector. Additionally, the study aims to understand whether the type of accommodation, size and year of construction or remodelling have an impact on the adoption of circular economy practices.Design/methodology/approachThe study is based on a survey administered to directors and owners of tourist accommodation facilities in Portugal. The questionnaire was developed based on an extensive literature review of circular economy practices in the accommodation sector.FindingsAccommodation companies currently operate in a linear economy model and are still in the early stages of transitioning to a more circular economic model. Among the most commonly implemented practices are those that represent expenditure savings for accommodation companies. The findings also suggest a growing awareness and commitment to sustainability and circular economy practices in the tourist accommodation sector, particularly in more recently constructed or renovated accommodation.Originality/valueTo the best of the authors' knowledge, this study is the first to evaluate the accommodation characteristics that impact the adoption of sustainability and circular economy practices in the tourist accommodation sector. It contributes to the literature by providing primary quantitative data supporting the adoption of such practices.

Primary Care Continuity, Frequency, and Regularity Associated With Medicare Savings

Reducing Medicare expenditures is a key objective of Medicare's transition to value-based reimbursement models. Improving access to primary care is an important way to reduce expenditures, yet less is known about how visits should be organized to maximize savings. To examine the association between Medicare savings and primary care visit patterns. This retrospective cohort study used data from a 5% sample of traditional Medicare claims from 2016 to 2019. Participants had at least 3 primary care visits with at least 180 days between the first and the last visit, were not enrolled in Medicare Advantage, did not have end-stage kidney disease, and were not institutionalized. Data were analyzed from June 2022 to April 2023. Primary care visit patterns: visit frequency, regularity, continuity of care. Savings in Medicare expenditures; risk-adjusted Medicare expenditures, number of emergency department (ED) visits, and hospitalizations. Among 504 471 beneficiaries (298 422 [59.16%] women; mean [SD] age, 74.26 [10.41] years), temporally regular visits with higher continuity were associated with the highest savings. For these patients, the savings increased with increasing visit frequencies, with peak savings observed at higher visit frequencies as clinical complexity increased. As regularity and continuity decreased, the association between savings and visit frequencies progressively inverted. The group with a regular and highly continuous pattern was associated with greater savings (175.87%; 95% CI, 167.40% to 184.33%; P < .001), lower risk-adjusted expenditures (-16.61%; 95% CI, -16.73% to -16.48%; P < .001), fewer risk-adjusted ED visits (-40.49%; 95% CI, -40.55% to -40.43%; P < .001), and fewer risk-adjusted hospitalizations (-53.32%; 95% CI, -53.49% to -53.14%; P < .001) compared with the irregular noncontinuous group. In this cohort study, savings in Medicare expenditures and improvements in acute care utilization were associated with visit frequency, regularity, and continuity in primary care in an interrelated fashion such that optimization of primary care visit patterns along each axis were associated with the largest improvement in outcomes. Demonstrating the magnitude and interdependence of these associations is useful for health care professionals and policymakers as Medicare continues its transition to value-based reimbursement models.

Paediatric clinical decision support: Evaluation of a best practice alert for red blood cell transfusion.

Providing red blood cell (RBC) transfusion to paediatric patients with a haemoglobin (Hb) level of <7 g/dL is the current best practice, but it is often difficult to ensure appropriateness of RBC transfusion on a health system level. Electronic health record (EHR) clinical decision support systems have been shown to be effective in encouraging providers to transfuse at appropriate Hb thresholds. We present our experience with an interruptive best practice alert (BPA) at a paediatric healthcare system. An interruptive BPA requiring physician response was implemented in our EHR (Epic Systems Corp., Verona, WI, USA) in 2018 based on Hb thresholds for inpatients. The threshold was initially <8 g/dL and later changed to <7 g/dL in 2019. We assessed total activations, number of RBC transfusions and hospital metrics through 2022 compared to the 2 years prior to implementation. The BPA activated 6956 times over 4 years, slightly less than 5/day, and the success rate, with no RBC transfusions within 24 h of order attempt, was 14.5% (1012/6956). There was a downward trend in the number of total RBC transfusions and RBC transfusions per admission after implementation, non-significant (p = 0.41 and p = >0.99). The annual case mix index was similar over the years evaluated. The estimated cost savings based on acquisition costs for RBC units were 213,822 USD or about $51,891 per year. BPA implementation led to sustained change in RBC transfusion towards best practice, and there were long-term savings in RBC expenditure.

Health and economic impact of improved glucose, blood pressure and lipid control among German adults with type 2 diabetes: a modelling study.

The aim of this study was to estimate the long-term health and economic consequences of improved risk factor control in German adults with type2 diabetes. We used the UK Prospective Diabetes Study Outcomes Model2 to project the patient-level health outcomes and healthcare costs of people with type2 diabetes in Germany over 5, 10 and 30 years. We parameterised the model using the best available data on population characteristics, healthcare costs and health-related quality of life from German studies. The modelled scenarios were: (1) a permanent reduction of HbA1c by 5.5 mmol/mol (0.5%), of systolic BP (SBP) by 10 mmHg, or of LDL-cholesterol by 0.26 mmol/l in all patients, and (2) achievement of guideline care recommendations for HbA1c (≤53 mmol/mol [7%]), SBP (≤140 mmHg) or LDL-cholesterol (≤2.6 mmol/l) in patients who do not meet the recommendations. We calculated nationwide estimates using age- and sex-specific quality-adjusted life year (QALY) and cost estimates, type2 diabetes prevalence and population size. Over 10 years, a permanent reduction of HbA1c by 5.5 mmol/mol (0.5%), SBP by 10 mmHg or LDL-cholesterol by 0.26 mmol/l led to per-person savings in healthcare expenditures of €121, €238 and €34, and 0.01, 0.02 and 0.015 QALYs gained, respectively. Achieving guideline care recommendations for HbA1c, SBP or LDL-cholesterol could reduce healthcare expenditure by €451, €507 and €327 and gained 0.03, 0.05 and 0.06 additional QALYs in individuals who did not meet the recommendations. Nationally, achieving guideline care recommendations for HbA1c, SBP and LDL-cholesterol could reduce healthcare costs by over €1.9 billion. Sustained improvements in HbA1c, SBP and LDL-cholesterol control among diabetes patients in Germany can lead to substantial health benefits and reduce healthcare expenditures.

Dampak Covid-19 Pada Perekonomian Masyarakat Petani Di Desa Patokaan Kecamatan Talawaan Kabupaten Minahasa Utara

The purpose of this study was to determine the Impact of Covid-19 on the Community Economy Especially Farmers in Patokaan Village, Talawaan District, North Minahasa Regency. Data collection techniques are observation and interviews with research informants and documentation studies. The research method is descriptive with data analysis namely data reduction, data presentation and drawing conclusions. The results showed that the impact of the Covid 19 pandemic on the economy of the people in Patokaan Village, Talawaan District, North Minahasa Regency was in the income sector, economic activity, expenditure and community savings. The income of people who work as farmers has decreased due to difficulties selling agricultural products so that the costs incurred are not in accordance with the results obtained, traders who have difficulty finding buyers, private employees who are forced to lay off. Public spending continues to increase for basic needs and the need for medical medicines as well as facing rising prices of basic goods. People cannot save/save but instead use their savings to be able to buy basic necessities whose prices are increasing. The central and regional governments are making various efforts to stimulate the economy with policies providing assistance, be it social assistance, non-cash food assistance, preemployment card policies and subsidies for MSMEs. In order to strengthen the economy of the people in Patokaan Village, the village government is actively helping the community to sell agricultural products to people outside the village and those in Patokaan Village. In addition to channeling assistance through village funds for direct cash assistance to the people of Patokaan Village, Talawaan District, North Minahasa Regency.

The total health gains and cost savings of eradicating cold housing in Australia

BackgroundCold indoor temperature (<18 °C) is associated with hypertension-related and respiratory disease, depression, and anxiety. We estimate total health, health expenditure and income impacts of permanently lifting the temperature in living areas of the home to 18 °C in cold homes in South-eastern Australia (N = 17 million). MethodsA proportional multistate lifetable model was used to estimate health adjusted life years (HALYs), health expenditure and income earnings, over the remainder of the lifespan of the population alive in 2021 (3% discount rate). Multiple data were integrated including the prevalence of cold housing (5.87%; mean temperature 15 °C), the effect of temperature to hypertension-related, respiratory disease, depression and anxiety. FindingsEradicating cold housing was predicted to lead to 89,600 (95% UI 47,700 to 177,000) lifetime HALYs gained over the population's remaining lifespan, nearly half of which occurred from 2021 to 2040. Respiratory disease (32.4%) and mental illness (60.6%) made large contributions to HALYs gained, but also had large uncertainty (95% UI 30.0%–42.9% and 45.1%–64.6%, respectively) due to uncertain estimates of their magnitude of causal association with cold housing. Health gains per capita were 6.1 times greater (95% UI 4.7 to 8.1) among the most compared to least deprived quintile. From 2021 to 2040, health expenditure decreased by AUD$0.87 billion (0.35–1.98) and income earnings increased by AUD$4.35 billion (1.89–9.81). InterpretationEliminating cold housing would lead to substantial health gains, reductions in health inequalities, savings in health expenditure, and productivity gains. Next steps require research to reduce uncertainty about the magnitude of causal associations of cold with mental and respiratory health.