Total Cost Savings Research Articles

EE83 Total Costs and Cost Savings of Comprehensive Knee Osteoarthritis Management Combined With Total Knee Arthroplasty in an Ambulatory Surgical Center

EE83 Total Costs and Cost Savings of Comprehensive Knee Osteoarthritis Management Combined With Total Knee Arthroplasty in an Ambulatory Surgical Center

Assessment of the utilization of real-time prescription benefits for patient cost savings within an outpatient setting

BackgroundThis study evaluates the impact of Real-Time Prescription Benefits (RTPB), a tool integrated into electronic health records (EHRs), on patient out-of-pocket costs in an academic institution. RTPB provides prescribers with alternative, less expensive medications based on insurance plans. The primary measure was cost-savings, defined as the difference between the out-of-pocket cost of the prescribed medication and its alternative. MethodsA retrospective analysis of prescriptions from outpatient clinics in a university-based health system was conducted between May 2020 and July 2021. Prescriptions were analyzed at the 2nd level of the Anatomical Therapeutic Chemical (ATC) classification system. Costs were standardized to a 30-day supply. Standardized cost and total cost per prescription, and overall savings for the top 20 medication classes at the 2nd ATC level were calculated. The overall impact of RTPB was estimated based on selecting the least expensive alternative suggested by RTPB. ResultsThe study found that RTPB information was provided for 22% of prescriptions, with suggested alternatives for 1.26%. Among prescriptions with an alternative selected, the standardized average cost saving was $38.83. The study realized $15,416 in patient total cost savings. If the least expensive RTPB-suggested alternative were chosen for all prescriptions, an estimated $276,386 could have been saved. Psychoanaleptic and psycholeptic medications were the most prescribed with an alternative, with most savings in specialty drugs like anthelmintic and immunostimulant medications. ConclusionThe study highlights the importance of RTPB in reducing patient costs. It reports patient cost-savings with RTPB in prescribing decisions. Future research could explore the impact of RTPB on medication adherence using pharmacy claims data.

APPLICATION OF VALUE ENGINEERING IN ARCHITECTURAL WORK ON THE LAHAIROI LATERI CHURCH, AMBON CITY

Effective construction cost control such as saving construction costs will increase the chances of project success and user satisfaction. The biggest component in construction costs is material. High material costs necessitate a review of building functions. Construction savings are made by reviewing the largest cost components in architectural work. Review of material components is carried out using the value engineering method. Value engineering is a method for getting an alternative picture so that the costs incurred are more efficient than the initial planning costs. The application of value engineering to construction projects has a major impact on planning by generating reviews to obtain cost effectiveness. Research was conducted at the Lahairoi Lateri Church Building project located in Ambon City. The aim of this research is to find alternative material substitutes for architectural work and obtain total cost savings by using the concept of value engineering. The use of the value engineering concept is carried out by information phase, analyzing the function of using index function analysis techniques, identifying alternative materials, and evaluating the results of the alternative materials. Research using the value engineering concept on the Lahairoi Lateri Church Building Construction project, Ambon City achieved cost savings of 861,116,841.05 IDR. This amount saves 5.32% of the initial architectural work costs of 16,170,539,500 IDR. These results show that value engineering can eliminate unnecessary costs in church-type building without changing the building function.

#2628 A haemodialysis patient-centred model of care with a multidisciplinary programme: what is its clinical and health efficiency impact?

Abstract Background and Aims Chronic kidney disease (CKD) constitutes a public health concern due to its notable morbidity & mortality and associated costs. The Patient Care Coordination program (PCC) provides comprehensive and personalized care to haemodialysis (HD) patients. This study evaluated the cost-effectiveness of PCC compared to standard of care (SoC). Method The study included patients in 9 HD clinics (5 PCC, 4 SoC) in Catalonia, Spain, in 2020-2021. A comparative effectiveness evaluation was conducted to compare change in Individual Patient Performance Score (IPPS, score 0-100, evaluates parameters such as vascular access, adequacy of HD, anaemia, mineral bone disease, arterial hypertension, nutrition/hydration status) and number of hospitalisations of PCC patients vs SoC during the first year in the program. Instrumental variables (IV) regression analysis was performed to address potential confounding; number of interactions with program specialists was a valid IV to estimate degree of PCC use. An incremental cost-effectiveness analysis (iCEA) through microsimulation was performed using the effectiveness data from the previous step, population data from the renal patient registry of Catalonia, and the cost of hospitalisations obtained from the Public Health System. Results 127 patients in PCC and 363 patients in SoC were included. The degree of PCC use had a positive impact on IPPS variation during the first year of the program (p = 0.012). In the iCEA the PCC program resulted in a mean gain of 3.4 additional IPPS points, a reduction of 0.2 hospitalisations per patient, and reduced mean costs of €1,265 per patient in the first year compared to SoC, resulting to be a dominant alternative (Fig. 1). Conclusion The holistic and interdisciplinary approach to the patient has further highlighted the relevance of programme use and not only belonging to the programme in achieving clinical goals. The PCC program represents thus a dominant alternative, with greater effectiveness and total cost savings that could sum up to €5.5 million per year in the region due to reduced hospitalizations. This approach may be an alternative to address the challenges of CKD and optimise the allocation of healthcare resources.

Business case for psychosocial interventions in clinics: potential for decrease in treatment discontinuation and costs

Research questionFrom a value-based healthcare (VBHC) perspective, does an assessment of clinical outcomes and intervention costs indicate that providing cognitive behavioural therapy (CBT) or mindfulness to women seeking fertility treatment add value compared with no such intervention? DesignProof-of-concept business case based on a VBHC perspective that considers clinical outcomes and costs. Potential effects on psychological and fertility outcomes were based on existing research. Cost outcomes were estimated with a costing model for the Dutch fertility treatment setting. ResultsThirty-two studies were identified; 13 were included. Women who received CBT had 12% lower anxiety, 40% lower depression and 6% higher fertility quality of life; difference in clinical pregnancy rates was six percentage points (CBT [30.2%]; control [24.2%]); difference in fertility discontinuation rates was 10 percentage points (CBT [5.5%]; control [15.2%]). Women who received training in mindfulness had 8% lower anxiety, 45% lower depression and 21% higher fertility quality of life; difference in mean clinical pregnancy rate was 19 percentage points (mindfulness [44.8%]; control [26.0%]). Potential total cost savings was about €1.2 million per year if CBT was provided and €11 million if mindfulness was provided. Corresponding return on investment for CBT was 30.7%, and for mindfulness 288%. Potential cost benefits are influenced by the assumed clinical pregnancy rates; such data related to mindfulness were limited to one study. ConclusionsThe provision of CBT or mindfulness to women seeking fertility treatment could add value. Higher quality primary studies are needed on the effect of mindfulness on clinical pregnancy rates.

Nonpharmacological intervention therapies for dementia: potential break-even intervention price and savings for selected risk factors in the European healthcare system

BackgroundNew effective treatments for dementia are lacking, and early prevention focusing on risk factors of dementia is important. Non-pharmacological intervention therapies aimed at these factors may provide a valuable tool for reducing the incidence of dementia. This study focused on the development of a mathematical model to predict the number of individuals with neurodegenerative diseases, specifically Alzheimer’s disease, Parkinson’s disease, vascular dementia, and amyotrophic lateral sclerosis. Scenarios for non-pharmacological intervention therapies based on risk factor reduction were also assessed. The estimated total costs and potential cost savings from societal were included.MethodsBased on demographic and financial data from the EU, a mathematical model was developed to predict the prevalence and resulting care costs of neurodegenerative diseases in the population. Each disease (Alzheimer’s disease, Parkinson’s disease, vascular dementia, and amyotrophic lateral sclerosis) used parameters that included prevalence, incidence, and death risk ratio, and the simulation is related to the age of the cohort and the disease stage.ResultsA replicable simulation for predicting the prevalence and resulting cost of care for neurodegenerative diseases in the population exhibited an increase in treatment costs from 267 billion EUR in 2021 to 528 billion EUR by 2050 in the EU alone. Scenarios related to the reduction of the prevalence of dementia by up to 20% per decade led to total discounted treatment cost savings of up to 558 billion EUR.ConclusionThe model indicates the magnitude of the financial burden placed on EU healthcare systems due to the growth in the population prevalence of neurodegenerative diseases in the coming decades. Lifestyle interventions based on reducing the most common risk factors could serve as a prevention strategy to reduce the incidence of dementia with substantial cost-savings potential. These findings could support the implementation of public health approaches throughout life to ultimately prevent premature mortality and promote a healthier and more active lifestyle in older individuals.

Analysis of long-term clinical and cost impact of etranacogene dezaparvovec for the treatment of hemophilia B population in the United States

Introduction Etranacogene dezaparvovec (EDZ), Hemgenix, is a gene therapy recently approved for people with hemophilia B (PwHB). Objective To estimate long-term clinical impact and cost of EDZ in the United States (US). Methods A decision-analytic model was developed to evaluate the long-term impact of introducing EDZ for PwHB over a 20-year time horizon. Factor IX (FIX) prophylaxis comparator was a weighted average of different FIX prophylaxis regimens based on US market share data. We compared a scenario in which EDZ is introduced in the US versus a scenario without EDZ. Clinical inputs (annualized FIX-treated bleed rate; adverse event rates) were obtained from HOPE-B phase 3 trial. EDZ durability input was sourced from an analysis predicting long-term FIX activity with EDZ. EDZ one-time price was assumed at $3.5 million. Other medical costs, including FIX prophylaxis, disease monitoring, bleed management, and adverse events were from literature. The model estimated annual and cumulative costs, treated bleeds, and joint procedures over 20 years from EDZ introduction. Results Approximately 596 PwHB were eligible for EDZ. EDZ uptake was estimated to avert 11,282 bleeds and 64 joint procedures over 20 years. Although adopting EDZ resulted in an annual excess cost over years 1-5 (mean: $53 million annually, total $265 million), annual cost savings were achieved beginning in year 6 (mean: $172 million annually; total $2.58 billion in years 6-20). The total cumulative 20-year cost savings was $2.32 billion, with cumulative cost savings beginning in year 8. Conclusion Introducing EDZ to treat PwHB is expected to result in cost savings and patient benefit over 20 years. Initiating PwHB on EDZ sooner can produce greater and earlier savings and additional bleeds avoided. These results may be a conservative estimate of the full value of EDZ, as PwHB would continue to accrue savings beyond 20 years.

Budget Impact Analysis of Circulating Tumor DNA Testing for Colon Cancer in Commercial Health and Medicare Advantage Plans

In a randomized clinical trial, treatment guided by tumor-informed circulating tumor (ct)DNA testing reduced adjuvant chemotherapy use without compromising recurrence-free survival in patients with stage II colon cancer. The potential effects of adopting ctDNA testing into routine patient care is unknown. To compare the total cost of patient care scenarios with and without the adoption of ctDNA testing. This budget impact analysis was conducted from the perspectives of US commercial health and Medicare Advantage payers. A decision-analytical model was populated with age-specific incidence of colon cancer, use of adjuvant chemotherapy, and use of single-agent or multiagent regimens. Total cost was estimated with the costs of ctDNA testing, drug acquisition, administration, surveillance, and adverse events. The analysis was conducted from September 2023 to January 2024. The adoption of ctDNA testing. The incremental cost in the first year following the adoption of ctDNA testing, where testing will affect patient treatment and costs. In hypothetical plans with 1 million individuals covered, 35 commercial health plan members and 102 Medicare Advantage members aged 75 years and younger were eligible for ctDNA testing. In the base case with a 50% adoption rate, total cost savings were $221 684 (equivalent to $0.02 per member per month [PMPM]) for a commercial payer and $116 720 (equivalent to $0.01 PMPM) for a Medicare Advantage payer. Cost savings were robust to variations in assumptions of all parameters in the commercial population but sensitive to variations in assumptions of adjuvant chemotherapy use rates in the Medicare Advantage population. The number needed to test to avoid 1 patient receiving adjuvant chemotherapy was 4 in the commercial population and 10 in the Medicare Advantage population. The budget-neutral cost for ctDNA testing was $16 202 for a commercial payer and $5793 for a Medicare Advantage payer. Use of tumor-informed ctDNA testing to guide adjuvant chemotherapy in postsurgery patients with stage II colon cancer was projected to result in cost savings for both commercial and Medicare Advantage payers. Adoption of ctDNA testing is therefore advantageous from a budgetary perspective.

Optimization of Fortune Cooking Oil Distribution Routes Using Ant Colony Optimization Method

In Indonesia, cooking oil is very important as a food ingredient. Where the production volume of a product can affect distribution system decisions. An efficient distribution process can provide a competitive advantage in terms of cost and service. Distribution at PT ABC is currently still done manually, besides that the company has not optimized the transport capacity of vehicles so that it results in swelling distribution costs, as well as distribution bridges. This research is aimed at finding the most optimal distribution route for cooking oil products at PT A using the Ant Colony Optimization method. After processing the data using the Ant Colony Optimization method, the optimal fortune cooking oil distribution route was obtained by dividing it into 4 subroutes with a total mileage of 2371 KM with a total distribution cost of Rp. 1,612,960. and the total mileage of the initial route was 2693 KM with a total distribution cost of Rp. 1,831,240. So we get a total savings in mileage of 322 KM and savings in total distribution costs of Rp. 218,960. Therefore, the results obtained using the Ant Colony Optimization method will be selected as the proposed method.

Eco-Energetical analysis of circular economy and community-based virtual power plants (CE-cVPP): A systems engineering-engaged life cycle assessment (SE-LCA) method for sustainable renewable energy development

Amidst the escalating complexity of energy demands and climate concerns, natural calamities, and the Black Swan phenomenon have all presented formidable obstacles to the advancement and implementation of renewable energy sources. In light of the present backlog of studies in energy technology, the three primary issues identified and resolved in this study are inadequate analysis of the actual situation, absence of evidence of sustainable development, and flawed systematic methodology. This study proposes a novel renewable energy development initiative known as the circular economy and community-based virtual power plant (CE-cVPP). By integrating community participation and circular economy principles, this initiative aims to foster sustainable development and facilitate resilient progress. The principal focuses of the model are community renewable energy supply, energy demand, and community participation management. The sustainable framework is constructed upon the principles of circular economy theory. The systems engineering-based life cycle assessment (SE-LCA) method is proposed as an innovative approach to whole life cycle assessment that is grounded in systems engineering. Its purpose is to facilitate a systematic implementation and empirical evaluation of the sustainability of energy, the environment, and the economy. On the basis of disparities in renewable energy sources and a variety of spatiotemporal dimensions, CE-cVPP is categorised into four representative groups. We present a business community model for energy and environmental analysis that is based on a hospital in Harbin. The results suggest that the overall lifecycle primary energy conservation rate is 67.21%, which is an exceptional outcome that significantly promotes sustainable development in comparison to conventional methods. This improves environmental and human health protection as the full lifecycle emission reduction ratios for atmospheric pollutants are 53.50% (SO2-eq.), 51.69% (PM2.5-eq.), and 74.85% (CO2-eq.). Consideration is given to raw materials, equipment construction, equipment operation, tariffs on six pollutants, and material recycling when calculating the total cost. The annual total cost savings ratio for the full lifecycle is 54.21% when compared to the traditional system. This research possesses methodological and theoretical applicability to the energy and power sectors.

The Cost-Effectiveness of Computer-Assisted Compared with Conventional Total Knee Arthroplasty: A Payer's Perspective.

Recent evidence showing that computer-assisted total knee arthroplasty (TKA) is associated with better outcomes compared with conventional TKA for patients with end-stage knee osteoarthritis has not been included in economic evaluations of computer-assisted TKA, which are needed to support coverage decisions. This study evaluated the cost-effectiveness of computer-assisted TKA from a payer's perspective, incorporating recent evidence. We compared computer-assisted TKA with conventional TKA with regard to costs (in 2022 U.S. dollars) and quality-adjusted life-years (QALYs) using Markov models for elderly patients (≥65 years of age) and patients who were not elderly (55 to 64 years of age). Costs and QALYs were estimated in the lifetime for elderly patients and in the short term for patients who were not elderly, under a bundled payment program and a Fee-for-Service program. Transition probabilities, costs, and QALYs were retrieved from the literature, a national knee arthroplasty registry, and the National Center for Health Statistics. Threshold and probabilistic sensitivity analyses were conducted to examine the robustness of key estimates used in the base-case analysis. Using projected estimates of TKA utilization, the total cost savings of performing computer-assisted TKA rather than conventional TKA were estimated. Compared with conventional TKA, computer-assisted TKA was associated with higher QALYs and lower costs for both elderly patients and patients who were not elderly, regardless of payment programs, making computer-assisted TKA a favorable treatment option. Widespread adoption of computer-assisted TKA in all U.S. patients would result in an estimated total cost saving of $1 billion for payers. Compared with conventional TKA, computer-assisted TKA reduces costs to payers while providing favorable outcomes. Payers may consider providing additional payment incentives to providers for performing computer-assisted TKA, to achieve outcome improvement and cost control by facilitating widespread adoption of computer-assisted TKA. Economic and Decision Analysis Level II. See Instructions for Authors for a complete description of levels of evidence.

A Branch-and-Price Algorithm for an Integrated Online and Offline Retailing Distribution System with Product Return

This study identifies critical inefficiencies within a dual-channel operation model employed by a fast fashion company, particularly the independent operation of three logistics distribution systems. These systems result in high operational costs and low resource utilization, primarily due to redundant vehicle dispatches to meet the distinct demands of retail store replenishment, online customer orders, and customer return demands, as well as random and scattered return requests leading to vehicle underutilization. To address these challenges, we propose a novel integrated logistics distribution system design and management method tailored for dual-channel sales and distribution businesses. The approach consolidates the three distribution systems into one cohesive framework, thus streamlining the delivery process and reducing vehicle trips by combining retail and customer visits. An optimization algorithm is introduced to factor in inventory and distribution distance, aiming to achieve global optimization in pairing retail store inventory with online customer orders and unifying the distribution of replenishment products, online products, and returned products. The paper contributes to the field by introducing a new variation of the Vehicle Routing Problem (VRP) that arises from an integrated distribution system, combining common VRP issues with more complex challenges. A custom Branch-and-Price (B&P) algorithm is developed to efficiently find optimal routes. Furthermore, we demonstrate the benefits of the integrated system over traditional, segregated systems through real-world data analysis and assess various factors including return rates and inventory conditions. The study also enhances the model by allowing inventory transfers between retail stores, improving inventory distribution balance, and offering solutions for scenarios with critically low inventory levels. Our findings highlight a significant reduction in total operating cost savings of up to 49.9% and vehicle usage when using the integrated distribution system compared to independent two-stage and three-stage systems. The integrated approach enables the utilization of vacant vehicle space and the dynamic selection and combination of tasks, preventing unnecessary mileage and space wastage. Notably, the integration of inventory sharing among retail stores has proven to be a key factor in generating feasible solutions under tight inventory conditions and reducing operational costs and vehicle numbers, with the benefits amplified in large-scale problem instances.

Novel heat pump assisted distillation configurations for energy and economic savings and their application on propylene/propane and I-butane/N-butane separation systems

Various configurations of vapor recompression heat pumps were previously proposed for enhancing its thermodynamic and/or economic performance. The outcomes of prior publications were documented using fundamentally distinct separation systems, making it challenging for process engineers to decisively determine the optimal processing options for a particular separation task. This difficulty arises from the variations in thermophysical properties exhibited by the materials involved. Despite limited research on bottom flashing heat pumps, they offer advantages over vapor recompression such as lower operating pressure and temperature in process sections. This can result in cost savings and safer operation. In this paper, novel configurations of bottom flashing are proposed, based on the ideas and schemes, previously proposed for vapor recompression. The novel processing systems were proposed and applied on propylene/propane and i-butane/n-butane separation processes as samples of close-boiling distillation systems. This study showed that the bottom flashing systems showed greater economic performances compared to vapor recompression for i-butane/n-butane separation. total annual costs savings of 19.0% was obtained, using the novel configuration of heat recuperated bottom flashing configuration on isobutane/n-butane separation. Also, annualized costs of the systems based on bottom flashing were 10.9%, 4.2% and 7.3% lower than their equivalent vapor recompression processes.

Real-World Health Care Resource Use and Costs Among Patients With Chronic Lymphocytic Leukemia Treated With Venetoclax-Based and Bruton Tyrosine Kinase Inhibitor-Based Regimens in the Second-Line Setting.

Real-world evidence comparing health care resource use (HRU) and costs between novel targeted therapies among patients with chronic lymphocytic leukemia (CLL) is lacking. We compared all-cause and CLL-specific HRU and costs between patients initiated on B-cell lymphoma 2 inhibitor (venetoclax)- or Bruton tyrosine kinase inhibitor (BTKi)-based regimens in the second-line (2L) setting. This is a retrospective observational study using Optum Clinformatics Data Mart of adult patients with CLL/small lymphocytic lymphoma who received 2L venetoclax- or BTKi-based regimens (January 2018-December 2021) for the first time and had ≥one CLL diagnostic claim after 2L initiation and ≥two claims for venetoclax or BTKi. Baseline characteristics were balanced using stabilized inverse probability of treatment weights. Mean monthly cost difference (MMCD) between cohorts for all-cause and CLL-specific per patient per month (PPPM) costs was estimated. Rates of PPPM-HRU were compared between cohorts using rate ratios (RRs). Of 280 patients, median age 75.5 years, 64.6% and 35.4% received BTKi- versus venetoclax-based regimens, respectively. Most BTKi-treated patients received monotherapy (88.4%), whereas 62.3% of venetoclax-treated patients received combination therapy with anti-CD20 agents. The median duration of 2L therapy was 11.6 and 11.0 months for BTKi versus venetoclax cohorts, respectively. All-cause total costs were lower for venetoclax versus BTKi (MMCD [SE], $-2,497.64 [$1,006.77] in US dollars (USD); P = .01), driven by lower medication costs offsetting medical costs; trends were similar for CLL-specific estimates. Outpatient HRU was higher for venetoclax versus BTKi (RR all-cause: 1.22 versus CLL-specific: 1.64). Venetoclax was associated with total monthly cost savings versus BTKis, illustrating the economic value of time-limited venetoclax-based regimens in the 2L setting.

Treatment-Free Interval: A Novel Approach to Assessing Real-World Treatment Effectiveness and Economic Impact Among Patients with Irritable Bowel Syndrome with Diarrhea.

Objective assessment of treatment effectiveness using real-world claims data is challenging. This study assessed treatment-free intervals (TFI) as a proxy for treatment effectiveness, and all-cause healthcare costs among adult patients with irritable bowel syndrome with diarrhea (IBS-D) treated with rifaximin or eluxadoline in the USA. Adult patients (18-64years) with IBS-D and ≥ 1 rifaximin or eluxadoline prescription were identified in the IQVIA PharMetrics® Plus database (10/01/2015-12/31/2021) and classified into two mutually exclusive cohorts (i.e., rifaximin and eluxadoline). Index date was the date of rifaximin or eluxadoline initiation. Entropy-balanced baseline characteristics, TFI (periods of ≥ 30consecutive days without IBS-D treatment), and healthcare costs were reported. Healthcare costs were compared between cohorts using mean cost differences. There were 7094 and 2161 patients in the rifaximin and eluxadoline cohorts, respectively. After balancing, baseline characteristics (mean age 44.1years; female 72.4%) were similar between cohorts. A higher proportion of patients treated with rifaximin achieved a TFI of ≥ 30days (76.2% vs. 66.7%), ≥ 60days (67.0% vs. 47.0%), ≥ 90days (61.0% vs. 38.7%), ≥ 180days (51.7% vs. 31.0%), and ≥ 240days (47.7% vs. 27.9%) compared to eluxadoline. Among patients with a TFI ≥ 30days, mean TFI durations were 8.3 and 6.0months for the rifaximin and eluxadoline cohorts. Mean all-cause healthcare costs were lower for rifaximin vs. eluxadoline ($18,316 vs. $23,437; p = 0.008), primarily driven by pharmacy costs ($7348 vs. $10,250; p < 0.001). In a simulated health plan of one million commercially insured lives, initiating 50% of patients on rifaximin instead of eluxadoline resulted in total cost savings of $2.1million per year or $0.18per-member-per-month. This real-world study suggests that TFI is a meaningful surrogate measure of treatment effectiveness in IBS-D. Patients treated with rifaximin had longer treatment-free periods and lower healthcare costs than patients treated with eluxadoline.

A cost analysis of upscaling access to continuity of midwifery carer: Population-based microsimulation in Queensland, Australia

ObjectiveTo quantify the economic impact of upscaling access to continuity of midwifery carer, compared with current standard maternity care, from the perspective of the public health care system. MethodsWe created a static microsimulation model based on a whole-of-population linked administrative data set containing all public hospital births in one Australian state (Queensland) between July 2017 to June 2018 (n = 37,701). This model was weighted to represent projected State-level births between July 2023 and June 2031. Woman and infant health service costs (inpatient, outpatient and emergency department) during pregnancy and birth were summed. The base model represented current standard maternity care and a counterfactual model represented two hypothetical scenarios where 50 % or 65 % of women giving birth would access continuity of midwifery carer. Costs were reported in 2021/22 AUD. ResultsThe estimated cost savings to Queensland public hospital funders per pregnancy were $336 in 2023/24 and $546 with 50 % access. With 65 % access, the cost savings were estimated to be $534 per pregnancy in 2023/24 and $839 in 2030/31. A total State-level annual cost saving of $12 million in 2023/24 and $19 million in 2030/31 was estimated with 50 % access. With 65 % access, total State-level annual cost savings were estimated to be $19 million in 2023/24 and $30 million in 2030/31. ConclusionEnabling most childbearing women in Australia to access continuity of midwifery carer would realise significant cost savings for the public health care system by reducing the rate of operative birth.

Design, Economic, and Environmental Accounting Assessment of a Solar-Powered Cold Room for Fish Storage in Traditional Markets

The food industry, crucial for emerging economies, faces challenges in refrigeration, particularly in fish storage. High energy consumption, environmental impact, and improper cooling methods leading to food waste are significant issues. Addressing these challenges is vital for economic and environmental sustainability in the food sector, especially concerning fish storage where spoilage rates are high. In this context, this research proposes a sizing methodology, evaluation, and parametric simulations based on multi-criteria attributes for a solar PV-powered cold room for storing fish in traditional markets in Morocco. To identify the cooling load of the system, TRNSYS 16 was utilized to simulate the transient behavior, while the PV array specifications were determined using SAM 2017.9.5 software. The design process introduced a cold room coupled to a refrigeration unit powered by a 15.3 m2 PV array with a 1.8 kWp nameplate capacity. Finally, yearly and life cycle metrics including self-sufficiency, self-consumption, Levelized Cost of Cooling (LCOC), discounted payback period (DPP), CO2 emissions avoided and total environmental penalty cost savings (TEPCS) are evaluated to assess the performance of the system and a sensitivity analysis was conducted on these metrics. The proposed system has an attractive LCOC of 0.131 $/kWhCold and a DPP of 3.511 years. Using the PV array proved to avoid 437.56 tons of CO2 emissions and generated TEPCS from $100.59 to $866.66. The results of this study highlight the potential for utilizing renewable energy sources in the refrigeration sector to improve both economic and environmental sustainability.

Energy community with shared photovoltaic and storage systems: influence of power demand in cost optimization

AbstractEnergy management of distributed energy resources has gradually become a complex problem because of the intermittent nature of renewable energy sources, such as photovoltaic power, and the large use of energy storage systems. A way to deal with these issues is to operate within an energy community. However, the efficient management of the community in terms of costs is particularly relevant. Specifically, the minimization of the energy community costs, which consists of properly utilizing shared energy storage and renewable energy sources, becomes an important objective. In this context, a fundamental role is played by demand power characteristics which strongly influence the benefits brought by this energy management scheme. This work investigates the influence of the variability of power demand on the minimization of the operating cost problem of an energy community while determining the optimal capacity of the energy storage system that increases the self‐consumption potential of the photovoltaic source. Two main scenarios are implemented where the effects of considering the community photovoltaic capacity as a variable or a parameter on costs and energy storage system size are investigated. This analysis consists of a multi‐objective optimization coupled with a Monte Carlo framework. The community management is conducted by considering random power demand profiles of each unit belonging to the same community, and different sizes, categories of users and users' aggregations. A comparison is led among different users' categories in terms of costs, photovoltaic unit and energy storage system size. The results provide an overview of how each category benefits from taking part in an energy community both in terms of cost and energy storage and photovoltaic sizes and show how these aspects change within a multi‐category aggregation where each category makes a different contribution to the community. In particular, we find evidence of the “synergy effect” brought by multi‐category aggregations capable of exploiting differences in consumption profiles. Each building category, with its numerosity, has a different effect on the energy community, resulting in a different impact on total costs and cost savings. We also investigate how the energy storage system capacity is affected by both the available photovoltaic capacity and the consumption profiles of the categories within the energy community.

Pharmacists as clinical care partners: How a pharmacist-led intervention is associated with improved medication adherence in older adults with common chronic conditions.

Hypertension, hyperlipidemia, and type 2 diabetes (T2D) are 3 of the most common chronic conditions, but related medication adherence rates are far below 80%. Consequences of poor adherence include high health care utilization/costs and increased mortality. There is accumulating evidence in support of the benefits of affording pharmacists the opportunity to practice at the full scope of their licensure by engaging in patients' clinical care. To examine the impact of a large national pharmacy chain's pharmacist-led interventions to improve medication adherence among older adults with hypertension, hyperlipidemia, or T2D. A secondary objective was to estimate the potential cost savings associated with improved adherence. Participants were Medicare patients aged 18 years or older who had 2 or more prescription fills in at least 1 of the 3 therapeutic classes. The primary outcome, optimal adherence, was defined as proportion of days covered (PDC) of 80% or higher. A difference-in-differences (DID) design with a generalized linear model analytical approach was applied to examine differences between intervention participants and controls. The study period spanned from 2020 to 2022. Intervention participants (n = 317,613, age 70.1 years, female sex 57.0%) had lower baseline optimal adherence than controls (n = 943,389, age 73.3, female sex 56.1%) for diabetes (76.9% vs 79.8%), hypertension (79.0% vs 83.0%), and cholesterol (78.6% vs 82.1%). The DID results showed that between 2020 and 2022, optimal adherence had significant absolute increases for intervention participants (diabetes: +4.0%, hypertension: +6.3%, cholesterol: +6.1%) vs controls who declined in adherence (diabetes: -1.6%, hypertension: -0.4%, cholesterol: -1.4%). All DID models were significant at P < 0.0001. Total cost of care was projected based on improvements in adherence. Based on PDC improvements for the test population, we estimate that the pharmacist consultations were associated with annual total health care cost savings of $10,329,284 ($109 per capita), $31,640,660 ($122 per capita), and $21,589,875 ($75 per capita) for test population patients with diabetes, hypertension, and hyperlipidemia, respectively. The study found that the pharmacist-led interventions were significantly associated with increased optimal adherence over 2 years. These findings demonstrate the potential of pharmacist-led interventions to improve medication adherence among older adults with chronic conditions. Strategies to expand pharmacist-provided care must be further examined.

Pharmaceutical cost savings from the treatment of oncology patients in clinical trials

ObjectiveThe aim of this study was twofold: to assess the annual pharmaceutical savings associated with the treatment of cancer patients at Marqués de Valdecilla University Hospital and to estimate the cost of innovative antineoplastic therapies that patients receive as experimental treatment, both during clinical trials throughout 2020. Material and methodsAn observational and financial analysis of the drug cost related to clinical trials was applied. Direct cost savings to the Regional Health System of Cantabria and the cost of innovative therapies used as an experimental treatment in clinical trials were quantified. ResultsThis study includes 38 clinical trials with a sample of 101 patients. The clinical trials analyzed provide a total cost savings of €603,350.21 and an average cost saving of €6,630.22 per patient. Furthermore, the total investment amounts to €789,892.67, with an average investment of €15,488.09 per patient. ConclusionsClinical trials are essential for the advancement of science. Furthermore, clinical trials can be a significant source of income for both hospitals and Regional Health Systems, contributing to their financial sustainability.