Cost-sharing Research Articles

What’s the Cost: Financial Toxicity and Screening Fatigue in Li-Fraumeni Syndrome

Abstract Patients with Li-Fraumeni syndrome are recommended to follow a comprehensive surveillance protocol, but the demanding nature may limit adherence. We sought to identify barriers to adherence, and to determine whether screening fatigue and financial hardship are contributors. A 39-item online survey was developed and distributed to patients presenting to a LFS clinic between 2017 and 2022. Of the 39 patients eligible, 20 responded to the survey (51%). Of respondents, 75% reported they do not skip surveillance tests, though this was not consistent when asked about specific tests, with only 65% and 40% up to date with colonoscopy and esophagogastroduodenoscopy, respectively. 100% of those diagnosed within the last 5 years said they never skip tests, whereas only 50% of those diagnosed over 5 years ago reported the same (p=0.01). Barriers to adherence were reported by 85% and most commonly included finances (40%), time (25%), and difficulty scheduling (25%). Only 21% felt no financial stress. 63% worried at least somewhat about their future financial situation because of LFS. Even with insurance, 65% felt their share of healthcare costs was too high. Adherence to rigorous cancer surveillance is imperfect and decreases over time among patients with LFS. While number of tests was not a commonly cited barrier, time and difficulty scheduling were common and may contribute to screening fatigue. The degree of financial stress in the affluent population studied should raise even greater concern about financial strain in the LFS population in general.

Impact of the Inflation Reduction Act on Patient Access and Out-of-Pocket Costs

The Inflation Reduction Act (IRA) represents a recent policy enactment that will influence prescription drug pricing. This paper examines the IRA's elements and their impact on patients' access to medications, specifically around programs funded by the Centers for Medicare and Medicaid. This review analyzed grey literature on patient medication access concerning the IRA, along with the legislation itself. It finds that the IRA contains six key provisions with the potential to impact patients' access to medications and stakeholder business practices: insulin and vaccine cost share, OOP cost limits, premium stabilizations, drug negotiations, and low-income subsidy programs. Although the IRA presents cost-saving provisions, it may exert downstream effects on new drug innovation, increased medication utilization management by payers and pharmacy benefit managers (PBMs), and how healthcare providers, manufacturers, and payers/(PBMs) work together to balance patient well being with fair economic returns for all stakeholders.

The Tipping Points of Video Conferencing Solutions

ABSTRACT Video conferencing solutions have been used to support remote work and distance education but have not yet been widely adopted. This study aims to contribute to the development and proliferation of video conferencing solutions for remote work and education by analyzing consumer preferences. For this purpose, a survey of 1,018 people was conducted in July and August 2021 in Korea. As the use of video conferencing became enforced due to COVID-19, the analysis reflected previous user experiences. In addition, various scenario-specific market share simulations were performed, assuming future video conferencing solutions. The survey results showed that several factors, including technology attributes, cost, and market share, influence consumers’ choice of video conferencing solutions. The survey also found that consumers have asymmetric preferences regarding video conferencing solutions depending on their previous experience. Finally, the study identified tipping points companies could use to gain a significant market share.

The cost burden of adolescent and young adult pregnancy: real-world evidence from the Brazilian public health care system

Background In low- and middle-income countries, pregnancy in adolescence represents an important public health issue. Rates of early pregnancy have significant social and economic consequences that extend beyond the individual sphere, impacting public/governmental budgets. Aim To estimate the cost implications of early pregnancies from the perspective of the Brazilian Unified Public Health System. Methods This retrospective secondary data analysis focuses on assessing direct hospital costs. The study cohort comprises adolescents and young adults who underwent prenatal care at a reference maternity hospital between January and December 2021. Individual procedure costs were extracted from hospital records and converted into monetary values using the Brazilian Federal Fee. The sample size for each group was determined based on preliminary data collected during a pilot study. Descriptive analyses presented costs stratified by age groups. To estimate budgetary impacts and sensitivity we used national live birth incidence rates. Results The mean cost per case of adolescent pregnancy was US$ 704.92 (SD: 1,707.74) and for adult pregnancy was US$ 592.40 (SD: 941.43). The cost of hospital admission accounted for 61% of the total cost of adolescent pregnancies. The annual budget impact of pregnancies among women under 30 years was estimated at US$ 1 billion, with 239 million coming from women under 20 years old. Conclusion Pregnancy in adolescence may lead to a significant annual budget impact, representing 24% of costs attributed to pregnancies among women under 30 years. Costs related to hospital admissions and complications represent a substantial share of the total costs of adolescent pregnancy.

Taxpayers' Share of US Prescription Drug and Insulin Costs: a Cross-Sectional Study.

Drug prices affect government budgets directly through spending on public programs like Medicare and Medicaid, and indirectly via private coverage for public employees and tax subsidies for private insurance. Yet, the Senate parliamentarian ruled that the Senate could not use streamlined Budget Reconciliation to extend the Inflation Reduction Act's controls on insulin co-payment or drug prices to private insurers on the grounds that their expenditures do not affect the federal budget. To quantify insulin and other drug costs borne by federal, state, and local governments, including direct expenditures and indirect government subsidies that flow through private insurers. Cross-sectional analysis of expenditures for outpatient retail prescription drugs reported by respondents and their pharmacies in the 2019 Medical Expenditure Panel Survey (adjusted downward for drug rebates), supplemented with information on employment-related insurance from the US Office of Management and Budget and other sources. The civilian non-institutionalized US population. Direct (payments by public health insurance programs) and indirect (taxpayer-funded payments via private insurers) government expenditures for outpatient retail drugs. Direct government expenditures for outpatient retail prescription drugs totaled $154.85 billion in 2019, including $15.68 billion for insulin. Indirect government expenditures channeled through private insurers totaled $53.59 billion (including $5.48 billion for insulins). Those indirect expenditures encompassed $32.32 billion in tax subsidies for employer-sponsored private coverage, $25 million for subsidies to private Affordable Care Act marketplace plans, and $21.24 billion for government-paid premiums for public employees and retirees. Overall, government expenditures for outpatient retail prescription drugs totaled $208.44 billion, 58.76% of all-payer spending and 65.96% of spending for insulin. Governments directly or indirectly fund most drug purchases, including substantial expenditures that flow through private insurers. Hence, prices paid by private insurers impact government budgets, supporting the view that government should be allowed to regulate drug prices.

Driving Forces of Strategic Outsourcing in Telecommunication Companies in Tanzania

Abstract This article aims to evaluate the driving forces of outsourcing strategies on the organizational performance of mobile network operators in mainland Tanzania. The objectives are to identify the driving forces of outsourcing and determine the challenges of outsourcing in telecommunication companies. The article adopted a descriptive cross-sectional survey. The selection of mobile companies is based on high market share and operation period. Findings show that customer needs for high-quality services, high-rated change in service, reduction of operational expenditure, and accessing the world’s capability are among the major driving forces for outsourcing. Dependability, loss of security, hidden costs, and selection of competent partners to mention a few are the challenges faced by telecom companies. It is noted that outsourcing enables network operators to advance their organizational performance in terms of operating cost, productivity, profitability, and market share. However, customer satisfaction suffers due to the inconsistency of the quality of service offered. Therefore, it is advised that mobile operators closely monitor outsourcing service providers to ensure that agreed service levels are met, thereby, safeguarding the reputation of the company to customers.

Cost of COVID-19 vaccine delivery in nine States in Nigeria via the U.S. Government Initiative for Global Vaccine Access

BackgroundIn 2022, the U.S. Centers for Disease Control and Prevention collaborated with implementing partners, African Field Epidemiology Network and Sydani Group, to support COVID-19 vaccination efforts in Nigeria. To characterize the costs of COVID-19 vaccination, this study evaluated financial costs per dose for activities implemented to support the intensification campaign for COVID-19 vaccination.MethodsThis retrospective evaluation collected secondary data from existing expenditure and programmatic records on resource utilization to roll out COVID-19 vaccination during 2022. The study included incremental financial costs of the activities implemented to support an intensification campaign for COVID-19 vaccination across nine states and six administrative levels in Nigeria from the perspective of the external donor (U.S. Government). Costs for vaccines and injection supplies, transport of vaccines, and any economic costs, including government in-kind contributions, were not included. All costs were converted from Nigerian Naira to 2022 U.S. Dollars (US$).ResultsThe estimated financial delivery cost of the COVID-19 vaccination intensification campaign was US$0.84 per dose (total expenditure of US$6.29 million to administer 7,461,971 doses). Most of the financial resources were used for fieldwork activities (86%), followed by monitoring and supervision activities (8%), coordination activities (5%), and training-related activities (1%). Labor (58%) and travel (37%) were the resource inputs that accounted for the majority of the cost, while shares of other resource inputs were marginal (1% for each). Most labor costs (79%) were spent on payments for mass vaccination campaign teams, including pay-for-performance incentives. By administrative level, the largest share of costs (46%) was for pay-for-performance incentives at the community, health facility, or campus levels combined, followed by local government area level (24%), community level only (15%), state level (9%), national level (3%), campus level only (1%), and health facility level only (< 1%).ConclusionsFindings from the evaluation can help to inform resources needed for vaccination activities to respond to future outbreaks and pandemics in resource-limited settings, particularly to reach new target populations not regularly included in routine childhood immunization delivery.

Projections of Socioeconomic Costs for Individuals with Dementia in China 2020-2050: Modeling Study.

Previous estimates on future socioeconomic costs of dementia in China are inconsistent, and the main drivers of these costs are unclear. This study projected future socioeconomic costs (healthcare, formal social care, and informal care costs) and value of quality adjusted life years (QALYs) lost to dementia in China and assessed drivers of socioeconomic costs. Based on our prior projection on dementia cases to 2050 by a Markov model, we forecasted future socioeconomic costs and the value of QALYs from a societal perspective, utilizing the China Health and Retirement Longitudinal Study and the Chinese Longitudinal Healthy Longevity Survey. In our main analysis, dementia incidence increased by 2.9% annually, while sensitivity analyses considered a flat or 1.0% annual decrease in the temporal trend of dementia incidence. Furthermore, we decomposed socioeconomic costs changes (2018 US$) into population growth, population aging, dementia prevalence and average socioeconomic costs per case. The annual socioeconomic costs and value of QALYs lost to dementia will reach $1,233 billion and $702 billion by 2050. If dementia incidence stays constant or decreases by 1.0% annually, the costs and QALYs would respectively decrease by 34% or 43% in 2050. Informal care is currently, and projected to remain, the largest share of socioeconomic costs. Population aging and rising dementia prevalence will mainly drive the growth in socioeconomic costs through 2050. Dementia casts an increasingly large economic burden on Chinese society, mainly driven by fast aging population and growing dementia prevalence.

Implementation Of New Mexico's 'No Behavioral Health Cost Sharing' Law: A Qualitative Study.

Out-of-pocket spending is a long-standing challenge for privately insured people. New Mexico passed the first US law prohibiting private insurers from applying cost sharing to behavioral health treatment, effective January1, 2022. We examined the perceptions of key informants, including clinicians, insurers, and state officials, about implementing the No Behavioral Health Cost Sharing law to explore how it might affect downstream outcomes such as spending and access. The law was viewed favorably and implemented without much difficulty. Clinicians noted widespread positive impacts, particularly for those needing intensive treatment. However, they worried about workforce capacity and the exclusion of people covered under self-insured employer plans, which are exempt from state regulation under the Employee Retirement Income Security Act (ERISA) of 1974. Insurers found the law to be in alignment with their organizational goals, but they expressed concern about the administrative burden caused by increased reviews of claims, and some were monitoring for unintended consequences (for example, waste and fraud) that could lead to increased premiums. Engagement strategies were needed to inform eligible members and facilitate enrollment in eligible plans. The law provides a potential model for states to improve access to behavioral health care, but impacts may be limited by factors such as workforce, awareness, and federal ERISA constraints.

Ресурсный потенциал сферы облачных инфокоммуникационных услуг в российских регионах: сравнительная оценка

The purpose of the study is to develop a methodological approach to comparative assessment of the resource potential of the cloud infocommunication services sphere in Russian regions in order to determine the state and development prospects of regional resources. The approach is based on the construction of integral indices of human and infrastruc-ture resources of the regions. The choice of statistical indicators included in the named indices was substantiated. The assessments of the level of development of the resource potential of the cloud infocommunication services sphere in Russian regions were constructed based on the current Rosstat data for 2022 and 2023. The regions were grouped by analogy with the groupings of the BCG matrix and the Gartner quadrant. Each region is assessed by two indices: «hu-man resources» and «infrastructure resources». Four groups of regions were defined, corresponding to the four quad-rants: with high scores for both indices; with high scores only for the infrastructure resources indicator; with high scores only for the human resources indicator; with low scores for both indicators. The prospects for the development of re-gional resources were determined, taking into account the identified specificity of regional resources and the share of costs for the implementation and use of digital technologies in the gross regional product. The results can be used to justify strategic directions for the development of the resource potential of the infocommunication sphere of Russian regions.

Inferring the metabolic rate of bone

The bone organ is poorly represented in comparative research on mammalian mass-specific metabolic rates. As a first order attempt to remedy this, from the literature we collected mass-specific metabolic rates for all major organs except for the bone organ, and by subtraction infer the rate for the bone organ. The scaling relationships are given of each whole-organ mass-specific metabolic rate and of the relationship between whole-organ metabolic rate and body mass. Scaling of the lung, adipose depot and bone organ with body mass is higher than would be expected by ¾ power scaling. We interpret the similar scalings of bone and the adipose depot in light of their evolved regulation of whole-body metabolism. We also briefly examine the supra-¾ power scaling of the lung as well as the independence of the mass-specific metabolic rate of the heart from body mass. The bone organ exhibits relatively high energy expenditure with increasing body size. The bone marrow and its medullary adipocyte store may be responsible for engendering the greater share of the bone organ's energetic cost.

Optimal design of a post-demolition autoclaved aerated concrete (AAC) recycling network using a capacitated, multi-period, and multi-stage warehouse location problem

Autoclaved aerated concrete is a popular building material in constructing one- and two-family houses because of its low thermal conductivity and fire resistance. Since autoclaved aerated concrete production rose significantly in the 1960s and 1970s, increasing post-demolition volumes can be expected in the following decades. However, these are currently landfilled as high-quality recycling options are still to be established.This study develops a new capacitated, multi-period, and multi-stage network model for optimising a Germany autoclaved aerated concrete recycling network. The multi-period character of the model enables the precise consideration of increasing post-demolition volumes by constantly allowing the move of recycling plants or opening new ones throughout the planning horizon. Additionally, the multi-stage formulation facilitates incorporating an optional second recycling step, which involves additional effort and higher revenues. The model aims to find a cost-minimised recycling network and identify optimal network transformations until 2050. Results show that recycling is preferred over landfilling. The optimised recycling network uses large recycling plants for economies of scale and opens new plants in the future to handle the expected increase in post-demolition autoclaved aerated concrete. Transport costs account for the largest share of total costs (50%), while fixed costs reach around 40%, and revenues offset approximately 20% of all costs. The total costs of the network reach about 2200 M€ until 2050, which is 4600 M€ (68%) less than without establishing recycling. The results offer new insights into cost-minimal network structures and their future development to encourage decision-makers to promote autoclaved aerated concrete recycling.

Adult Pharmacy Costs and Characteristics of Very High-Cost Prescription Drug Users in the United States, 2018–2022

Objective: This study sought to identify: (1) the demographic and clinical characteristics of very high-cost users (defined as patients with pharmaceutical expenditures that were equal to or greater than the 99th percentile), (2) whether or not these characteristics changed over time, (3) sociodemographic and clinical correlates of being very high-cost users, (4) the average pharmaceutical costs of very-high cost users, and (5) the therapeutic classes and medications that contributed to these high costs Background: There are growing public concerns about rising drug costs, in part due to increased availability, greater effectiveness, and market considerations. There is a concentrated portion of patients that accounts for a disproportionately large portion of pharmaceutical expenditures. Methods: A large serial cross-sectional study was conducted with De-identified, member-level pharmacy claims (n = 65,739,791) from a large, national pharmacy benefits manager from January 1, 2018 to December 31, 2022. The main outcome and measures were 2018–2022 pharmaceutical expenditures; amounts were adjusted for inflation to reflect 2022-dollar values. Results: Across the study period, the odds of being classified as a very high-cost user were 1.31 times as high for those 45–64 years old compared with those 18–44 years old (reference category); the odds were 1.42 times as high for males compared with females; 1.13 times as high before those identifying as non-Hispanic Black compared with non-Hispanic white; 1.11 times as high for those enrolled in a health care exchange plan compared with a commercial plan. In addition, very high-cost users lived in areas with higher social needs. Human immunodeficiency virus, inflammatory conditions, multiple sclerosis, and cancer accounted for the largest share of costs among this group. Conclusions: This study identified the unique characteristics of very high-cost pharmaceutical users and identified the top conditions and prescription drugs that drove high pharmaceutical expenditures among this population. These findings are essential to understanding rising pharmaceutical costs in the United States and can help identify the issues and solutions of specific cost drivers within our health care policies.

Sustainability and environmental costs in the textile industry: a case study

The impact of greenhouse gas and carbon emissions on climate change and more frequent natural disasters in recent years have increased people's and government's environmental awareness. The enactment of environmental legislation and new standards have resulted in some additional environmental costs for companies. Every additional cost is very important for companies operating under intense competitive pressure. Companies operating in the textile sector undertake the costs of prevention, use and damage at every stage of their production. In this study, the importance of the textile sector in Türkiye in terms of the country's economy has been revealed and the environmental costs of textile enterprises have been examined. The study aims to reveal the environmental costs for yarn production, yarn dyeing process, weaving-confection processes and dyeing-finishing processes separately and to calculate the share of these costs in total operating expenses. According to the results of the study, it has been determined that the share of environmental costs in total expenses in the textile company is 3.1%. It has been observed that the share of environmental costs in total expenses varies between 0.5% and 6% at different production stages.

Pharmacoeconomic aspects of drug provision for diabetic patients in the Novosibirsk Region

Aim – to assess pharmacological and economic aspects of drug provision for patients with diabetes mellitus in the Novosibirsk region at federal and regional levels for the period of 2019–2021. Material and methods. An array of data on drug provision for diabetic patients in the Novosibirsk region for the period of 2019–2021 was collected and subjected to analysis. The research process used a systematic approach with the following methods: logical analysis, content analysis, ABC analysis, XYZ analysis. Results. For the period of 2019–2021, the burden on the regional drug provision system for diabetic patients had been steadily increasing. At the same time, the share of costs for drug provision for diabetic patients at the federal level continued to grow, despite the reducing number of covered prescriptions. Potentially, it could be explained by the constant increase in the average cost of a prescription. The ABC/XYZ inventory analysis of the consumed drugs and medical devices showed an increasing need for additional (non-hypoglycemic) medicines for the treatment of complications and concomitant diseases in diabetic patients. A greater increase in prescriptions of additional medicines and their funding was observed at the regional level in the period of 2019–2021.

Research on Vehicle-Road Intelligent Capacity Redistribution and Cost Sharing in the Context of Collaborative Intelligence

The vehicle-road collaborative intelligence approach has become an industry consensus. It can efficiently tackle the technical hurdles and reduce the performance requirements and costs of on-board perception and computing devices. There is a need for in-depth quantitative studies to optimize the allocation of vehicle-road intelligent capabilities for collaborative intelligence. However, current research tends to focus more on qualitative analysis, and there is little research on the redistribution of vehicle and roadside intelligent capabilities. In this paper, we present a model for distributing perception and computing capabilities between vehicle-side and roadside, ensuring to meet the needs of various autonomous driving levels. Meanwhile, the collaborative intelligence approach will also introduce the costs of intelligent infrastructure deployment, energy, and maintenance. Different roads have varying scene characteristics and usage intensities. It is necessary to conduct a cost-effectiveness analysis of the intelligent deployment of different road types. A vehicle-road cost allocation model is developed based on the lifecycle traveled distance of vehicles and the lifecycle traffic flow of various roads to evaluate the function-cost effectiveness. Our study presents several vehicle-road intelligent schemes that meet the needs of various autonomous driving levels and selects Beijing for case analysis. The results indicate that primary intelligent infrastructure can reduce the lifecycle cost of the vehicle-side intelligent scheme for intermediate autonomous driving from ¥65,301 to ¥37,703, and advanced intelligent infrastructure can reduce the lifecycle cost for advanced autonomous driving from ¥126,938 to ¥42,180. Considering the distributed cost of vehicle-side and roadside, urban roads in Beijing have higher function-cost effectiveness compared to highways, especially urban expressways, which are expected to generate 43.3 times the vehicle-function-cost benefits after the advanced intelligent upgrades. The corresponding research findings can serve as a reference for city managers to make decisions on intelligent road deployment.

Utilizing FSA conservation loan programs to support farm conservation activities

PurposeThe Farm Service Agency (FSA) conservation loan program was introduced in the 2008 Farm Bill to provide additional credit to assist producers implementing approved Natural Resources Conservation Service (NRCS) conservation projects. This paper explores why this program has been widely underutilized despite an overall increase in United States Department of Agriculture (USDA) Conservation Program participation.Design/methodology/approachThe FSA administrative loan data are merged with NRCS program participation and payments data for 2010–2021. The share of project costs paid by producers and resulting savings achieved by farmers participating in both programs if their cost-share portion was paid by FSA loans are estimated, as well as the impact on farmer conservation spending under different estimates of increased participation.FindingsA significant share of FSA farmers are likely to take advantage of NRCS programs, with the majority of participants paying under $25,000 in cost-share portions. These loans are less suited to guaranteed conservation loans and more appropriate for the discontinued direct conservation loan program. Few FSA borrowers participating in NRCS cost-share programs pay more than $50,000 in cost-share portions. These loans would receive the majority of benefits from interest reduction schemes under the current guaranteed loan program.Practical implicationsOur results and suggestions provide valuable information when discussing the Guaranteed Conservation Loan Program in the 2023 Farm Bill legislation.Originality/valueNo prior research has attempted to merge FSA guaranteed or direct loan data with conservation program participation and payment data, focused on producer cost-share levels or the FSA Guaranteed Conservation Loan Program in the last decade, making this study a valuable contribution to the literature.

Estimation and determinants of direct hospitalisation cost for coronary heart disease in a low-middle-income country: evidence from a nationwide study in Iranian hospitals

BackgroundCoronary heart disease (CHD) is the most prevalent type of cardiovascular disease in Iran. This study aims to investigate the estimation and determinants of direct hospitalisation cost for patients with...

A systematic review of the economic burden of colorectal cancer.

Colorectal cancer is the third most common cancer in the Western Hemisphere. It is the third most common cancer in men after prostate and lung cancers and the second most common cancer in women after breast cancer. According to some studies, the incidence and prevalence of colorectal cancer is increasing rapidly. In the present study, a systematic review of the articles related to the economic burden of colorectal cancer was carried out. The articles were taken from the following databases: SID, Medline/Pubmed, Embase, Scopus, Web of Science, NHS Economic Evaluation Database (EED), Econlit, and Google Scholar. Furthermore, the PICOTS model was used to select the inclusion criteria. The quality of the articles' methodologies was evaluated using Drummond's checklist. Then, some data were extracted from relevant articles, in terms of year, place of research, sample size, costing approach, type of measured costs, average direct medical costs, average direct nonmedical costs, and average indirect costs. The data from 37 studies dealing with the costs of patients with colorectal cancer were extracted. Most of the studies were conducted in the United States, and the social perspective was the most common perspective to measure the costs. According to the majority of the studies, direct medical costs were considered the greatest driver in causing the economic burden of colorectal cancer. The costs of hospitalization, medicine, surgery, chemotherapy, and radiotherapy accounted for the largest share of direct medical costs, and the costs of transportation, accommodation, and home care were the greatest share of direct nonmedical costs. Furthermore, the costs associated with disability, absenteeism, and premature death were identified as the main drivers of indirect costs. The findings of this study showed that colorectal cancer imposes great direct and indirect costs on families, the health system, and society. The best way to deal with this disease and, hence, to reduce its economic burden is to take comprehensive preventive measures and modify the lifestyle. In addition, health policymakers can limit the costs of this disease by expanding the screening program.

Representing Carbon Dioxide Transport and Storage Network Investments within Power System Planning Models

Carbon dioxide (CO2) capture and storage (CCS) is frequently identified as a potential component to achieving a decarbonized power system at least cost; however, power system models frequently lack detailed representation of CO2 transportation, injection, and storage (CTS) infrastructure. In this paper, we present a novel approach to explicitly represent CO2 storage potential and CTS infrastructure costs and constraints within a continental-scale power system capacity expansion model. In addition, we evaluate the sensitivity of the results to assumptions about the future costs and performance of CTS components and carbon capture technologies. We find that the quantity of CO2 captured within the power sector is relatively insensitive to the range of CTS costs explored, suggesting that the cost of CO2 capture retrofits is a more important driver of CCS implementation than the costs of transportation and storage. Finally, we demonstrate that storage and injection costs account for the predominant share of total costs associated with CTS investment and operation, suggesting that pipeline infrastructure costs have limited influence on the competitiveness of CCS.