Significant Cost Savings Research Articles

Manufacture of long spars: Laminate design, experimental trials and non-destructive evaluation

Although an enabler of high-rate manufacture, automated forming of components from flat laminates can result in fibre wrinkling. For the first time, fibre length is demonstrated to be a key driver of wrinkling defects when forming a C-spar with a central recess, at industrial length scales. Three such spars, of equal in-plane stiffness, were manufactured using Single Diaphragm Forming. Two contained standard ply angles (0°, 90° or ±45°) including 6 m long 0° fibres but had different stacking sequences, one shown to be formable in short spar trials, the other un-formable. A third spar also had a formable sequence but contained non-standard ply angles (angles other than 0°, 90° or ±45°) so that maximum fibre length was less than 0.6 m. Wrinkles occurred in both standard angle spars but did not occur in the non-standard angle case, demonstrating that use of formable, non-standard angle laminates can reduce scrappage of automatically formed aerospace parts, leading to significant time and cost savings in production.

Cost-efficiency analysis of conversion to biosimilar filgrastim for supportive cancer care and resultant expanded access analysis to supportive care and early-stage HER2+ breast cancer treatment in Saudi Arabia: simulation study

AimsThis study estimated, for Saudi Arabia, the cost-efficiency of converting patients from reference Neupogen and Neulastim to one of two filgrastim biosimilars (Nivestim, Zarzio); the budget-neutral expanded access to supportive care with biosimilar filgrastim and therapeutic care to ado-trastuzumab emtansine thus afforded; and the number-needed-to-convert (NNC) to provide supportive or therapeutic treatment to one patient.Materials and methodsReplicating prior studies, we modeled the cost-efficiencies gained from converting varying proportions of a hypothetical panel of 4,000 patients undergoing six cycles of cancer treatment from Neupogen or Neulastim to one of the two biosimilar G-CSF formulations, using national cost inputs. Cost-savings in USD were used to estimate the additional doses of biosimilar G-CSF and expanded access to ado-trastuzumab emtansine on a budget-neutral basis, and NNC to purchase one additional dose of supportive or therapeutic treatment.ResultsSavings from conversion from reference to a biosimilar filgrastim were $3,086,400 (Nivestim) and $3,460,800 (Zarzio). With reference pegfilgrastim, savings from conversion were $11,712,240 (Nivestim) and $12,086,640 (Zarzio). Biosimilar conversion from reference to biosimilar filgrastim enabled expanded access to ado-trastuzumab emtansine ranging from 61 patients (5 days, Nivestim) to 191 patients (14 days, Zarzio). For supportive care, biosimilar conversion enabled expanded access ranging from 8,244 patients (5 days, Nivestim) to 25,882 patients (14 days, Zarzio). For biosimilar conversion from daily filgrastim, the NNC for treatment with ado-trastuzumab emtansine decreased as days of injections increased [5 days: 395 (Nivestim), 352 (Zarzio); 14 days: 141(Nivestim), 126 (Zarzio)]. Alternately, for biosimilar conversion from single-injection pegfilgrastim to daily biosimilar filgrastim, the NNC for treatment with ado-trastuzumab emtansine rose as days of injections increased, being highest under the 14-day scenario (146, Nivestim; 130, Zarzio).ConclusionThis simulation study demonstrated significant potential cost-savings from biosimilar conversion. These savings provide budget-neutral increased access to supportive and therapeutic cancer care.

Cost savings associated with palliative care among patients with genitourinary malignancies.

474 Background: The cost of cancer treatment has increased significantly in recent decades, and highest costs incurred in the last 6-months of life. Patients’ health insurance status is a factor influencing to cost of care in different from individuals’ ability to access hospital care. 80% of Thai people use the Thailand’s Universal Coverage Scheme (UCS), about 15% use the Civil Servants Medical Benefit Scheme (CSMBS). Only CSMBS can reimburse all costs of in-patient care, but UCS had to co-pay at some cost. All health scheme is equality accessibility to palliative care. Early integrated palliative care services improve the GU malignancy patients care experience, decreases healthcare utilization, and improved quality of life. Study aim was to examine Hospital-based palliative care interventions in GU malignancy patients may reduce costs. Methods: A retrospective claims database in Ramathibodi Hospital was analyzed, that included cancer patients had a medical claim for death between Jan 1, 2016 - Dec 31, 2020. Our study compared cost in patients receiving palliative care (PC) and patients receiving usual care. Costs were determined by summing paid amounts on all hospital services used within the last 6, 3 and 1 months before death, including cancer-related inpatient service, emergency room visits, cancer-related outpatient services and other hospital services with cancer diagnosis. Results: Of the 1,772 cancer patients who died, 289 (16.3%) integrated treated with PC matched to 1,483 (83.7%) were usual care patients. 107 Genitourinary Malignancies patients including 44 TCC, 36 Prostate, 22 RCC and 2 Testicular cancer, that 22 (20.6%) integrated treated with PC. Median age was 72.4 years. Patients categorized as CSMBS 48% and UCS 44.4%. The PC group had $10,244.1 (+/- 8,705.6) in last 3 months hospital costs that significantly less than in usual care $(17,174.3 +/-14,262.5) (P= 0.032) that PC group had significant reductions in medications, laboratory, and intensive care unit costs compared with usual care patients. Direct costs of inpatient care in the last 3 months of life for patients were lower in patient who received earlier PC that patients who received PC consults < 90 days was $9,728.8 (+/- 1,044.5) and patients received PC consults < 30 days cost was $12,517.7 +/- 1,476. Patients in SSS and UCS had a significantly saving cost when they received PC consultation, P=0.032. However, there was no difference in CSMBS. Conclusions: Integrated palliative care in caring GU malignant patients associates with significant hospital cost savings. Insurance status not limited in access to palliative care consultation, but influences in cost of end-of-life care.

Optimization of micro grid with distributed energy resources using physics based meta heuristic techniques

AbstractRecently, modern power systems depend heavily on MicroGrids (MGs), which can accommodate Distributed Energy Resources (DERs) economically and with high flexibility. MGs integrated with DERs can assist in enhancing energy security, significant cost savings, and reduction in emission of greenhouse gases. In this paper, the assessment of operating performance of proposed MG system with DERs is employed to investigate the multi‐objective problems of cost optimization and economic scheduling. A grid‐connected Micro‐grid (MG) combined with solar photovoltaic (PV), wind turbine (WT), fuel cell (FC), and Battery Energy Storage System (BESS) is implemented to model the problem. This proposed model is considered as a test system for cost optimization and battery charging/discharging optimization. The developed framework is presented as multi‐objective function with constraints that can be tackled using an effective optimization technique. The above stochastic multi‐objective problem is optimized using various commonly used Physics based Meta‐heuristic techniques such as Simulated Annealing (SA), Harmony Search (HS), Slime Mold Algorithm (SMA), Gravitational Search Algorithm (GSA), Black Hole Optimization (BHO), Sine Cosine Algorithm (SCA), Multiverse optimization (MVO) and Lightning Search Algorithm (LSA). The assessment of the aforementioned physics‐based optimization techniques used on the proposed MG test system is compared using the results. According to the analysis, Black Hole Optimization (BHO) and Lightning Search Algorithm (LSA) both provide greater cost savings overall and for battery charging, respectively. The suggested optimization methods will take the BESS charging/discharging pattern and total cost savings into account.

Women Worker Protection: A Systematic Review On Maternity Protection In Indonesia

Implementing maternity protection at the workplace is found significant benefits and cost savings to businesses, but many young women workers in garment factories in Indonesia remained vulnerable within their maternity period. This research was focused on why to have a clear and comprehensive overview on the need of women workers protection; how is women worker maternity protected. Through a Systematic Literature Review, data base was obtained through seven prominent publishers by writing key words “women worker protection and maternity protection”; inclusive articles were sorted by publication time 2012 – 2022; and the considerations of specific relevance of the article with this research questions. Other literature sources were also used to be added for more comprehensive literature review for the the research questions. It was found that breastfeeding was neglected by 33.6 million young working women in Indonesia, which costed US$1.5–9.4 billion annually, despite the prescription of the Constitution that worker shall have humane livelihood; fair treatment, and human dignity, in line with ILO and the SDG. Rights and measures on family leave, maternity leave, childcare and family services, social security and working conditions provisions will resulted in improved work performance, enhance female workers loyalty and reduce turnover. State shall more tightly supervise on the implementation of Law for protection of women worker rights and employer’s social solidarity, communality, and brotherhood

A qualitative evidence synthesis exploring people after stroke, family members, carers and healthcare professionals' experiences of early supported discharge (ESD) after stroke.

Early supported discharge (ESD) after stroke has been shown to generate significant cost savings and reduce both hospital length of stay, and long-term dependency. This study aimed to systematically review and synthesise qualitative studies of the experiences and views of ESD from the perspective of people after stroke, their family members, carers and healthcare professionals. A systematic search of eleven databases; CINAHL, PubMed Central, Embase, MEDLINE, PsycINFO, Sage, Academic Search Complete, Directory of Open Access Journal, The Cochrane Library, PsycARTICLES and SCOPUS, was conducted from 1995 to January 2022. Qualitative or mixed methods studies that included qualitative findings on the perspectives or experiences of people after stroke, family members, carers and healthcare professionals of an ESD service were included. The protocol was registered with the Prospero database (Registration: CRD42020135197). The methodological quality of studies was assessed using the 10-item CASP checklist for qualitative studies. Results were synthesised using Thomas and Harden's three step approach for thematic synthesis. Fourteen studies were included and five key themes were identified (1) ESD eases the transition home, but not to community services, (2) the home environment enhances rehabilitation, (3) organisational, and interprofessional factors are critical to the success of ESD, (4) ESD is experienced as a goal-focused and collaborative process, and (5) unmet needs persisted despite ESD. The findings of this qualitative evidence synthesis highlight that experiences of ESD were largely very positive. The transition from ESD to community services was deemed to be problematic and other unmet needs such as information needs, and carer support require further investigation.

Feasibility and acceptability of a telemedicine triage model among Medicaid patients with low back pain referred to a spine center

BackgroundThe data for primary triage via telemedicine for spine related conditions are sparse but has potential to improve access, quality of care, and offer significant cost savings for Medicaid insured patients who have very limited access to care. The purpose of this study was to evaluate the feasibility and acceptability of implementing a telehealth triage framework using synchronous video conferencing appointments. MethodsThis is a prospective cohort feasibility study conducted within an academic spine center in the United States. Participants include Medicaid insured patients referred to an academic spine center for low back pain. We collected demographic information, a spine red flag survey, a patient satisfaction survey and demand and implementation feasibility metrics. Participants completed a demographic and red-flag survey followed by a telehealth spine appointment with a physiatrist. Immediately after the appointment, the participant completed a satisfaction survey. ResultsNineteen patients met inclusion criteria but declined telehealth either due to preference for in-person appointment or lack of comfort with technology. Thirty-three participants enrolled and attended their initial telehealth appointment. Few participants reporting 1 or more red flag symptom also screened positive during their subsequent telehealth evaluation with the physician (n=7/28). Participant satisfaction was high across all domains including ease of scheduling, efficiency of virtual check in, ability to report their symptoms fully and accurately to the provider, imaging review, explanation of diagnosis and treatment plan. Most participants (n=19/20, 95%) would recommend an initial telehealth appointment. ConclusionsThe telehealth framework used was feasible and provided an acceptable form of care for Medicaid patients who were interested and able to participate in this form of care. Our acceptability results are promising but should be interpreted with caution given the proportion of patients who declined to participate.

Maximising the benefits of renewable energy infrastructure in displacement settings: Optimising the operation of a solar-hybrid mini-grid for institutional and business users in Mahama Refugee Camp, Rwanda

Humanitarian organisations typically rely on expensive, polluting diesel generators to provide power for services in refugee camps, whilst camp residents often have no access to electricity. Integrating solar and battery storage capacity into existing diesel-based systems can provide significant cost and emissions savings and offer an opportunity to provide power to displaced communities. By analysing monitored demand data and using computational energy system modelling, we assess the savings made possible by the integration of solar (18.4 kWp) and battery (78 kWh) capacity into the existing diesel-powered mini-grid in Mahama Refugee Camp, Rwanda. We find that the renewables infrastructure reduces fuel expenditure by $41,500 and emissions by 44 tCO2eq (both 74%) over five years under the generator’s current operational strategy. An alternative strategy, with deeper battery cycling, unlocks further savings of $4100 and 12.4 tCO2eq, using 33% of battery lifetime versus 15% under the original strategy. This reduces the cost of electricity by 33% versus diesel generation alone, whilst more aggressive cycling strategies could prove economical if moderate battery price decreases are realised. Extending the system to businesses in the camp marketplace can completely offset the system fuel costs if the mini-grid company charges customers the same tariff as the one it uses in the host community, but not the national grid tariff. Humanitarian organisations and the private sector should explore opportunities to integrate renewables into existing diesel-based infrastructure, and optimise its performance once installed, to reduce costs and emissions and provide meaningful livelihood opportunities to displaced communities.

Pavement crack detection based on a deep learning approach and visualisation by using GIS

ABSTRACT One of the most prevalent ailments of the road is crack. When it does, the standard of road engineering will be significantly lower and may even result in road collapse. Early detection of the cracks will result in significant maintenance cost savings if timely maintenance is performed. Although direct detection is highly challenging, the range of image cracks on the actual pavement is too large, the image quality is insufficient, the composition is complicated and the image range is too wide. Traditional manual detection methods have a number of drawbacks, including a lack of precision, a significant danger of detecting operation and a lengthy processing time. Therefore, in this research, we employed a novel technique based on image processing for the pavement detection method based on the features of pavement cracks. In order to avoid those difficulties Pre-processing (Median Filter), feature extraction (ResNet-50) and feature selection (Adaptive Salp Swarm Algorithm) techniques are also included in order to produce a clear image. With this proposed method, a variety of crack types including longitudinal, transverse, alligator and block can be identified.

Interturn Short-Circuit Fault Diagnosis of Interior Permanent Magnet Synchronous Motor for Electric Vehicle Based on Search Coil

This article proposes an interturn short-circuit fault diagnosis method for permanent magnet synchronous machines for electric vehicles based on search coils (SC) with a unique structure. In this proposed structure, the SCs are uniformly wound in the main flux direction of each phase, and the number of SCs is twice the number of phases, resulting in significant cost savings. Based on this structure, a novel fault feature based on the negative-sequence components of the second carrier frequency sideband harmonics in the voltage signal of the SC is proposed. As a result, this fault characteristic frequency component is not only more obvious than the fundamental component used in the traditional SCs method but also can be transformed to a dc indicator by two coordinate transformations, which is conducive to online implementation in both stationary and nonstationary conditions. Finally, experiments are presented to verify the proposed diagnosis strategy.

OUTPATIENT PERCUTANEOUS ULTRASOUND-GUIDED FLEXOR TENOTOMY FOR NEUROPATHIC APICAL TOE ULCERS

Percutaneous flexor tenotomy involves cutting the flexor digitorum tendons to correct claw toe deformity to treat apical pressure areas and prevent subsequent infection in patients with peripheral neuropathy. Performing this under ultrasound guidance provides reassurance of complete release of the tendon and increases procedural safety.This study is a retrospective case series evaluating the effectiveness, safety, and patient satisfaction of performing percutaneous ultrasound-guided flexor tenotomy in an outpatient setting. People with loss of protective sensation, a digital flexion deformity, and an apical toe ulcer or pre-ulcerative lesion who presented to our institution between December 2019 and June 2022 were included in this study. Participants were followed-up at a minimum of 3 months. Time to ulcer healing, re-ulceration rate, patient satisfaction, and complications were recorded. An Australian cost analysis was performed comparing this procedure performed in rooms versus theatres.There were 28 ulcers and 41 pre-ulcerative lesions. A total of 69 tenotomy procedures were performed on 38 patients across 52 episodes of care. The mean time to ulcer healing was 22.5 +/- 6.4 days. There were 2 cases of re-ulceration. 1 patient sustained a transfer lesion. There were four toes that went onto require amputation, all in the setting of pre-existing osteomyelitis. 94% of patients strongly agreed that they were satisfied with the outcome of the procedure. Costs saved were estimated to be $1426.Flexor tenotomy is a minimally invasive procedure that can be performed in the outpatient setting, and therefore without delay to treatment, reducing risk of ulcer progression and need for subsequent amputation. This is the first study to report on flexor tenotomy under ultrasound-guidance.Ultrasound-guided percutaneous flexor tenotomy is safe and effective, with high patient satisfaction and low recurrence rates. This performance in the outpatient setting ensures significant time and cost savings for both the practitioner and patient.

EXTERNAL PNEUMATIC COMPRESSION FOR PREOPERATIVE MANAGEMENT OF SWELLING FOR ANKLE FRACTURES: A PROSPECTIVE RANDOMIZED CONTROLLED TRIAL

Patients awaiting resolution of swelling and oedema prior to ankle surgery can represent a significant burden on hospital beds. Our study assessed whether external pneumatic intermittent compression (EPIC) can reduce delays to surgery.Our prospective randomised controlled trial (n= 20) compared outcomes of patients treated with EPIC vs control group managed with ice and elevation. Included were patients aged <18 years with isolated closed ankle fractures admitted for management of swelling prior to surgery. Excluded were open fractures, injuries to contralateral leg, diabetes, absent pulses, peripheral vascular disease, inability to consent, no requirement for admission. Eligible patients were randomised to active or control arms. All patients were managed initially with reduction and back slab application. Patients in active arm fitted with EPIC (Hydroven 3000) device over the back slab. Assessment by treating team determined the time at which patient is assessed ready for surgery.Patients in the treatment arm were assessed as ready for surgery sooner, (123 hrs vs 168hrs, T score = 1.925, P 0.035) and had a shorter time to surgery (167 hrs vs 216 hrs, T score = 1.748, P 0.047) Length of stay was reduced bud did not reach statistical significance. (259 hrs vs 269 hrs, T score 0.229, P 0.41)Our results showed a statistically and clinically significant reduction in time that patients were assessed ready for surgery and time to surgery in the treatment cohort. We conclude that although further data is needed to achieve an adequately powered study and assess the safety profile of the EPIC, incorporation of EPIC into routine clinical practice has the potential for significant cost savings.

ПОПУЛЯРНІСТЬ МЕТОДОЛОГІЙ УПРАВЛІННЯ У СВІТОВІЙ ПРАКТИЦІ

ПОПУЛЯРНІСТЬ МЕТОДОЛОГІЙ УПРАВЛІННЯ У СВІТОВІЙ ПРАКТИЦІ

RLTiering: A Cost-Driven Auto-Tiering System for Two-Tier Cloud Storage Using Deep Reinforcement Learning

The cloud storage boom has prompted providers to offer two storage tiers, i.e., hot and cold tiers, which are respectively purpose-built to provide the lowest cost for frequent and infrequent access patterns. However, for cloud users, it is non-trivial to determine cost-effective tiers because it is hard to obtain future access patterns in advance and is difficult to predict them exactly. The lack of future information poses a risk of increasing costs instead of saving costs. This is not the only challenge encountered when it comes to cost optimization. In this article, we take Amazon S3 as an example to analyze the pricing of two-tier cloud storage and derive several major challenges faced by cost optimization. Then, assuming a priori knowledge of future access patterns, we propose an optimal offline algorithm based on dynamic programming to determine cost-effective tiers for each time slot. Further, to handle online workload arrivals, we formulate the problem using Markov decision processes and propose RLTiering based on deep reinforcement learning. Eventually, the cost performance of RLTiering is evaluated based on real-world traces and prevalent Amazon S3 pricing, and the results show that it achieves significant cost-savings.

Fault Detection and Protection of Power Transformer Using Fuzzy Logic

Abstract: Power transformer malfunctions cause significant power outages and, as a result, material damage. This critical issue must be resolved. Power transformers must be protected from various fault conditions and power system failure. Fuzzy logic is used in this study to detect and protect power system transformer faults. In the simulation system that diagnoses transformer faults and monitors its operating conditions, the fuzzy logic (FL) toolbox in MATLAB/ SIMULINK software was used. The input variables, current and rate of change of current with time, have been identified as "Error" and "Error-Dot" in the programme. The study's findings show that when the output response is zero, the current in the transformer is normal. This is obtained by injecting [0] and [0] input values into the system, resulting in a response of "6e(-017)," which is close to zero. If the output response is greater than zero, the transformer current is rising above normal and the protection scheme should be notified. This condition is achieved by giving the system input values of [-1.5] and [5] and expecting a response of "+5". If the response is less than zero, the transformer current is less than normal, and the protection scheme should be notified. The study concluded that electrical faults and mechanical failures in power transformers can be quickly identified using Fuzzy logic. Thus, power transformer damage is avoided by controlling relays more effectively and quickly. This has resulted in significant savings in maintenance and repair costs. It is assumed that the study was a success.

P477 Patient satisfaction and cost saving analysis of telemedicine in patients with inflammatory bowel disease.

Abstract Background Crohn’s disease (CD) and Ulcerative Colitis (UC) are chronic inflammatory bowel diseases (IBD). Telemedicine (TM) is particularly useful in patients with chronic diseases who need frequent monitoring to achieve therapeutic outcomes and improve their quality of life. We examined the differences in patient satisfaction comparing telemedicine versus traditional in-person visits. We also examined the potential cost savings benefits of utilizing telemedicine. Methods All consecutive patients with IBD in clinical remission evaluated by Partial Mayo Score (PMS) for UC and Harvey Bradshaw Index (HBI) for CD were considered eligible (PMS<2 or HBI<5). Patients were randomized into two arms: telemedicine or in-person visits after a questionnaire investigating the Information and communication technology (ICT) skills . All patients were asked to respond to an 11-items survey investigating their trust in telemedicine at first in-person visit. Enrolled patients performed after 3 months a telehealth or an in-person visit. All patients answered a standard questionnaire to evaluate the indirect costs of managing their disease. Patients randomized into telemedicine arm answered a specific 28-item survey investigating their degree of satisfaction. Results We enrolled 30 patients with IBD randomized to telemedicine (n. 22; 11 CD; 13 female; mean age 45 years) or in-person visits (n. 8; 5 CD; 3 female; mean age 52 years). All patients randomized in TM (100 %) showed interest in this new clinical practice and were satisfied of the received information about telemedicine management. No patients thought that telemedicine would have no positive effects on their health status. Regarding demographic data, 6 out of 22 patients randomized to TM (27.2%) lived in a different province than our hospital’s and16 patients (72.7%) had high school diploma or degree. All TM patients (100%) were satisfied of the televisit and considered clear the information received during conversation with physician. From a technical point of view, only one patient had problems of connection and three patients needed the support of a caregiver. Eighteen patients (81.8 %) thought that the efficacy of the televisit was equivalent to the in-person visit. Nineteen patients (86.3 %) were convinced that televisit is a tool to be promoted for future clinical practice. Patients randomized to telemedicine had an average saving of 125 €. Data shown are illustrated in the figure 1. Conclusion In patients with IBD in remission, telemedicine is feasible and effective in the majority of patients. In addition, TM has allowed a significant cost savings without reducing the quality of the health assistance.

P432 Patient satisfaction and patient costs associated with telephone clinic appointments in Inflammatory Bowel Disease (IBD) following the pandemic

Abstract Background Prior to the COVID-19 pandemic, conventional management of outpatient care in IBD predominantly revolved around face-to-face clinic appointments. In the changing landscape of care provision during the pandemic, appointments were conducted almost exclusively through telephone consultation. An electronic questionnaire was developed to assess patient satisfaction and patient costs. Methods A pilot was carried out with 15 patients to identify any technical issues with e-mail delivery of the questionnaire and gauge face validity of the questionnaire content. 1400 patients registered with the TrueColours-IBD remote digital monitoring system were sent the questionnaire link via e-mail in May 2021. No demographic data were collected by design, in order to avoid the perception of bias and ensure freedom of expression through anonymity. Results 506 responses were received including 21 duplicates which were excluded, totalling 485 valid responses. 408/485 patients reported having a telephone appointment with the IBD service since March 2020, 484/485 reported having had a face-to-face appointment in the past. 348/408 (86%) were either ‘very satisfied’ or ‘somewhat satisfied’ with their most recent telephone consultation, while 22 (6%) were either ‘very dissatisfied’ or ‘somewhat dissatisfied’. 247/408 (61%) were also either ‘very satisfied’ or ‘somewhat satisfied’ with the ease of accessing further care if required, compared to 33/408 (8%) who were either ‘very dissatisfied’ or ‘somewhat dissatisfied’. Given the choice, 195/408 (48%) patients preferred to receive a telephone appointment in the future; 147/408 (36%) would opt for face-to-face and 66/408 (16%) stated no preference, all with the option of changing that choice if needed. Telephone appointments were associated with a mean total patient time off-work or leisure of 23 minutes (S.D. 51, n=408) compared to 190 minutes (S.D. 96, n=484) for face-to-face appointments. The average cost of time off work or leisure associated with telephone appointments was £5.55 (S.D. = £15.74, n=408), compared to £43.42 (S.D. = £31.27, n=484) for face-to-face appointments (Table 1). Costs of transport add further to face-to-face appointment costs. Greater proportions of patients had a companion for their face-to-face appointment and required childcare compared to telephone consultations (Table 2), which again increases the difference in costs. Conclusion Almost half of surveyed patients stated a preference for telephone appointments, although a third still preferred traditional follow-up. An evolution of care pathways is supported by patient preference and the statistically significant time and cost savings to patients receiving telephone appointments.

P428 Pharmacist led clinic in Inflammatory Bowel Disease

Abstract Background Only 13% of IBD teams across the UK have a specialist pharmacist within the MDT (1). Pharmacists have a crucial role in safe and effective medication prescribing and monitoring (2). Studies have shown that pharmacist led clinics are acceptable to clinicians and patients (2). At our trust we set up a pharmacist led biologic switch clinic where a specialist pharmacist counselled regarding biologic therapy switch from intravenous (IV) to subcutaneous (SC) medication and assessed disease burden at baseline and follow up. We set up thiopurine clinic where the specialist pharmacist arranges monitoring and facilitates pre-emptive switch of stable patients to shared care prescribing with the GP, in line with the national commitment of providing convenient and easy access to services. We analysed patient feedback, biologic and shared care prescribing data to assess the impact of our pharmacist-led clinics. Methods Patients who had been scheduled in thiopurine and biologic switch clinic were sent with questionnaires either by post or email. Both paper and electronic data were collected and analysed using Microsoft ExCel. Biologic therapy and thiopurine prescribing and monitoring databases were setup and data were captured and analysed retrospectively. Results 112 patients were switched from IV biologic therapy to SC therapy of which 8 patients needed to be switched back to IV due to either an adverse reaction or uncontrolled IBD. By reducing drug cost and increasing hospital CIU capacity, the biologic switch clinic has generated significant financial savings to the organisation (estimated £333,666 per annum). In thiopurine clinic, 80 patients were identified as suitable candidates for shared care agreement with primary care. 88% patients have been successfully transferred to primary care and the remaining 12% remained under secondary care because the GP opted-out. 88% of patients who had been scheduled in pharmacist led clinic were happy with the service and the remainder had a neutral opinion regarding the service (see chart). Some patients fed-back that the telephone consultation did not happen at scheduled time or they preferred face to face clinic. Conclusion Pharmacist led clinic led to significant cost savings, increased accessibility to thiopurines and was acceptable to patients. In response to patient feedback we amended our appointment letters to clarify appointment time frames and give pharmacist contact details for further patient queries. We have also set up face to face clinics for patients preferring this option.

Evaluation of New York/New York III permanent supportive housing program

In 2005, the city and state of New York launched New York/New York III (NY/NY III), a permanent supportive housing program for individuals experiencing homelessness or at risk of homelessness with complex medical and behavioral health issues. This review paper summarizes a decade of findings (2007–2017) from the NY/NY III evaluation team, to analyze this program’s impact on various housing and health outcomes. The evaluation team linked NY/NY III eligible persons with administrative data from two years pre- and two years post-eligibility and compared housing and health outcomes between placed and unplaced groups using propensity score analysis. Placement into NY/NY III housing was associated with improved physical and mental health outcomes, increased housing stability, and statistically significant cost savings per person after one year of placement. The evaluation team recommends that municipalities invest in supportive housing as a means for mitigating homelessness and improving health outcomes in this vulnerable population.

P808 Risk of relapse after vedolizumab withdrawal in Inflammatory Bowel Disease for patients in histological remission

Abstract Background A key clinical question is whether we should be withdrawing advanced inflammatory bowel disease (IBD) medications after a period of sustained remission. There is data to suggest that risk of relapse on withdrawal of vedolizumab is higher than that of anti-TNF therapy1. Drug costs are still considerable and so withdrawal of medications will also have significant financial benefits. The aim was to review the outcomes of vedolizumab withdrawal in patients in remission, in particular for those where a clinical decision was made following confirmed histological remission of their IBD Methods This was a single-centre retrospective review of patients in the IBD clinic at a tertiary referral centre in London. We analysed all those who had stopped vedolizumab at least six months prior and were in either clinical, biochemical, radiological, endoscopic or histological remission. We assessed for evidence of a flare of disease following withdrawal of vedolizumab and the need of further biological treatment. Results 38 patients had vedolizumab withdrawal for remission with a median length of treatment of 36 months. 28 (74%) had a flare up of disease requiring medication change with 24 (63%) requiring biologics. 21 restarted vedolizumab and 79% responded to this medication. Importantly, 5 patients are still less than a year since stopping and so still at high risk of relapse. Of the 21 patients confirmed to be in histological remission, 17 (81%) had a flare of disease requiring further treatment, of which 15 (71%) required biologics. Median time to flare was 7 months with only two patients flaring after a year of cessation. All 15 were started on vedolizumab and 12 (80%) responded to this but one had a subsequent early secondary loss of response. Of those who did not respond to vedolizumab, one required emergency surgery, one responded to ustekinumab and one only has partial response to a third biologic. Conclusion Relapse following vedolizumab withdrawal occurs in a significant number of patients even when they have been in remission for a long period of time. It usually occurs quickly within the first year and having confirmed histological remission does not seem influence this risk. Recapture of response is reasonably good and occurs in four fifths of patients. Despite the significant cost savings of stopping vedolizumab, clinicians need to consider the risk to benefit ratio of stopping when relapse is such a common event. 1 Martin, A., Nachury, M., Peyrin-Biroulet, L., et al, GETAID-Vedo-STOP Study Group (2020). Maintenance of Remission Among Patients With Inflammatory Bowel Disease After Vedolizumab Discontinuation: A Multicentre Cohort Study. Journal of Crohn's & colitis, 14(7), 896–903. https://doi.org/10.1093/ecco-jcc/jjaa005