Significant Difference In Cost Research Articles

Joint optimization of production, inspection, and maintenance under finite time for smart manufacturing systems

Given the flexible and configurable characteristics of smart manufacturing systems with a limited time per manufacturing task, the assumption of infinite time for prostems is no longer applicable to the joint-control strategy. Consequently, a joint-control model that considers production, inspection, and maintenance within a finite-time scenario for smart manufacturing systems is proposed in this paper. The objective is to optimize overall production and maintenance functions to minimize the total system cost. Comparing the joint strategy under infinite time with the proposed finite-time approach reveals significant differences in unit costs between the two scenarios. To enhance the effectiveness of the model, a discrete iterative algorithm with multiple loops was developed. Through a case study, it was observed that 1) joint strategies implemented within a finite time horizon were more cost-effective than those under infinite time, thus emphasizing the need for business managers to develop strategies within a finite time frame; 2) different production planning and efficiency levels had varying effects on the final joint strategy, necessitating customized strategies based on different production durations. Overall, the research gap regarding joint strategies within a finite-time context was addressed in this research, serving as a methodological foundation for practitioners to develop various strategies that minimize total costs across diverse real-world scenarios.

Can a behaviour change toothbrushing intervention prevent dental caries in 11-13-year-olds?

The Brushing RemInder 4 Good oral HealTh (BRIGHT) multi-centre randomized controlled trial was based in state-funded secondary schools in England, Wales and Scotland. It had two arms, aiming to assess the clinical and cost effectiveness of a 50 min education session and twice daily brush reminder text messages on toothbrushing and caries rates, compared to the normal education curriculum and no SMS. Outcomes were assessed at intervals over 2.5 years and were assessor-blinded. Pupils aged 11-13 were recruited from participating schools, and in each school randomised via year group to either the intervention or control group following baseline assessments by calibrated dental professionals. Exclusion criteria included not having a functioning mobile phone. The primary outcome, D4-6 MFT (Decayed, Missing and Filled Teeth), was analysed using mixed-effect logistic regression and sensitivity analyses were conducted. A cost-utility analysis was also undertaken. In total 42 schools, containing 84 year groups were randomised, and 4680 pupils were in the final sample. 663 pupils withdrew from follow up. At 6 months, there was evidence that intervention group pupils were more likely to report brushing at least twice per day However, by 2.5 years this effect was no longer evident. 2383 participants had a valid dental assessment at both baseline and 2.5 years, with 514 children in the intervention and 529 children in the control group presenting with obvious decay experience in at least one permanent tooth after 2.5 years. The intervention was estimated to have a 7% chance of being cost-effective. Over the 2.5-year follow-up, there were no significant differences in QALYs and costs between groups. The findings from the BRIGHT trial indicate no evidence of a statistically significant difference between the intervention and control groups for the prevalence of caries after 2.5-years. The behaviour change intervention did not translate into a reduction in caries rates.

A randomized controlled trial of a novel home-based palliative care program: A report of a trial that could not be completed.

In response to a growing need for accessible, efficient, and effective palliative care services, we designed, implemented, and evaluated a novel palliative care at home (PC@H) model for people with serious illness that is centered around a community health worker, a registered nurse, and a social worker, with an advanced practice nurse and a physician for support. Our objectives were to measure the impact of receipt of PC@H on patient symptoms, quality of life, and healthcare utilization and costs. We enrolled 136 patients with serious illness in this parallel, randomized controlled trial. Our primary outcome was change in symptom burden at 6 weeks. Secondary outcomes included change in symptom burden at 3 months, change in quality of life at 6 weeks and 3 months, estimated using a group t-test. In an exploratory aim, we examined the impact of PC@H on healthcare utilization and cost using a generalized linear model. PC@H resulted in a greater improvement in patient symptoms at 6 weeks (1.30 score improvement, n = 37) and 3 months (3.14 score improvement, n = 21) compared with controls. There were no differences in healthcare utilization and costs between the two groups. Unfortunately, due to the COVID-19 pandemic and a loss of funding, the trial was not able to be completed as originally intended. A palliative care at home model that leverages community health workers, registered nurses, and social workers as the primary deliverers of care may result in improved patient symptoms and quality of life compared with standard care. We did not demonstrate significant differences in healthcare utilization and cost associated with receipt of PC@H, likely due to inability to reach the intended sample size and insufficient statistical power, due to elements beyond the investigators' control such as the COVID-19 public health emergency and changes in grant funding.

Cost of Pegfilgrastim for the Prophylaxis of Chemotherapy-induced Febrile Neutropenia in Patients with Breast Cancer Receiving Perioperative Chemotherapy in Daily Practice in Japan: A Posthoc Analysis in a Single-center Retrospective Study.

This study aimed to estimate the medical costs associated with febrile neutropenia (FN) prophylaxis with pegfilgrastim and evaluate its impact on survival outcomes in daily practice in Japan. In this single-center retrospective study, we obtained data from 296 Japanese patients with breast cancer receiving fluorouracil, epirubicin, and cyclophosphamide (FEC)-100 chemotherapy; the patients were divided into the pegfilgrastim and non-pegfilgrastim groups. We analyzed the median costs of chemotherapy, drugs for all adverse events (AEs) and FN, and hospitalization due to FN. We also assessed the survival outcomes. The pegfilgrastim group showed a significantly higher median total cost (JPY 872320.0 vs. JPY 466715.0, p<0.001). This difference was associated with the prophylactic use of pegfilgrastim. The median costs of the drugs for all AE treatments were JPY 9030.4 and JPY 24690.6, with the non-pegfilgrastim group showing a significantly higher cost (p<0.001). In 11 patients hospitalized for FN management, no significant difference in hospitalization cost was observed between the pegfilgrastim and non-pegfilgrastim groups (JPY 512390.0 vs. JPY 307555.0, p=0.102). No significant difference in the 3-year overall survival was observed between the pegfilgrastim and non-pegfilgrastim groups (79.9% vs. 88.3%, p=0.672). In this study, although the total medical cost in daily practice increased because of primary prophylaxis with pegfilgrastim, the 3-year overall survival was not impacted by the use of pegfilgrastim. Our study data suggested that the primary prophylaxis pegfilgrastim should be used during FEC-100 chemotherapy based on the patient-related FN risk factors, instead of routine use.

Carbon pricing: Necessary but not sufficient

Global carbon pricing has been recognized as one of the most efficient mechanisms that can be used to reduce CO2 emissions, but questions remain about the magnitude of the price and the speed of implementation. We examine this important issue by extending the Dynamic Integrated Climate and Economy (DICE) model to estimate global carbon prices that will be required to reach various warming scenarios. Our analysis suggests that while carbon pricing can play a critical role in reducing greenhouse gas emissions and limiting global warming, it must be supported by other policy measures and innovations in order to reach the Paris Agreement targets. In particular, we found there was no feasible carbon pricing scenario that was high enough to limit emissions sufficiently to achieve anything below 2.4°C warming on its own. We project significant differences in global physical costs due to climate change across various warming scenarios, which range from a total (to 2100) of $152tr under a 1.5° scenario to $765tr under 4.2° warming.

COST ANALYSIS OF DIRECT ANTERIOR VERSUS DIRECT LATERAL APPROACH FOR OUTPATIENT TOTAL HIP ARTHROPLASTY

The increased demand for total hip arthroplasty (THA) is having a significant impact on healthcare resources, resulting in increased interest in outpatient care pathways to reduce resource consumption. This study compared costs between patients who underwent outpatient THA using a Direct Anterior (DA) approach compared to a Direct Lateral (DL) approach to understand the effect of surgical approach on resource use.We conducted a prospective randomized controlled trial for DA patients undergoing primary THA. We compared patients in the outpatient arm of the trial to a prospective cohort of outpatient DL approach THAs. We recorded all costs including: equipment, length of stay in hospital, and laboratory or other medical tests. Following discharge, participants also completed a self-reported cost diary recording resource utilization such as emergency department visits or subsequent hospitalizations, tests and procedures, consultations or follow-up, healthcare professional services, rehabilitation, use of pain medications, informal care, productivity losses and out of pocket expenditures.We report costs from both Canadian public health care payer (HCP) and a societal perspective. The HCP perspective includes any direct health costs covered by the publicly funded system. In addition to the health care system costs, the societal perspective also includes additional costs to the patient (e.g. physiotherapy, medication, or assistive devices), as well as any indirect costs such as time off paid employment for patients or caregivers.We included 127 patients in the DA group (66.6 years old) and 51 patients in the DL group (59.4 years old) (p&lt;0.01).There were no statistically significant differences in costs between groups from both the healthcare payer (DA= 7910.19, DL= 7847.17, p=0.80) and societal perspectives (DA= 14657.21, DL= 14581.21, p=0.96)In patients undergoing a successful outpatient hip replacement, surgical approach does not have an effect on cost from in hospital or societal perspectives.

Immediate and delayed flap reconstruction have equivalent outcomes and associated costs following soft tissue sarcoma surgery.

Surgical treatment of soft tissue sarcoma (STS) involves wide resection of the tumor, which can necessitate soft tissue reconstruction with local or free tissue flaps. This retrospective study compares cost, surgical and oncologic outcomes between patients undergoing reconstruction with immediate versus delayed flap coverage following STS resection. Thirty-four patients who underwent planned flap reconstruction following resection of primary STS were identified retrospectively. Twenty-four (71%) received immediate reconstruction during the index surgery and 10 (29%) underwent planned delayed reconstruction. Preoperative patient-specific metrics, tumor characteristics, and surgical and patient outcomes were collected. Total hospital charges associated with every encounter during the perioperative period were obtained. Patient demographics, comorbidities, tumor metrics, and surgical characteristics were equivalent between groups. Postoperative wound complications, reoperations, readmissions, and disease-specific survival did not differ between cohorts. Costs associated with each reconstruction strategy were equivalent on bivariate and multivariate testing, when accounting for operating room time, hospital length of stay, and reoperation rate. Our study identifies no significant difference in patient outcome measures or cost between planned immediate and delayed flap reconstruction following STS resection. These results support the implementation of either treatment strategy in keeping with patient-centered, multidisciplinary care principles.

Clinical outcomes, management, healthcare resource utilization, and cost according to the CHA2DS2-VASc scores in Asian patients with nonvalvular atrial fibrillation

BackgroundThe prognosis among non-valvular atrial fibrillation (NVAF) patients with different CHA2DS2-VASc scores in the contemporary Asian population remains unclear. Additionally, there is a lack of research examining the disparities in management patterns, healthcare resource utilization (HCRU), and cost among these patients. Methods and resultsThis retrospective cohort study assessed patients diagnosed with NVAF between January 2018 and July 2022. Patients were stratified into 3 cohorts by CHA2DS2-VASc scores: low-risk, intermediate-risk, and high-risk. One-year incidence rates and cumulative incidence of clinical outcomes (including ischemic stroke [IS], transient ischemic attack [TIA], arterial embolism [AE], and major bleeding [MB]) were calculated. Management patterns, HCRU, and cost were analyzed descriptively. Among 419,490 NVAF patients (mean age: 75.2 years, 45.1 % female), 16,541 (3.9 %) were classified as low-risk, 38,494 (9.2 %) as intermediate-risk, and 364,455 (86.9 %) as high-risk. The one-year incidence rates for IS, TIA, AE, and MB were 12.4 (95 % CI, 12.3–12.5), 1.1 (95 % CI, 1.0–1.1), 0.5 (95 % CI, 0.5–0.5), and 3.1 per 100 person-years (95 % CI, 3.1–3.2), with an increasing trend from the low-risk to the high-risk group, respectively. During follow-up, 16.4 % and 11.1 % of patients in the low-risk and high-risk cohorts received oral anticoagulants (OACs), respectively. In addition, significant differences in HCRU and cost were observed in these three cohorts. ConclusionThis study demonstrates that contemporary Asian NVAF patients with higher CHA2DS2-VASc scores experience higher incidence of adverse outcomes and increased hospital resource consumption. Additionally, suboptimal management was present across all CHA2DS2-VASc score groups.

Modified Thoracoplasty for Rib Hump Deformity in Scoliosis Patients: A Case-Control Study

Razorback deformity with stiff thoracic scoliosis creates a complex three-dimensional deformity. Posterior spinal fusion (PSF) and thoracoplasty (TP) can correct rib hump deformity and improve patient satisfaction. However, conventional thoracoplasty (CTP) may impair pulmonary function and increase complications. We present a modified thoracoplasty (MTP) technique for addressing rib hump deformity in stiff thoracic scoliosis patients, emphasizing its clinical efficacy and safety. This study included 44 patients with stiff thoracic scoliosis and razorback deformity who underwent surgery between January 2010 and May 2021. Patients were divided into PSF+MTP (n=27) and PSF (n=17) groups. Surgical parameters, complications, radiographic improvements, pulmonary function, and SRS-22 scores were evaluated preoperatively and at 3 months and 2 years postoperatively. There were no significant differences in baseline characteristics between the two groups, except for the rib hump height, which was higher in the PSF+MTP group. The PSF+MTP group showed superior correction of the thoracic curve and rib hump height compared to the PSF group, with significant improvements in self-image scores. No significant differences were observed in pulmonary function between the groups. The operative time was longer in the PSF+MTP group, but there were no significant differences in intraoperative blood loss, hospitalization costs, or major complications. Regression analysis indicated that the type of surgery, thoracic Cobb angle and preoperative self-image scores were significant predictors of postoperative self-image scores. MTP provides enhanced correction of thoracic curve and rib hump deformity without significantly increasing pulmonary function impairment or complication rates. It also improves patients' self-image, making it a valuable addition to PSF in treating stiff thoracic scoliosis with rib hump deformity.

Robot learning-enhanced tree-based algorithms for kinodynamic motion planning: A comparative analysis

Kinodynamic motion planning is pivotal in advancing robotics, en- abling autonomous systems to navigate dynamic environments effectively while adhering to both kinematic and dynamic constraints. This study delves into the efficacy of tree sampling-based planners, namely the Rapidly- exploring Random Tree (RRT), Rapidly-exploring Random Tree Star (RRT*), and Dominance Informed Region Trees (DIRT), in kinodynamic motion planning. Through a comparative analysis focusing on both fully informed and uninformed versions of these algorithms, I explore their performance in environments with dynamic constraints. Special emphasis is placed on the integration of learned controls, aiming to enhance maneuver planning. My research reveals significant differences in success rates, iterations, and path costs among the algorithms, underscoring DIRTs superiority under certain conditions and the beneficial impact of learned controls. These findings contribute valuable insights into the selection and optimization of motion planning algorithms, paving the way for more efficient and adapt- able autonomous systems.

Dual-task costs in speed tasks: a comparison between elite ice hockey, open-skill and closed-skill sports athletes.

Ice hockey is a high pace sports game that requires players to integrate multiple skills. Players face perceptive, cognitive, and motor tasks concurrently; hence, players are regularly exposed to dual- or multi-task demands. Dual-tasking has been shown to lead to decreased performance in one or both performed tasks. The degree of performance reductions might be modulated by the exhaustion of cognitive resources. Literature on dual-task paradigms that combine sport-relevant elements is scarce. Therefore, a novel paradigm combining cyclical speed of the lower extremities and concurrent visuo-verbal speed reading was tested and validated. Additionally, to understand the nature of dual-task costs, the relationship between these costs and cognitive performance was assessed. We hypothesized occurrence of dual-task costs in all athletes without relationship to single task performance. Differences in dual-task cost were expected between open-skill and closed-skill sports, as well as differing expertise levels. Level of cognitive function was expected to explain some variance in dual-task cost. A total of 322 elite athletes (120 ice hockey, 165 other team sports, 37 closed-skill sports) participated in this study. Each athlete performed a tapping task, a visuo-verbal speed-reading task, and both tasks simultaneously. All ice hockey athletes performed additional cognitive tests assessing processing speed, spatial working memory, sustained attention, two choice reaction time, and motor inhibition. The results of paired-sample t-tests confirmed significant dual-task costs for all sport groups (p < 0.001). Single-task performance and dual-task costs correlated weakly in a positive direction. A one-way ANOVA revealed significantly greater costs in closed-skill sports athletes than in ice hockey and other sports athletes. No significant differences in dual-task costs were found between teams of differing expertise levels. Lastly, no significant regression model was found to predict dual-task costs from cognitive test performance. Our study suggests that this novel dual-task paradigm was successful in inducing dual-task costs for all elite athletes. Since it distinguishes between closed-skill and open-skill sports athletes, it might be a valuable diagnostic tool for performance and for talent development of open-skill athletes. Dual-task costs could not be relevantly predicted via cognitive performance measures, questioning cognitive resource theories as an explanation for dual-task costs.

Costs and outcomes associated with the administration of Intravenous Acetaminophen in neonates after esophageal atresia and tracheoesophageal fistula repair

BackgroundOver the last decade, the intravenous (IV) formulation of acetaminophen (APAP) has gained popularity as a safe and effective first-line analgesic in the neonatal intensive care unit and it is especially useful in peri-operative settings where oral agents are contraindicated. The primary objective was to examine the outcomes and costs associated with the use of IV APAP in combination with opioids versus opioids alone as a pain management strategy after neonatal esophageal atresia (EA) and tracheoesophageal fistula (TEF) repair. MethodsData from the Pediatric Health Information System was used to examine 1137 hospitalizations for EA/TEF repair from October 2015 to September 2018. Neonates administered opioids only, or IV APAP in combination with opioids as pain management, were included. ResultsNeonates receiving IV APAP experienced a longer median LOS, but a significantly lower mortality rate, a decreased mean daily cost, and reduced opioid use compared to neonates given only opioids. The two groups had no significant differences in pharmacy and total costs. ConclusionOur findings suggest that the use of IV APAP alongside opioids in EA/TEF repair is associated with reduced mortality and opioid use, as well as longer LOS.

GREEN ACCOUNTING PRACTICES IN INDONESIAN COMPANIES

This research aims to analyze green accounting practices in Indonesia. Environmentally accounting practices are assessed using the Global Reporting Initiative (GRI). The research sample consists of companies on the Indonesia Stock Exchange that produce sustainability reports from 2020 to 2022. The descriptive analysis describes insights into environmentally friendly accounting practices in Indonesia, while the ANOVA test is used to test the differences in environmentally friendly accounting practices based on industry types and years of study. The results show that environmental disclosure in Indonesia is still deficient. The companies allocate minimal expenditure on environmental issues. The different test results show that there is no significant difference in environmental costs based on industry type, there is a significant difference in environmental disclosure based on industry type, there is no significant difference in environmental costs based on year of study, and there are significant differences in environmental disclosure based on year of study.

Cost Analysis of a Hand Hygiene Improvement Strategy in Long-Term Care Facilities

ObjectivesTo evaluate whether the costs of a successful tailored multifaceted strategy to improve hand hygiene compliance outweighed the savings by reducing infection costs in Dutch long-term care facilities (LTCFs). DesignA retrospective cost analysis alongside a stepped-wedge cluster-randomized controlled trial. Setting and ParticipantsThe study included 14 LTCFs (23 wards) in the Netherlands. MethodsThe cost analysis was based on the costs of the intervention vs the savings from avoided infections and associated treatment costs. Infection-related costs of the “usual-care” period were compared with the combined infection-related costs and intervention costs from the “intervention” period and the costs in the “post-intervention period.” Multilevel analyses, with a linear model with periods as fixed effects, random effects for cluster LTCFs, and fixed effects for each step, were completed. ResultsThere are no significant differences in total costs considering the 3 periods. When adjusting for time and clustering, the mean infection-related costs per week per LTCF for all the infections combined were highest during “usual-care” before the hand hygiene intervention was performed, namely 680 euros per week. Assuming the effect of the improvement strategy would be present for 12 months, the costs per week in the “intervention” and “post-intervention” periods were 627 euros (95% CI, 383–871) and 731 euros (95% CI, 508–954), respectively. Assuming the effect of the improvement strategy will last longer than 1 year (ie, 18 and 24 months), the average cost for the “intervention period” and the “post-intervention” period decreased to 615 euros and 719 euros during the intervention and 609 euros and 715 euros after the intervention, respectively. Conclusions and ImplicationsOur multifaceted hand hygiene improvement strategy achieves cost savings. The results of our study are the first of an economic analysis of a hand hygiene improvement strategy in LTCFs. The results need to be confirmed by further economic evaluations.

Unit Cost Analysis of Haemodialysis Services By Activity Based Costing Approach as a Strategy For Increasing Hospital Profits

One of the catastrophic diseases that is the focus of health insurance financing is kidney failure. Haemodialysis is a type of kidney replacement therapy for chronic kidney disease using special equipment. One method of financing haemodialysis procedures is the National Health Insurance Program. Hospitals, as health service providers for JKN participants, have an interest in the INACBG rates. Based on the Regulation of the Minister of Health of the Republic of Indonesia Number 3 of 2023 concerning Health Service Tariff Standards in the Implementation of the Health Insurance Program, there are changes to tariffs for haemodialysis services. With the current tariff changes, single-use and re-use services are divided into two different tariffs. The research was conducted at Siloam Hospital Bali. The data taken is secondary data originating from the Financial Division of Siloam Hospital Bali, the Medical Records Department of Siloam Hospital Bali, and the Haemodialysis Department of Siloam Hospital Bali during the period January–April 2023. The data collected and the hypothesis formulated in this research will be tested using the MANOVA (Multivariate Analysis of Variance) test method, using SPSS software. The research results show that there is a significant difference in total costs for re-use and single-use haemodialysis services; there is a significant difference in the total INACBG rates per patient for re-use and single-use haemodialysis services and there is no significant difference in the difference between INACBG rates and total costs in re-use and single-use haemodialysis services.

Impact of planned delivery mode on neonatal outcomes and costs in twin pregnancies in Kenya

BackgroundTwin pregnancies are associated with higher risks of adverse neonatal outcomes compared to singleton pregnancies. The choice of delivery mode, when twin A presents cephalic, remains a subject of debate. In low- and middle-income countries, where healthcare resources are limited, the decision on the mode of delivery is even more critical. ObjectiveTo evaluate the neonatal outcomes and the hospital costs of planned vaginal delivery compared to cesarean section (CS) in twin pregnancies with twin A presenting cephalic at Tenwek Hospital, Kenya. Study DesignThis retrospective cohort study analyzed data from all twin deliveries at Tenwek Hospital, Kenya from, April 1, 2017, to March 30, 2023. Maternal data, mode of delivery, and neonatal data were collected from delivery logs, electronic health records, and neonatal records. Neonatal outcomes were a composite of either Appearance, Pulse, Grimace, Activity, and Respiration score less than seven at 5 minutes, neonatal intensive care unit admission, resuscitation, birth trauma, or neonatal complications, including death before discharge from the hospital. A logistic regression model was created to assess the impact of the planned mode of delivery on neonatal outcomes, controlling for antenatal care clinic visits, noncephalic presentation of twin B, and birth weight category. ResultsThe study included 177 twin deliveries: 129 (72.9%) were planned as vaginal deliveries and 48 (27.1%) were planned for CS. Among the planned vaginal deliveries, 66 (51.2%) experienced adverse outcomes, compared to 14 (29.2%) in the CS group (P=.009). Logistic regression showed that the odds of adverse outcomes were 0.35 times lower in the CS group compared to the planned vaginal delivery group (95% CI: 0.15–0.83; P=.017). The average total hospital costs for planned vaginal delivery were 104,608 Kenya Shillings (standard deviation 111,761) compared to 100,708 Kenya Shillings (standard deviation 75,468) for CS (P=.82). ConclusionPlanned cesarean deliveries in twin pregnancies with twin A presenting cephalic at Tenwek Hospital were associated with fewer adverse neonatal outcomes compared to planned vaginal deliveries. There was no significant difference in hospital costs. These findings raise the question of the safest mode of delivery for patients in a resource-constrained setting.

Prescription drug, healthcare utilization, and lost earnings cost of behavioral interventions for fear of cancer recurrence in breast cancer survivors.

e24095 Background: Breast cancer survivors experience distress due to the fear of cancer recurrence. Acceptance and commitment therapy (ACT) and cognitive behavioral therapy (CBT) can treat the fear of cancer recurrence. However, no study has applied economic evaluation methods to estimate ACT and CBT behavioral intervention costs for breast cancer survivors. Methods: 384 adult stage I-IIIA breast cancer survivors with fear of cancer recurrence were randomly assigned to either the ACT (n = 128), CBT (n = 128), or enhanced usual care (EUC, n = 128) groups. Through micro-costing, we assessed the societal perspective cost of behavioral interventions using 2022 dollars. Per-capita drug costs, healthcare utilization, and lost productivity were calculated using participant survey data. Drug costs were estimated using Micromedex’s Red Book wholesale unit price. The 2022 Medicare Physician Fee Schedule for Indiana estimated healthcare utilization costs from outpatient, inpatient, and emergency visits. Lost productivity costs included work loss, productivity loss, and unpaid work loss, valued by Indiana's mean hourly wage. We assessed the cost differences between baseline (T1) and after the 6-week intervention period (T2). We evaluated between-group differences with Bonferroni's tests for each pairwise group comparison and within-group differences with a paired t-test at a p-value of &lt; 0.05. Results: The mean total per-capita cost change from T1 to T2 in the ACT, CBT, and EUC groups was -$563, -$1622, and -$981, respectively (Table 1). This cost reduction stemmed from drug and healthcare utilization. There was no significant between-group difference in total cost at T1 or T2 and no significant between-group or within-group cost change from T1 to T2. Conclusions: Our cost estimates will be updated at 6 and 12 months of intervention and combined with changes in quality of life and mental health metrics to assess the cost-effectiveness of ACT and CBT for fear of breast cancer recurrence. Clinical trial information: NCT05364450 . [Table: see text]

Real-world costs and outcomes associated with biomarker testing by comprehensive genomic profiling (CGP) and non-CGP approaches among patients with metastatic non-small cell lung cancer (mNSCLC).

e20598 Background: Guideline-recommended molecular testing is essential for identifying appropriate targeted therapies (Rx) for treatment of mNSCLC patients (pts). Biomarker testing can be performed by single gene tests, small NGS panels (e.g., &lt; 50 genes), or CGP approaches. There is little evidence on the rate of biomarker testing in the real world setting and the impact of different approaches on Rx utilization and cost of care. This study examined real-world utilization of biomarker testing among mNSCLC pts and outcomes with CGP and non-CGP testing. Methods: De-identified administrative claims data from the Optum Labs Data Warehouse were analyzed to identify newly diagnosed adult mNSCLC pts from 1/2018 to 8/2021; the date of the first claim indicating metastasis was the index date. Continuous enrollment in a commercial (COM) or Medicare Advantage (MA) plan with medical and pharmacy benefits for 12 mo prior to (baseline), and ≥6 mo post index date (follow-up) was required; pts with &lt; 6 mo follow-up due to death were included. Initiation of a line of therapy (LOT1) during follow-up was required. We categorized pts based on receipt and type of biomarker testing prior to LOT1: CGP ( &gt; 50 gene panel), non-CGP (5-50 gene panels or single gene testing), or no testing. Differences in receipt of targeted Rx, overall survival (OS), and total overall per patient per month (PPPM) costs during LOT1 were examined with multivariable regression analyses. Results: 9,945 mNSCLC pts (1,970 COM, 7,975 MA) were identified: 5,484 with no testing, 2,215 with CGP, and 2,246 with non-CGP testing prior to LOT1. Biomarker testing rates prior to LOT1 were low (45%) but increased during the study period from 42% to 48% (p &lt;0.01). Testing rates were higher for the COM vs MA population (49% vs 44%, p &lt;0.01). A higher percent of pts with CGP received targeted Rx compared to the non-CGP and no testing group (17% vs 11% and 5% respectively, p&lt; 0.01); after adjustment, CGP pts were still more likely to receive targeted Rx. Compared to the no testing group, OS was more favorable for the CGP [HR 0.8, 95% CI 0.8-0.9] and non-CGP [HR 0.9, 95% CI 0.8-0.9] groups. There was no significant difference in PPPM costs between tested groups: CGP [CR 1.2, 95%CI 1.1-1.2] vs non-CGP [CR 1.1, 95%CI 1.1-1.2]. Conclusions: Rates of biomarker testing among mNSCLC pts are far from optimal despite well-established guideline recommendations and insurance coverage for testing. There was evidence of improved intermediate outcomes (receipt of targeted Rx) with CGP compared to non-CGP or no testing. In addition, OS was improved for tested pts compared to untested. Interventions to help improve biomarker testing are needed. Given the potential benefits of CGP testing (including assessment of biomarkers that cannot be evaluated using small panels), increasing CGP testing may improve outcomes.

Continuity of care by a primary midwife (caseload midwifery): a cost analysis using results from the COSMOS randomised controlled trial

IntroductionCaseload midwifery (continuity of midwifery carer) offers benefits including lower caesarean section rates, lower risks of preterm birth and stillbirth, and improved maternal satisfaction of care. Despite these advantages, concerns...

The Impact of the Withdrawal of SGLT2 Inhibitors on Clinical Outcomes in Patients with Heart Failure.

Background: The clinical impact of the withdrawal of sodium-glucose cotransporter 2 inhibitors (SGLT2i) on all-cause readmission in patients with heart failure remains unknown. Methods: We enrolled a total of 212 consecutive patients who were hospitalized for heart failure and received SGLT2i during their index hospitalization between February 2016 and July 2022. Of these patients, 51 terminated SGLT2i during or after their index hospitalization. We evaluated the prognostic impact of the withdrawal of SGLT2i on the primary outcome, which was defined as the all-cause readmission rate/times. Results: Over a median of 23.2 months, all-cause readmission occurred in 38 out of 51 patients (74.5%) withdrawn from SGLT2i and 93 out of 161 patients (57.8%) with continuation of SGLT2i (p = 0.099). The incidence of all-cause readmissions per year was 0.97 [0-1.50] in patients withdrawn from SGLT2i and 0.50 [0-1.03] in patients with continuation of SGLT2i (p = 0.030). There was no significant difference in total medical costs (62,906 [502-187,246] versus 29,236 [7920-180,305] JPY per month, p = 0.866) between both patient groups. Conclusions: Termination of SGLT2i may be associated with incremental all-cause readmission and no benefit in reducing total medical costs.