Significant Reduction In Total Cost Research Articles

Adoption of clinical pharmacist roles in primary care: Longitudinal evidence from English general practice.

Over the last decade, the number of clinical pharmacists working within multidisciplinary teams in English general practice has expanded Aim: This study examines changes in quality of prescribing after the adoption of clinical pharmacists in English general practices. Two-way fixed effects regression was used to compare differences in prescribing indicators in general practices in England with and without pharmacists following implementation between September 2015 and December 2019 Results: Between September 2015 and December 2019, the proportion of practices employing a clinical pharmacist increased from 236/ 7,623 (3.10%) to 1,402/ 6,836 (20.51%). Clinical pharmacist implementation resulted in statistically significant reductions in total costs of medicines per 1,000 patients (-0.85% ,95% CI -1.50%, -0.21%), the total number of opioid prescriptions per 1,000 patients (- 1.06%, 95% CI -1.82%, -0.29%), and the average daily quantity (ADQs) of anxiolytics per 1,000 patients (-1.26%, 95% CI -2.40%, -0.12%). Clinical pharmacist implementation also resulted in reductions in the total number of prescriptions per 1,000 patients (-0.58%, 95% CI -1.30%, 0.13%), and the total number of antibiotic prescriptions per 1,000 patients (-0.51%, 95% CI -1.30%, 0.27%) that trended towards statistical significance. There were no statistically significant differences in the share of broad-spectrum versus narrow-spectrum antibiotics (0.02%, 95% CI -0.07%, 0.11%) and the oral morphine equivalence of high-dose opioids (>120mg per 24 hours) per 1,000 patients (1.19%, 95% CI -0.46%, 2.85%). Our analysis is limited by aggregate data at the practice-level but supports the hypothesis that clinical pharmacist implementation results in improvements in prescribing quality.

High-Quality Hospital Status on Health Care Costs for Pediatric Congenital Heart Disease Care for U.S. Military Beneficiaries.

Congenital heart disease (CHD) is the most common and resource demanding birth defect managed in the United States, with approximately 40,000 children undergoing CHD surgery year. Researchers have compared high-volume to low-volume hospitals and found significant hospital-level variation in major complications, health resource utilization, and health care costs after CHD surgery. Using nationwide representative claim data from the United States Military Health System from 2016 to 2020, TRICARE beneficiaries diagnosed with CHD were tabulated based on ICD-10 codes (International Classification of Diseases, 10th revision). We examined the relationships between total costs and total hospitalizations costs post 1-year CHD diagnosis and presence or absence of High-Quality Hospital (HQH) designation. We applied both the naive generalized linear model (GLM) to control for the observed patient and hospital characteristics and the 2-stage least squares (2SLS) model to account for the unobserved confounding factors. This study was approved by University of Maryland, College Park Institutional Review Board (IRB) (Approval Number: 1576246-2). A relationship between HQH designation and total CHD related costs was not seen across 2SLS model specifications (marginal effect; -$41,579; 95% CI, -$83,429 to $271). For patients diagnosed with a moderate-complex or single ventricle CHD, the association of HQH status was a statistically significant reduction in total costs (marginal effect; -$84,395; 95% CI, -$140,560 to -$28,229) and hospitalization costs (marginal effect; -$73,958; 95% CI, -$121,878 to -$26,039). It is very imperative for clinicians and patient support advocates to urge policymakers to deliberate the establishment of a quality designation authority for CHD management. These efforts will not only help to identify and standardize quality care metrics but to improve long-term health, effectiveness, and equity in the management of CHD. Furthermore, these efforts can be used to navigate patients to proven HQH, thereby improving care and reducing associated treatment costs for CHD patients.

New synthetic red- and orange-emitting luciferases to upgrade in vitro and 3D cell biosensing.

Bioluminescence (BL), i.e., the emission of light in living organisms, has become an indispensable tool for a plethora of applications including bioassays, biosensors, and in vivo imaging. Current efforts are focused on the obtainment of new luciferases having optimized properties, such as improved thermostability at 37 °C, pH-insensitive emission, high quantum yield, extended kinetics and red-shifted emission. To address these issues we have obtained two new synthetic luciferases, an orange and a red-emitting luciferase, which were designed to achieve high sensitivity (BoLuc) and multiplexing capability (BrLuc) for in vitro and in vivo biosensing using as a starting template a recently developed thermostable synthetic luciferase (BgLuc). Both luciferases were characterized in terms of emission behaviour and thermal and pH stability showing promising features as reporter proteins and BL probes. As proof-of-principle application, an inflammation assay based on Human Embryonic Kidney (HEK293T) 3D cell cultures was developed using either the orange or the red-emitting mutant. The assay provided good analytical performance, with limits of detection for Tumor Necrosis Factor (TNFα) of 0.06 and 0.12 ng mL-1 for BoLuc and BrLuc, respectively. Moreover, since these luciferases require the same substrate, D-luciferin, they can be easily implemented in dual-color assays with a significant reduction of total cost per assay.

Vehicle-to-ski: A V2G optimization-based cost and environmental analysis for a ski resort

Ski resorts are becoming perfect demonstrations for the integration of renewable sources. Moreover, the ever-growing global fleet of electric cars (EV) and the increase of battery capacities allow the vehicles to be used for purposes other than driving. This paper aims to study the implementation of a vehicle-to-grid (V2G) application and the development of an MPC-based energy management system (EMS) within a ski resort in the Trentino-Alto Adige Italian region. Using real data for load and production power estimation, the study analyses the economic and environmental impact in three different scenarios by considering the resort’s future trends. The results show that photovoltaic power generation has a significant impact on both cost and environmental aspects, leading to a reduction in total expenditure and CO2 of about 7%. However, assuming an increasing number of charging stations, the exploitation of V2G technology for energy arbitrage does not lead to significant total cost and CO2 reductions (≈2%) for the future scenarios. Conversely, self-consumption improves (≈100%) using different charging strategies. Despite this, a sensitivity analysis on PV production and a joint increase in EVs and energy price gap leads to a significant reduction in total costs of up to 7.7% and 15.2%, respectively.

Feasibility and Cost Analysis of Ambulatory Endovascular Aneurysm Repair

Purpose: We sought to compare the costs of ambulatory endovascular aneurysm repair (a-EVAR) and inpatient EVAR (i-EVAR) at up to 1-year of follow-up. Materials and Methods: A retrospective cohort study of consecutive patients undergoing elective EVAR between April 2016 and December 2018 at two academic centers. Patients planned for a-EVAR were compared with i-EVAR. Costs at 30 days and 1 year were extracted. These included operating room (OR) use, bed occupancy, laboratory and imaging, emergency department (ED) visits, readmissions, and reinterventions. Baseline characteristics were compared. Multiple regression model was used to identify predictors of increased EVAR costs. Repeated measures analysis of variance (ANOVA) was used to compare cost differences at 30 days and 1 year via an intention-to-treat analysis. Bonferroni post hoc test compared between-group differences. A p value<0.05 was considered statistically significant. Results: One hundred seventy patients were included. Most underwent percutaneous EVAR (>94%) under spinal anesthesia (>84%). Ambulatory endovascular aneurysm repair was successful in 84% (84/100). Ambulatory endovascular aneurysm repair patients (76±8 years) were younger than i-EVAR (78±9 years). They also had a smaller mean aneurysm diameter (56±6 mm) compared with i-EVAR (59±6 mm). Emergency department visits, readmissions, and reinterventions were similar up to 1 year (all p=NS). Ambulatory endovascular aneurysm repair costs showed a non-statistically significant reduction in total costs at 30 days and 1 year by 27% and 21%, respectively. Patients younger than 85 years and males had a 30-day cost reduction by 34% (p=0.027) and 33% (p=0.035), respectively with a-EVAR. Conclusions: Same-day discharge is feasible and successful in selected patients. Patients younger than 85 years and males have a short-term cost benefit with EVAR done in the ambulatory setting without increased complications or reinterventions. Clinical Impact This study shows the overall safety of ambulatory EVAR with proper patient selection. These patient had similar post-intervention complications to inpatients. Same day discharge also resulted in short-term reduction in costs in male patients and patients younger than 85 years.

Real-World Data on Liposomal Bupivacaine and Inpatient Hospital Costs After Colorectal Surgery.

This study compared costs of care among colorectal surgery patients who received liposomal bupivacaine versus those who did not (control) from a health institution perspective. This pharmacoeconomic evaluation was conducted among adults undergoing open or minimally invasive colorectal resection at an academic medical center from May 2016 to February 2018. Healthcare resource utilization was derived from the electronic health record. Total cost of care (2018 USD) was analyzed using a generalized linear model adjusted for American Society of Anesthesiologists score, enhanced recovery after surgery management, open surgery, opioid use before surgery, height, cancer, and age. The primary analysis used public costs. A sensitivity analysis used internal costs from the hospital to maximize internal validity. Of 486 included patients, 286 (59%) received liposomal bupivacaine. Total cost of care using public costs included perioperative local anesthetics (mean±standard deviation [SD]: $392±74 liposomal bupivacaine versus $8±13 control), analgesics within 48h after surgery (mean±SD: $132±99 liposomal bupivacaine versus $117±127 control), postoperative ileus management (mean±SD: $5±51 liposomal bupivacaine versus $65±284 control), and hospital length of stay (mean±SD: $4459±3576 liposomal bupivacaine versus $7769±7082 control). Liposomal bupivacaine was associated with an adjusted absolute difference in total cost of care of -$1435 (95% confidence interval -$2401 to -$470; P=0.004) using public costs and -$1345 (95% confidence interval -$2215 to -$476; P=0.002) using internal costs. Use of liposomal bupivacaine in colorectal surgery was associated with a significant reduction in total cost of care that was predominately driven by reduced costs for hospital stay and postoperative ileus management despite higher medication costs.

Safety, Feasibility and Economic Analysis of Same Day Discharge Following Elective Percutaneous Coronary Intervention.

Background:Advances in percutaneous coronary intervention (PCI) has made the possibility of facilitating same day discharge (SDD) of patients undergoing intervention. We sought to investigate the feasibility, safety and economic impact of such a service.Methods:We retrospectively collected data on all patients undergoing outpatient PCI at our institution over a 12-month period. We included in-hospital and 30-day major adverse cardiac events (MACE), vascular complications, acute kidney injury and any re-hospitalisations. We analysed the cost effectiveness of SDD compared to overnight admission post PCI and staged PCI following diagnostic angiography.Results:A total of 147 patients undergoing PCI with 129 patients deemed suitable for SDD (88%). Mean age was 65.7 years. Most patients had type C lesions (60.3%); including 4 chronic total occlusions (CTOs). At 30-day follow-up there were no MACE events (0%). There were 10 (7.8%) re-hospitalisations of which majority (70%) were non cardiac presentations. We also included cost analysis for an elective PCI with SDD, which equated to $2090 per patient (total of $269 610 for cohort). Elective PCI with an overnight admission was $4440 per patient (total of $572 760 for cohort), an additional $2350 per patient (total $303 150). Total cost of an angiogram followed by a staged PCI with an overnight stay was $4700 per patient (total $606 300).Conclusion:SDD is safe and feasible in the majority of patients that have elective coronary angiography that require PCI. SDD leads to a significant reduction in total cost and hospital stay of patients undergoing elective PCI.

O51 BIOSYNTHETIC MESH VERSUS NON-ABSORBABLE SYNTHETIC MESH IN COMPLEX ABDOMINAL WALL REPAIR (CAWR): A UK NHS COST-CONSEQUENCE ANALYSIS OF MANAGEMENT STRATEGIES

Abstract Aim CAWR is marked by high complication and hernia recurrence rates. Different management strategies of CAWR may result in a significant reduction in quality of life and increased financial burden. The use of certain non-absorbable synthetic meshes in CAWR may be associated with an increased risk of adverse events for certain patients. Recent evidence suggests that biosynthetic meshes may contribute to lower complications and may be more cost-effective. Material and Methods To compare the cost between a synthetic mesh, and a bio-synthetic mesh in the management of patients undergoing CAWR. A cost-consequence model was developed to simulate clinical pathways for patients undergoing CAWR with different management strategies. Clinical parameters were informed by literature review and expert opinion. Adverse events associated with the use of a mesh, resource utilisation and re-admissions were compared between patient management strategies over a period of two years. Costing information were gathered from national tariffs using NICE methodology. Results Use of a biosynthetic mesh was associated with a significant reduction in total costs (£15,489 / €17,953) compared to a synthetic mesh at two years. Cost-savings were driven by a lower rate adverse events (hernia recurrence [2% vs.8%] and sepsis [5% vs. 12%] respectively), and resource utilisation after the initial procedure in the management of complications. There was no difference in the intra-procedural time and complications. Conclusions The use of a certain biosynthetic mesh is likely to be highly cost saving compared to a certain synthetic mesh in high-risk patients undergoing CAWR. Well conducted comparative clinical studies are needed to inform robust economic modelling.

Development of sustainable and resilient healthcare and non-cold pharmaceutical distribution supply chain for COVID-19 pandemic: a case study

PurposeThis study evaluated the influence of the coronavirus pandemic on the healthcare and non-cold pharmaceutical care distribution supply chain.Design/methodology/approachThe model involves four objective functions to minimize the total costs, environmental impacts, lead time and the probability of a healthcare provider being infected by a sick person was developed. An improved version of the augmented e-constraint method was applied to solve the proposed model for a case study of a distribution company to show the effectiveness of the proposed model. A sensitivity analysis was conducted to identify the sensitive parameters. Finally, two robust models were developed to overcome the innate uncertainty of sensitive parameters.FindingsThe result demonstrated a significant reduction in total costs, environmental impacts, lead time and probability of a healthcare worker being infected from a sick person by 40%, 30%, 75% and 54%, respectively, under the coronavirus pandemic compared to the normal condition. It should be noted that decreasing lead time and disease infection rate could reduce mortality and promote the model's effectiveness.Practical implicationsImplementing this model could assist the healthcare and pharmaceutical distributors to make more informed decisions to minimize the cost, lead time, environmental impacts and enhance their supply chain resiliency.Originality/valueThis study introduced an objective function to consider the coronavirus infection rates among the healthcare workers impacted by the pharmaceutical/healthcare products supply chain. This study considered both economic and environmental consequences caused by the coronavirus pandemic condition, which occurred on a significantly larger scale than past pandemic and epidemic crises.

PSU5 Liposomal Bupivacaine and Inpatient Hospital Costs after Colorectal Surgery

To compare total costs of care between patients who received liposomal bupivacaine (LB) versus those who did not (control) from a health institution perspective. This economic evaluation was conducted among adults undergoing open or minimally invasive colorectal resection at an academic medical center from May 2016 to February 2018. Patients with surgery after hospital day 2 or ostomy were excluded. The primary analysis used public charges. A sensitivity analysis used hospital-specific costs. Healthcare resource utilization was derived from the electronic health record. Total costs of care (in 2018 USD) were analyzed using a generalized linear model adjusted for American Society of Anesthesiologists score, enhanced recovery after surgery management, open surgery, opioid use before surgery, height, cancer, and age. Of 486 included patients, 286 (59%) received LB. Total costs of care using public charges included perioperative local anesthetic use (mean ± SD; $392 ± 74 LB vs. $8 ± 13 control), analgesia 48-hour after surgery ($132 ± 99 LB vs. $117 ± 127 control), postoperative ileus management ($5 ± 51 LB vs. $65 ± 284 control), and hospital length of stay ($4,459 ± 3,576 LB vs. $7,769 ± 7,082 control). After adjusting for covariates, LB was associated with an average reduction in total costs of care of $1,435 (95%CI [470 to 2,401]; p=0.004) using public charges and $1,345 (95%CI [476 to 2,215]; p=0.002) using hospital-specific costs. In a sensitivity analysis where administration of LB was assumed to increase operating room time by 5 minutes, LB was associated with a significant reduction in total costs of care as long as cost per minute of operating room time was ≤$80. Following colorectal surgery, LB was associated with a significant reduction in total costs of care that were predominately driven by reduced costs for hospital stay and postoperative ileus management despite higher medication costs.

Efficient Production of Specialized Polymers with Highly Flexible Small‐Scale Plants

AbstractShortened product life cycles and increased demand for specialized products lead to more challenges in efficiently satisfying customer needs. Customer demands are increasingly uncertain in terms of type, location, and volume. As a result, more flexible chemical production plants are required. Modular small‐scale plants can be installed in transportation containers and, therefore, offer the flexibility of easy relocation, enabling production close to the customer or supplier. In a mathematical optimization model, the economic benefit of small‐scale plants in the specialty chemicals market of polymer production is analyzed. Different scenarios created from the real data of a chemical company show that the use of small‐scale plants may lead to a significant reduction in total costs that is mainly due to the transportation costs of raw materials and products.

The Role of Tungsten Oxide in Enhancing the Carbon Monoxide Tolerance of Platinum-Based Hydrogen Oxidation Catalysts.

Significant reductions in total cost of ownership can be realized by engineering PEM fuel cells to run on low-purity hydrogen. One of the main drawbacks of low-purity hydrogen fuels is the carbon monoxide fraction, which poisons platinum electrocatalysts and reduces the power output below useful levels. Platinum-tungsten oxide catalyst systems have previously shown high levels of CO tolerance during both ex situ and in situ investigations. In this work, we explore the mechanism of enhanced tolerance using in situ electrochemical attenuated total reflection-infrared (ATR-IR) and Raman spectroscopy methods and investigate, using a mixture of Pt/C and WO3 powders, the role of the WV/WVI redox couple in the oxidation of adsorbed CO.

Energy recovery system in small reverse osmosis desalination plant: Experimental and theoretical investigations

The shortage of potable water, especially in developing countries has attracted researchers to try and overcome this problem. Desalination is one of the most effective methods used to solve this problem. Among desalination techniques, Reverse Osmosis (RO) has higher priority than thermal desalination methods, on account of its comparatively limited energy consumption. Different methods were introduced to enhance the performance of RO desalination plants. This study focused on employing an Energy Recovery System (ERS) to enhance the performance of the small RO plant for remote areas. The unit capacity was 2.4 m3/day, occupied with two double-acting cylinders with their control elements working as an ERS. An experimental setup is used to verify the effectiveness of the proposed ERS. A simulation model is designed and implemented to enable changing system parameters of the plant. The different system pressure experimental and model results were exposed and compared. The obtained results showed good agreement between experimental and simulation model values. The effect of recovery ratio on the power saving is highlighted. The ERS saved power consumption by 80%. The cost analysis of the small RO desalination plant with and without ERS was evaluated and showed a significant reduction in total cost.

Impact of Behavioral Health Homes on Cost and Utilization Outcomes.

This study evaluated the impact of two behavioral health home (BHH) approaches, provider-supported care and self-directed care, on health care utilization and cost outcomes among adult Medicaid recipients with serious mental illness. Eleven community mental health provider sites were randomly assigned to one of the BHH approaches, which each site implemented over a 2-year period. In both approaches, staff were trained in wellness coaching to support patients' progress toward general health and wellness goals. Provider-supported sites employed a full-time on-site registered nurse, who provided consultation to patients and wellness coaches. Each approach had a consistently enrolled treatment group (combined N=859) with a matched comparison cohort that was identified for analysis. Approaches were compared with each other and with baseline, and differences between each approach and its comparison cohort were examined by using analysis of covariance to determine impact on total health care cost, prescription costs, and use and cost of general medical and behavioral health services. Relative to its comparison cohort, each approach achieved significant reductions in total cost (15% for provider-supported care and 26% for self-directed care) and increases in use of outpatient general medical services (43% for provider-supported care and 29% for self-directed care). Compared with self-directed care, provider-supported care resulted in approximately 28% lower use of general medical inpatient services and 26% lower related costs. BHH approaches in community mental health settings can produce health care savings and decrease use of inpatient health care.

A Technical-Economic Comparison between Conventional Tillage and Conservative Techniques in Paddy-Rice Production Practice in Northern Italy

In this study a technical-economic comparison was conducted to compare three different agronomic practices applied to paddy rice cultivation areas in Italy: one based on conventional tillage (CT), and two adopting conservative agriculture approaches, namely minimum tillage (MT) and no-tillage (NT). Data about production inputs (seed, fertilizers, agrochemicals, fuel) and working time were measured for each technique during the whole production season in three experimental fields. The total production costs were computed by adding the mechanization costs, calculated through the ASABE (American Society of Agricultural and Biological Engineers) EP (Engineering Practice) 496.3 methodology, and the production input costs. The results of the study highlighted a significant reduction of total costs obtained with both minimum (−16%) and no-tillage (−19%) compared to conventional tillage.

A quantitative model for optimization and disruption mitigation in a supply chain (Auto parts case study)

However, there is a lot of capital and plenty of manpower in the auto spare part industry, the enterprises and supply chains of this industry do not perform well in our country. This research models a three-level supply chain with multiple manufacturers, distribution centers and retailers, to minimize the total cost by taking into account various disruptions. The database of two active car spare parts companies for five strategic products in one year has been used. Then, the mathematical model is analyzed by considering disruptions based on three different sales policies: back orders, lost sales and outsourcing. Besides, to evaluate the performance of the model some numerical examples are used and analyzed to determine that algorithm works. Model solved efficiently by MATLAB software. The results show that the proposed algorithm of this research can neutralize the effect of the disruptions and cause a significant reduction in total cost of the system. The model is useful for helping decision makers to adopt an active approach to maintaining business benefits when disruptions take place in the supply chain.

Integrated condition-based planning of production and utility systems under uncertainty

A general rolling horizon optimization framework for the integrated condition-based operational and maintenance planning of production and utility systems in process industries is presented. In brief, the proposed optimization framework considers for the production and utility units: (i) improved unit performance degradation and recovery models that depend on both the cumulative time of operation and the unit operating levels deviation of units; (ii) modified operating capacities under online cleaning periods; (iii) different types of cleaning tasks (flexible time-window and online or offline condition-based); (iv) alternative options for offline cleaning tasks; (v) limited availability of cleaning resources; (vi) the initial state of the overall system at the beginning of each planning horizon; and (vii) terminal constraints for the rolling horizon problem. Total cost constitutes the objective function of the resulting problem and includes unit operating costs, cleaning costs, energy consumption costs and resource purchases costs. The case studies solved show that when compared to solutions obtained by sequential approaches the proposed integrated approach provides significantly better solutions in terms of total costs (reduction from 5% to 32%), and especially in cost terms related to utility units operation, energy consumption, cleaning and startup/shutdown operations. Unnecessary cleanings and purchases of resources can be avoided by the proposed integrated approach. Overall, the significant reduction in total costs is a direct result of the enhanced energy efficiency of the overall system through the efficient generation and use of energy, the improved utilization of energy and material resources resulting in a more sustainable and cleaner production practices.

Synthesizing distributed pipelining systems with timing constraints via optimal functional unit assignment and communication selection

The design of efficient optimization techniques is important to synthesize application-specific distributed systems with timing constraints. In many applications, represented by task graphs, the consecutive executions of a task graph can be overlapped in a pipelined fashion with a proper buffer placement. The performance of such a system is closely related to the behavior of pipelining. Given a timing (throughput) constraint, however, using the fastest functional units or communication protocols may incur unacceptable high cost. In the design of such distributed pipelining systems with timing constraint, several problems need to be solved: how to properly place buffers, assign functional unit types for each task, and select communication protocols for each pair of tasks. This paper presents efficient optimization algorithms by integrally considering the above problems, such that the resultant systems can satisfy the timing constraints with the minimum total cost. In this paper, we first study the properties of distributed pipelining systems by using a rigorous model, called self-timed model, and then we present theorems to accurately compute the system throughput. Based on these understandings, we devise efficient algorithms to obtain the optimal solutions. Experiments show that the typical greedy approaches cannot find a feasible solution for the tight timing requirements while our algorithms can. For the few cases that greedy approaches may find solutions, our algorithms can achieve significant reductions in total cost.

A novel approach for optimal combinations of wind, PV, and energy storage system in diesel-free isolated communities

A new approach for optimal combinations of Hybrid Renewable Energy Systems (HRESs) is proposed, for diesel-free remote communities and related decision-making problems. The objective of the design is to satisfy the load with total cost’s minimization considering related constraints, where all analytical equations are given. The proposed system is a DC configuration for renewable energy integration in which Wind Turbines (WTs) are connected to the DC bus and the battery system removes the fluctuations in the DC bus. The WT is assumed to be well controlled to obtain the power curve and provide proper electricity to the grid. It is found that WT and Photovoltaic (PV) systems should be considered simultaneously on diesel-free generation islands to achieve a reliable and optimized configuration. A novel strategy is introduced for determining the range of batteries, which can be determined using the renewable energy potential to satisfy the load. It is also demonstrated that WTs are an essential power component in real HRES installations. It is illustrated that the range of WT operation must be first taken into account in real installations. Increasing WT fraction from an initial value, for instance 8%, to a desired value of about 33%, can lead to significant reductions in total cost as well as in the number of PV systems and batteries, even if the WT cost is significantly higher than that of PVs. A WT fraction higher than approximately 50% should not be considered. Finally, discussions are extended to consider the optimum WT fraction in a HRES.

Effectiveness and cost-effectiveness of individually tailored Internet-delivered cognitive behavior therapy for anxiety disorders in a primary care population: A randomized controlled trial

A significant proportion of the general population suffers from anxiety disorders, often with comorbid psychiatric conditions. Internet-delivered cognitive behavior therapy (ICBT) has been found to be a potent treatment for patients with specific psychiatric conditions. The aim of this trial was to investigate the effectiveness and cost-effectiveness of ICBT when tailoring the treatment to address comorbidities and preferences for primary-care patients with a principal anxiety disorder. One hundred participants were recruited through their primary-care contact and randomized to either treatment or an active control group. The treatment consisted of 7–10 weekly individually assigned modules guided by online therapists. At post-treatment, 46% of the treatment group had achieved clinically significant improvement on the primary outcome measure (CORE-OM) and between-group effect sizes ranged from d = 0.20 to 0.86, with a mean effect of d = 0.59. At one-year follow-up, within-group effect sizes varied between d = 0.53 to 1.00. Cost analysis showed significant reduction of total costs for the ICBT group, the results were maintained at one-year follow-up and the incremental cost-effectiveness ratio favored ICBT compared to control group. Individually tailored ICBT is an effective and cost-effective treatment for primary-care patients with anxiety disorders with or without comorbidities. Trial RegistrationClinicaltrials.gov: NCT01390168.