Standard Cost Research Articles

Productivity loss due to acute COVID-19 and post COVID-19 condition in the Northern Netherlands

Abstract Introduction The COVID-19 pandemic caused significant socioeconomic and health shocks worldwide. Yet, research is still scarce on how acute COVID-19 and post COVID-19 condition (PCC) have impacted workers productivity in terms of absenteeism, presenteeism and reduced unpaid work. This study examines the effect of acute COVID-19 and PCC on Dutch workers’ loss of work productivity in standardized hourly costs compared to those with neither disease. Methods This study included data from 31 waves (March 2020 - October 2022) of the Lifelines COVID-19 cohort, a populational cohort from the Netherlands. Productivity was measured in 7 waves in terms of absenteeism, presenteeism, and loss of unpaid work using the Medical Technology Assessment Productivity Costs Questionnaire. We selected workers aged 18 to 64 in the first wave (n = 10,950). Using administrative data, average hourly costs of productivity were calculated as 38.67€ for absenteeism and presenteeism and 15.94€ for unpaid work. The friction cost method was used. To compare group differences, a Kruskal-Wallis rank sum test with Holms-Bonferroni p-value adjustment was performed. Results In total, 33.4% of participants had acute COVID-19, 5.7% had PCC, and 60.9% had neither disease. The mean total combined productivity loss per person of those with PCC was 7,118€, compared to 3,410€ for those with acute COVID-19, and 3,076€ for those with neither. When comparing groups, significant differences in costs were found for all aspects of productivity, except for unpaid work loss between acute COVID-19 and those with neither disease. Discussion Although the number of people with acute COVID-19 represents a large societal cost in terms of accumulated loss, those with PCC incurred on average twice as much productivity losses per person across all domains. This study highlights the high costs associated with PCC, which continues to chronically burden workers. Policies should be aimed at lessening this burden. Key messages • Post COVID-19 condition is associated with significantly higher average productivity costs per person than acute COVID-19, which highlights the individual burden of this chronic disease. • Acute COVID-19, despite relatively lower average productivity costs, represents a large societal cost in terms of accumulated loss.

Economic Analysis of kharif Vegetable Cultivation in Palghar District of Maharashtra State, India

The study was undertaken with the specific objective to workout costs, returns and profitability in vegetables production of a sample of 90 vegetable cultivators of three tahsil of Palghar viz. Vasai, Palghar and Dahanu during 2023.Simple statistical tools such as arithmetic mean, average, percentage, ratios and frequency distribution were worked out. For working out cost of production, standard cost concepts viz., cost-A1, cost-A2 cost-B1, cost-B2, cost-C1, cost-C2, cost-C3 were used. The cost of cultivation of kharif brinjal, okra, cowpea, tomato, cucumber, bottle gourd and bitter gourd was Rs.130880, Rs.172317, Rs.74835, Rs.145956, Rs.166815, Rs.220387and Rs.209361for respectively. The gross returns obtained from kharif brinjal, okra, cowpea, tomato, cucumber, bottle gourd and bitter gourd was Rs.141240, Rs.271560, Rs.77532, Rs.280280, Rs.227850, Rs.337506 and Rs.345345 respectively. The benefit-cost ratio for kharif brinjal, okra, cowpea, tomato, cucumber, bottle gourd and bitter gourd was 1.08, 1.58, 1.04, 1.92, 1.37, 1.53 and 1.65 respectively. The promising benefit-cost ratios indicate a favorable environment for vegetable farming in Palghar, suggesting that with strategic crop selection and enhanced agricultural practices, the future of vegetable cultivation in the region is likely to be both profitable and sustainable.

DGRPool, a web tool leveraging harmonized Drosophila Genetic Reference Panel phenotyping data for the study of complex traits

Genome-wide association studies have advanced our understanding of complex traits, but studying how a GWAS variant can affect a specific trait in the human population remains challenging due to environmental variability. Drosophila melanogaster is in this regard an excellent model organism for studying the relationship between genetic and phenotypic variation due to its simple handling, standardized growth conditions, low cost, and short lifespan. The Drosophila Genetic Reference Panel (DGRP) in particular has been a valuable tool for studying complex traits, but proper harmonization and indexing of DGRP phenotyping data is necessary to fully capitalize on this resource. To address this, we created a web tool called DGRPool (dgrpool.epfl.ch), which aggregates phenotyping data of 1034 phenotypes across 135 DGRP studies in a common environment. DGRPool enables users to download data and run various tools such as genome-wide (GWAS) and phenome-wide (PheWAS) association studies. As a proof-of-concept, DGRPool was used to study the longevity phenotype and uncovered both established and unexpected correlations with other phenotypes such as locomotor activity, starvation resistance, desiccation survival, and oxidative stress resistance. DGRPool has the potential to facilitate new genetic and molecular insights of complex traits in Drosophila and serve as a valuable, interactive tool for the scientific community.

DGRPool, a web tool leveraging harmonized Drosophila Genetic Reference Panel phenotyping data for the study of complex traits.

Genome-wide association studies have advanced our understanding of complex traits, but studying how a GWAS variant can affect a specific trait in the human population remains challenging due to environmental variability. Drosophila melanogaster is in this regard an excellent model organism for studying the relationship between genetic and phenotypic variation due to its simple handling, standardized growth conditions, low cost, and short lifespan. The Drosophila Genetic Reference Panel (DGRP) in particular has been a valuable tool for studying complex traits, but proper harmonization and indexing of DGRP phenotyping data is necessary to fully capitalize on this resource. To address this, we created a web tool called DGRPool (dgrpool.epfl.ch), which aggregates phenotyping data of 1034 phenotypes across 135 DGRP studies in a common environment. DGRPool enables users to download data and run various tools such as genome-wide (GWAS) and phenome-wide (PheWAS) association studies. As a proof-of-concept, DGRPool was used to study the longevity phenotype and uncovered both established and unexpected correlations with other phenotypes such as locomotor activity, starvation resistance, desiccation survival, and oxidative stress resistance. DGRPool has the potential to facilitate new genetic and molecular insights of complex traits in Drosophila and serve as a valuable, interactive tool for the scientific community.

Coconut Cultivation in South Konkan Region of Maharashtra: A Study of Economic Well-being

A study on economic well-being was conducted in the South Konkan region with 144 sample coconut growers. The objective behind this study was to estimate cost, returns, profitability and financial feasibility of coconut production. The study was conducted by means of adoption index, standard cost concept and financial feasibility measures. Numerous technologies have been suggested by the Regional Coconut Research Station, Bhatye, Dr. Balasaheb Sawant Konkan Krishi Vidyapeeth, to enhance the quality of coconut production after extensive research in the field. The extent up to which the technologies were adopted was 45.51 per cent overall. This suggested a wide scope for raising the adoption rate. The economic analysis of coconut production in the research area showed that growing coconuts through the use of recommended technology was profitable. It was observed that farmers are saving more on each expense due to the high adoption rate. In coconut cultivation, the net present value was positive (Rs. 230665). The B: C ratio is greater than one (1.41) and the internal rate of return (IRR) is higher than the going interest rate (23.01%). This demonstrated the economic viability of coconut production. The policy should be made to spread the recommendations to the farmers and training should be provided to farmers on larger scale for more profitable production.

Price Setting and Price Stickiness: A Behavioral Foundation of Inaction Bands

Abstract This paper puts forward a behavioral theory of price setting where managers maximize perceived profits following a process of mental accounting. The theory predicts a pricing rule that is similar to—but crucially different from—that of a standard menu cost theory: there is an inaction band, but there are two rather than just one target prices, depending on whether the firm updates its price upwards or downwards. The calibrated model replicates two patterns of price microdata that standard menu cost models have difficulty accounting for: (i) The distribution of price changes has both small and large price changes, and (ii) the hazard function of price changes is downward sloping initially, that is, firms that have just recently changed their price have a higher probability of changing it again, while this probability becomes constant thereafter.

An Effective Method for Reproducing the Flow of a Gas-Liquid Mixture Using a Flow Standard

The appearance on the market of measuring equipment of multiphase flowmeters used in the oil and gas industry to measure the amount of extracted hydrocarbons directly at wells without preliminary separation and performing the function of operational accounting raised the question of their metrological support in accordance with the requirements of regulatory documents of the sphere of state regulation in this field of measurements. His decision was to create a reference base, the basis of which was the State primary special standard for units of mass flow of gas-liquid mixtures GET 195-2011 and a verification scheme for measuring multiphase flow rates, regulated by GOST 8.637-2013. When transmitting units of volume and mass flow of a multiphase mixture with the required accuracy, the main problem is the difficulty of reproducing and maintaining stability of several flow parameters at once – mass flow and content of liquid components (water and oil simulator) and volume flow of the gas phase. It should also be borne in mind that test programs for the purpose of approving the type of multiphase flow measuring instruments, as well as verification and calibration methods, provide for changing the modes of reproduction of a gas-liquid mixture, covering the measurement ranges of multiphase flowmeters. Such standards used in practice represent a very complex measuring system consisting of storage tanks for components, supply pumping and compressor units, control equipment, mixers and separators, measuring instruments for the physical parameters of multiphase flow components and an automated control system. Given the high cost of multiphase standards, when creating them, effective methods and methods should be used to reproduce the flow of a multiphase mixture with specified parameters, as well as to make a fairly rapid transition to the next mode provided by the program or methodology, which will reduce the time and production costs for the procedure of transferring units of measurement from the standard to the working measuring instrument. This article describes a method for reproducing the flow rate of a gas-liquid mixture according to the original technological scheme introduced during the development of the 1st category standard. Constructive solutions are presented that increase the efficiency of the liquid component separation apparatus to increase the dosing accuracy, as well as expand the range of reproduction of the flow rate and parameters of the multiphase flow, ensuring the consistency of the composition of the liquid mixture at a given regime. An original rational method of compressing and maintaining the pressure of the gas phase is described, which allows you to quickly switch to the next mode, confirmed by the results of experimental studies of the standard.

Cost Drivers of Pars Plana Vitrectomy for Retinal Detachment: Time-Driven Activity-Based Costing Analysis

Introduction: To determine drivers of day-of-surgery costs for pars plana vitrectomy (PPV) in the management of retinal detachment (RD) repair, the mainstay treatment, based on surgical complexity and intraoperative factors. Methods: Economic analysis was performed using time-driven activity-based costing methodology for patients who had standard (Current Procedural Terminology [CPT] code 67108) or complex (CPT 67113) RD repair with PPV at the University of Michigan in 2021. Data were obtained via the electronic health record and previous literature. PPV expenses were determined with time-driven activity-based costing, a cost calculation that incorporates time and key resource costs, and were analyzed using univariate and multivariate regression. Results: The analysis included 412 PPVs (270 standard and 142 complex based on CPT code). The operating room time was significantly increased in complex cases ( P < .01). Univariate analysis found that complex PPV, cryopexy, staining agent use, retinectomy, simultaneous scleral buckling, perfluoro-N-octane (PFO) use, silicone oil tamponade, and perfluoropropane tamponade were associated with a statistically significant difference in costs ( P < .01); use of laser retinopexy was not significantly associated ( P = .7190). Multivariate analysis found that standard PPV cost an average $5132.33 and significant incremental costs were found for complex PPV (+$1185.55; P < .001), cryopexy (+$465.02; P = .032), staining (+$525.16; P = .04), PFO use (+$1089.54; P < .0001), retinectomy (+$2031.17; P < .0001), and simultaneous scleral buckling (+$916.34; P = .006). Conclusions: The intraoperative factors that increase operating room time and ultimately the incurred cost of complex PPV cases vs standard PPV were identified and economically defined. These findings can improve practice patterns by optimizing costs for effective surgical planning in the management of RD repair.

Comparative view of the modified Vogel’s approximation methods in transportation problem

Recently, the whole world is experiencing economic hardship and one fast road to ply is to cut out some expenses. Xlife group is equally affected and so the study proposes a means to minimize its transportation cost if effected. A comparative surgery on Vogel’s approximation with its modified versions were conducted on minimizing the cost of transporting manufactured goods from (Xlife group’s) points of supply to certain destinations was undertaken. The Vogel's Approximation Method (VAM) and the Modified Vogel's Approximation Method based on standard deviation, distribution indicators and average cost were applied to determine an initial basic feasible solution and optimal solution for certain transportation problems. All methods yield identical minimum transportation cost except at an instance.

Effects of Adopting Preventive Drug Lists on Medication Costs and Disparities by Income Over 2 Years: A Natural Experiment for Translation in Diabetes (NEXT-D) Study.

To examine the association between preventive drug lists (PDLs) and changes in medication costs among patients with diabetes insured in commercial health plans over 2 follow-up years. We conducted a quasiexperimental study using the Optum deidentified Clinformatics Data Mart Database (January 2003 to December 2017). The intervention group included 5,582 patients with diabetes age 12-64 years switched by employers to PDL coverage; the control group included 5,582 matched patients whose employers offered no PDL. Outcomes included out-of-pocket costs, standardized costs, and 30-day fills for all medications because PDL-associated savings could be used to pay for medicines in other classes and for five therapeutic classes covered by the PDLs (oral diabetic medications, insulins, test strips, antihypertensive drugs, and lipid-lowering drugs). Pre- to post-out-of-pocket spending for all medications declined by 29.7% in follow-up year 2 (95% CI -36.0, -23.4%) among PDL members relative to controls. Higher-income and lower-income PDL members experienced significant reductions in out-of-pocket spending for all medications in year 2 (30%) and for key therapeutic classes (range -23 to -67%). We found significant increases in use of key therapeutic classes in the overall population (range 8-15%) and in higher-income and lower-income PDL members (range 9-50%). PDLs offer an effective strategy for employers and insurers to lower member cost sharing and encourage increased use of important medications to prevent or manage chronic illnesses. For patients with diabetes, especially those with lower incomes, PDL coverage resulted in substantial and persistent reductions in out-of-pocket medication costs, medication use increases, and some increased use of more expensive products.

Association between physical activity and costs in very mild to moderately frail community-dwelling older adults: a cross-sectional study.

Physical activity (PA) plays a vital role in maintaining the functional ability that enables well-being in older age (healthy aging), potentially also saving costs for the healthcare system and society. The aim of this study was to examine the association between PA and healthcare and societal costs in a sample of very mild to moderately frail older adults. This cross-sectional study is a secondary analysis using baseline data from the PromeTheus randomized-controlled trial, which included 385 very mild to moderately frail community-dwelling older adults (70 + years) from Germany. Participants self-reported their health-related resource use in the previous 6 months (FIMA questionnaire), which was monetarily valued using standardized unit costs. PA was also self-reported using the German Physical Activity Questionnaire for middle-aged and older adults (German-PAQ-50+) and categorized as 'insufficient'/'sufficient' or 'insufficient'/'moderate'/'high' in accordance with the World Health Organization guidelines for PA. Mean and median healthcare costs (including outpatient, inpatient, rehabilitation, formal care, and medication costs) and societal costs (healthcare costs plus informal care costs) for different PA groups were estimated using generalized linear models and quantile regression, with sociodemographic variables and physical capacity (Short Physical Performance Battery) as covariates. Of the sample, 24% were classified as insufficiently, 23% as moderately, and 54% as highly active. Sufficient PA, especially high PA, was associated with lower costs in the 6 months prior to data collection compared to insufficient PA (-€6,237, 95% CI [-10,656; -1,817] and -€8,333, 95% CI [-12,183; -4,483], respectively). The cost difference between PA intensity groups was largely driven by differences in informal care costs and decreased substantially when physical capacity was accounted for in the analyses; e.g., the mean difference in societal costs between sufficient and insufficient PA decreased from -€7,615 (95% CI [-11,404; -3,825]) to -€4,532 (95% CI [-7,930; -1,133]). Promoting PA throughout the lifespan as a means of promoting healthy aging and reducing dependency in old age could potentially provide economic benefits and help to mitigate the economic consequences of an aging population with increasing health and long-term care needs. Future longitudinal studies should attempt to disentangle the mediating and confounding role of physical capacity and health status in the association between PA and costs.

Cost-Utility Analysis of PCSK9 Inhibitors and Quality of Life: A Two-Year Multicenter Non-Randomized Study.

The primary objective of this study was to conduct a cost-utility analysis of proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors in real-world, comparing their use with standard care for managing cardiovascular disease. A multicenter prospective study was conducted across 12 Spanish hospitals from May 2020 to April 2022, involving 158 patients with hypercholesterolemia or atherosclerotic cardiovascular disease. This study assessed health-related quality of life (QoL) using the EQ-5D-3L questionnaire. The cost-utility analysis evaluated the economic impact of PCSK9 inhibitors when used with standard care compared to standard care alone, calculating the incremental cost-effectiveness ratio (ICER). This study included 158 patients with an average age of 61 years, male (66.5%). For patients initiating PCSK9 inhibitors, the treatment cost was EUR 13,633.39, while standard therapy cost EUR 3638.25 over two years. QoL for PCSK9 inhibitors stood at 1.6489 over two years, compared to 1.4548 for standard therapy. The results revealed favorable cost-utility outcomes, with an ICER of EUR 51,427.72. Significant improvements were observed in the domains of mobility, self-care, daily activities, pain/discomfort, and anxiety/depression (p < 0.001). This study presents the first real-world cost-utility analysis of PCSK9 inhibitors, supporting their economic rationale and highlighting their benefits in clinical practice. Healthcare decision-makers can use these results to inform their decisions and reimbursement policies concerning PCSK9 inhibitors. Trial Registration clinicaltrials.gov Identifier: NCT04319081.

Multi-Layer QCA Reversible Full Adder-Subtractor Using Reversible Gates for Reliable Information Transfer and Minimal Power Dissipation on Universal Quantum Computer

The effects of quantum mechanics dominate nanoscale devices, where Moore’s law no longer holds true. Additionally, with the recent rapid development of quantum computers, the development of reversible gates to overcome the problems of energy and information loss and the nano-level quantum-dot cellular automata (QCA) technology to efficiently implement them are in the spotlight. In this study, a full adder-subtractor, a core operation of the arithmetic and logic unit (ALU), the most important hardware device in computer operations, is implemented as a circuit capable of reversible operation using QCA-based reversible gates. The proposed circuit consists of one reversible QCA gate and two Feynman gates and is designed as a multi-layer structure for efficient use of area and minimization of delay. The proposed circuit is tested on QCADesigner 2.0.3 and QCADesigner-E 2.2 and shows the best performance and lowest energy dissipation. In particular, it shows tremendous improvement rates of 180% and 562% in two representative standard design cost indicators compared to the best existing studies, and also shows the highest circuit average output polarization.

A systematic review of cost-effectiveness analyses of gene therapy for hemophilia type A and B.

In 2022-2023, the US Food and Drug Administration approved 2 novel gene therapies, valoctocogene roxaparvovec and etranacogene dezaparavovec, for hemophilia A and B, respectively. These one-time-administered gene therapies have been marketed at prices that create financial challenges for payers and patients. Understanding the magnitude and uncertainties around the long-term value of these therapies and how they can potentially relate to managed care practices is of high interest to the payer and patient community. To conduct a systematic review of cost-effectiveness analysis (CEA) studies to assess (1) the long-term value of valoctocogene roxaparvovec and etranacogene dezaparavovec and (2) the relevance and validity of the underlying data and assumptions used in the CEA models and discuss how they relate to the challenges identified for CEAs of gene therapies. A systematic review of cost-effectiveness studies of novel hemophilia A and B gene therapy was conducted. PubMed and Embase were searched for published studies from inception to January 12, 2024. Original research articles published in English that conducted a CEA on gene therapy treatments for hemophilia A and B, with a comparison of incremental costs and health effects, were considered. Critical appraisal of the quality of reporting and the underlying modeling assumptions were conducted to assess the relevance and validity of the results. Two hundred thirty-eight studies were identified, of which 4 met the inclusion criteria. Three studies were conducted from a US health care perspective and 1 from a Dutch societal perspective. Despite the high upfront costs of the gene therapies, all included studies' (3 hemophilia A and 1 hemophilia B) modeled results showed that gene therapies had lower overall costs and better health outcomes compared with factor concentrate replacement therapies and emicizumab. The results were driven by the assumption that gene therapies will have a durable effect of at least 10 years and offset the high cost of the current standard of care. The modeled health improvements varied substantially across studies, showing that the long-term value is sensitive to varying clinical and economic assumptions. The novel hemophilia gene therapy treatments can potentially be a cost-effective use of treatment resources if the treatment effects are durable over time. To reduce the risk for payers while still facilitating patient access, outcomes-based agreements similar to what has recently been proposed by the Centers for Medicare & Medicaid Services for sickle-cell therapies are well supported.

Classification and comparison of impacted tooth extraction costs with OECD countries: Running title : Cost of impacted tooth extraction in OECD countries

Purpose: The purpose of this study is to compare the cost of impacted tooth extraction in Korea and some OECD countries and ultimately use it as basic data for the future revision of the relative value of national health insurance.Materials and Methods: Costs of tooth extraction in Korea, Japan, the United States, Australia, the United Kingdom, Germany, France, and Canada were investigated. The costs were investigated through the dental association or association of oral and maxillofacial surgery in each country with literature review. In countries such as Korea, Japan, and Germany, which have a universal health insurance system at the national level, a survey was conducted based on a data collection listing standard tooth extraction cost. The costs were compared using the price level of each country and Big Mac Index.Results: The classification and cost system for impacted tooth extraction were different in each country. Nevertheless, when comparing them by grouping them as similar as possible, the cost of impacted tooth extraction of Korea is lowest compared to some OECD countries. In addition, the cost is lowest even considering comparative price levels and the Big Mac index.Conclusion: In conclusion, we believe that the fees for impacted tooth extraction need to be appropriately adjusted to a level similar to that of OECD countries, reflecting various factors. It is also believed that changes and approvals for a new the tooth extraction cost system are needed.

Techno economic analysis and performance based ranking of 3–200 kW fuel flexible micro gas turbines running on 100% hydrogen, hydrogen fuel blends, and natural gas

Micro gas turbines ranging from 3 to 200 kW are vital for decentralized power generation due to their reliability, rapid load response, and adaptability to 100% hydrogen and hydrogen fuel blends. This paper conducts a techno-economic assessment of MGTs powered by hydrogen, focusing on their environmental, economic, and technical viability. Key factors include the transition from natural gas to hydrogen to achieve net-zero emissions and enhance grid stability. Despite hydrogen's higher initial costs, its declining production costs and cleaner combustion make it a promising alternative. The study utilizes five micro gas turbine models (3, 30, 65, 100, and 200 kW) to evaluate a techno-economic analysis using 100% hydrogen, a 30% hydrogen and 70% natural gas blend, and 100% natural gas as fuels. Technical results are supported by experimental data from the world's first 100% hydrogen-fired micro gas turbine unit in Stavanger, Norway. Standard cost estimations for capital, operation and maintenance, and fuel costs are provided. The study introduces a novel technique for cost estimation and assesses econometric indicators such as net present value, internal rate of return, return on investment, payback period, and cost-benefit analysis. It compares economic scenarios for 2024, 2030, and 2040, highlighting the impact of fuel price volatility and regulatory changes on micro gas turbine techno-economics. Micro gas turbines are ranked using the Technique for Order Preference by Similarity to Ideal Solution-Multi-Criteria Decision Making (TOPSIS-MCDM) method based on their techno-economic performance. The ranking of microturbines based on techno-economic analysis performance is a novel contribution of this paper. Finally, a sensitivity analysis on the five micro gas turbines is carried out by changing the hydrogen fuel price. This research provides a comprehensive framework for stakeholders to make informed investment decisions, ensuring a smooth transition to 100% hydrogen-based power generation. The findings support the adoption of hydrogen and natural gas blends as an interim solution towards achieving a hydrogen economy.

The economic burden of prostate cancer in Iran: a cross-sectional cost-of-illness study

ObjectiveThis study aims to assess the economic burden of prostate cancer in Iran by analyzing direct medical costs, direct non-medical costs, and indirect costs. We conducted a cross-sectional cost-of-illness study in Khorramabad, located in western Iran, during 2023, using a prevalence-based, bottom-up approach. Data were collected from 285 prostate cancer patients using questionnaires, interviews, and patient records.ResultsOur study estimated the economic burden of prostate cancer at $744,990. Direct medical costs accounted for 63.50% of this, totaling $153,330, with therapy being the largest component. Direct non-medical costs were $62,130, and indirect costs from productivity losses were $209,760. The calculated overall cost per patient was $2,614.88. Extrapolating from the 2021 Global Burden of Disease data, which reported approximately 83,000 prostate cancer patients in Iran, the national economic burden is estimated at $217,034,040. This substantial burden highlights the need for improved insurance coverage and early detection. The findings suggest that policymakers and healthcare providers in Iran should develop standardized cost analysis methods and enhance financial protection to alleviate economic strain and improve healthcare outcomes and sustainability.

A value approach to measuring the effect on health resource usage of specialist cardiac interventions in Wales

Objective and ApproachThe Welsh Health Specialised Services Committee wanted to demonstrate how specialised interventions reduced subsequent pressures on the health services. We analysed the variation in the cost of patient pathways for eight cardiac interventions in both planned and emergency settings. A standard cost was allocated to each health event (hospital admissions, general practitioner interactions, outpatient attendances and accident and emergency attendances). A comparison was made for each intervention relating to the condition before the intervention against costs afterwards. In addition, analysis was carried out measuring which patient's characteristics affected the likelihood that patients incurred higher post-intervention costs. Results10,480 interventions were analysed. In 9 (of the 16) intervention combinations, post-intervention costs dropped. After the implantation of a Cardiac Device, health resource usage dropped by £1,461 per annum. In addition, the likelihood of falling into a higher cost category increased depending on deprivation. For percutaneous coronary intervention (PCI) the odds ratio and 95% confidence interval was 1.34 (1.03 to 1.76) and for Cardiac Devices 2.91 (1 to 15.23). Conclusions and ImplicationsSome interventions in Cardiac realise significant post intervention savings for the health service. Deprivation affects the risk of patients falling into high post-intervention cost categories for PCI and Cardiac Devices. By using anonymised population-scale linked individual-level data, it is possible to highlight interventions that as well as benefiting patients successfully, reduce future health resource usage. This type of analysis can also highlight how deprivation is linked to increased post intervention costs.

The benefits of active management of coronary heart disease (CHD) in Wales: how the use of routine collected administrative data can drive efficiency and encourage best practice in condition management.

Objective and ApproachWe analysed the effect on subsequent costs of the setting of the first contact for patients with coronary heart disease in Wales. By categorising health events as proactive or reactive, from the event data source (proactive = primary care (general practice) interactions, elective hospital bed days and outpatient attendances. Reactive = accident and emergency (A&amp;E) attendances and emergency hospital bed days). A standard cost was applied to obtain an annualised cost for each patient. The unit cost for each source was GP £36, bed days £398, outpatient £143, A&amp;E £188. ResultsWe found 42,563 people having CHD events during 2015-2019. Of these, 18,390 had a proactive event as their first event, 23,840 had a reactive event first. The ratio of proactive to reactive events was 1: 3.7 (ratio of costs were £1: £6.30). When the first event was proactive the ratio of events was 1: 0.85 (costs were £1: £1.33). When the first event was reactive the ratio was 1: 4.4 (costs were £1: £33.00). Conclusion and ImplicationsThe setting of the first contact appears to be key, with costs reducing by a factor of 14 if the first contact was carried out in a planned environment. Can investment in more active management of a condition reduce overall costs? The work has highlighted the power of using anonymised population-scale linked individual-level data and indicates the health resource reductions possible from improved managed care of patients.

Facing the economic tribunal: how calculative techniques impede effective finance capital taxation in Europe

ABSTRACT The rise of new financial transaction schemes enabled new forms of tax fraud in Europe in the 2010s. Despite extensive public attention to this issue, the political measures adopted to strengthen taxation control have remained remarkably lax. The article analyses the emergence and spread of US neoliberal problematisations of administrative burdens to the OECD, and how these problematisations coalesced with the development of standardized regulatory cost‒benefit techniques. Focusing on the Danish case, this constellation of problematizations and techniques is argued to have worked as an economic tribunal, effectively obstructing the control of tax dividend reclaims.