Subsequent Costs Research Articles

Ultrasound-Guided vs Non-Ultrasound-Guided Angio-Seal Vascular Hemosasis After Endovascular Treatment for Peripheral Artery Disease: An Observational Study.

Ultrasound visualization of vascular closure devices during endovascular access closure leads to a significant decrease in overall and major post interventional access site complications. This non-invasive and often readily available imaging technique could therefore lead to an important decrease in morbidity and subsequent overall health care costs when added to the standard intervention protocol. With the increasing use of endovascular techniques to treat peripheral artery disease, the addition of ultrasound-techniques in closure of endovascular access sites could potentially have a large clinical impact, both on patient outcomes as well as financial outcomes.

Cost-effectiveness of comparative survey designs for helminth control programs: Post-hoc cost analysis and modelling of the Kenyan national school-based deworming program

Background Soil-transmitted helminths (STH) and schistosomiasis comprise the most wide-spread NTDs globally. Preventative chemotherapy is a cost-effective approach to controlling morbidity of both diseases, but relies on large scale surveys to determine and revise treatment frequency. Availability of detailed information on survey costs is limited despite recent methodological surveying innovations. We micro-costed a survey of STH and schistosomiasis in Kenya, and linked results to precision estimates of competing survey methods to compare cost-efficiency. Methods Costs from a 2017 Kenyan parasitological survey were retrospectively analyzed and extrapolated to explore marginal changes when altering survey size, defined by the number of schools sampled and the number of samples taken per school. Subsequent costs were applied to simulated precision estimates of model-based geostatistical (MBG) and traditional survey designs. Cost-precision was calculated for a range of survey sizes per method. Four traditional survey design scenarios, based around WHO guidelines, were selected to act as reference cases for calculating incremental cost-effectiveness ratios (ICERs) for MBG design. Findings MBG designed surveys showed improved cost-precision, particularly if optimizing number of schools against samples per school. MBG was found to be more cost-effective under 87 of 92 comparisons to reference cases. This comprised 14 situations where MBG was both cheaper and more precise, 42 which had cost saving with precision trade off (ICERs; $8,915-$344,932 per percentage precision lost); and 31 more precise with increased cost (ICERs; $426-$147,748 per percentage precision gained). The remaining 5 comparisons represented extremes of MBG simulated site selection, unlikely to be applied in practice. Interpretation Efficiency gains are possible for deworming surveys when considering cost alone, such as through minimizing sample or analysis costs. However further efficiency maximization is possible when designing surveys using MBG given its improved precision and ability to optimize the balance between number of schools and sample size per school.

Fire management now and in the future: Will today's solutions still apply tomorrow?

Climate change and fire management actions are the two key drivers of fire regime changes now and into the future. The predicted effects of these drivers vary between regions and global climate projections; however, it is expected that fire regimes globally are likely to intensify. Increased wildfire extent, frequency and severity mean impacts to people, property, infrastructure, production and the environment are also likely to increase under worsening climate conditions. Fire management programs aim to reduce the influence of worsening climatic conditions on wildfires and risk to assets now and into the future However, given the pace of changes to fire regimes, trade-offs between assets are increasingly likely. Therefore, understanding the cost-effectiveness of fire management in the form of both fuel management and suppression is critical for managers to make informed decisions regarding resource allocation. We develop and test a Bayesian Decision Network (BDN) incorporating data from ~1200 fire regime simulations capturing 16 management strategies across six regions and six climate models. We quantify the effects of management and climate on fire size and risk to environmental, infrastructure, and production assets, as well as people and property. We calculate the overall cost-effectiveness of the management scenario based on the cost of implementing the program and the subsequent cost of impacts caused by wildfires. We found that costs increased under future climate conditions for all management scenarios in most regions. Despite some regional variation in the cost-effectiveness of management scenarios we were able to identify key scenarios which consistently had high cost-effectiveness. These were combinations of prescribed burning and suppression. Importantly, the model clearly demonstrates the risk of a do-nothing approach and highlights that action is needed to prevent high impacts now and into the future and to reduce the overall costs of wildfires.

The dual timescales of gait adaptation: initial stability adjustments followed by subsequent energetic cost adjustments.

Gait adaptation during bipedal walking allows people to adjust their walking patterns to maintain balance, avoid obstacles and avoid injury. Adaptation involves complex processes that function to maintain stability and reduce energy expenditure. However, the processes that influence walking patterns during different points in the adaptation period remain to be investigated. We assessed split-belt adaptation in 17 young adults aged 19-35. We also assessed individual aerobic capacity to understand how aerobic capacity influences adaptation. We analyzed step lengths, step length asymmetry (SLA), mediolateral margins of stability, positive, negative and net mechanical work rates, as well as metabolic rate during adaptation. Dual-rate exponential mixed-effects regressions estimated the adaptation of each measure over two timescales; results indicate that mediolateral stability adapts over a single timescale in under 1 min, whereas mechanical work rates, metabolic rate, step lengths and SLA adapt over two distinct timescales (3.5-11.2 min). We then regressed mediolateral margins of stability, net mechanical work rate and metabolic rate on SLA during early and late adaptation phases to determine whether stability drives early adaptation and energetic cost drives late adaptation. Stability predicted SLA during the initial rapid onset of adaptation, and mechanical work rate predicted SLA during the latter part of adaptation. Findings suggest that stability optimization may contribute to early gait changes and that mechanical work contributes to later changes during adaptation. A final sub-analysis showed that aerobic capacity levels <36 and >43 ml kg-1min-1 resulted in greater SLA adaptation, underscoring the metabolic influences on gait adaptation. This study illuminates the complex interplay between biomechanical and metabolic factors in gait adaptation, shedding light on fundamental mechanisms underlying human locomotion.

Incremental healthcare costs of the simple SOF measure of phenotypic frailty in community-dwelling older adults.

Frailty defined by the Cardiovascular Health Study (CHS) phenotype is associated with higher healthcare expenditures in community-dwelling Medicare beneficiaries after accounting for claims-based cost indicators. However, frailty assessment using the CHS phenotype is often not feasible in routine clinical practice. We evaluated whether frailty identified by the simple Study of Osteoporotic Fractures (SOF) phenotype is associated with subsequent incremental costs after accounting for claims-derived cost indicators. Prospective study utilizing data from four cohort studies of older adults linked with Medicare claims composed of 8264 community-dwelling fee-for-service beneficiaries (4389 women, 3875 men). SOF Frailty Phenotype (three components: weight loss, poor energy, and inability to rise from chair five times without using arms) and CHS Frailty Phenotype (operationalized using five components) derived from cohort data. Participants were classified as robust, prefrail, or frail using each phenotype. Multimorbidity index (CMS Hierarchical Conditions Categories score) and Kim frailty indicator (approximating the deficit accumulation index) derived from claims. Annualized total and sector-specific healthcare costs ascertained for 36 months after frailty assessment. Average annualized total healthcare costs (2023 US dollars) were $15,021 in women and $15,711 in men. After accounting for claims-based multimorbidity and frailty indicators, average incremental costs of SOF phenotypic frailty (two or three components) versus robust (none) were $7142 in women and $5961 in men, only modestly lower than incremental costs of CHS phenotypic frailty ($9422 in women, $6479 in men). SOF phenotypic frailty in both sexes was associated with higher subsequent expenditures in the inpatient, skilled nursing facility, and home healthcare sectors. As observed with CHS phenotypic frailty, SOF phenotypic frailty is associated with higher subsequent total and sector-specific expenditures after accounting for claims-derived indicators. The parsimonious SOF phenotype can be readily assessed in space-constrained and time-limited practice settings to improve identification of older adults at high risk of costly care.

Simultaneous optimization of simulated moving bed adsorption and distillation for 2,3‐butanediol recovery

AbstractA combined simulated moving bed (SMB) and distillation separation scheme is developed to recover 2,3‐butanediol (BDO) from a dilute fermentation broth. The scheme was integrated into a lignocellulosic biorefinery that produces hydrocarbon fuels from corn stover with BDO as an intermediate. BDO recovery is one of the most challenging processes in this biorefinery; and given the high associated energy duties, direct distillation is considered cost‐prohibitive. An alternative separation is SMB adsorption in nanoporous materials, which can reject 90% of the water and reduce subsequent distillation costs. Rigorous models were used to optimize the SMB and distillation simultaneously. The separation can be added to the biorefinery while keeping the projected minimum fuel selling price (MFSP) below $0.66 USD (US dollars) per liter gasoline‐equivalent ($2.50/GGE, gallon gasoline equivalent). Finally, sensitivity analyses were conducted to assess the effects of cost and lifetime of the adsorbent, titer concentration, and BDO purity.

Digital twin‐based production logistics resource optimisation configuration method in smart cloud manufacturing environment

AbstractTo adapt to the dynamic, diverse, and personalised needs of customers, manufacturing enterprises face the challenge of continuously adjusting their resource structure. This has led manufacturers to shift towards a smart cloud manufacturing mode in order to build highly flexible production logistics (PL) systems. In these systems, the optimal configuring of PL resources is fundamental for daily logistics planning and vehicle scheduling control, providing necessary resources for the entire PL segment. However, traditional resource configuration methods face limitations, such as incomplete information acquisition, slow response in resource configuration, and suboptimal configuration results, leading to high subsequent operational costs and inefficient logistics transportation. These issues limit the performance of the PL system. To address these challenges, the authors propose a digital twin‐based optimisation model and method for smart cloud PL resources. The approach begins with constructing an optimisation model for the PL system considering the quality of service for a cloud resource is constructed, aiming to minimise the number of logistics vehicles and the total cost of the PL system. Additionally, a DT‐based decision framework for optimising smart cloud PL resources is proposed. Alongside a DT‐based dynamic configuration strategy for smart cloud PL resources is designed. By developing a multi‐teacher grouping teaching strategy and a cross‐learning strategy, the teaching and learning strategies of the standard teaching‐learning‐based optimisation algorithm are improved. Finally, numerical simulation experiments were conducted on the logistics transportation process of a cooperating enterprise, verifying the feasibility and effectiveness of the proposed algorithms and strategies. The findings of this study provide valuable references for the management of PL resources and algorithm design in advanced manufacturing modes.

Locality-constrained robust discriminant non-negative matrix factorization for depression detection: An fNIRS study

Major depressive disorder (MDD) is having an increasingly severe impact worldwide, which creates a pressing need for an efficient and objective method of depression detection. Functional near-infrared spectroscopy (fNIRS), which directly monitors changes in cerebral oxygenation, has become an important tool in depression research. Currently, feature extraction methods based on multi-channel fNIRS data often overlook the local structure of the data and the subsequent classification cost. To address these challenges, we introduce an innovative feature extraction algorithm, namely locality-constrained robust discriminant non-negative matrix factorization (LRDNMF). The algorithm incorporates ℓ2,1 regularization, local coordinate constraints, within-class scatter distance, and total scatter distance, achieving a fusion of robustness, locality, and discrimination. LRDNMF enhances feature representation, reduces noise impact, and significantly boosts classification ability. Based on experimental results from 56 participants, LRDNMF achieves an accuracy of 90.55%, a recall of 91.48%, a precision of 90.46%, and an F1 score of 0.91 under full stimuli. These results outperform existing algorithms, validating the effectiveness of LRDNMF and demonstrating its significant potential in auxiliary diagnosis of depression.

Identification and transfer to stepped care of depressed and psychosocially stressed parents during peri- and postpartum—UPlusE: study protocol for cluster randomized trial of a screening intervention

BackgroundPerinatal depression affects 10–15% of mothers and approximately 5% of fathers. However, only a small number of affected individuals seek treatment. If left unrecognized and untreated, it can have negative long-term consequences for the family’s health, leading to subsequent high costs. Early treatment is crucial, yet there is a notable underdiagnosis and undertreatment. Affected individuals are often seen during this time, e.g. in paediatric practices, but not by specialists in mental health. Consequently, this study aims to increase detection and treatment rates of affected individuals by implementing a screening for depression and psychosocial stress in perinatal and postpartum parents within routine obstetric and paediatric care with subsequent advice and—if necessary—further referral to a mental health specialist.MethodsUPlusE is a prospective, cluster-randomized controlled trial conducted in an outpatient setting. Obstetric and paediatric practices will be randomized into an intervention and control group (1:1 ratio). Practices and enrolling patients will be required to use specific smartphone apps (practice apps) for interaction. The screening will occur with the apps at each paediatric checkup up to the child’s age of 12 months, using the Edinburgh Postnatal Depression Scale (EPDS), KID-PROTEKT questionnaire, and the scale 1 (impaired bonding) of the Postpartum Bonding Questionnaire (PBQ-1). The goal is to screen 10,000 patients across Germany. Gynaecologists and paediatricians will receive certified training on peripartum depression. Participants in the intervention group with scores above cut-offs (EPDS ≥ 10, KID-PROTEKT ≥ 1, PBQ-1 ≥ 12) will receive counselling through their treating gynaecologists/paediatricians and will be provided with regional addresses for psychiatrists, psychotherapists, and “Frühe Hilfen” (early prevention) as well as family counselling centres, depending on symptom severity. At each screening, participants will be asked whether they sought support, where, and with whom (utilization). Utilization is the primary outcome.DiscussionThe screening is designed to reduce underdiagnosis to enable suitable support at an early stage (especially for those often overlooked, such as individuals with “high-functioning depression”) and hence to avoid manifestation of mental health problems in the whole family, especially infants who are exceptionally dependent on their parents and their well-being will benefit from this program.Trial registrationGerman Clinical Trials Register, DRKS00033385. Registered on 15 January 2024.

Costly Missteps: The Price of Defects in Project Phases

This paper investigates the correlation between defects occurring in various project phases and their subsequent cost implications. It evaluates strategies for early defect detection and deliberates on methods for balancing cost with quality to mitigate the adverse effects of defects on project outcomes. Keywords: Defects, Project Phases, Cost Implications, Early Defect Detection, Quality Management, Cost-Quality Balance.

A rapid economic assessment of Wildlife Trusts’ nature prescribing programmes

BackgroundThe Wildlife Trusts play an important role in reducing the impact of poor public health on NHS services, improving human health through nature engagement projects. To bring these health benefits to light, the authors conducted a rapid economic assessment of Wildlife Trusts’ projects. MethodsFive green prescribing projects with the most comprehensive data were selected. Benefits to the participants were identified, including improved mental and physical health and reduced loneliness and physical health. To refine the methodologies for valuing the benefits achieved with each service type and its associated costs, a targeted literature review was conducted. The review encompassed studies considering the valuation of green prescribing services, mental health benefits, physical health benefits, and the economic implications related to reduced loneliness. The costs of running each Wildlife Trusts programme were established, and a subsequent cost:benefit figure calculated. FindingsThe authors concluded from the results that green prescribing has the potential to deliver cost saving benefits to the NHS and “take weight out of the system”. For example, through the Wild at Heart project, that involved 82 participants over a year in Rotherham and Sheffield, they estimated a reduction in NHS costs associated with inpatient admissions, A&E attendances and outpatient appointments by £38 646 per year. Or, every £1 spent on this project is estimated to deliver a £1·19 benefit in terms of reduced costs to the NHS. The research then examined the potential impact if this programme was delivered at scale. Reaching a similar demographic of 1·2 million people living with poor mental health would achieve cost savings to the NHS of £635·6 million and a potential running cost of £534 million. InterpretationNature prescribing projects can deliver a greater saving in healthcare costs than the cost of running them. The Wildlife Trusts and other organisations in the environment sector delivering ‘social prescribing’ should be further integrated into health and social care services in the community. We now need policies that sustainably fund the provision. FundingRoyal Society of Wildlife Trusts.

Incidental Findings on MRIs for Asymmetric Sensorineural Hearing Loss: A Clinical and Economic Analysis.

The gold-standard assessment of asymmetric sensorineural hearing loss (ASNHL) is contrast-enhanced MRI. Although rates of identifying a vestibular schwannoma are low (<5%), it is generally accepted as cost-effective. Yet, the impact of incidentalomas is rarely considered. This study aims to characterize the incidence of incidentalomas in the workup of ASNHL and quantify the associated socioeconomic burden. Retrospective cohort study. Single academic institution in a midsized city in the United States. Radiology records were queried for MRI's ordered for ASNHL between January 2012 and November 2022. Results were characterized as "group 1: normal," "group 2: abnormal read/normal variant," "group 3: abnormal-likely cause of ASNHL," or "group 4: abnormal-follow-up needed." Subsequent costs of workup for group 4 were estimated using Medicare Physician Fee Schedule for Medicare costs, US Congressional Budgeting Office data for private insurer costs, and USC-Brookings Schaeffer Initiative for Health Policy estimates for uninsured individuals. Six hundred patients met the inclusion criteria. Eighteen (3.0%) were categorized in group 3, whereas 40 (6.7%) were categorized in group 4. Of these patients, 7.5% (n = 3) had interventions to manage their incidental findings. Estimated per patient cost for further workup of incidental findings amounted to approximately $744, $1,534, and $2,260 for Medicare, private insurance, and uninsured costs, respectively. Incidentalomas occur over twice as often as retrocochlear pathologies responsible for ASNHL. Although the number of patients requiring treatment for incidentaloma is low, the economic impact is not insubstantial and should be considered for both individual patients and health system payers.

Economic burden of healthcare-associated infections (HAI) in a pediatric hospital in Honduras

Abstract Background In numerous reports, the World Health Organization has published that in LMICs approximately 15% of hospitalized patients acquire an HAI. In the Region of the Americas, many countries have made considerable progress in implementing IPC Programs. At Hospital María Especialidades Pediátricas (HMEP), the IPC Program aims to generate a patient safety culture mainly, but also reduce costs for the hospital and the patient. However, in LMICs, non-quality costs, including those associated with HAI, are rarely measured. This abstract aims to demonstrate the economic burden of HAI in hospitalized patients at HMEP between January 2020 and October 2023 and estimate the number of HAIs and associated costs prevented by the IPC Program. Methods At HMEP the IPC Program started in 2017, and the Accounting Department has measured the costs associated with treating and managing every HAI reported since January 2020. Provider costs for every HAI are estimated using a bottom-up (microcosting) approach in which three variables are considered: days of stay, all laboratory tests used for diagnosis and follow-up, and antimicrobials administered to treat the infection. The costs for each variable derive from the hospital’s purchasing system. This process allows us to estimate the annual HAI expenditure. For the estimation of costs avoided, we first calculated the average cost of each HAI using the yearly amount spent and dividing this amount by the number of HAIs registered in the same period. Considering the proportion of patients who suffered an HAI at HMEP compared to the 15% incidence reported by the WHO, we calculated a difference in proportions and were able to estimate the number of HAIs prevented and subsequent costs avoided. We use the NHSN HAI definitions since Honduras does not have a National IPC Program with standardized epidemiological criteria. The results are presented using descriptive statistics. Results During this time, 260 HAIs were identified at HMEP, average 5.6 per month, 57-70 yearly. The proportion of patients who developed an HAI was found to have decreased from 8.6% in 2020 to 5.2% in 2023. The total expenditure attributed to HAIs during the period was USD 913,774.21 (USD 19,865.0 pm). The costliest HAIs were CVC-associated bloodstream infections. HMEP is a public hospital and operates with funds provided by the government, which are deemed insufficient considering the complexity of the patients receiving care at the hospital. The estimated costs represent 2-3% of the hospital’s annual budget. Without the IPC Program, the predicted number of HAIs, according to the WHO, would have been 570 (15% of inpatients). We estimate 310 prevented HAIs, with an associated total cost of USD 1,103,577.99. Conclusion Regardless of the hospital’s methodology, measuring the economic burden related to HAIs is important for decision-making. The main objective of an IPC Program is to guarantee patient safety; however, especially in low-resource settings, it is also important to aim for a cost reduction. Limitations: our methodology does not include other variables (e.g. human resources); therefore, the data underestimates the real expenditure. We aim to improve the costing methodology for more accurate data.

Functional Impairments, Phenotypic Frailty, and Sector-Specific Incremental Healthcare Costs in Older Adults.

This study quantifies incremental healthcare expenditures of functional impairments and phenotypic frailty in specific healthcare sectors. Pooled 2023 analysis of 4 prospective cohort studies linked with Medicare claims including 4318 women and 3847 men attending an index examination (2002-2011). Annualized inpatient, skilled nursing facility (SNF), home healthcare (HHC), and outpatient costs (2023 dollars) ascertained for 36 months following index examination. Functional impairments (difficulty performing 4 activities of daily living) and frailty phenotype (operationalized using 5 components) derived from cohort data. Weighted multimorbidity index including demographics derived from claims. Mean age at index examination was 79.2 years. After accounting for multimorbidity and each other, average annualized incremental costs of 3-4 functional impairments versus no impairment in women (men) were $2838 ($5516) in inpatient, $1572 ($1446) in SNF, and $1349 ($1060) in HHC sectors; average incremental costs of phenotypic frailty versus robust in women (men) was $4100 (not significant for men) in inpatient, $1579 ($1254) in SNF, and $645 ($526) in HHC sectors. Incremental inpatient costs were primarily due to a higher hospitalization risk, while incremental SNF and HHC costs were related to both increased risks of utilization and higher costs among individuals with utilization. Neither geriatric domain was associated with outpatient costs. In this study of community-dwelling beneficiaries, functional impairments were independently associated with higher subsequent expenditures in inpatient, SNF, and HHC sectors among both sexes. Phenotypic frailty was independently associated with higher subsequent inpatient costs in women, and higher SNF and HHC costs in both sexes.

A multicenter randomized control trial: Point-of-care syndromic assessment versus standard testing in urgent care center patients with acute respiratory illness.

Syndromic assessment with multiplex polymerase chain reaction (mPCR) testing in patients with acute respiratory illness (ARI) allows for simultaneous identification of multiple possible infectious etiologies. Point-of-care (POC) syndromic assessment can be conducted in a clinical setting, such as an urgent care center (UCC), without requiring certified laboratories. The primary objective of this study was to determine whether POC syndromic assessment improved patient satisfaction for patients seen at an UCC with ARI; secondary objectives included whether syndromic assessment reduced self-isolation time, increased diagnostic confidence, and reduced overall antibiotic utilization. We conducted an unblinded multicenter randomized controlled trial on UCC patients with an ARI. Patients were randomized to either SC (defined as standard UCC testing for ARI) or syndromic assessment with POC mPCR. Patients were surveyed for patient satisfaction, self-isolation plans, diagnostic confidence, and overall antibiotic utilization. Among the 360 patients enrolled, those in the syndromic assessment group were more satisfied with the time required to communicate the results (98.4%vs. 42.4%, p<0.001) on day of treatment, more likely to resume normal activities sooner (83.3%vs. 69.4%, p=0.039), and more confident in their illness cause (60.7%vs. 29.6%, p<0.001); however, the rate of antibiotic utilization did not differ (33.5%vs. 26%, p=1.0). In conclusion, our study provides evidence supporting the use of syndromic assessment in UCCs for ARI diagnosis, including patient-centered outcomes such as greater confidence in diagnosis and more efficient isolation strategies. This study did not show a difference in more clinically oriented outcomes, such as a change in antibiotic utilization. Future studies should identify clinical care pathways to improve antibiotic stewardship for likely viral syndromes and whether the increased initial cost of syndromic assessment is offset by the clinical benefits and subsequent cost savings.

SEROPREVALENCE, RISK ASSOCIATIONS, AND TESTING COST OF SCREENING FOR HCV, HBV, AND HIV INFECTIONS AMONG A GROUP OF PRE-OPERATIVE EGYPTIAN PATIENTS

Background: Routine pre-operative testing for Human Immunodeficiency Virus (HIV) and other blood-borne viruses, Hepatitis B Virus, Hepatitis C Virus (HBV, HCV) has been stated as a strategy to reduce the risk of healthcare workers' infection by preventing and reducing their infection. However, the argument that screening is essential or not is strong. Aim: This study aims to determine the incidence of HBV, HCV, and HIV infections identified during pre-operative screening in a cohort of Egyptian individuals, along with the associated risk factors and the subsequent testing costs. Methods: This study comprised 138 patients, with 92 (66.7%) males and 46 (33.3%) females. All patients scheduled for surgical procedures underwent testing for HCV Ab, HBsAg, and HIV Ag/ Ab by chemiluminescent microparticle immunoassay conducted with the ARCHITECT i2000SR Immunoassay (Abbot Japan CO., Ltd, Tokyo, Japan). Among the participants, 23 out of 138 (16.7%) tested positive for HCV, while 5 out of 138 (3.3%) showed equivocal results for HCV, and 110 out of 138 (79.7%) tested negative for HCV. Additionally, 2 out of 138 (1.4%) were positive for HBsAg, while 136 out of 138 (98.6%) tested negative for HBsAg. Furthermore, 1 out of 138 (0.7%) was found to be HIV-positive, while 137 out of 138 (99.3%) tested negative for HIV. Results: The prevalence of each infection detected through pre-operative testing of HCV,HBV and HIV and a questionnaire was compared. Furthermore, we calculated the screening cost per confirmed infection by assessing the incidence of infections linked to different risk factors, ages, genders, and levels of HBV vaccination. Conclusions: Age markedly impacted HCV and HBV rates. There was no link between viral infections and gender. The expenses associated with each affirmative result were 1763 LE for HCV, 5520 LE for HBV, and 22080 LE for HIV. While self-assessment through questionnaires can be partially efficacious, it lacks sufficient screening accuracy.

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.

The risk of free flap revision and subsequent medical costs in patients with hypopharyngeal cancer.

Few studies have examined the preoperative risks and healthcare costs related to free flap revision in hypopharyngeal cancer (HPC) patients. A 20-year retrospective case-control study was conducted using the Chang Gung Research Database, focusing on HPC patients who underwent tumor excision and free flap reconstruction from January 1, 2001, to December 31, 2019. The impacts of clinical variables on the need for re-exploration due to free flap complications were assessed using logistic regression. The direct and indirect effects of these complications on medical costs were evaluated by causal mediation analysis. Among 348 patients studied, 43 (12.4%) developed complications requiring re-exploration. Lower preoperative albumin levels significantly increased the risk of complications (OR 2.45, 95% CI 1.12-5.35), especially in older and previously irradiated patients. Causal mediation analysis revealed that these complications explained 11.4% of the effect on increased hospitalization costs, after controlling for confounders. Lower preoperative albumin levels in HPC patients are associated with a higher risk of microvascular free flap complications and elevated healthcare costs, underscoring the need for enhanced nutritional support before surgery in this population.

The economic impact of open lower limb fractures in the Netherlands: a cost-of-illness study

PurposeTo estimate the one-year sum of direct costs related to open lower limb fracture treatment in an academic setting in the Netherlands. The secondary objective was to estimate the impact of deep infection and nonunion on one-year total direct costs.MethodsA multi-center, retrospective cost analysis of open lower limb fractures treated in an academic setting in the Netherlands, between 1 January 2017 and 31 December 2018, was conducted. The costing methodology was based on patient level aggregation using a bottom-up approach. A multiple linear regression model was used to predict the total costs based on Fracture-related-infections, multitrauma, intensive care unit (ICU) admission, Gustilo-Anderson grade and nonunion.ResultsOverall, 70 fractures were included for analysis, the majority Gustilo-Anderson grade III fractures (57%). Median (IQR) one-year hospital costs were €31,258 (20,812–58,217). Costs were primarily attributed to the length of hospital stay (58%) and surgical procedures (30%). The median length of stay was 16 days, with an increase to 50 days in Fracture-related infections. Subsequent costs (46,075 [25,891–74,938] vs. 15,244 [8970–30,173]; p = 0.002), and total hospital costs (90,862 [52,868–125,004] vs. 29,297 [21,784–40,677]; p < 0.001) were significantly higher for infected cases. It was found that Fracture-related infection, multitrauma, and Gustilo-Anderson grade IIIA-C fractures were significant predictors of increased costs.ConclusionIn treatment of open lower limb fractures, deep infection, higher Gustilo-Anderson classification, and multitrauma significantly increase direct hospital costs. Considering the impact of infection on morbidity and total healthcare costs, future research should focus on preventing Fracture-related infections.

Cost-effectiveness of blinatumomab for the treatment of B‑precursor acute lymphoblastic leukemia pediatric patients with high‑risk first‑relapse in Mexico

BackgroundBlinatumomab is a CD3/CD19-directed bispecific T-cell engager molecule that engages T cells to lyse CD19-expressing B cells. Based on a multicenter, open-label, phase 3, randomized clinical trial (Clinical Trials ID: NCT02393859), we aimed to evaluate the cost-effectiveness (CE) of blinatumomab compared to standard consolidation chemotherapy (SC) for the treatment of pediatric patients with high-risk first-relapsed Philadelphia chromosome-negative B-cell precursor acute lymphoblastic leukemia (B-ALL) from a Mexico healthcare payer perspective. MethodsA decision-analytic model, a partitioned survival model, was used to estimate the life-years (LYs) and costs over a lifetime horizon. We assumed that patients who remained alive beyond a 5-year period were cured. To account for the lingering impacts of cancer treatment, an excess mortality rate was incorporated into the model. Event-free survival (EFS) and overall survival (OS) were estimated by fitting mixture-cure and standard parametric survival distributions to the time-to-event data from the phase 3 trial. The model accounted for treatment costs, adverse event costs, follow-up costs, subsequent allogeneic hematopoietic stem cell transplantation (alloHSCT) costs, and subsequent treatment costs. ResultsBlinatumomab was associated with a lifetime gained of 5.11 years at an incremental cost of $621,111 MXN, relative to SC. The ICER for blinatumomab vs Standard of care was estimated to be $121,526 MXN/LY gained in the base case. Cost-effectiveness was sensitive to varying the time horizon. Blinatumomab had a probability of 99 % of being cost-effective, relative to SC, at the willingness to pay threshold defined in Mexico. LimitationsHealth-related quality of life values were not included in the analysis and therefore we did not estimate the quality-adjusted life-years gained. ConclusionsBlinatumomab was associated with greater benefit in terms of OS and EFS relative to SC. Probabilistic, deterministic, and scenario analyses indicate that blinatumomab represents the best value for money. Therefore, blinatumomab administered as part of consolidation therapy in B-ALL pediatric patients with high-risk first relapse is a cost-effective option.