Average Total Cost Research Articles

Challenges in adapting a stroke unit in a middle-income country: warning about costs and underfunding to achieve the Brazilian Ministry of Health's benchmark.

Since the implementation of the stroke care line in Brazil, the relationship (adequacy) of costs spent during hospitalization with the Brazilian Ministry of Health indicators for a stroke unit have not yet been analyzed. This study aimed to assess the adequacy of a comprehensive stroke center for key performance indicators and analyze the costs involved in hospitalization. We verified the association between stroke severity at admission and care costs during hospitalization. A retrospective medical chart review of 451 patients was performed using semiautomatic electronic data from a single comprehensive stroke center in Brazil between July 2018 and January 2020. Clinical and resource utilization data were collected, and the mean acute treatment cost per person was calculated. The Kruskal-Wallis test with Dunn's post-test was used to compare the total costs between stroke types and reperfusion therapies. A robust linear regression test was used to verify the association between stroke severity at hospital admission and the total hospitalization costs. Good adequacy rates were observed for several indicators. Data from 451 patients were analyzed. The stroke unit had good adaptation to key performance indicators, but some critical points needed revision and improvement to adapt to the requirements of the Ministry of Health. The average total cost of the patient's stay was the USD 2,637.3, with the daily hospitalization, procedure, operating room, and materials/medication costs equating to USD 2,011.1, USD 220.7, USD 234.1, and USD 98.8, respectively. There was a positive association between the total cost and length of hospital stay (p < 0.001). The stroke unit complied with most of the main performance indicators proposed by the Brazilian Ministry of Health. Underfunding of the costs involved in the hospitalization of patients was verified, and high costs were associated with the length of stay, stroke severity, and mechanical thrombectomy.

ROI for a Fall Prevention Intervention: Invest a Little, Save a Lot.

Patient falls within the hospital setting continue to be a significant challenge globally with almost one million hospital falls occurring in the U.S. annually. Recent calculations showed that the average total cost of a hospitalized patient fall was $62,521. One evidenced-based tool that has been shown to be effective is a colorful laminated poster, Fall TIPS poster, that was designed to engage and involve the patient in their fall prevention. One academic medical center utilized this implementation showing a successful return on investment (ROI). This project used a pre-post implementation design. After a successful pilot using the poster on one unit, the implementation was spread to all Adult Acute Care units (n = 10) within the institution. The outcome measures were fall and fall with injury counts and rates. The process measure was the completion of the fall prevention poster measured via audits. The calculation of ROI was completed using a four-step framework. The outcome data of fall and fall with injury showed a decrease from the pre-intervention months with both the fall count and rate decreasing by 23% and the fall with injury count and rate decreasing by 40%. The overall ROI calculation estimated an ROI of $982,700. The successful results from this project support the evidence that shows this program and the use of the Fall TIPS poster helps reduce patient falls within the hospital and yields a favorable ROI.

Analisis Pendapatan dan Kelayakan Usaha Kopra di Desa Tulabolo Barat Kecamatan Suwawa Timur Kabupaten Bone Bolango

Most farmers in West Tulabolo Village, located in East Suwawa District, carry out extensive coconut cultivation. Farmers obtain coconut in granular form. Usually, coconut farmers who live in West Tulabolo Village sell copra as the primary means of commercialising their coconut products. The main objective of this research is to determine the income and feasibility of the copra industry in West Tulabolo Village, located in East Suwawa District, Bone Bolango Regency. The research location was deliberately chosen because the potential for coconut cultivation is quite significant. The research was carried out from March to June 2023. The population in this study consisted of a sample of 15 farmers selected using a saturated sampling technique, which included the entire copra farming community. This research uses primary and secondary data sources. This research uses a quantitative descriptive methodology to analyse the data. Research findings reveal an average total cost of IDR. 4,127,127 per harvest, which is the total revenue of IDR9,772,500 per harvest, and a total income of IDR5,645,373 per harvest. The calculated R/C value is 2.36, while the B/C value is 1.36. Therefore, it can be said that the copra business in West Tulabolo Village shows that it is feasible to continue, as evidenced by the R/C and B/C ratios exceeding 1.

Trends in Management and Cost Burden of Facial Fractures: A 14-Year Analysis.

To discuss patient demographics and management and better understand the economic impact associated with the treatment of facial fractures at a major metropolitan level 1 trauma center. Retrospective chart review. We identified 5088 facial fractures in 2479 patients who presented from 2008 to 2022. Patient demographics, mechanism of injury, associated injuries, treatment information, and hospital charges were collected and analyzed to determine factors associated with surgical management and increased cost burden. Our 14-year experience identified 1628 males and 851 females with a mean age of 45.7 years. Orbital fractures were most common (41.2%), followed by maxilla fractures (20.8%). The most common mechanism was fall (43.0%). Surgical management was recommended for 41% of patients. The odds of surgical management was significantly lower in female patients, patients age 65 and older, and patients who presented after the onset of the COVID-19 pandemic. The odds of surgical management was significantly higher for patients who had a mandible fracture or greater than 1 fracture. The average cost of management was highest for naso-orbito-ethmoidal fractures ($37,997.74 ± 52,850.88), followed by LeFort and frontal fractures ($29.814.41 ± 42,155.73 and $27,613.44 ± 39.178.53, respectively). The highest contributor to the total average cost of management was intensive care unit-related costs for every fracture type, except for mandible fractures for which the highest contributor was operating room (OR)-related costs. This study represents one of the largest comprehensive databases of facial fractures and one of the first to provide a descriptive cost analysis of facial trauma management. 4 Laryngoscope, 134:3120-3126, 2024.

Long-term impact of weight loss in people with class II obesity on the overall burden of disease: Evidence from the National Health Screening Cohort in Korea

BackgroundObesity is known to increase overall disease burden but does obesity management actually help reduce disease burden? ObjectivesTo investigate the effects of weight loss on disease burden in people with obesity using the National Health Insurance Service-Health Screening Cohort (NHIS-HEALS) in Korea. SettingPure longitudinal observational study using Nationwide cohort database. MethodsOut of 514,866 NHIS-HEALS cohort, participants with class II obesity in Asia-Pacific region (30 ≤ body mass index [BMI] < 35) who underwent health check-up provided by NHIS during 2003–2004 (index date) were included. All final participants continued to receive a total of 5 biennial health check-ups over the next 10 years without missing. A group-based trajectory model (GBTM) was used to categorize subjects based on 10-year BMI change patterns. The changes of co-morbidities, healthcare resource utilization, and medical cost were analyzed. ResultsThe final study subjects (9857) were categorized into 3 trajectory clusters based on the pattern of BMI (kg/m2) change: maintenance (57.35%) with an average change of −.02 ± .06, loss (38.65%) with −.04 ± .08, and substantial loss (4.0%) with −.10 ± .18. The annual increases in the number of co-morbidities per subject in each cluster were .18, .18, and .16 (all P < .001), respectively. The increase of healthcare resource utilization over time was lowest for the substantial loss compared to maintenance and loss. With each passing year, the average annual total healthcare cost increased by ₩21,200 ($16.48, P = .034) and ₩10,500 ($8.16, P = .498) in the maintenance and loss, respectively, but decreased by ₩62,500 ($48.59, P = .032) in the substantial loss. ConclusionsWeight loss in people with obesity was associated with a reduced burden of disease, as evidenced by lower co-morbidity, healthcare resource utilization rate, and decreased medical costs. This study highlights the potential positive long-term impact on Korean society when actively managing weight in individuals with obesity.

Cost-Effectiveness of a Government Policy to Incentivise Chronic Disease Management following Stroke: A Modelling Study

Introduction: Little is known about the cost-effectiveness of government policies that support primary care physicians to provide comprehensive chronic disease management (CDM). This paper aimed to estimate the potential cost-effectiveness of CDM policies over a lifetime for long-time survivors of stroke. Methods: A Markov model, using three health states (stable, hospitalised, dead), was developed to simulate the costs and benefits of CDM policies over 30 years (with 1-year cycles). Transition probabilities and costs from a health system perspective were obtained from the linkage of data between the Australian Stroke Clinical Registry (cohort n = 12,368, 42% female, median age 70 years, 45% had CDM claims) and government-held hospital, Medicare, and pharmaceutical claims datasets. Quality-adjusted life years (QALYs) were obtained from a comparable cohort (n = 512, 34% female, median age 69.6 years, 52% had CDM claims) linked with Medicare claims and death data. A 3% discount rate was applied to costs in Australian dollars (AUD, 2016) and QALYs beyond 12 months. Probabilistic sensitivity analyses were used to understand uncertainty. Results: Per-person average total lifetime costs were AUD 142,939 and 8.97 QALYs for those with a claim, and AUD 103,889 and 8.98 QALYs for those without a claim. This indicates that these CDM policies were costlier without improving QALYs. The probability of cost-effectiveness of CDM policies was 26.1%, at a willingness-to-pay threshold of AUD 50,000/QALY. Conclusion: CDM policies, designed to encourage comprehensive care, are unlikely to be cost-effective for stroke compared to care without CDM. Further research to understand how to deliver such care cost-effectively is needed.

Costs and scale-up costs of community-based Oral HIV Self-Testing for female sex workers and men who have sex with men in Jakarta and Bali, Indonesia

BackgroundThe proportion of individuals who know their HIV status in Indonesia (66% in 2021) still remains far below the first 95% of UNAIDS 2030 target and were much lower in certain Key Populations (KPs) particularly Female Sex Workers (FSW) and Male having Sex with Male (MSM). Indonesia has implemented Oral HIV Self-testing (oral HIVST) through Community-based screening (HIV CBS) in addition to other testing modalities aimed at hard-to-reach KPs, but the implementation cost is still not analysed. This study provides the cost and scale up cost estimation of HIV CBS in Jakarta and Bali, Indonesia.MethodsWe estimated the societal cost of HIV CBS that was implemented through NGOs. The HIV CBS’s total and unit cost were estimated from HIV CBS outcome, health care system cost and client costs. Cost data were presented by input, KPs and areas. Health care system cost inputs were categorized into capital and recurrent cost both in start-up and implementation phases. Client costs were categorized as direct medical, direct non-medical cost and indirect costs. Sensitivity and scenario analyses for scale up were performed.ResultsIn total, 5350 and 1401 oral HIVST test kits were distributed for HIV CBS in Jakarta and Bali, respectively. Average total client cost for HIV CBS Self testing process ranged from US$1.9 to US$12.2 for 1 day and US$2.02 to US$33.61 for 2 days process. Average total client cost for HIV CBS confirmation test ranged from US$2.83 to US$18.01. From Societal Perspective, the cost per HIVST kit distributed were US$98.59 and US$40.37 for FSW and MSM in Jakarta andUS$35.26 and US$43.31 for FSW and MSM in Bali.ConclusionsCBS using oral HIVST approach varied widely along with characteristics of HIV CBS volume and cost. HIV CBS was most costly among FSW in Jakarta, attributed to the low HIV CBS volume, high personnel salary cost and client cost. Future approaches to minimize cost and/or maximize testing coverage could include unpaid community led distribution to reach end-users, integrating HIVST into routine clinical services via direct or secondary distribution and using social media network.

Inventory Model for Deteriorating Pharmaceutical Items with Linear Demand Rate

Good management of goods is needed so that the inventory activities of a business can run smoothly as the part of supply chain management which aims to monitor the flow of stock of goods from the purchasing process, and storage to the point of sale. In terms of inventory or supplies of pharmaceutical goods, conditions such as shortages or stockouts must also be considered which are a matter of control, management, and security. In this study, an inventory model is formulated with deterioration or damage to pharmaceutical goods that occurs due to the length of time when the goods are stored with a linear demand level. In the optimal solution, the inventory time occurs when it reaches the zero point (t1) of 0.34 and the cycle length (T1) of 0.83 with an average minimum total cost (TC) of $445.25 per cycle which is completed by WolframAlpha software. Sensitivity analysis changes the value results in the value of (TC) which that increases for all parameters. In increasing the linear function variables (a and b), it produces t1 and T1 stable values. An increase in the cost of each item damage (DC) and constant damage rate (theta) produces a t1 stable value, but the value of T1 increases. The increase in storage costs (h) results in a decrease in the value of t1 and T1. An increase in the cost of shortages (s) results in an increase in the value of t1 and a decrease in the value of T1.

Analysis Of The Cost Effectiveness Of Oral Iron Cleaning Drugs Between Deferipron And Deferasiroks In Patients With Thalasemia Major At Bhayangkara Kindergarten Hospital. Ii Setukpa Lemdiklat Polri

Thalassemia is a blood disorder characterized by reduced or absent synthesis of globin chains, particularly thalassemia major, imposes significant financial burdens due to the lifelong need for blood transfusions and iron chelation drugs. This research aims to assess the cost and efficacy of oral iron chelators, specifically deferasirox and deferiprone, in treating thalassemia major patients at Setukpa Lemdiklat Polri Tk—II Hospital in 2023. The data were retrospectively gathered through total sampling from patients' medical records and the hospital information system. The findings indicate that the average total treatment cost for thalassemia major patients using deferasirox (IDR 52,969,775,-) is higher than deferiprone (IDR 49,407,613,-). Deferasirox exhibits greater effectiveness (1,364 ng/mL) than deferiprone (1,210 ng/mL). The cost-effectiveness ratio of deferasirox (IDR 38,834,-) is lower than that of deferiprone (IDR 40,833,-). Transitioning from deferiprone to deferasirox incurs an additional IDR 23,130 per unit cost. The average cost-effectiveness ratio suggests that deferasirox is more economically efficient than deferiprone.thalassemia major

Racial and Ethnic Differences in Hypertension-Related Telehealth and In-Person Outpatient Visits Before and During the COVID-19 Pandemic Among Medicaid Beneficiaries.

Background: Little is known about the trends and costs of hypertension management through telehealth among individuals enrolled in Medicaid. Methods: Using MarketScan® Medicaid database, we examined outpatient visits among people with hypertension aged 18-64 years. We presented the numbers of hypertension-related telehealth and in-person outpatient visits per 100 individuals and the proportion of hypertension-related telehealth outpatient visits to total outpatient visits by month, overall, and by race and ethnicity. For the cost analysis, we presented total and patient out-of-pocket (OOP) costs per visit for telehealth and in-person visits in 2021. Results: Of the 229,562 individuals, 114,445 (49.9%) were non-Hispanic White, 80,692 (35.2%) were non-Hispanic Black, 3,924 (1.71%) were Hispanic. From February to April 2020, the number of hypertension-related telehealth outpatient visits per 100 persons increased from 0.01 to 6.13, the number of hypertension-related in-person visits decreased from 61.88 to 52.63, and the proportion of hypertension-related telehealth outpatient visits increased from 0.01% to 10.44%. During that same time, the proportion increased from 0.02% to 13.9% for non-Hispanic White adults, from 0.00% to 7.58% for non-Hispanic Black adults, and from 0.12% to 19.82% for Hispanic adults. The average total and patient OOP costs per visit in 2021 were $83.82 (95% confidence interval [CI], 82.66-85.05) and $0.55 (95% CI, 0.42-0.68) for telehealth and $264.48 (95% CI, 258.87-269.51) and $0.72 (95% CI, 0.65-0.79) for in-person visits, respectively. Conclusions: Hypertension management via telehealth increased among Medicaid recipients regardless of race and ethnicity, during the COVID-19 pandemic. These findings may inform telehealth policymakers and health care practitioners.

Average Length of Stay, Average Preventable Readmission Rates, and Average Total Cost of Care: Is there a Relationship?

Average Length of Stay (ALOS), Average Preventable Readmission Rates (APRRs), and Average Total Cost of Care (ATCc) were examined to see if any relationship exists among the variables. Secondary data from the Texas Hospital data collection database was used for the study. Out of 379 acute care hospitals in Texas, 65 hospitals were selected for analysis using a G*Power analysis. Demographic analysis, Spearman’s Rank correlation, and Regression Analyses were conducted to explore the relationship. The results of the Spearman’s Rho correlation showed a significant negative relationship between ALOS and ATCc [ALOS – ATCc (rs = - .271, p = .016)], and for APRRs and ATCc, there was no statistically significant relationship [APRRs – ATCc (rs = .065, p = .564)]. The multiple regression analysis showed there was no statistically significant relationship between the variables [ALOS – ARRs – ATCc (F (2,62) = 1.584, p = .211)]. The results showed that ALOS and APRRs do not necessarily predict ATCc. Consequently, based on the study results ATCc is not solely determined by ALOS and APRRs. The absence of a significant relationship between ALOS, APRRs, and ATCc does not necessarily indicate inefficiency in practice or lack of effectiveness. The results showed that there are other mediating factors impacting care that were not assessed in the study that need to be examined carefully which may have implications for practice, research, and methodology. Future research should be considered to determine these moderating factors to better understand the complex relationship between ALOS, APRRs, and ATCc. An understanding of these complex dynamics may inform managerial strategies and help with critical clinical and fiscal decisions in a healthcare setting.&#x0D; Keywords: Average Length of Stay, Average Preventable Readmission Rates, Average Total Cost of care

Socioeconomic per-case costs of stroke, myocardial infarction, and preterm birth attributable to air pollution in Sweden.

Incident cases of stroke, myocardial infarction, and preterm birth have established exposure-response functions associated with air pollution. However, there are no studies reporting detailed costs per case for these health outcomes that are adapted to the cost-benefit tools that guide the regulation of air pollution. The primary objective was to establish non-fatal per-case monetary estimates for stroke, myocardial infarction, and preterm birth attributable to air pollution in Sweden, and the secondary objective was to ease the economic evaluation process of air pollution morbidity effects and their inclusion in cost-benefit assessments. Based on recommendations from the literature, the case-cost analysis considered direct and indirect medical costs, as well as production losses and informal costs relevant for the calculation of the net present value. A literature search was conducted to estimate the costs of each category for each incident case in Sweden. Informal costs were estimated using the quality-adjusted life-years approach and the corresponding willingness-to-pay in the Swedish population. The total average per-case cost was estimated based on specific health outcome durations and severity and was discounted by 3.5% per year. Sensitivity analysis included varying discount rates, severity of health outcome, and the range of societal willingness to pay for quality-adjusted life years. The average net present value cost estimate was €2016 460k (185k-1M) for non-fatal stroke, €2016 24k (16k-38k) for myocardial infarction, and €2016 34k (19k-57k) for late preterm birth. The main drivers of the per-case total cost estimates were health outcome severity and societal willingness to pay for risk reduction. Varying the discount rate had the largest effect on preterm birth, with costs changing by ±30% for the discount rates analysed. Because stroke, myocardial infarction, and preterm birth have established exposure-response functions linking these to air pollution, cost-benefit analyses should include the costs for these health outcomes in order to adequately guide future air pollution and climate change policies.

Real-world economic burden of metastatic castration-resistant prostate cancer before and after first-line therapy initiation

Aims To describe healthcare costs of patients with metastatic castration-resistant prostate cancer (mCRPC) initiating first-line (1 L) therapies from a US payer perspective. Methods Patients initiating a Flatiron oncologist-defined 1 L mCRPC therapy (index date) on or after mCRPC diagnosis were identified from linked electronic medical records/claims data from the Flatiron Metastatic Prostate Cancer (PC) Core Registry and Komodo’s Healthcare Map. Patients were excluded if they initiated a clinical trial drug in 1 L, had <12 months of insurance eligibility prior to index, or no claims in Komodo’s Healthcare Map for the Flatiron oncologist-defined index therapy. All-cause and PC-related total costs per-patient-per-month (PPPM), including costs for services and procedures from medical claims (i.e. medical costs) and costs from pharmacy claims (i.e. pharmacy costs), were described in the 12-month baseline period before 1 L therapy initiation (including the baseline pre- and post- mCRPC progression periods) and during 1 L therapy (follow-up). Results Among 459 patients with mCRPC (mean age 70 years, 57% White, 16% Black, 45% commercially-insured, 43% Medicare Advantage-insured, and 12% Medicaid-insured), average baseline all-cause total costs (PPPM) were $4,576 ($4,166 pre-mCRPC progression, $8,278 post-mCRPC progression). Average baseline PC-related total costs were $2,935 ($2,537 pre-mCRPC progression, $6,661 post-mCRPC progression). During an average 1 L duration of 8.5 months, mean total costs were $13,746 (all-cause) and $12,061 (PC-related) PPPM. The cost increase following 1 L therapy initiation was driven by higher PC-related outpatient and pharmacy costs. PC-related medical costs PPPM increased from $1,504 during baseline to $5,585 following 1 L mCRPC therapy initiation. Limitations All analyses were descriptive; statistical testing was not performed. Conclusion Incremental costs of progression to mCRPC are significant, with the majority of costs driven by higher PC-related costs. Using contemporary data, this study highlights the importance of utilizing effective therapies that slow progression and reduce healthcare resource demands despite the initial investment in treatment costs.

Acoustic properties of natural fiber reinforced composite micro-perforated panel (NFRC-MPP) made from cork fiber and polylactic acid (PLA) using 3D printing

The present study investigated the acoustic performance of biodegradable MPP absorbers made of natural fiber-reinforced composites (NFRC) using 3D printing. The novelty of this current research lies in the recent development of a methodology that aids industry professionals in optimizing the production of MPP (Micro-Perforated Panel) at a competitive cost. This is achieved by addressing and eliminating various issues commonly faced in traditional manufacturing processes, such as manual preparation and pressing. The FDM technique was used to fabricate test samples utilizing the PLA/corkwood composite. Using an impedance tube device with two microphones, the acoustic absorption coefficients of MPPs with different perforation diameters, thicknesses, and perforation rates were measured. Maa's analytical model was used to predict the acoustic absorption performance. Moreover, considering the average sound absorption and total cost of fabricating the samples, RSM-CCD was employed to optimize these samples. In the end, the parallel arrangement of MPP double layer and the combination of MPP with kenaf porous material were tested in order to improve the sound absorption performance. The results showed that the average sound absorption coefficient of the NFRC-MPP sound absorber is 25 % more than that of conventional MPP sound absorbers. The sample with a perforation diameter of 0.70 mm, a panel thickness of 0.90 mm, and an 8 mm distance between the perforations was selected as the optimal sound absorber. The measurement and model data for NFRC-MPP panels do not correspond well. The parallel arrangement of two layers of MPP and the addition of an optimized kenaf layer behind the MPP significantly improved the sound absorption performance in the intended frequency range. The findings of this study, coupled with data available in the literature for other types of biocomposite Micro-Perforated Panel (MPP), strongly indicate that Cork fiber-based MPP exhibits substantial promise for application, either independently or in conjunction with Kenaf materials, as a material for acoustic conditioning. Implementing smart manufacturing techniques for acoustic panels not only enhances engineering noise control efforts but also amplifies the overall effectiveness of Hearing Conservation Programs.

Efficacy and safety of biosimilar Peg-filgrastim after autologous stem cell transplant in myeloma and lymphoma patients: a comparative study with biosimilar Filgrastim, Lenograstim, and originator Peg-filgrastim

Data about biosimilar Peg-filgrastim (bioPEG) in autologous stem cell transplant (ASCT) are still scarce. The aim of this study has been to assess efficacy and safety of bioPEG among lymphoma and myeloma patients undergoing ASCT, comparing these data with historical controls receiving other G-CSFs. Furthermore, an economic evaluation has been included to estimate the savings by using bioPEG. This is a prospective cohort study comparing lymphoma and myeloma patients undergoing ASCT and receiving bioPEG (n = 73) with three historical consecutive cohorts collected retrospectively who received other G-CSFs (Lenograstim — Leno — n = 101, biosimilar Filgrastim — bioFIL n = 392, and originator Peg-filgrastim — oriPEG n = 60). We observed a significantly shorter time to neutrophils and platelet engraftment (p < 0.001) in patients treated with bioPEG and oriPEG. Moreover, patients who received bioPEG showed a shorter hospitalization time (p < 0.001) and a lower transfusion need (p < 0.001). We did not observe any significant difference in terms of transplant-related mortality, mucositis, and diarrhea among the four groups. No serious adverse events were associated with bioPEG. Similar data were obtained after running a stratified analysis for lymphomas and myeloma separately conducted by using a propensity score matching. The average total cost per patient of bioPEG was € 18218.9 compared to € 23707.8, € 20677.3 and € 19754.9 of Leno, oriPEG, and bioFIL, respectively. In conclusion, bioPEG seems to be as effective as the originator and more effective than short-acting G-CSFs in terms of post-transplant engraftment in myeloma and lymphoma patients undergoing ASCT. Moreover, bioPEG was cost-effective when compared with the other G-CSFs.

Cost analysis of endovascular treatment for unruptured intracranial aneurysms at a private hospital in Brazil.

Intracranial aneurysms have a prevalence of 1-6% and significant rupture risks, leading to high morbidity and mortality. Endovascular therapy demands an understanding of its economic impacts. This study evaluates the costs and complications of unruptured intracranial aneurysm treatment in a private Latin American hospital. A retrospective longitudinal observational study was carried out in a private hospital in Brazil from February 2015 to January 2021. Patients undergoing elective endovascular treatment for unruptured intracranial aneurysms (UIAs) were included in the study. Data collected included patient demographics, aneurysm characteristics, treatment modalities, costs, and clinical outcomes. Costs were adjusted to their present value in 2023 US dollars (USD). Descriptive statistics summarized the data. A total of 77 patients (68 females and nine males) with 111 aneurysms were included. The average total cost per patient was $31,831.08, with materials (65.9%) and hospital daily rates (11.3%) being the primary cost drivers. Device associations included flow diverter (51.9%), stent-assisted coiling (19.2%), and coiling (11.5%). Clinical outcomes were favorable, with an average inpatient stay of 6.5 ± 10.2 days, 6.5% of patients requiring readmission for complications, and no deaths within 90 days. The highest costs were associated with coiling and stent-assisted coiling. The cost of endovascular treatment for UIAs at a private hospital in Brazil is substantial, primarily driven by materials and hospital daily rates. Despite high costs, clinical outcomes were favorable, with low complication rates. These findings underscore the need for continuous cost-effectiveness evaluation and treatment optimization to balance clinical benefits with financial considerations.

Projected Healthcare System Cost Burden of Metabolic Dysfunction-Associated Steatotic Liver Disease in Canada

Background and aimsMetabolic dysfunction-associated steatotic liver disease (MASLD) is the most common cause of chronic liver disease worldwide. The current and projected cost of treating individuals with MASLD in Canada remains unknown. Our objective was to calculate the projected liver-specific and total healthcare costs for people living with MASLD in Canada from 2020 to 2050. MethodsThe healthcare usage of a cohort of patients diagnosed with MASLD in Calgary, Alberta was calculated using administrative data. Liver-specific encounters were identified and the average costs per year per patient were calculated. Projected costs were calculated by multiplying the average cost per patient within each health state by the projected prevalence of each health state. ResultsThere were 6,358 patients in the cohort. The annual average liver-specific cost per patient was $7.02 for F0/F1, $35.30 for F2, $60.46 for F3, $72.55 for F4, $933.26 for patients with decompensated cirrhosis, and $10,074.23 for patients with hepatocellular carcinoma (HCC). The projected Canada-wide liver-specific cost was $289.5 million in 2020 and was expected to increase by $143 million by 2050. The average annual total healthcare cost per patient was $397.90 for F0/F1, $781.53 for F2, $2,881.84 for F3, $1,598.82 for F4, $933.26 for patients with decompensated cirrhosis, and $10,074.23 for patients with HCC. Thus, the projected Canada-wide total healthcare cost was $4.20 billion in 2020 and was expected to increase by almost $2 billion by 2050. ConclusionThese estimates underscore the need for a MASLD framework that focuses on both prevention and innovative care models to change the predicted trajectory of healthcare costs.

A Rapid and Safe Minimally Invasive Procedure for Percutaneous Pedicle Screw Removal: A Case-Control Study and Technical Description.

Percutaneous pedicle screw fixation is a common minimally invasive treatment for traumatic thoracolumbar and lumbar fractures; however, research on hardware removal after successful healing is limited. We aimed to introduce a rapid, safe, minimally invasive, and cost-effective method for percutaneous pedicle screw removal. We conducted a retrospective analysis of demographic (age, sex, body mass index, alcohol use, and current smoking), clinical (hypertension and diabetes mellitus), surgical (affected levels, number of screws, time of surgery, and blood loss), and treatment cost characteristics of 92 patients who had undergone percutaneous pedicle screw removal between May 2016 and February 2023. The first 57 patients underwent the conventional method, and the remaining 35 underwent the modified method. Independent-sample t-tests and chi-square tests were used to compare continuous and categorical variables, respectively, between the two groups. No significant differences were observed in the demographic parameters, complications, or affected levels between the groups. However, the average surgical time (P=0.000) was significantly shorter, and the average blood loss volume (P=0.002) and total cost (P=0.000) were significantly lower in the modified group than in the conventional group. Compared with the conventional method, our modified method can shorten the surgical time, reduce blood loss, and reduce the total cost of treatment. It is a quick and safe minimally invasive method that does not require additional surgical instruments and is suitable for implementation in primary hospitals.

Green Catalysts for Sustainable Biodiesel Production from Waste Cooking Oil

Biodiesel manufacturing from waste cooking oil has emerged as a potential alternative in the search of sustainable energy. This process helps mitigate environmental pollution and reduces reliance on fossil fuels. This research examines the catalytic efficiency of environmentally friendly catalysts in this process, with a specific emphasis on catalysts based on enzymes. It assesses their effectiveness in terms of the production of biodiesel, the rate of the chemical reactions, cost efficiency, and their influence on the environment. Experimental evidence demonstrates that enzyme-based catalysts have enhanced catalytic activity, leading to an average biodiesel production of 90%, outperforming traditional catalysts such as solid acids, bases, and heterogeneous metal catalysts. Moreover, enzyme catalysts exhibit enhanced reaction rates due to their unique enzymatic activity and gentle reaction conditions. The cost study shows that the manufacturing costs for enzyme catalysts are competitive, with an average total cost of $800, which is equivalent to traditional catalysts. Environmental impact evaluation emphasizes the sustainability of enzyme catalysts by demonstrating their lower energy consumption, waste production, and greenhouse gas emissions compared to traditional alternatives. The results highlight the capacity of green catalysts, namely enzyme-based catalysts, to enhance sustainable biodiesel production methods, hence promoting a more eco-friendly and robust energy framework.

Cost Analysis of a Patient Portal Used to Remotely Monitor COVID-19 Patients in Quebec.

Telemonitoring for COVID-19 has gained much attention due to its potential in reducing morbidity, healthcare utilization, and costs. However, its benefit with regard to economic outcomes has yet to be clearly demonstrated. To analyze the costs associated with the use of the Opal portal to monitor COVID-19 patients during their 14-day confinement in Quebec and compare them to those of non-users of any home telemonitoring technology. A cost analysis was conducted through a cross-sectional study between COVID-19 patients who used (PU) the Opal platform during their 14-day confinement at home and those who did not use (PNU) any home remote monitoring technology. Data was collected between June 2021 to April 2022. An individual interview with each participant using an adapted questionnaire was conducted by telephone or online using a teleconferencing platform. A micro-costing approach was undertaken using a dual patient and Quebec's health-care system perspective. 27 telemonitoring participants, 29 non-users, 8 clinicians, and 4 managers were included. Telemonitoring reduced the average total costs incurred by PU by 82% ($537.3CAD) between PU ($117.2CAD) and PNU ($654.5CAD). Telemonitoring enrollees used healthcare less intensely with fewer emergency room visits (1 PU compared to 6 PNU), which translated to an average savings of $253.3CAD per patient. This is the first study to demonstrate that telemonitoring through the Opal platform is a viable strategy to reduce healthcare costs and utilization for patients and the healthcare system. The evidence provides strong support for introducing telemonitoring as a component of case management.