Total Service Costs Research Articles

Direct and indirect costs of paediatric asthma in the UK: a cost analysis

ObjectiveTo estimate the cost of paediatric asthma from a UK National Health Service (NHS) and societal perspective and explore determinants of these costs.DesignCost analysis based on data from a large...

An Improved Equilibrium Optimizer for Solving Multi-quay Berth Allocation Problem

The multi-quay berth allocation problem (MQBAP) is an important problem in the planning of seaside operations (POSO) to find the best berthing solution for all the vessels. In this paper, an efficient method based on equilibrium optimizer (EO) is proposed for MQBAP. The dynamic multi-swarm strategy (DMS) is proposed to improve rapid decline problem in population diversity during the iterative process of EO, which is subsequently applied to MQBAP. In this paper, a certain improvement is also made on the original model of MQBAP by proposing an alternate quay selection mechanism, which aims to make the MQBAP model more complete. To verify the effectiveness of the proposed algorithm on MQBAP, this paper uses six test cases and seven comparative algorithms to verify it comprehensively from total service cost, berthing time, and berthing location. The results show that DEO achieved the smallest total service costs of 7584 and 19,889 on medium-scale, and 44,998, 38,899, and 57,626 on large-scale systems.

Impact of efficiency on affordability: A study of the Brazilian new water loss goals

ABSTRACT Infrastructure service affordability has become a burgeoning concern over the past years due to the recent economic crisis and the growing role of tariffs in funding the services. Pressure on utilities to promote social assistance programs in addition to an efficient service has risen toward providing water as affordable as possible. This study shows the positive impact of efficient services on families' water affordability by analyzing the new Brazilian water loss goals and the potential effect of water loss reduction on total expenses reported in the Brazilian utilities' National Water and Sanitation Information System. The total service cost for water and sanitation (before and after the aforementioned goals) was then translated to average tariff per cubic meter and affordability ratios. The potential water volume saved in physical losses can reach up to 16.6% of the water consumed in the country, and although the impact on water affordability was timid, the positive results indicate utilities have an important role in assuring water and sanitation for all, and regulators must be involved toward taking a deep look at local conditions.

Estimating the Costs of End-of-Life Care in Patients With Advanced Cancer From the Perspective of an Insurance Organization: A Cross-Sectional Study in Iran

ObjectivesCancers are significant medical conditions that contribute to the rising costs of healthcare systems and chronic diseases. This study aimed to estimate the average costs of medical services provided to patients with advanced cancers at the end of life (EOL). MethodsWe analyzed data from the Sata insurance claim database and the Health Information System of Baqiyatallah hospital in Iran. The study included all adult decedents who had advanced cancer without comorbidities, died between March 2020 and September 2020, and had a history of hospitalization in the hospital. We calculated the average total cost of healthcare services per patient during the EOL period, including both cancer-related and noncancer-related costs. ResultsA total of 220 patients met the inclusion criteria. The average duration of the EOL period for these patients was 178 days, with an average total cost of $8278 (SD $5698) for men and $9396 (SD $6593) for women. Cancer-related costs accounted for 64.42% of the total costs, including inpatient and outpatient services. Among these costs, hospitalization was the primary cost driver and had the greatest impact on EOL costs. This observation was supported by the multiple linear regression model, which suggested that hospitalization in the final days of life could potentially drive costs in these patients. Notably, no specialized palliative care was provided to the patients included in this study. ConclusionsThe results demonstrate that there is a significant rise in costs of care in patients receiving routine cancer care rather than optimized EOL care.

What is the Cost of Logistics Activities in Healthcare Businesses? A Case Study of a Medical Centre in Türkiye

Logistics holds an important role in healthcare provision. One of the significant dimensions of logistics is the cost incurred for these activities. However, the cost of logistics is an overlooked issue in most healthcare organisations. The purpose of this study is to provide an insight into the cost of logistic activities in healthcare businesses. A case study was conducted in a medical centre in Istanbul. Historical data (second half of 2021) were used for the analysis. Activity-based costing method was adopted for cost calculation. In line with this approach, logistic activities of the medical centre were examined, and logistic activity centres were determined. Resource consumption of each centre was determined based on interviews with staff and records of the accounting department. Consequently, the costs of all logistic activities of the medical centre were calculated, and their share in the total cost of service production was determined. The total logistical cost of the healthcare centre was calculated to be ₺689,983. The cost of patient services and transporting activity centres accounted for 49% of total logistical costs. The costs of logistic activities accounted for 15.42% of the total cost of service. The results of the study show that logistic activities have a significant share of the total cost of service production in the medical centre. Activity-based costing is an effective way of calculating costs of logistic activities in healthcare services. Managers can use cost data to improve logistic processes.

Trend in basic oral treatment needs in relation to taxation of sweets, ice cream, and sugar-sweetened beverages in Finland: a registry-based study.

The aims were to explore the trend in basic oral treatment needs and total operating cost of public dental services (PDS) in relation to total excise tax revenue generated from sugary products during 2011-2020 and to evaluate the impact of tax policy in excise tax revenue of sugary products and average sugar consumption. The study comprised longitudinal data retrieved from Finnish registries during the years 2011-2020. Basic oral treatment needs, and total operating cost of PDS, total excise tax revenue generated from sugary products and average sugar consumed (kg per capita) during the years 2011-2020 were obtained. Simplified panel analyses and sensitivity analyses were used to evaluate the effects of explanatory variables on outcomes. Results: An approximate one EUR 1,000,000 increase in total excise tax revenue generated from sugary products corresponds to a 0.4% increase in total operating cost of PDS. There was a significant positive trend in total operating cost of PDS in Finland over the study period. Similarly, an approximate one EUR 1,000,000 rise in total excise tax revenue corresponds to a 0.2% increase in basic oral treatment needs. Additionally, there was a statistically significant difference in the average excise tax revenue for sugary products between the periods before and after 2017. No change in average sugar consumption was observed despite implementing the new sugar policy. Therefore, it may be worthwhile to reconsider the excise tax on sweets and ice cream as it will significantly increase the total national revenues.

Cost Minimization of Digital Twin Placements in Mobile Edge Computing

In the past decades, explosive numbers of Internet of Things (IoT) devices (objects) have been connected to the Internet, which enable users to access, control, and monitor their surrounding phenomenons at anytime and anywhere. To provide seamless interactions between the cyber world and the real world, Digital twins (DTs) of objects (IoT devices) are key enablers for real time monitoring, behavior simulations and predictive decisions on objects. Compared to centralized cloud computing, mobile edge computing (MEC) has been envisioning as a promising paradigm for low latency IoT applications. Accelerating the usage of DTs in MEC networks will bring unprecedented benefits to diverse services, through the co-evolution between physical objects and their virtual DTs, and DT-assisted service provisioning has attracted increasing attention recently. In this paper, we consider novel DT placement and migration problems in an MEC network with the mobility assumption of objects and users, by jointly considering the freshness of DT data and the service cost of users requesting for DT data. To this end, we first propose an algorithm for the DT placement problem with the aim to minimize the sum of the DT update cost of objects and the total service cost of users requesting for DT data, through efficient DT placements and resource allocation to process user requests. We then devise an approximation algorithm with a provable approximation ratio for a special case of the DT placement problem when each user requests the DT data of only one object. Meanwhile, considering the mobility of users and objects, we devise an online, two-layer scheduling algorithm for DT migrations to further reduce the total service cost of users within a given finite time horizon. We finally evaluate the performance of the proposed algorithms through experimental simulations. The simulation results show that the proposed algorithms are promising.

A Randomized Controlled Trial of a Pay-for-Performance Initiative to Reduce Costs of Care for High-Need Psychiatric Patients.

Pay-for-performance (P4P) initiatives hold promise for improving health care delivery but are rarely applied to behavioral health or tested in randomized controlled trials (RCTs). This RCT examined the effectiveness of a P4P initiative to reduce total cost of 24-hour care among patients with high needs for psychiatric care in a large county in California. From August 2016 to March 2022, a total of 652 adult residents of Santa Clara County, California, were enrolled in a P4P initiative (mean±SD age=46.7±13.3 years, 61% male, 51% White, and 60% diagnosed as having a bipolar or psychotic disorder). Participants were randomly assigned to usual full-service partnerships from the county (N=327) or a comparable level of care from a contractor who agreed to a schedule of financial penalties and rewards based on whether enrollees (N=325) used more or less care than a historical cohort of similar county patients. The primary outcome was total cost of 24-hour psychiatric services. Secondary outcomes were costs of each of the 24-hour care services. The proportion of the total sample that used 24-hour psychiatric services decreased over the 36-month study period. Intent-to-treat analyses revealed no differences between the two study conditions in total care costs during the follow-up period. No significant care utilization differences were observed between the two conditions in most of the individual 24-hour services. A P4P initiative for high-need patients was no more effective than usual care for reducing costs of 24-hour psychiatric care.

RESEARCH AND MANAGEMENT OF THE PRICE POLICY IN THE FIELD OF MARKETING SERVICES OF THE ENTERPRISE USING MODERN INFORMATION TECHNOLOGIES IN THE CONDITIONS OF SUSTAINABLE DEVELOPMENT

The article determines that in modern conditions of a competitive market environment, effective management of price policy is a crucial aspect of strategic marketing of enterprises. Modern approaches to pricing management in marketing services using modern information technologies are considered. Data analysis, price modelling tools, and automated management systems are essential to optimise pricing strategies effectively. The importance of considering demand, the competitive situation on the market and the total cost of services when setting prices by the enterprise is proven. The influence of digital platforms and online channels on the formation of prices and consumer value of the final product is analysed. The need to develop pricing strategies has been identified to enhance competitiveness and meet the needs of the modern market for marketing services.

Economic and environmental benefits of automated electric vehicle ride-hailing services in New York City

A precise, scalable, and computationally efficient mathematical framework is proposed for region-wide autonomous electric vehicle (AEV) fleet management, sizing and infrastructure planning for urban ride-hailing services. A comprehensive techno-economic analysis in New York City is conducted not only to calculate the societal costs but also to quantify the environmental and health benefits resulting from reduced emissions. The results reveal that strategic fleet management can reduce fleet size and unnecessary cruising mileage by up to 40% and 70%, respectively. This alleviates traffic congestion, saves travel time, and further reduces fleet sizes. Besides, neither large-battery-size AEVs nor high-power charging infrastructure is necessary to achieve efficient service. This effectively alleviates financial and operational burdens on fleet operators and power systems. Moreover, the reduced travel time and emissions resulting from efficient fleet autonomy create an economic value that exceeds the total capital investment and operational costs of fleet services.

A two-step approach for deploying heterogeneous vessels and designing reliable schedule in liner shipping services

Schedule reliability is a crucial metric for measuring liner container shipping service. Due to the inherent uncertainties at sea and ports, schedule delays and unreliable on-time performance have long plagued shipping companies. In practice, the heterogeneity of container vessels also creates challenges for deployment and schedule optimization. To address the problem, we develop a two-step approach with two programming sub-models. In the first step, we tackle the challenges of ship deployment and scheduling by considering heterogeneous vessels and capturing the interarrival time between adjacent ports of call. In the second step, we use the conditional value-at-risk (CVaR) to address the uncertainty risk avoidance in schedule design. To solve the stochastic programming models, we employ a solution framework based on the outer linear approximation method and the risk measure method, where CVaR is specified as the risk measure. We illustrate the application of our model on a case study concerning a real route operated by COSCO Shipping Lines. The results show that the total cost of liner shipping service with heterogeneous fleet on the route can be reduce by 4.77% compared with homogeneous fleet. And the cost of risk with the reliable schedule can be decreased by 8.04% compared with the ideal schedule. The research conclusions can provide some useful decision-making references for shipping companies to deploy heterogeneous vessels and design reliable schedules.

Long-term catheter management in the community: a population-based analysis of user characteristics, service utilisation and costs in England.

Long-term urinary catheters are problematic and burdensome for patients, carers and health services. Nursing practice to improve the management of long-term urinary catheters has been held back by a lack of evidence to support policy and practice. Little is known about who uses a catheter long term and the resources and costs needed for their management. Understanding these costs will help to target innovations to improve care. There have been no substantial innovations to urinary catheters or their management recently and no publications to characterise users and costs. To describe long-term catheter users and explore catheter-related service use and costs in England. Descriptive information on the characteristics of catheter users and their use of services was obtained from: General Practice records (n = 607), district nursing records (n = 303), questionnaires to patients (n = 333) and triangulated, 2009-2012. Annual service costs (British pounds 2011) were computed. Most catheter users (59.6%) were men, nearly three-quarters (71.2%) were over 70 years and 60.8% used a urethral catheter. Women tended to be younger than men and more likely to use a suprapubic catheter. The services used most frequently over 12 months were general practitioner (by 63.1%) and out of hours services (43.0%); 15.5% accessed Accident and Emergency services for urgent catheter-related care. Hospital use accounted for nearly half (48.9%) of total health service costs (mainly due to inpatient stays by 13.6% of participants); catheter supplies/medications were next most costly (25.7%). Half of all costs were accounted for by 14.2% of users. The median annual cost of services used was £6.38, IQR: £344-£1324; district nursing services added approximately a further £200 per annum. Finding better ways to reduce catheter problems (e.g. blockage, infection) that cause unplanned visits, urgent or hospital care should be a priority to improve quality of life for long-term catheter users and reduce health service expenditure.

Investigation of hospitalization costs in orthopedics and traumatology clinic

The aim of the study was to analyze inpatient costs in the Orthopedics and Traumatology clinic of a public hospital. The hospitalizations in the Orthopedics and Traumatology clinic of the 525-bed AII group hospital in 2019, 2020 and 2021 were retrospectively evaluated. The study was planned as a cross-sectional descriptive study and data were obtained from the Hospital Management Information System. There were 27,330 inpatients in 2019, 18,604 in 2020 and 21,709 in 2021. The average number of days of hospitalization was 4.07 days in 2019, 2.99 days in 2020 and 2.34 days in 2021. The total annual inpatient cost of Orthopedics and Traumatology service was realized as 3,761,369.20 $ (21,326,963.36 TL) in 2019, 2,061,248.96 $ (14,428,742.72 TL) in 2020 and 1,231,753.09 $ (10,937,967.44 TL) in 2021. The average hospitalization cost of inpatients was 137.63 $ (780.36 TL) in 2019, 110.80 $ (775.60 TL) in 2020 and 56.71 $ (503.58 TL) in 2021. The decrease in total inpatient costs and average cost per patient over the years is a result of the Covid-19 pandemic. In calculating costs for cost control in hospitals, it is important to investigate the reasons for the change in costs over time as well as revealing the current situation. It is recommended to investigate the sources of changes in costs in future research.

AN INTEGRATED TRANSITIONAL CARE INTERVENTION IMPROVES PATIENT-REPORTED OUTCOMES IN OLDER ADULTS WITH STROKE

Abstract The transition between hospital and home is associated with significant challenges resulting in hospital readmissions and poor health outcomes. This study aimed to test, in real-world clinical practice, the effectiveness of a Transitional Care Stroke Intervention (TCSI) compared to usual care on patient-reported outcomes and health and social service use costs in older adults (> 55 years) with stroke and multimorbidity (> 2 chronic conditions). The TCSI was delivered virtually by an interprofessional (IP) team, and included care coordination/system navigation support, phone/video visits, monthly IP team conferences, and an online resource co-designed with patient partners to support self-management and system navigation. The primary outcome was risk of hospital readmission after six-months. Secondary outcomes included physical and mental functioning, stroke self-management, patient experience, and health and social service costs. Ninety participants were enrolled (44 intervention, 46 control); 11 (12%) participants were lost to follow-up, leaving 79 (39 intervention, 40 control). Differences favoring the intervention group were seen in physical functioning (SF-12 PCS mean difference: 5.10; 95% CI: 1.58-8.62, p=0.005), self-management (Southampton Stroke Self-Management Questionnaire mean difference: 6.00; 95% CI: 0.51—11.50, p=0.03), and patient experience (Person-Centred Coordinated Care Experiences Questionnaire mean difference: 2.64, 95% CI: 0.81, 4.47, p=0.005). No significant between-group differences were seen for baseline to six-month risk of hospital readmission or total health and social service costs. The TCSI produced greater gains in patient-reported physical health, self-management and experience compared with usual stroke care. These improvements were achieved without increasing total healthcare costs.

Calculation of the Cost of Training Medical Students in One of the AJA Universities of Medical Sciences Using Time-Driven Activity-Based Costing Method

Background: Estimating the total cost of services is crucial for utilizing available resources more efficiently and effectively. By employing the time-driven activity-based costing (TDABC) method, not only can costs be calculated, but also the efficiency and unused capacity of resources can be assessed. Objectives: This study aimed to calculate the cost of education for each medical student at one of the AJA Medical sciences Universities in 2022 using the TDABC method. Methods: This quantitative study was conducted cross-sectionally and retrospectively in a descriptive-analytical manner. The data were collected and analyzed through interviews and observations. To analyze and allocate costs, administrative and educational departments were categorized into three levels: Overhead, intermediate, and final activity centers. Then, using the TDABC approach in Microsoft Excel 2013 software costs from the overhead and intermediate activity centers to the final activity center and students. Results: The study estimated the average cost of educating each medical student to be approximately IRR 6 267 568 065. Additionally, the unused capacity of resources in overhead and intermediate centers was observed to be 30% (range: 4 - 44%) and 33% (range: 26 - 43%), respectively. Conclusions: The findings indicated that the cost per student is somewhat reasonable; however, there is a high level of unused capacity in the university and faculty activity centers. The effective management of human resources and equipment is necessary to enhance service delivery processes, increase productivity, and reduce unused capacity.

Developing Topics.

This study aims to detect direct cost savings with early detection of Alzheimer's disease (AD) and related dementias. We hypothesize that earlier diagnosis of AD can reduce direct healthcare costs and unnecessary utilization. A retrospective case-control study is conducted using Optum Market Clarity Claims/EHR linked dataset on Medicare Advantage population from Jan 1 2011 to Dec 31 2020. Based on whether the patient was diagnosed with prior Mild Cognitive Impairment (MCI) before progressing to an AD diagnosis per ICD-9/10 cm diagnosis codes, AD patients are categorized into early vs. late diagnosis (for those who were identified in the MCI stage vs not). Both groups are compared on annual all-cause healthcare costs and frequency of encounters longitudinally spanning across 6 years pre-index period and 3 years post-index with AD diagnosis date as the index date. To understand the impact of early diagnosis, we estimated total cost, medical service cost and drug cost post-index within the first 3 years by risk adjustment on baseline demographics, comorbidities, procedures, lab tests, and visits prior to AD diagnosis using propensity score weighting. Early-diagnosed patients (N = 421) have a lower utilization rate of inpatient skilled nursing facility, nursing home and hospitalization than late-diagnosed patients (N = 2817) after being diagnosed with AD. We also observed average medical service cost savings in all 3 years post-index, ranging from $320 to $2556 per patient per year. Per cost allocation analysis, medical service cost savings are observed in inpatient, emergency room, inpatient SNF, urgent care, nursing home/assisted living, and observation unit. Risk adjusted cost savings with statistical significance are observed in year 3 post-index. The mean cost difference between late and early diagnoses: total cost ($15472.11), medical service ($15013.7) and medication cost ($1601.61). The study highlights opportunities for earlier diagnosis and suggests long-term healthcare savings for AD patients who have been diagnosed at MCI stage compared to patients who were directly diagnosed with AD. Further research is needed to drill down into the driver of cost savings and whether it is attributable to disease management of MCI or other complications.

Cohort study to characterise surgical site infections after open surgery in the UK’s National Health Service

ObjectiveTo characterise surgical site infections (SSIs) after open surgery in the UK’s National Health Service.DesignRetrospective cohort analysis of electronic records of patients from Clinical Practice Research Datalink, linked with Hospital...

Examining the Relationship Between Screening for Postpartum Depression and Associated Child Health Service Utilization and Costs: A Study Using the All Our Families Cohort and Administrative Data

IntroductionDespite a recognized association between maternal postpartum depression (PPD) and adverse child health outcomes, evidence examining the relationship between PPD symptoms and associated child health service utilization and costs remains unclear. In addition, there is a paucity of evidence describing the relationship between early identification of maternal PPD and associated health service utilization and costs for children. This study aims to address this gap by describing the secondary associations of screening for maternal PPD and annual health service utilization and costs for children over their first five years of life.MethodsMothers and children enrolled in the prospective All Our Families cohort were linked to provincial administrative data in Alberta, Canada. Multivariable generalized linear models were used to estimate the average annual inpatient, outpatient, physician, and total health service utilization and costs from a public health system perspective for children of mothers screened high risk for PPD, low/moderate risk for PPD, or unscreened.ResultsTotal mean costs were greatest for children during their first year of life than other years. Those whose mothers were not screened had significantly lower costs compared to those whose mothers were screened low/moderate risk, despite equivalent health service utilization.DiscussionFindings from this study describe the secondary associations of screening for maternal PPD using a public health system perspective. More research is required to fully understand variations in health costs for children across maternal PPD screening categories.

NATIONWIDE DEMOGRAPHIC DISPARITIES IN UNITED STATES EMERGENCY DEPARTMENT VISITS IN PATIENTS WITH RHEGMATOGENOUS RETINAL DETACHMENT.

Within the evolving landscape of healthcare in the United States (US), delineating the demographic nuances and financial implications of emergent conditions, such as rhegmatogenous retinal detachment (RRD), is paramount. This study seeks to analyze the demographic and hospital billing amount/cost of service disparities in RRD visits to emergency departments (EDs) nationwide. We conducted a retrospective, cross-sectional, population-based study using International Classification of Diseases, 10th revision , and Current Procedural Terminology codes in the 2016 to 2019 Nationwide Emergency Department Sample databases to identify RRD visits. The analysis included demographics, hospital billing amount, and cost of service of RRD ED management. A total of 12,492 RRD encounters were identified with men constituting 64% and a prominent age group being 50 to 64 years (49.3%). Most patients (90%) were managed in metropolitan teaching hospitals, predominantly in the southern U.S. region (56.1%). Private insurance covered 45% of patients. Same-day RRD repair odds increased in November and December. Whites had a higher likelihood for same-day treatment. Hospital billing amount rose from $23,600 in 2016 to $30,354 in 2019, with stable mean total cost of service. Rhegmatogenous retinal detachment ED visit incidence did not show seasonal variation ( P = 0.819). Most patients with RRD in U.S, EDs were middle-aged men, with Whites more likely to receive same-day repair. There was no sex bias observed in same-day repair decision-making. Although hospital billing amount increased over the study period, total cost of service remained stable. The incidence of RRD ED visits showed no seasonal variation.

Budesonide/formoterol maintenance and reliever therapy in childhood asthma: Real-world effectiveness and economic assessment.

The study aims to compare the real-world effectiveness and economy of the budesonide/formoterol reliever and maintenance therapy (SMART) with fixed-dose inhaled corticosteroids (ICS)/long-acting b-agonist (LABA) or ICS alone plus as-needed, short-acting β2 agonists (SABA) in pediatric patients. The outpatient data warehouse of a hospital in China was used. A total of 103 patients under 18 years old in the SMART group and 63 patients in the control group were included from January1, 2020 to December 31, 2021. The effectiveness was assessed using asthma attacks and lung function at baseline, 6 months and 12 months follow-up. Cost-effectiveness analysis was performed with a three-state Markov model from the healthcare system perspective. One-way sensitivity analyses and probabilistic sensitivity analyses were performed to check the robustness of the results. The SMART regimen was more effective than other strategies in reducing the risk of mild and severe attacks in the real-life management of childhood asthma. Patients in both groups showed significant improvement in lung function at 6 and 12 months in contrast to baseline. Compared with other strategies, the forced expiratory volume in 1 s (FEV1 ) level in the SMART group was markedly improved at 6 months. The total cost of outpatient service using the SMART regimen was lower than that of other strategies, while the drug costs were similar in different groups. Incremental cost-effectiveness analysis results showed that using the SMART regimen reduced the total cost by approximately CNY 10,516.11 per year with a 0.12 quality-adjusted life year (QALYs) increase. Sensitive analyses supported that the SMART regimen was the dominant choice at the willingness-to-pay threshold of CNY 85,698, per capita GDP in China. Collectively, our findings indicate that the real-world effectiveness and economy of the SMART regimen are superior to the traditional strategies in pediatric asthma patients.