Total Treatment Costs Research Articles

. Comparison of Denosumab versus Zoledronic acid on serum bone alkaline phosphatase (BAP), total procollagen type 1 amino-terminal propeptide (TP1NP), bone gamma carboxy-glutamic acid containing proteins (BGP), and β isomer of C-terminal telopeptide of ty

Background/aim: To compare the efficacy of Denosumab (DEN) versus Zoledronic acid (ZOL) in treating patients with osteoporotic vertebral compression fractures (OVCF) after percutaneous kyphoplasty (PKP). Materials and methods:In this study, 128 OVCF patients who underwent PKP in our hospital from June 2020 to August 2023 were selected and randomized into a DEN group treated with DEN and a ZOL group treated with ZOL. Bone mineral density (BMD), bone metabolism, pain, and lumbar mobility were compared between the two groups before and after treatment, and the anterior vertebral height and local kyphotic angle were measured. Finally, the one-year re-fracture rate and treatment cost were counted. Results: The two groups showed no notable difference in pain, lumbar mobility, anterior vertebral height, and local kyphotic angle after treatment (P>0.05). BMD was higher in DEN group at 6 and 12 months after treatment, while β isomer of C-terminal telopeptide of type I collagen (β-CTX) was lower (P<0.05). No statistical inter-group difference was identified in the one-year re-fracture rate (P>0.05), while the total treatment cost was lower in DEN group compared with ZOL group (P<0.05). Conclusions: Both DEN and ZOL is effective in improving the prognosis of OVCF patients after PKP, but DEN can more significantly improve BMD and bone metabolism with higher economic benefits.

Impact of a virtual antenatal intervention for improved diet and iron intake in Kapilvastu district, Nepal - the VALID randomized controlled trial

IntroductionCounseling, together with iron and folic acid supplements, can improve hemoglobin levels in pregnant women, but few interventions have tested a virtual method of delivering counseling. We hypothesized that a virtual counseling intervention delivered via a mobile device (mHealth) would prevent and treat anemia, compared with routine antenatal care (ANC).MethodsVirtual antenatal intervention for improved diet and iron intake (VALID) was a non-blinded parallel group two-arm, individually randomized superiority trial (1:1 allocation). Participants were pregnant women who were married, aged 13–49 years, able to answer questions, 12–28 weeks’ gestation and living in Kapilvastu district, Nepal. Women were randomized to receive routine ANC (control arm), or ANC plus a virtual antenatal intervention of two problem-solving counseling sessions via video call. The primary outcome was iron folic acid (IFA) tablet compliance (consumption on 12 or more days of the previous 14 days). Secondary outcomes were dietary diversity, promoted food consumption, iron bioavailability enhancement, and knowledge of iron-rich foods. Primary logistic regression analysis was by intention-to-treat, adjusting for baseline values.ResultsWe enrolled 319 pregnant women (161 control, 158 intervention) from 23 January 2022 to 6 May 2022 and analyzed outcomes in 144 control and 127 intervention women. Compliance with IFA increased in both arms. In the intervention arm, compliance increased by 29.7 percentage points (pp) (49.0–78.7%) and 19.8 pp. in the control arm (53.8–73.6%). Despite the more significant increase in the intervention arm, we found no intervention effect upon IFA compliance (adjusted odds ratio [aOR] 1.33; 95% confidence interval [CI]: 0.75, 2.35; p = 0.334), dietary diversity, or ANC visits. The intervention increased knowledge of iron-rich foods (coefficient 0.96; 95% CI: 0.50, 1.41; p < 0.001), consumption of promoted foods (aOR: 1.81; 95% CI: 1.08, 3.02; p = 0.023), behavior to enhance iron bioavailability (aOR: 4.41; 95% CI: 1.23, 15.83; p = 0.023), and coronavirus disease 2019 (COVID-19) knowledge (aOR: 4.06; 95% CI: 1.56, 10.54; p = 0.004). The total intervention cost was US$35,193, and the cost per pregnant woman receiving two virtual counseling sessions was US$277.ConclusionVirtual counseling can improve antenatal health behaviors, such as the consumption of promoted foods and methods to enhance bioavailability. Improved IFA consumption and ANC attendance may require additional family/community support.Clinical trial registrationhttps://www.isrctn.com/ISRCTN17842200, identifier ISRCTN17842200.

Microplastics removal from a hospital laundry wastewater combining ceramic membranes and a photocatalytic membrane reactor: Fouling mitigation, water reuse, and cost estimation

The release of microplastics (MPs) through industrial laundry wastewater accounts for 35 % of global MPs emissions into the environment and it is a significant environmental problem, especially because MPs can absorb contaminants of emerging concern (CECs) from garments. This study is the first to evaluate and perform a cost estimation of the MP removal from hospital laundry wastewater (HLWW) using a combination of ceramic membranes and a pilot-scale photocatalytic membrane reactor (PMR) as a fouling mitigation strategy. The HLWW, from a hospital in Copenhagen, Denmark, contained a total organic carbon (TOC) of 345 mg L⁻1 and 1.4 × 106 MP L−1, mainly of polyethylene terephthalate (PET) ranging between 100 and 200 μm in size. The pre-treatment with an ultrafiltration (UF) ZrO₂ membrane successfully removed 96 % of MPs and over 98 % of suspended solids and turbidity at an estimated cost of 0.45 US$ per m3 of permeate. In the PMR stage, ultraviolet light emitting diodes (UV LED) irradiation reduced irreversible fouling, improving permeate flow and minimizing the need for chemical cleaning. The Ce–Y–ZrO2/TiO2 photocatalytic membrane achieved over 99 % removal of turbidity, colour, and suspended solids, as well as 99.9 % removal of MPs, allowing the potential effluent reuse within the hospital laundry. Additionally, the retentate from the PMR process had lower TOC, easing the discharge of this concentrated stream. The cost estimation demonstrated that the photocatalytic degradation combined with traditional techniques, i.e. backflush and chemical cleaning, is more economical than using these techniques separately. Therefore, the total treatment cost was 1.09 US$ per m3 of permeate, which is lower than the cost of fresh water in Denmark. In conclusion, this innovative treatment strategy offers a sustainable and cost-effective solution for HLWW management, not only reducing water consumption by enabling water reuse in the hospital laundry but also advances towards achieving net-zero liquid discharge and contributing to the UN Sustainable Development Goals for clean water (Goal 6) and climate action (Goal 13).

Out-of-pocket payment and catastrophic health expenditure of tuberculosis patients in accessing care at public-private mix clinics in Myanmar, 2022

BackgroundThe financial burden of tuberculosis (TB) can hinder patients and their families, creating obstacles throughout the care cascade, despite TB prevention and control being provided free of charge. In Myanmar, patients can visit private providers operating under public-private mix (PPM) schemes, where TB services (diagnosis and treatment) are typically offered at no cost. The study focused on quantifying the financial burden faced by TB patients seeking care from Myanmar's PPM providers.MethodsThis cross-sectional telephone survey included 695 adults seeking TB treatment [drug-susceptible TB (DS-TB) and retreatment TB] from various private providers in four states and regions with high TB burden in Myanmar. Telephone interviews were conducted in May and June 2022. Both direct and indirect costs incurred from the patient and their household perspective were valued in 2022 and estimated throughout pre- and post-TB treatment episodes. The TB-affected households were defined as experiencing catastrophic health expenditure if their expenditure due to TB exceeded 20% of their capacity to pay, as recommended by the World Health Organization. All cost data were collected in Myanmar Kyats (MMK) and converted to USD (1 USD = 1850 MMK as of July 20, 2022). Logistic regression analysis was done to identify the determinants of catastrophic health expenditure.ResultsThe findings showed patients made a median of 7 times for clinic visits throughout their treatment, with the median total cost for the entire TB treatment being 53.4 US dollars (USD), including direct medical and testing costs (11.9 USD) and direct non-medical patient expenditure (11.6 USD). Pre-treatment costs were higher compared to post-treatment costs (the intensive phase and continuation phase). During the intensive phase, TB care cost was nearly free, but during the continuation phase, it was a median of 2.6 USD. About 34.5% of patients experienced catastrophic health expenditure due to TB treatment, with expenses exceeding 20% of their capacity to pay. Multivariate regression analysis revealed that patients with a history of hospitalization (aOR = 14.84; P < 0.01), seeking care from regions other than Yangon (aOR = 2.6; P < 0.01), and using coping strategies (aOR = 12.53; P < 0.01), were more likely to face catastrophic financial burdens. Higher monthly household income (over 162 USD) was associated with a decreased risk of incurring catastrophic health expenditure (aOR = 0.38; P < 0.01).ConclusionsTB patients and their households in Myanmar faced risk of catastrophic costs, even when treated in the private sector with free diagnostic charges and anti-TB medicine. The study highlighted the need for additional strategies or policies to make TB care affordable and mitigate the financial burden of TB-affected households.Graphical

A cost-utility analysis of single maintenance and reliever (SMART) therapy as compared to step 3 fixed-dose therapy in patients aged 12 years or more with uncontrolled asthma.

A significant percentage of patients with asthma appear to benefit from the addition of long-acting β2-agonists (LABAs) to ICS to achieve better control of their disease. The aim of the present study was to determine the cost-utility of single inhaler combination inhaled ICS/LABAs as both maintenance and reliever (SMART) versus remaining at the same treatment step with fixed-dose ICS-LABA maintenance with a short-acting β2-agonist (SABA) as reliever in patients aged 12 years or more with uncontrolled asthma. A Markov-type model was developed to estimate the costs and health outcomes of a simulated cohort of patients aged 12 years or more with uncontrolled asthma treated for 12 months. The effectiveness data and transition probabilities were obtained from a recent meta-analysis. Cost data were obtained from official databases provided by the Colombian Ministry of Health. The main outcome was the variable "quality-adjusted life-years" (QALYs). The base-case analysis showed that compared with remaining at the same GINA treatment step with ICS/LABA maintenance plus SABA reliever, ICS/LABAs as SMART was associated with lower costs, US$2,906.92 versus $4,462.02 average cost per patient, and the greatest gain in QALYs, 0.8540 versus 0.8258 QALYs on average per patient, thus leading to dominance. Compared with remaining at the same GINA treatment step with ICS/LABA maintenance plus SABA reliever, ICS/LABAs as SMART is more cost-effective in patients aged 12 years or more with uncontrolled asthma. This is because ICS/LABAs as SMART showed a greater gain in QALYs at lower total treatment costs.

Evaluation of a risk-sharing agreement for atezolizumab treatment in patients with non-small cell lung cancer: a strategy to improve access in low-income countries.

Using immune checkpoint inhibitors (IO) is a promising approach to maximize clinical benefits for patients with non-small cell lung cancer (NSCLC). PD-L1 expression serves as a predictive factor for treatment outcomes with IO. However, the high cost of this treatment creates significant barriers to access. Substantial evidence demonstrates the sustained clinical benefits experienced by patients who respond to immunotherapy. While IOs show promise in NSCLC treatment, their high cost poses access barriers. This study focused on a prospective cost analysis conducted at a high-specialty health facility to assess the economic implications of implementing a risk-sharing agreement (RSA) for atezolizumab in NSCLC. The study included 30 patients with advanced NSCLC, with the pharmaceutical company funding the initial cycles. If patients responded, a government program covered costs until disease progression. A median progression-free survival of 4.67 months across populations, rising to 9.4 months for responders. The 2-year overall survival rate for the response group was 64%, significantly higher than for non-response. Without an RSA, a total treatment cost of $881 859.36 ($29 395.31/patient) was reported, compared to $530 467.12 ($17 682.24/patient) with an RSA, representing a 40% cost reduction. In responders, the average cost per year of life per patient dropped by 22%. Risk-sharing, assessed through non-parametric tests, showed a statistically significant difference in pharmacological costs (P < .001). Implementing RSAs can optimize resource allocation, making IO treatment more accessible, especially in low-income countries.

Economic burden of vulvar, vaginal, anal, penile and head &amp;amp; neck cancers in Bulgaria

A retrospective, cost-of-illness study aimed at identifying direct healthcare costs of vulvar, vaginal, anal, penile, and H&amp;N cancers in Bulgaria from the payer perspective and calculating indirect costs and the associated years of life lost was carried out. Costs’ data were obtained from the National Health Insurance Fund from January 2018 to December 2020. Years of life lost were calculated based on the country and gender-specific life expectancy. The human capital approach was used to evaluate the indirect costs. The total treatment costs for 3623 patients were EUR 10,875,771 (2018), EUR 11,922,521 (2019) and EUR 12,329,463 (2020). The costs associated with radiotherapy and drug acquisition and administration accounted for the majority (75–78%) of total healthcare costs. A cumulative loss of approximately 33,299 life years occurred between 2018 and 2020. The costs of productivity losses were estimated at EUR 14,113,265.

Integrated Care in a Large Public System Improves Simple Kidney Stone Management.

In the Los Angeles County Department of Health Services-the second largest public health care system in the United States-clinical integration allows specialists and primary care providers to collaboratively provide specialty care. We used time-driven activity-based costing to compare patient burden and cost of kidney stone diagnosis, workup, and management with and without clinical integration. We interviewed and observed teams of physicians and staff to understand workflow practices and personnel, space, material, and device requirements for stone care in the 2 models. We created process maps that outline the entire arc of care and used time-driven activity-based costing to calculate the all-inclusive costs of kidney stone diagnosis, workup, and scheduling for surgical treatment. The total cost of kidney stone treatment per stone episode in the integrated pathway was $499.04, compared with $699.81 in the traditional, nonintegrated pathway, a difference of 29%. The number of steps needed to arrive at operating room scheduling was 11 with integration and 14 without it. Clinical integration resulted in more efficient and cost-effective care from patient, provider, and health system perspectives. Integrated care may improve access to specialty care and increase the value of care and reduce treatment burden on patients.

Cost-effectiveness of expanding national health insurance coverage for composite resin restorations in cancer patients in South Korea

ObjectivesCancer patients often have compromised oral health, making them vulnerable to severe dental caries and restoration failures. Due to the nature of cervical or anterior caries in cancer patients, the use of adequate restorative materials is important. However, public dental insurance coverage for composite treatments varies among countries and only glass ionomer cements (GICs) are covered in all age groups in South Korea. This study examined the cost-effectiveness of expanding national health insurance coverage to include resin composite (RC) restorations as compared with GIC in cancer patients. MethodsData from cancer patients who received direct restoration using GIC were identified from the National Health Screening Cohort. The relative effect of RC compared to GIC was determined through a meta-analysis, which was then utilized in calculating corresponding transition probabilities within a multi-state model. A Markov-chain Monte Carlo microsimulation was performed to estimate useful life-years and total treatment costs at the tooth level. The incremental cost-effectiveness ratio (ICER) of RC versus GIC was calculated, considering scenarios with and without expanded national health insurance coverage. The robustness of the results was confirmed through various sensitivity analyses. ResultsBetween the two materials, RC resulted in a 0.4-year longer useful life. From a limited societal perspective, it cost $9.6 less with expanded coverage but $24.3 more without expansion, resulting in an ICER of -$25.2 and $63.9 per tooth-year, respectively. From a patient's perspective, the ICER values were -$72.7 versus $138.8 per tooth-year, respectively, translating into $200 more in savings with the expansion. Various sensitivity analyses consistently demonstrated a smaller ICER when insurance coverage was expanded. ConclusionsThe expansion of national health insurance coverage to include RC restorations for cancer patients appears to be clearly cost-effective. This emphasizes the need for further policy considerations to ensure access to dental care for cancer patients. Clinical SignificanceTimely management of dental caries is crucial for cancer patients, as untreated caries can escalate into severe oral conditions, negatively impacting treatment outcomes and increasing care costs. Expanding a national health insurance coverage for cancer patients in the treatment of early dental lesions is necessary to prevent advanced dental diseases.

Secukinumab (Cosentyx)

It is recommended that Cosentyx be reimbursed by public drug plans for the treatment of adult patients with moderate to severe hidradenitis suppurativa (HS) (acne inversa) who have responded inadequately to conventional systemic HS therapy only if certain conditions are met. Cosentyx should only be covered to treat patients who have moderate to severe HS (Hurley stage II or III), a total abscess and nodule count of 5 or greater, and lesions in at least 2 separate areas of the body. Additionally, these are patients whose HS did not adequately respond to conventional therapy. Cosentyx should only be reimbursed if prescribed by a physician experienced in the management of HS but should not be reimbursed if used in combination with other biologic therapies for HS. Cosentyx should be reimbursed for ongoing treatment if there is improvement in HS after starting treatment with Cosentyx. The price of Cosentyx should be negotiated so that its total drug cost does not exceed the total drug cost of treatment with the lowest-cost adalimumab.

Vaccination subsidy allocation under budget constraints considering the human interpersonal contact pattern and vaccine protection effect in epidemics

Vaccination subsidy is one of the most important measures to increase the willingness of people to be vaccinated for epidemic prevention and control. Given the budget constraint of vaccination subsidy and the different roles of various age groups population in the epidemic transmission process, a novel approach is proposed to optimize the utilization of the limited vaccination subsidy budget. First, an age-structured SIR model that integrates the human interpersonal contact pattern and vaccine protection effect is developed to simulate the epidemic trend under a certain vaccination state. Then, a decision model is constructed to determine the optimal vaccination subsidy allocation scheme for various age groups based on the age-structured SIR model. A case study of Wuhan City is used to verify the decision approach, and a series of sensitivity analyses are conducted. The result shows that the peak time of an epidemic is positively related to the total treatment cost for all the infections, and more subsidies should be allocated to the populations with higher interpersonal contact frequencies for epidemic prevention and control.

Single inhaler combination inhaled corticosteroid–formoterol as both maintenance and reliever (SMART) compared with a step up of treatment with fixed-dose inhaled corticosteroid–long-acting β2-agonist maintenance with a short-acting β2-agonist as reliever in adolescents and adults with poorly controlled asthma in Colombia: a cost-utility analysis

Objective The aim of the present study was to determine the cost-utility of single inhaler combination inhaled corticosteroid and a long-acting β2-agonist (ICS/LABAs) as both maintenance and reliever (SMART) compared with a step-up maintenance treatment with a fixed medium to high dose of ICS combined with LABA and a short-acting β2-agonist (SABA) as reliever (ICS-LABA maintenance plus SABA) among patients aged 12 years or more with poorly controlled asthma in Colombia. Methods A Markov-type model was developed to estimate the costs and health outcomes of a simulated cohort of patients aged 12 years or more with uncontrolled asthma treated for 12 months. The main effectiveness data were obtained from a recent meta-analysis. The main outcome was the variable ‘‘quality-adjusted life-years’’ (QALYs). Results The base-case analysis showed that the budesonide/formoterol (BUD/FORM) SMART strategy was associated with lower overall treatment costs (US $3,062.37 vs. $4,462.02 average cost per patient over 12 months) and the greatest gain in QALYs (0.8511 vs. 0.8258 QALYs on average per patient over 12 months) compared with ICS-LABA maintenance plus SABA at step 4, thus leading to dominance. Conclusions In patients aged 12 years or more with uncontrolled asthma at GINA step 3 or 4, the BUD/FORM SMART strategy at either step 3 or 4 is cost-effective compared with the ICS-LABA maintenance plus SABA at step 4 strategy, because it shows a greater gain in QALYs at lower total treatment costs.

Environmental and economic impact assessment of hydrophobic treatment of cotton using low-pressure-low-temperature plasma

The purpose of this paper is to compare the environmental impact, using Life Cycle Assessment, and the total cost of two hydrophobic fluorocarbon treatment methods: a novel plasma surface modification technique and a traditional pad-dry-curing treatment of fabric. These two techniques have been chosen as two alternatives, with the pad-dry curing being a traditional liquid-based treatment and the plasma treatment a novel gas-based treatment. Such a comparison is a novel effort and will provide to the relevant industrial stakeholders an indication about the sustainability and the financial viability of the plasma treatment technique in comparison to the current state-of-the-art.The Life Cycle Inventory for both techniques has been compiled based on experiments performed at the Technical Textiles Research Centre, using lab scale equipment. The environmental impact has been assessed using the Environmental Footprint 3.0 method and is expressed in micro ecopoints (μPt). The findings have revealed that for plasma treatment (duration of 5 min using 13 cm3/min of C2F6), the environmental footprint is 47% lower than the conventional pad-dry-curing (8.95 μPt per 10 g of treated cotton compared to 18.9 μPt) and the total treatment cost is 81% lower (£1.03 per 10 g of treated cotton compared to £5.47 using pad-dry-curing). The most significant contributor to the environmental performance of the plasma treatment is the electricity consumption, thus a minimization of the treatment time without losing the functionality of the process, and the subsequent operating expenses, will lead to the optimal plasma treatment conditions.

Clinical Outcomes of Continuation and Maintenance Electroconvulsive Therapy

Large-scale evidence for the efficacy of continuation and maintenance electroconvulsive therapy (c/mECT) is lacking. To provide an exhaustive and naturalistic insight into the real-world outcomes and the cost-effectiveness of c/mECT in a large dataset. This cohort study included all patients in the Danish National Patient Registry who initiated treatment with ECT from 2003 through 2022. The data were analyzed from October 2023 to February 2024. ECT. An algorithm to identify c/mECTs in the dataset was developed: (>3 treatments with ≥7 and <90 days between adjacent treatments, occurring within a time frame of 180 days [cECT] or more [mECT] after an acute [aECT] series). The association of c/mECT with subsequent 6- to 12-month risk of hospitalization or suicidal behavior using Cox proportional hazard regression with multiple adjustments and aECT only as a reference, propensity score matching, and self-controlled case series analysis using a Poisson regression model. A cost-effectiveness analysis based on hospitalization and ECT expenses was made. A total of 19 944 individuals were treated with ECT (12 157 women [61%], 7787 men [39%]; median [IQR] age, 55 [41-70] years). Of these, 1533 individuals (7.7%) received c/mECT at any time point (1017 [5.1%] cECT only and 516 [2.6%] mECT). Compared with patients receiving aECT only, c/mECT patients more frequently experienced schizophrenia (odds ratio [OR], 2.14; 95% CI, 1.86-2.46) and schizoaffective disorder (OR, 2.42; 95% CI, 1.90-3.09) and less frequently unipolar depression (OR, 0.56; 95% CI, 0.51-0.62). In all models, c/mECT was associated with a lower rate of hospitalization after finishing aECT (eg, 6-month adjusted hazard ratio, 0.68; 95% CI, 0.60-0.78 [Cox regression]; 6-month incidence rate ratio, 0.51; 95% CI, 0.41-0.62 [Poisson regression]). There was no significant difference in the risk of suicidal behavior. Compared with the periods before the end of aECT, c/mECT was associated with a substantial reduction in total treatment costs. In a nationwide and naturalistic setting, c/mECT after aECT was infrequently used but associated with a lower risk of readmission than aECT alone. The totality of the evidence indicates that c/mECT should be considered more often to prevent relapse after successful aECT in patients whose condition does not respond sufficiently to other interventions.

Estimating the Economically Justifiable Price of Limited-Duration Treatment with Donanemab for Early Symptomatic Alzheimer's Disease in the United States.

The goal of this economic model is to estimate an economically justifiable price (EJP) for using donanemab for the treatment of early symptomatic Alzheimer's disease (AD) in the United States based on clinical data from the phase 3 TRAILBLAZER-ALZ 2 trial (NCT04437511). We adapted an AD Markov state-transition model developed by the Institute for Clinical and Economic Review to estimate the EJP for donanemab at different willingness-to-pay (WTP) thresholds from the health care system perspective and the societal perspective as co-base cases. Assuming a WTP threshold of $150,000 per quality-adjusted life-year (QALY) gained, the model estimates a 1-year (13-dose) EJP for donanemab of $80,538 from the health care system perspective and $91,126 from the societal perspective; at a WTP threshold of $100,000 per QALY gained, the model estimates a 1-year (13-dose) EJP for donanemab of $44,691 from the health care system perspective and $55,419 from the societal perspective. Mean total treatment costs per patient at the $150,000 per QALY gained EJP derived from the health care system perspective were estimated at $77,812 based on the average number of doses of donanemab patients received in the co-base case analysis. One-way sensitivity analysis (OWSA) indicated that treatment efficacy, disease severity at the time of treatment initiation, and duration of treatment effect were the main drivers of the potential EJP. Results from this modeling simulation informed by the TRAILBLAZER-ALZ 2 study support an EJP for limited-duration treatment with donanemab that exceeds per-dose list prices for currently available amyloid-targeting therapies, implying potentially lower lifetime costs and better value for money.

Effect of Da Vinci robotic transanal minimally invasive surgery for rectal neoplasms

Objective: To investigate the efficacy of Da Vinci robotic transanal minimally invasive surgery (R-TAMIS) for rectal neoplasms. Methods: The patients of rectal neoplasms who underwent R-TAMIS and were regularly followed up at the First Medical Center of Chinese PLA General Hospital from January 2021 to January 2024 were retropectively selected. Follow-up visits were conducted at 1, 2, and 4 weeks postoperatively, and then every 3 months until January 20, 2024. The perioperative situation, postoperative histopathological results, and follow-up status of the patients were observed. Results: A total of 17 patients were included, including 10 males and 7 females, aged 35-80 (59±13) years. Eleven patients underwent surgery using the da Vinci® Si robot, while 6 patients underwent surgery using the da Vinci® Xi robot. The height of the resected tumor from the anal verge [M (Q1, Q3)] was 3.5 (3.0, 3.8) cm. The total operative time was 55.0 (50.0, 55.0) minutes, the platform installation time was 32.5 (30.0, 35.0) minutes. The actual surgical operation time was 22.5 (20.0, 27.5) minutes. Intraoperative blood loss was 9.2 (5.0, 10.0) ml. The postoperative hospital stay was 3.2 (3.0, 3.8) days. The total treatment cost was (29 447±4 765) yuan. Two patients who achieved clinical complete remission after neoadjuvant chemoradiotherapy experienced incision dehiscence one week postoperatively, which was resolved after four weeks of rectal irrigation therapy. All surgical specimens were intact, and all resection margins were negative. A total of 44(31,73) weeks were followed up, without local recurrence or distant metastasis. Conclusion: Da Vinci robotic transanal minimally invasive local resection may be a safe and feasible treatment option for rectal neoplasms.

An Economic Cost Analysis of Implementing a Frailty Care Bundle to Reduce Risk of Hospital Associated Decline Among Older Patients.

To conduct an economic cost analysis and budget impact assessment (BIA) of implementing the Frailty Care Bundle (FCB) intervention nationally over five-years for hip fracture patients. The FCB was designed to reduce hospital associated decline in older hospitalised patients. The FCB was delivered in two Irish hospitals on two wards per hospital. A micro level cost analysis, from the Irish health service perspective was undertaken. Direct costs of the FCB were considered (personnel, training, resources), expressed in Euros (2020). For the BIA national population estimates for hip fracture and costs avoided were based on 18% difference in patients returning to their baseline capability in the post compared to pre-intervention group, valued using cost estimates of functional decline. We estimated total intervention costs at €53,619 (89% for personnel) and the average cost per patient was €156.03. The expected costs of implementing the FCB nationally over 12-months was €57,274 per hospital (€72.92 per patient). The BIA for an expected targeted population (16,000 over 5 years), estimated that the cost of implementing the FCB (€1.2m) was less than the expected value of functional decline avoided owing to the intervention (€3.6m), suggesting a positive net effect (€2.4m). Investment in the FCB can be offset with more rapid patient return to baseline functional capability, reducing health care costs. Trial and Protocol Registration (retrospective): BMC ISRCTN 15145850, (https://doi.org/10.1186/ISRCTN15145850).

Efficient hydrogen peroxide synthesis with Pluggable Capsule cathode for Electro-Fenton treating actual landfill leachate

Membrane concentrate of landfill leachate is the typical refractory wastewater with high contaminants concentration, high complexity, and high toxicity, posing a huge potential threat to the surface and subsurface water. Electro-Fenton (EF) based on in-situ synthesis of H2O2 is an effective method for the treatment of refractory organic pollutants. However, the low accumulative concentration of H2O2 and the poor scalability of the system remain major bottlenecks, limiting the practical application of EF. This study presented a modular air-breathing cathode, Pluggable Capsule Cathode (PCC), for efficient in-situ H2O2 synthesis through 2-electron oxygen reduction reaction (ORR). Based on PCC, corridor reactors (CR) were fabricated for in-situ H2O2 synthesis and actual landfill leachate treatment. Operated under the optimal conditions (dual-chamber, A/V=240 cm2 L−1, 2 M NaOH electrolytes and J=20 mA cm−2), the H2O2 concentration reached 28.1 g/L. In the EF system based on single-chamber CR equipped with PCCs, 81 % of COD and 89 % of NH3-N in landfill leachate were removed within 3 h. The total cost of landfill leachate treatment by the EF system based on CR-PCC was calculated as $ 5.06 m−3. The PCC based EF system was a promising process for the treatment of actual refractory wastewater, which provides a new insight for the structure design of cathode and reactor in the future.

Degradation of Procion Golden Yellow H-R Dye Using Ultrasound Combined with Advanced Oxidation Process

The current study aims to degrade Procion Golden Yellow H-R through ultrasound-induced cavitation coupled with various oxidants. A comprehensive investigation was conducted to examine the impact of parameters, specifically pH, power, and frequency, on the extent of degradation. The primary aim was to optimize degradation by solely utilizing a cavitation reactor where only 23.8% degradation was observed under the established optimum conditions of pH 2.5, frequency of 22 kHz, and power of 200 W. The investigation of the combined process of cavitation with H2O2, Fenton reagent (H2O2/Fe2+), NaOCl, and potassium persulphate (KPS) was subsequently conducted under optimized conditions. The combined operations greatly enhanced degradation with the use of H2O2 loading of 0.1 g/L leading to 53.3% degradation and the H2O2/Fe2+ ratio of 1:0.25 resulting in 94.6% degradation, while the NaOCl quantum of 0.075 g/L yielded 90% degradation and the KPS quantity of 2 g/L resulted in 97.5% degradation in the specific combinations. A toxicity test on two bacterial strains, Staphylococcus aureus and Escherichia coli, was carried out using the original dye solution and after treatment. The various individual and combination processes were compared using the parameters of cavitational yield and total treatment cost. The study elucidates that combining ultrasonic cavitation with KPS is an effective method for treating wastewater containing Procion Golden Yellow H-R dye, especially when implemented at a larger scale of operation.

Economic Impact of Bladder Cancer in the USA.

Incidence and mortality for bladder cancer has changed very little over the past 20 years. Approximately 40% of patients with high-risk nonmuscle invasive bladder cancer eventually recur/progress. It is important to understand the economic impact of disease recurrence/progression in bladder cancer. Our aim was to estimate and understand the direct costs associated with the treatment of bladder cancer from the payer's perspective in the USA, in the year of 2021, including costs for both newly diagnosed bladder cancer (stages 0a-IV) and recurrent patients. An economic model was constructed to calculate the number of patients receiving each treatment modality at every stage of disease and their respective costs. Epidemiological data were based on the CancerMPact Patient Metrics (PM) database and treatment modality data retrieved from CMP Treatment Architecture (TA), 2021 version. Resource utilization and costs were obtained from medical literature and public data sources. Only direct costs were considered. There were an estimated 83,532 newly diagnosed patients with bladder cancer of all stages in 2021 with a projected total cost of treatment of ~$2.6 billion. Average cost per newly diagnosed patient varied from $19,521 (stage 0a) to $169,533 (metastatic disease). Cost profile differed substantially among the stages of disease. For the 75,760 patients that were expected to have a recurrence in 2021, an additional cost of ~$3.9 billion was estimated at an average cost per patient of $52,179. The expected total cost to treat newly diagnosed and newly recurrent patients is reported in this model, with the total cost in 2021 estimated to exceed $6.5 billion. Treatment and resource costs increase for bladder cancer as the disease recurs/progresses. More effective treatments that can delay recurrence/progression may reduce the economic burden associated with bladder cancer.