Cost Trends Research Articles

Understanding trends of US breast cancer hospitalization, mortality and costs using the National Inpatient Sample database.

11162 Background: Studies have shown a rising breast cancer incidence in the US. However, its impact on healthcare utilization is unclear. Our study delves into the previously unexplored territory of hospitalization and cost trends among breast cancer patients, aiming to shed light on resource allocation and potential areas for improvement. Methods: To investigate trends in breast cancer admissions and costs, we queried the National Inpatient Sample database. Patients admitted between January 2011 and December 2019 with following criteria were included in the analysis: female gender, age ≥ 18, and ICD diagnosis code corresponding to unspecified malignant neoplasm of the breast as their primary reason for admission. Our primary outcome was defined as the temporal trends in the number of admissions, discharge rates, length of stay, and cost of hospitalization and mortality rates. Analyses were performed using Stata version 15.1 College station TX: StataCorp LP 2017. Appropriate discharge weights were applied to the dataset during the analyses to account for critical elements of sampling design. A p-value of <0.05 was considered statistically significant. Results: Between 2011 and 2019, hospital admissions for breast cancer as the primary diagnosis declined significantly, from 32,126 to 12,742 (P < 0.001). However, while average length of stay increased slightly from 4.3 to 4.9 days (P < 0.01), hospital charges for breast cancer rose dramatically. Adjusted for inflation, mean charges per patient rose 38.8%, from $50,663.86 in 2011 to $70,334.11 in 2019 (P < 0.001). Despite this surge, the total aggregate cost ("national burden") of hospitalizations with breast cancer as main discharge diagnosis decreased, falling from $1.63 billion in 2011 to $896 million in 2019 (inflation adjusted) (P < 0.001). Discharges for breast cancer peaked in women between 45 and 64, followed by the 65-84 demographic. Compared to the overall decrease in hospitalization rates, the declines in the above age groups were notably steeper with declines of 62% for 45-64 and 48% for 65-84 (p<0.001). Although absolute number of breast cancer deaths decreased from 2011 to 2019, the mortality rate paradoxically increased from 4.3% to 5.8% over the same period (P < 0.001). This seemingly contradictory trend warrants further investigation to better understand contributing factors. Conclusions: While breast cancer diagnoses are on the rise in women, our study reveals a fascinating paradox: significant declines in hospitalization, associated costs, and overall mortality. This encouraging trend likely stems from widespread surveillance mammography with increases in early stage, curable disease diagnosis, and the flourishing landscape of outpatient therapies, including targeted treatments, with more tolerable toxicity profiles allowing for majority of breast cancer care to be completed in the outpatient setting.

Revision Total Knee Arthroplasty in an Outpatient Setting: A Growing Alternative

BackgroundRecent studies have focused on the safety and efficacy of performing primary total knee arthroplasty (TKA) in an outpatient setting. Despite being associated with greater costs, much less is known about the accompanying impact on revision TKA (rTKA). The purpose of this study was to describe the trends in costs and outcomes of patients undergoing inpatient and outpatient rTKA. MethodsAn observational cohort study was conducted using commercial claims databases. Patients who underwent 1-component and 2-component rTKA in an inpatient setting, hospital outpatient department (HOPD), or ambulatory surgery center (ASC) from 2018 to 2020 were included. The primary outcome was the 30-day episode-of-care costs following rTKA. Secondary outcomes included surgical cost, 90-day readmission rate, and emergency department visit rate. Covariates for analyses included patient demographics, surgery type, and indication for revision. ResultsThere were 6,515 patients who were identified, with 17.0% of rTKAs taking place in an outpatient setting. On adjusted analysis, patients in the highest quartile of 30-day postoperative costs were more likely to be those whose rTKA was performed in an inpatient setting. One-component revisions were more common in an outpatient setting (HOPD, 50.7%; ASC, 62.0%) compared to an inpatient setting (39.6%). The 90-day readmission rates were higher (P = .003) for rTKAs performed in inpatient (+9.2%) and HOPD (+8.6%) settings compared to those in an ASC. ConclusionsThe ASC may be a suitable setting for simpler revisions performed for less severe indications and is associated with lower costs and 90-day readmission and emergency department visit rates.

Integrated operational model to analyse policies and socio-demography leading to selection of electric vehicle - A case study on Bihar

In the push for sustainability in the power sector, Electric Vehicles show substantial promise. However, they still face hurdles in replacing traditional combustion engine cars, which have dominated the market for decades. Consumer awareness, especially regarding new technologies like Electric Vehicles, remains a significant barrier to adoption. This study aims to bridge the gap between technical aspects and consumer knowledge and a case study is done on the Indian state of Bihar. Using a hybrid Multi-Criteria Decision-Making approach with Triangular Fuzzy Numbers, a customized model is presented to help residents choose the right Electric Vehicle based on their needs and resources. Results are analyzed from customers’ perspective using Quality Function Deployment and conduct Sensitivity Analysis to explore cost trends. This survey examines seven Electric Vehicle models available in India, with MG ZS Electric Vehicle emerging as a potential standout. It's important to note that this research work does not endorse any specific Electric Vehicle model; rather, a mathematical framework is build to guide customers in selecting an Electric Vehicle that suits their requirements.

Real-world persistence and adherence to glucagon-like peptide-1 receptor agonists among obese commercially insured adults without diabetes.

In 2014, the US Food and Drug Administration approved the first glucagon-like peptide-1 (GLP-1) receptor agonist product, liraglutide injection, for obesity treatment. Many GLP-1 obesity treatment clinical trials report significant weight loss and medication adherence at more than 85%. Little is known about the real-world GLP-1 obesity treatment adherence, persistence, and switch rates. To measure GLP-1 therapy persistence, adherence, and switch rates in a real-world cohort of members without diabetes using these drugs for obesity treatment. Integrated pharmacy and medical claims data from 16.5 million average monthly commercially insured membership were used to identify obese members without diabetes newly initiating GLP-1 therapy between January 1, 2021, and December 31, 2021. Members were required to be continuously enrolled 1-year before and after the GLP-1 therapy start date and aged 19 years of age or older. Persistence was measured as no greater than or equal to 60-day gap with allowance for GLP-1 switching. Adherence was measured as the proportion of days covered (PDC) and members with a PDC greater than or equal to 80% were considered adherent. GLP-1 product switching was also assessed descriptively. 4,066 commercially insured obese members without diabetes that newly initiated GLP-1 therapy met all study criteria. The mean age was 46 years, and 81% were female. Overall, GLP-1 persistence was 46.3% at 180 days and 32.3% at 1 year. The highest and lowest persistence rates at 1 year were observed for semaglutide (Ozempic) at 47.1% and liraglutide (Saxenda) 19.2%, respectively. Average PDC during the 1-year assessment was 51.0% with 27.2% adherent to therapy and 11.1% switched GLP-1 drugs. This GLP-1 weight loss treatment real-world analysis, among obese individuals without diabetes, found poor 1-year persistence and adherence and low rates of switching between products. These findings will aid in assessing products cost-effectiveness, understanding obesity care management program needs, forecasting future GLP-1 use and cost trends, and negotiating GLP-1 pharmaceutical manufacturer value-based purchasing agreements.

Trends in prescription and cost of Sativex, a cannabinoid-based medicine, in treating patients with multiple sclerosis in England.

Cannabis-based medication has recently been made available in the NHS for reducing pain and spasticity in patients with multiple sclerosis (MS). The currently available preparation of Sativex (nabiximols) contains a combination of botanical cannabis extracts with cannabidiol (CBD) and tetrahydrocannabinol (THC) with almost equal amounts in addition to minor cannabinoids and terpenoids and is delivered via an oro-mucosal spray. The present study aims to examine the use and trends in prescribing cannabinoid-based Sativex to control pain in patients diagnosed with MS. Primary care prescribing data for cannabinoid-based Sativex (2013-2022) from the Prescription Cost Analysis were extracted and analysed. Linear regression analyses were performed to examine prescription trends and prescription costs (average change per year). There was a general increasing trend in the number of prescriptions each year, from 4.42 items dispensed per 100,000 people in 2013 to 5.15 in 2022. Overall, prescription items for cannabinoid-based Sativex increased by 0.34% per year (95% CI:-3.98, 4.67, p = 0.860) on average between 2013 and 2022. On average, a 2.43% (95% CI: -5.78, 0.92, p = 0.133) increase per year was observed for the costs of cannabinoid-based Sativex from 2013 to 2022. The results suggested that cannabinoid-based Sativex should be considered an option due to its effectiveness, acceptable tolerance, and safety profile in the prescribing of Sativex.

Renewable Energy Support Through Feed-in Tariffs: A Retrospective Stakeholder Analysis

Abstract This study develops a generalized evaluation framework that can be used to quantify the financial, economic, stakeholder, and environmental impacts of renewable energy support programs. The application of this framework is demonstrated by evaluating the feed-in tariff (FIT) program for solar distributed energy resources (DER) in Ontario, Canada. Our analysis reveals that Ontario’s FIT program has successfully promoted the adoption of solar DER across communities. However, the program has caused inequitable societal outcomes through a cross-subsidization with a present value of 9 CAD billion, paid for by the electricity consumer base for the benefit of only the 0.06 percent of electricity consumers who could install solar systems. The cost imposed on the Canadian economy ranges from 2.86 to 5.37 CAD billion, depending on the discount rate applied. The sensitivity analysis results indicate that the burden of this program on the Canadian economy would have been reduced by 50 percent if the program had been delayed and implemented in 2016 instead of 2010 due to the declining trend in solar system investment costs. The lessons from this analysis provide insights for designing future environmental and emission reduction policies.

Trends and predictors of inflation-adjusted costs in transcatheter and surgical aortic valve replacement in a nationally representative sample

BackgroundTranscatheter aortic valve replacement has become an accepted alternative to surgical aortic valve replacement. We examined the trends and predictors in inflation-adjusted costs of transcatheter aortic valve replacement and surgical aortic valve replacement. MethodsNational Inpatient Sample identified patients who underwent aortic valve replacement for severe aortic stenosis by International Classification of Diseases, Ninth and Tenth Revisions, codes. Hospitalization costs were inflation-adjusted using the Federal Reserve’s consumer price index to reflect current valuation. Outcomes of interest were unadjusted trend in annual cost for each procedure and predictors of in-patient cost. Generalized linear models with a log link function identified predictors of adjusted costs. Interaction terms determined where cost predictors were different by operation type. ResultsBetween 2011 and 2019, the mean annual inflation-adjusted cost of surgical aortic valve replacement increased from $62,853 to $63,743, in contrast to decreasing cost of transcatheter aortic valve replacement from $64,913 to $56,042 ($1,854 per year; P = .004). Significant independent predictors of patient-level cost included operation type (transcatheter aortic valve replacement associated with $9,625 increase; P < .001), incidence of in-hospital mortality ($28,836 increase; P < .001), elective status ($2,410 decrease; P < .001), Elixhauser Index ($995 increase; P < .001), and postoperative length of stay ($2,014 per day increase; P < .001). Compared to discharges with Medicare, discharges with private insurance and Medicaid paid $736 less (P = .004) and $1,863 less (P = .01), respectively. Increasing hospital volume was a significant predictor of decreasing patient level cost (P < .001). ConclusionAnnual cost of transcatheter aortic valve replacement has decreased significantly and has been a more cost-effective modality compared to surgical aortic valve replacement since 2017. Predictors of patient-level costs allow for mindful preparation of healthcare systems for aortic valve replacement.

Geothermal power generation potential in the United States by 2050

Geothermal energy provides a dispatchable source of carbon-free electricity that can balance the output of variable resources. However, geothermal provides just 3.7 gigawatts (GW e ) ( < 1%) of electricity in the United States today, mostly from hydrothermal resources that are geographically constrained. Enhanced geothermal systems (EGS), which extract heat from deep rock, could be applicable in more locations. However, baseline levels and potential trends in EGS costs have been insufficiently characterized by previous studies. Here, we assess geothermal penetration potential by using as baseline the latest available data on drilling costs from three costing models to create updated estimates of costs and performance. We input those estimates along with various scenarios of cost trends, emissions policies, and electricity demand into the regional energy deployment system (ReEDS) capacity expansion model to simulate electricity generation in the United States through 2050. The scarcity of hydrothermal resources limits deployments to no more than 18 GW e across our scenarios. EGS is more costly than hydrothermal for now, but it has greater potential to scale nationwide. Thus, future deployments of EGS depend strongly on projected cost reductions and emissions policies. In scenarios with moderate ( < 50%) reductions in costs by 2050, very little EGS is likely to be built, since wind and solar with storage provide lower-cost electricity. However, over 70% cost reductions from our updated baseline would make geothermal the least-cost carbon-free dispatchable resource. Under those cost trends, we project that 3 GW e of EGS would be built by 2050 under existing policies, 11 GW e with a 95% decarbonization policy, and 152 GW e if full decarbonization of electricity is mandated. Most geothermal would likely first be built in western states with the steepest subsurface temperature gradients, although mandates for full decarbonization could drive it to be deployed in other states.

Analyzing Labor Costs in The Transport and Storage Sector in European Countries Through Trend and Cluster Analysis:2007-2022

Trends in the transport and storage industry's labor markets in Europe have significantly impacted changes in labor costs. Technological advancements, increased privatization and deregulation, and changes in global capital flows are among the key reasons that have resulted in significant changes in labor costs in the logistics sector during the last few decades, especially in Europe. The amount of remuneration for logistics personnel and its pace of change over time are essential aspects influencing not just capital investment choices but also country competitiveness. The clusters of countries with similar wage increases over time are also impacted by their economic, social, and ecological problems to a similar extent. The existence of probable trends in labor costs in transport and storage on a country level, as well as cluster analysis over the countries where the trend is found, will aid in revealing significant similarities and contrasts concerning the sector and the countries involved in the research. The Labor Cost Index (LCI), according to NACE Rev. 2 Activity-nominal value, quarterly data released by Eurostat was utilized for this research. Sixty-four quarterly periods have been covered between the first quarter of 2007 and the fourth quarter of 2022. The research was based on data collected from 23 different European countries. The Mann-Kendall trend test and Sen's slope test were used for trend analysis, and the K-means clustering algorithm was used for cluster analysis.

Is It Getting More Expensive to Treat Patients Who Have a High Comorbidity Burden? Financial Trends in Total Knee Arthroplasty From 2013 to 2021

BackgroundUtilization of total knee arthroplasty (TKA) continues to rise among patients who have a high comorbidity burden (HCB). With changes in reimbursement models over the past decade, it is essential to assess the financial impact of HCB TKA on healthcare systems. This study aimed to examine trends in revenue and costs associated with TKA in HCB patients over time. MethodsOf 14,978 TKA performed at a large, urban academic medical center between 2013 and 2021, we retrospectively analyzed HCB patients (Charlson comorbidity index ≥ 5 and American Society of Anesthesiology scores of 3 or 4). A total of 1,156 HCB TKA patients who had complete financial data were identified. Patient demographics, perioperative data, revenue, costs, and contribution margin were collected for each patient. Changes in these financial values over time, as a percentage of 2013 values, were analyzed. Linear regression was performed with a trend analysis to determine significance. ResultsFrom 2013 to 2021, the percentage of HCB TKAs per year increased from 4.2% in 2013 to 16.5% in 2021 (P < .001). The revenue of TKA in HCB patients remained steady (P = .093), while direct costs increased significantly (32.0%; P = .015), resulting in a decline of contribution margin to a low of 82.3% of 2013 margins. There was no significant change in rates of 90-day complications or home discharge following HCB TKA during the study period. ConclusionsThe results of this study indicate a major rise in cost for TKA among HCB patients, without a corresponding rise in revenue. As more patients who have HCB become candidates for TKA, the negative financial impact on institutions should be considered, as payments to institutions do not adequately reflect patient complexity. A re-evaluation of institutional payments for medically complex TKA patients is warranted to maintain patient access among at-need populations.

Inpatient Cost Burdens of Treating Chronic Hepatitis B in US Hospitals: A Weighted Analysis of a National Database.

This study evaluates the cost burdens of inpatient care for chronic hepatitis B (CHB). We aimed to stratify the patients based on the presence of cirrhosis and conduct subgroup analyses on patient demographics and medical characteristics. The 2016-2019 National Inpatient Sample was used to select individuals diagnosed with CHB. The weighted charge estimates were derived and converted to admission costs, adjusting for inflation to the year 2016, and presented in United States Dollars. These adjusted values were stratified using select patient variables. To assess the goodness-of-fit for each trend, we graphed the data across the respective years, expressed in a chronological sequence with format (R2, p-value). Analysis of CHB patients was carried out in three groups: the composite CHB population, the subset of patients with cirrhosis, and the subset of patients without cirrhosis. From 2016 to 2019, the total costs of hospitalizations in CHB patients were $603.82, $737.92, $758.29, and $809.01 million dollars from 2016 to 2019, respectively. We did not observe significant cost trends in the composite CHB population or in the cirrhosis and non-cirrhosis cohorts. However, we did find rising costs associated with age older than 65 (0.97, 0.02), white race (0.98, 0.01), Hispanic ethnicity (1.00, 0.001), and Medicare coverage (0.95, 0.02), the significance of which persisted regardless of the presence of cirrhosis. Additionally, inpatients without cirrhosis who had comorbid metabolic dysfunction-associated steatotic liver disease (MASLD) were also observed to have rising costs (0.96, 0.02). We did not find a significant increase in overall costs with CHB inpatients, regardless of the presence of cirrhosis. However, certain groups are more susceptible to escalating costs. Therefore, increased screening and nuanced vaccination planning must be optimized in order to prevent and mitigate these growing cost burdens on vulnerable populations.

The cost implications of Wilson disease among hospitalized patients: analysis of USA hospitals.

In this study, we used a national cohort of patients with Wilson's disease (WD) to investigate the admissions, mortality rates, and costs over the captured period to assess specific subpopulations at higher burden. Patients with WD were selected using 2016-2019 National Inpatient Sample (NIS). The weighted estimates and patient data were stratified using demographics and medical characteristics. Regression curves were graphed to derive goodness-of-fit for each trend from which R2 and P values were calculated. Annual total admissions per 100 000 hospitalizations due to WD were 1075, 1180, 1140, and 1330 ( R2 = 0.75; P = 0.13) from 2016 to 2019. Within the demographics, there was an increase in admissions among patients greater than 65 years of age ( R2 = 0.90; P = 0.05) and White patients ( R2 = 0.97; P = 0.02). Assessing WD-related mortality rates, there was an increase in the mortality rate among those in the first quartile of income ( R2 = 1.00; P < 0.001). The total cost for WD-related hospitalizations was $20.90, $27.23, $24.20, and $27.25 million US dollars for the years 2016, 2017, 2018, and 2019, respectively ( R2 = 0.47; P = 0.32). There was an increasing total cost trend for Asian or Pacific Islander patients ( R2 = 0.90; P = 0.05). Interestingly, patients with cirrhosis demonstrated a decreased trend in the total costs ( R2 = 0.97; P = 0.02). Our study demonstrated that certain ethnicity groups, income classes and comorbidities had increased admissions or costs among patients admitted with WD.

Dermatology medications with the highest cost burden on Medicare Part D: Potential implications of the Inflation Reduction Act

Signed into law in August 2022, the Inflation Reduction Act includes provisions requiring the federal government to negotiate prices for medications covered under Medicare Part D. Initial negotiations will target drugs with the highest total spending and price increases relative to inflation. In this study, we identify dermatology prescriptions with the highest cost burden on Medicare Part D and analyze recent trends in total spending and unit costs.

Reliability analysis of respirators based on the analytic hierarchy process and multicriteria decision-making

This study examined the reliability of respirators using hierarchical analysis and multicriteria decision-making. The hierarchical structure, which consists of three assessment criteria and six product assemblies as decision possibilities, reveals that the priority of evaluation criteria follows the trend of cost, complexity and technology. Face-piece, triple-piece and visor assemblies have the highest failure rate, according to an analysis of product reliability at the assembly level. However, according to the analysis at the parts level, the most likely failures are found in the face-piece, upper and lower visor frames, visor, head-harness, exhalation valve disc and exhalation valve seat. In addition, the Weibull distribution function (with a shape parameter >1) can be utilized to predict product reliability. Among the six defined product assemblies, according to the sensitivity analysis, the overall weight of the triple-piece assembly and the visor assembly has the most sensitivity to changes in the priority of evaluation criteria.

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.

The weight of obesity: a retrospective analysis of the direct costs of hospitalizations due to obesity between 2011 and 2020 for the unified health system in Brazil

Aim: This study aimed to analyze the evolution of obesity-related costs over the past 10 years for Brazil's Unified Health System (SUS) and provide insights for guiding and expanding health management and promotion measures. Methods: An observational and retrospective study was conducted using secondary data from 2011 to 2020, extracted from DataSUS with the ICD-10 code for obesity. Statistical analysis was performed to assess trends in hospitalizations and costs related to obesity. Results: During the analyzed period, there was a substantial increase of 110% in hospitalizations and 167% in obesity-related costs for SUS. Female patients (86%) accounted for the majority of hospitalizations, while males (14%) had lower representation. Predominantly, white individuals (62%) were admitted, whereas indigenous individuals had the lowest representation (0,007%). The Southern region contributed to 46% of total cases, in contrast to the Northern region, which accounted for only 0,9%. Conclusion: The findings of this study indicate a significant rise in hospitalizations and associated costs related to obesity for Brazil's Unified Health System. These results underscore the urgency of implementing health promotion and prevention measures, both in the public and private sectors. There is a need for optimized allocation of human resources, including trained professionals for obesity treatment, to mitigate the burden of obesity-related morbidity and mortality and alleviate the strain on the healthcare system.

Utilization and Cost of Gender-affirming Surgery in the United States from 2012-2019.

To characterize the trends in and characteristics associated with the utilization and cost of gender-affirming surgery (GAS) in the United States from 2012-2019. GAS is one option among gender-diverse (GD) people to transition from their biologic anatomy to the anatomy congruent with their gender. Little is known about its utilization and cost trends and whether patient and hospital characteristics are associated with differences in utilization and cost. This serial cross-sectional study collected retrospective data from the Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample (NIS), a representative pool of inpatient visits in the United States. Records from 2012-2019 that indicated ages 18 or older, GD diagnoses, and GAS procedures were identified using the International Classification of Diseases, Ninth and Tenth Revisions. Within this cohort, demographics, utilization, and cost were collected and analyzed using descriptive statistics and multivariable regression models. 6,325 records with GD diagnoses and GAS procedures were identified. From 2012-2019, utilization increased by more than 5-fold (0.9 to 5.0 per 100,000 records among all records), and the mean, inflation-adjusted cost increased by 36% ($19,451 to $26,517). This cost trend was similar by type of surgery, and genital surgery had consistently higher costs than chest surgery from 2012 to 2019 (genital: $21,487 to $26,712, chest: $13,238 to $21,309). Lower odds of utilization were found in records with Medicaid (OR = 0.27, 95% CI [0.22-0.35], P<0.001) and Medicare (OR = 0.15, 95% CI [0.11-0.23], P<0.001) compared to private insurance, as well as those in the lowest income quartile (OR = 0.68, 95% CI [0.54-0.85], P<0.001) compared to the highest quartile. Lower costs were found in records that indicated hospital location in the Midwest (27% lower, 95% CI [0.61-0.87], P<0.001), Northeast (34% lower, 95% CI [0.55-0.80], P<0.001) and South (39% lower, 95% CI [0.53-0.71], P<0.001) compared to the West. As demand for GAS increases with varying utilization and costs based on patient and hospital characteristics, there will likely be a need for more qualified surgeons, increased insurance coverage, and policies to ensure equitable access to GAS.

Identifying a selection mechanism of distribution channel for the supply chain: The barriers to the application of web 3.0

The application of Web 3.0 will bring unprecedented changes to the supply chain, where many industries are seeing significant cost reductions. However, due to the requirement of stability for supply chain, sometimes the total cost of supply chain cannot decrease effectively under Web 2.0, which may hinder the application of Web 3.0. Following the application from Web 2.0 to Web 3.0, this paper discusses the selection of distribution channel whose cost is under user stickiness and the degree of digitalization. The system optimum model, which is commonly used in dynamic traffic allocation, is applied to solve the distribution channel selection problem. The results implies that when the degree of digitalization is low, the distribution channel cost first decreases and then increases as user stickiness increases. This trend of channel cost illustrates the price induction on user stickiness initially, and gradually adjust the price to be higher when user stickiness makes channel transformation costly. Customers with unclear user stickiness perceptions and weak channel control can easily be trapped in the transition from Web 2.0 to Web 3.0. Distributors will also be forced to accept high product costs due to the price induction from product distribution channels.

Analysis of standard unit carbon emission and cost assessment of the changing building envelope over material production phase

It is undeniable that the material production stage is crucial to the whole life cycle of structures. This study proposes the window-to-envelope ratio (WER) based on standard units to determine the inherent relationship between changes in door and window areas and carbon emissions, presuming six distinct types of engineering practices for various buildings are selected. It was concluded that larger door and window areas would result in more embodied carbon emissions. Additionally, as the size of windows and doors increases, the costs and embodied carbon of prefabricated and cast-in-place construction become more comparable. According to the analysis, when the building scale is larger and the door and window opening area is also larger, prefabrication has more potential for saving carbon than cast-in-place building, but with a cost of approximately 10–20% higher. Considering the perspective of consumers, producers, and markets, this study revealed a costing assessment methodology based on standard units for prefabricated structures. In this methodology, producers choose and create various residential layouts based on the distinctive requirements of consumers, while tracking the trends in carbon emissions and production costs. This assessment method tries to create a favorable atmosphere for moral market activity and offers an acceptable solution for the trade-off between environmental and economic factors throughout the material production phase of the building.

Drivers and recent trends of hospitalisation costs related to acute pulmonary embolism.

The socio-economic burden imposed by acute pulmonary embolism (PE) on European healthcare systems is largely unknown. We sought to determine temporal trends and identify cost drivers of hospitalisation for PE in Germany. We analysed the totality of reimbursed hospitalisation costs in Germany (G-DRG system) in the years 2016-2020. Overall, 484 884 PE hospitalisations were coded in this period. Direct hospital costs amounted to a median of 3572 (IQR, 2804 to 5869) euros, resulting in average total reimbursements of 710 million euros annually. Age, PE severity, comorbidities and in-hospital (particularly bleeding) complications were identified by multivariable logistic regression as significant cost drivers. Use of catheter-directed therapy (CDT) constantly increased (annual change in the absolute proportion of hospitalisations with CDT + 0.40% [95% CI + 0.32% to + 0.47%]; P < 0.001), and it more than doubled in the group of patients with severe PE (28% of the entire population) over time. Although CDT use was overall associated with increased hospitalisation costs, this association was no longer present (adjusted OR 1.02 [0.80-1.31]) in patients with severe PE and shock; this was related, at least in part, to a reduction in the median length of hospital stay (for 14.0 to 8.0days). We identified current and emerging cost drivers of hospitalisation for PE, focusing on severe disease and intermediate/high risk of an adverse early outcome. The present study may inform reimbursement decisions by policymakers and help to guide future health economic analysis of advanced treatment options for patients with PE.