Cost Utility Research Articles

Osteochondroplasty with or without labral repair is more cost-effective than arthroscopic lavage with or without labral repair for treatment of young adults with femoroacetabular impingement: A cost-utility analysis based on data from a randomized controlled trial

ObjectivesThe objective of this study was to conduct a cost–utility analysis of osteochondroplasty with or without labral repair compared to arthroscopic lavage with or without labral repair for femoroacetabular impingement (FAI) from a Canadian public payer perspective. MethodsA Markov model was constructed to compare the lifetime quality-adjusted life years (QALYs) and costs of the two treatment strategies. The target population was surgical FAI patients aged 36 years. The primary data source was patient-level data from the Femoroacetabular Impingement Randomised Controlled Trial, which evaluated the efficacy of the surgical correction of FAI via arthroscopic osteochondroplasty with or without labral repair compared to arthroscopic lavage with or without labral repair in Canada. Long-term data were extrapolated using a generalized gamma model. The primary outcome was the incremental cost-effectiveness ratio, calculated by dividing the difference in costs by the difference in QALYs between osteochondroplasty and lavage, with or without labral repair. Probabilistic sensitivity analyses and one-way sensitivity analyses were used to characterize uncertainty of model parameters and assumptions. ResultsOver a lifetime horizon, osteochondroplasty, with or without labral repair, had a greater expected benefit (0.63 QALYs gained per patient) and lower costs ($955.89 saved per patient), as compared with lavage with or without labral repair. Probabilistic sensitivity analyses demonstrated that the probability of osteochondroplasty, with or without labral repair, being cost-effective was 90.5% at a commonly used willingness-to-pay threshold of $50,000/QALY in Canada. Across all one-way sensitivity analyses, osteochondroplasty with or without labral repair remained a cost-effective option. ConclusionOver a lifetime time horizon, osteochondroplasty, with or without labral repair, is a cost-effective treatment strategy for young adults with FAI. Future research involving real-word data is needed to further validate these findings. Level of evidenceIII.

Variations in healthcare costs by body mass index and obesity-related complications in a UK population: A retrospective open cohort study.

To estimate healthcare resource utilization (HCRU) and healthcare costs by body mass index (BMI) in a UK cohort and to explore how this varied by defined BMI strata. This retrospective open cohort study used Discover, a linked primary and secondary electronic health records database covering 2.7 million individuals. Adults were stratified by BMI as: overweight (25-<30 kg/m2); obesity class I (30-<35 kg/m2); obesity class II (35-<40 kg/m2); or obesity class III (≥40 kg/m2). Cost data, comprising primary care, secondary care (inpatient admissions, outpatient appointments and emergency room visits) and prescriptions, were reported for 2015-2019. Overall, 1 008 101 individuals were overweight, 278 782 had obesity class I; 80 621 had obesity class II, and 42 642 had obesity class III. Healthcare costs and HCRU events per person per year increased over time (2015: £851-£1321 and 10.6-13.4 events; 2019: £1143-£1871 and 11.4-14.9 events), and were higher for each successive BMI group. Groups with chronic kidney disease or cardiovascular disease incurred particularly high costs. In 270 493 individuals with obesity in 2019, more than 72% of total healthcare costs were incurred by the highest cost quintile, which had a higher mean age and more obesity-related complications (ORCs) than lower cost quintiles. The economic impact of obesity could be alleviated by weight management support based on unmet need, to limit the effects of BMI progression and ORC development.

Palliative care consultation in patients hospitalized with out-of-hospital cardiac arrest: Impact on invasive procedures, do-not-resuscitate orders, and healthcare costs

BackgroundThe impact of palliative care consultation on the management and outcomes of patients hospitalized with out-of-hospital cardiac arrest (OHCA) remains poorly understood. This study examined associations between palliative care consultation and in-hospital outcomes of patients hospitalized with OHCA, stratified by survival status. MethodThis cross-sectional study used data from the National Inpatient Sample (2016–2021). Adult patients hospitalized with OHCA who received cardiopulmonary resuscitation were included. Multivariable analyses assessed associations between palliative care consultation and outcomes in non-terminal and terminal OHCA hospitalizations, adjusting for demographics, hospital characteristics, and comorbidities. ResultsAmong 488,700 OHCA hospitalizations, palliative care consultation was associated with lower odds of invasive procedures in non-terminal hospitalizations, including percutaneous coronary intervention (PCI) (aOR 0.30, 95 % CI 0.25–0.36), mechanical circulatory support (aOR 0.54, 95 % CI 0.44–0.68), permanent pacemaker (aOR 0.27, 95 % CI 0.20–0.37) and implantable cardioverter defibrillator insertion (aOR 0.22, 95 % CI 0.16–0.31), and cardioversion (aOR 0.62, 95 % CI 0.55–0.70). In terminal hospitalizations, palliative care was associated with lower odds of PCI (aOR 0.78, 95 % CI 0.70–0.87) and cardioversion (aOR 0.91, 95 % CI 0.85–0.97), but higher odds of therapeutic hypothermia (aOR 3.12, 95 % CI 2.72–3.59), gastrostomy (aOR 1.22, 95 % CI 1.05–1.41), and renal replacement therapy (aOR 1.19, 95 % CI 1.12–1.26). Palliative care was associated with higher DNR utilization in both subgroups and lower hospital costs in non-terminal hospitalizations but higher costs in terminal hospitalizations. ConclusionPalliative care consultation in OHCA is associated with differences in invasive procedures, DNR utilization, and hospital costs, varying by survival status.

P125. Enhanced cost utility in adult deformity corrections can be achieved by application of contemporary age-adjusted realignment criteria

P125. Enhanced cost utility in adult deformity corrections can be achieved by application of contemporary age-adjusted realignment criteria

Teaching With the GlobalSurgBox: Trainer Perceptions of a Portable Surgical Simulator

Evaluate the utility of a low cost, portable surgical simulator (GlobalSurgBox) for surgical teaching and its ability to dismantle barriers faced by trainers when attempting to use surgical simulation. An anonymous survey was administered to surgical trainers who were involved in leading simulation events using the GlobalSurgBox in the past 2 years. The survey was designed to understand current barriers to using simulation as a trainer, and the utility of the GlobalSurgBox in overcoming these barriers. Academic medical training centers or conferences in the United States, Rwanda and Kenya. 10 practicing surgeons, 3 practicing physicians, 11 surgical residents, 15 medical students and 1 anesthesia resident. The top 3 barriers for effective teaching were lack of convenient access to the simulator (50%), lack of trainer time (43%) and cost (28%). After using the GlobalSurgBox, 100% and 98% of respondents felt that it encourages more practice and offers significant advantages over current simulators in their program. About 90%, 88% and 70% of respondents believed that the GlobalSurgBox makes surgical simulation more convenient, affordable, and compatible with trainer time limitations, respectively. 83% of trainers agreed that it is a good replica of the operating room experience, and 85% practicing physicians were more likely to give autonomy to trainees after demonstrating competence on the GlobalSurgBox. The GlobalSurgBox mitigates several barriers surgical educators experience when practicing surgical skills with trainees. The convenience of the GlobalSurgBox can help facilitate the development of foundational surgical skills outside of the operating room.

Coaching People with Cardiovascular Disease to Close Their “Treatment Gaps” Reduces Hospital Utilization, Saves Lives, and Delivers Net Cost Savings Over 10 Years

BackgroundDisease management programs are an essential tool in the fight against rising prevalence and costs associated with cardiovascular disease (CVD). However, there is a lack of evidence on the long-term impact of these programs on clinical outcomes, healthcare utilization, and cost. This study presents a long-term follow up of clinical, healthcare utilization and cost, and mortality consequences of The COACH Program, a 6-month telephone delivered CVD prevention program. MethodsWe conducted 10-year retrospective propensity score matched cohort study of potentially eligible participants comparing individuals that participated to those that did not receive the Program. Primary outcomes of interest were differences in mortality, private healthcare utilization and cost of private healthcare utilization sourced from private health insurance claims data. ResultsOf the 24,932 potentially eligible participants, 11,988 were invited to participate in The COACH Program between July 1, 2010, and December 31, 2020. The COACH Program participants (n = 2,271) were 1:1 matched with individuals who did not participate in the Program. Participation in The COACH Program was associated with a 34% reduction in the risk of mortality (HR: 0.66, 95% CI: 0.54, 0.79), an 8% reduction in the number of hospitalizations (IRR: 0.92, 95% CI: 0.85, 0.98), and an annual reduction in healthcare costs of $1,499 (95% CI: $1,909, $1,087). Results were robust to sensitivity analyses. ConclusionsA structured 6-month telephone delivered coaching program focused on closing “treatment gaps” in people with a history of CVD saves lives and reduces hospital utilization, health care costs over 10-years follow-up.

Opioid Use and Healthcare Utilization in Adults With Psoriatic Arthritis and Ankylosing Spondylitis.

Opioid use among individuals with spondyloarthritis is common; however, data on whether these individuals have higher utilization of the healthcare system are lacking. We examined the association between opioid use and healthcare utilization and costs among patients with psoriatic arthritis (PsA) and ankylosing spondylitis (AS). We included adults with PsA or AS enrolled in the FORWARD registry, with ≥ 1 completed disease activity or disability questionnaire between 2010 and 2019. The exposure was patient-reported opioid use, and the outcomes were annualized healthcare utilization and prescription costs. We used negative binomial regression to assess the association between opioid use and the utilization outcomes, and generalized linear models with γ-distribution and log link function for the association between opioid use and costs. Models were adjusted for age, sex, and hospitalization. AS and PsA were studied separately. Among 828 patients with PsA, 21.4% used opioids; for those with AS, 27.2% of 334 patients reported opioid use. Opioid users had higher healthcare utilization and costs, including increased medical visits, diagnostic tests, direct medical costs, and pharmacy expenses. Opioid users had 32-33% more medical visits annually vs nonusers. Patients using opioids spent more on medical visits annually compared to nonusers (US $3464 vs $2706 for PsA; US $4500 vs $3660 for AS). Compared to patients not using opioids, patients with PsA and AS who used opioids had higher healthcare utilization and higher health-related costs. New care pathways are needed to improve care and reduce costs.

Impact of pharmacist-led transitions of care model on length of hospital stay and 30-day readmission rates at a quaternary care hospital: A pilot study

BackgroundData about the impact of pharmacist-led transitions of care (TOC) approach are not well established. ObjectivesThe objective of this pilot study was to evaluate the impact of pharmacist-led TOC enhanced workflow on the length of hospital stay (LOS) and the 30-day hospital readmission rates (HRRs). MethodsThis is a quality improvement pilot project conducted at a quaternary care hospital in the United Arab Emirates over 6 weeks on a medical floor and 4 weeks on a cardiac floor. TOC was defined as admission medication reconciliation (AMR) and discharge medication reconciliation (DMR). ResultsThe median LOS was statistically significantly lower in patients who received AMR on the medical floor (4 days [3-8]) than those who did not (7 days [4-20]) (P < 0.001). The median LOS on the cardiac floor was not statistically significantly affected—3 (1.75-8) versus 3 (1-8) (P = 0.736). However, the multivariate linear regression model, adjusting for the number of interventions, indicated that LOS was statistically significantly lower on both floors; AMR was an independent risk factor for reducing the LOS on the medical floor (B = −8.37 [95 CI −11.37 to −5.36], P = .001) and on the cardiac floor (B = −2.76 [95% CI −5.23 to −0.28], P = 0.029). The 30-day HRR was not different on the medical floor but was numerically lower on the cardiac floor in patients who received DMR alone (12.9%) than in those who did not (17.2%) (P = 0.476). However, the multivariate logistic regression analysis, adjusting for number of interventions, indicated that the pharmacist-led AMR and DMR combined were numerically associated with lower rates of 30-day HRR with respective odds ratios of 0.64 (95% CI 0.3–1.38) and 0.83 (95% CI 0.4–1.9) (P = 0.83) on the medical floor and of 0.96 (95% CI 0.3–2.6) and 0.7 (95% CI 0.3–1.8) (P = 0.28) on the cardiac floor. In addition, the impact of the described pharmacist-led TOC approach on health care costs at the hospital was quantifiable and reflected a median medications utilization cost of $1142.95 (639.69-2444.88) when TOC is performed versus $1371.54 (402.92-4277.39) without TOC (P < 0.001) on the medical floor and of $4728.98 (2436.66-6846.34) versus $5252.79 (3907.63-7784.57) (P < 0.001) on the cardiac floor throughout the study time period. ConclusionPharmacist-led TOC interventions, specifically AMR, significantly reduced the LOS on the medical and the cardiac floors, whereas both AMR and DMR represented promising predictors of decreased 30-day HRR on the studied floors. Furthermore, the TOC interventions were generally associated with a statistically significant financial impact on both studied floors.

Optimal design of reduced vapor transfer dividing wall structures with and without heat integration

AbstractA dividing wall column (DWC) is a prime example of process intensification, whereby significant energy and cost savings can be achieved for some systems compared to operation in conventional design of two columns in series. It has been theorized that the vapor and liquid thermal coupling streams in the DWC could be replaced by liquid‐only transfer streams, making the DWC unit less complex. The ultimate structure is the liquid‐liquid (LL) structure with all thermal coupling streams replaced and a dividing wall extending from the top to the bottom. This article compares the separation and economic performances of the regular DWC and the LL structure, and further investigates the benefits of heat‐integrated alternatives of both (combined condenser and reboiler, double‐effect, vapor recompression assisted). Optimization uncovered that vapor recompression assisted structures exhibit substantial energy savings and lowered total annualized cost but that the savings depend on electricity and utility costs.

Economic burden of recurrent hyperkalemia in patients with chronic kidney disease.

Hyperkalemia is a common complication of chronic kidney disease (CKD) and can become recurrent in half of cases. However, the incremental economic burden associated with recurrent hyperkalemia is unknown. To evaluate all-cause health care resource utilization (HRU) and medical costs in patients with stage 3/4 CKD with recurrent hyperkalemia vs normokalaemia and vs nonrecurrent hyperkalemia. Data were from Optum's de-identified Market Clarity Data (January 1, 2016, to August 1, 2022). This retrospective observational cohort study compared patients with stage 3/4 CKD with recurrent hyperkalemia (≥2 hyperkalemia events within 1 year [hyperkalemia event: hyperkalemia diagnosis or potassium [K+]>5 mmol/l]; index was the first hyperkalemia event) with an exact- and propensity score-matched cohort of patients with normokalemia (K+ ≥3.5 to ≤5 mmol/l; random K+ as index) and separately with a matched cohort of patients with nonrecurrent hyperkalemia (1 hyperkalemia event within 1 year; index was hyperkalemia event). Patient characteristics, medication use, HRU, and medical costs were compared between cohorts using standardized mean differences during the 12-month baseline period. All-cause HRU and medical costs during the 12-month follow-up were compared using Wilcoxon rank sum tests for continuous variables and McNemar tests for categorical variables. Substudies of recurrent hyperkalemia vs normokalemia were conducted for patients with Medicare coverage and renin-angiotensin-aldosterone system inhibitor (RAASi) use. The recurrent hyperkalemia vs normokalemia sample comprised 4,549 matched pairs (Medicare substudy: 3,151; RAASi substudy: 3,535) and the recurrent hyperkalemia vs nonrecurrent hyperkalemia sample comprised 1,599 matched pairs. Baseline characteristics, HRU, and medical costs of the cohorts were similar after matching. During follow-up, patients with recurrent hyperkalemia had a mean of 11.2 more health care encounters (0.5 more inpatient admissions, 0.3 more emergency department visits, and 7.2 more outpatient visits) than patients with normokalemia. Patients with recurrent hyperkalemia also had double the total annual medical costs vs normokalemia ($34,163 vs $15,175; P < 0.001), mainly driven by inpatient costs ($21,250 vs $7,392), which accounted for 62.2% and 48.7% of total costs, respectively. Results were similar in the RAASi and Medicare substudies. Recurrent hyperkalemia was associated with a mean 4.3 more all-cause health care encounters and $14,057 higher medical costs (both P < 0.001) than nonrecurrent hyperkalemia. Recurrent hyperkalemia in patients with stage 3/4 CKD was associated with higher all-cause HRU and medical costs compared with normokalemia (including in patients with Medicare coverage and RAASi use) and nonrecurrent hyperkalemia. Research is needed to understand if long-term treatment strategies aimed at preventing hyperkalemia recurrence may alleviate this economic burden.

Multi-Combination Method for Intelligent Remote Sensing of Solar Energy Resources in Different Regions

Solar energy is the main means of new energy development, which has the characteristics of a clean, safe and wide range of resources, but there are problems of large differences in radiation and heat in the process of solar energy collection, and how to effectively utilize solar energy resources is the focus of current research In order to improve the utilization effect of solar energy resources, this paper proposes a multi-component remote sensing analysis method based on remote sensing. Firstly, the solar energy resources were quantitatively analyzed to construct the solar energy resource utilization set. Then, with the help of multiple combination indicators such as solar trajectory, direct inclination, and light intensity, intelligent remote sensing judgment was carried out on solar energy resources. Finally, compared with a single measurement method, the utilization accuracy, utilization amount and utilization cost of solar energy resources are verified. The results show that the multivariate combination method can remotely sense solar energy resources in different regions and times, with a control rate of 56%, and a solar energy utilization set with an increase rate of 20%. Moreover, the multi-combination method can expand the control area of solar energy resources, and the expansion rate can be increased by 10%. Therefore, the multi-combination method can improve the utilization rate of solar energy resources, reduce labor costs and management costs, and increase power generation, which is better than a single measurement method.

Engineering Cells for Cancer Therapy.

ConspectusCells, particularly living cells, serve as natural carriers of bioactive substances. Their inherent low immunogenicity and multifunctionality have garnered significant attention in the realm of disease treatment applications, specifically within the domains of cancer immunotherapy and regenerative tissue repair. Nevertheless, several prominent challenges impede their swift translation into clinical applications, including obstacles related to large-scale production feasibility and high utilization costs. To address these issues comprehensively, researchers have proposed the notion of bionic cells that are synthetically generated through chemical or biosynthetic means to emulate cellular functions and behaviors. However, artificial cell strategies encounter difficulties in fully replicating the intricate functionalities exhibited by living cells while also grappling with the complexities associated with design implementation for clinical translation purposes. The convergence of disciplines has facilitated the reform of living cells through a range of approaches, including chemical-, biological-, genetic-, and materials-based methods. These techniques can be employed to impart specific functions to cells or enhance the efficacy of therapy. For example, cells are engineered through gene transduction, surface modifications, endocytosis of drugs as delivery systems, and membrane fusion. The concept of engineered cells presents a promising avenue for enhancing control over living cells, thereby enhancing therapeutic efficacy while concurrently mitigating toxic side effects and ultimately facilitating the realization of precision medicine.In this Account, we present a comprehensive overview of our recent research advancements in the field of engineered cells. Our work involves the application of biological or chemical engineering techniques to manipulate endogenous cells for therapeutics or drug delivery purposes. For instance, to avoid the laborious process of isolating, modifying, and expanding engineered cells in vitro, we proposed the concept of in situ engineered cells. By applying a hydrogel loaded with nanoparticles carrying edited chimeric antigen receptor (CAR) plasmids within the postoperative cavity of glioma, we successfully targeted tumor-associated macrophages for gene editing, leading to effective tumor recurrence inhibition. Furthermore, leveraging platelet's ability to release microparticles upon activation at injury sites, we modified antiprogrammed death 1 (PD-1) antibodies on their surface to suppress postoperative tumor recurrence and provide immunotherapy for inoperable tumors. Similarly, by exploiting bacteria's active tropism toward sites of inflammation and hypoxia, we delivered protein drugs by engineered bacteria to induce cancer cell death through pyroptosis initiation and immunotherapy strategies. In the final section, we summarize our aforementioned research progress while providing an outlook on cancer therapy and the hurdles for clinical translation with potential solutions or future directions based on the concept of engineered cells.

Experience Curve With the Cone Procedure for Ebstein’s Anomaly: Effect on Cost and Resource Utilization

BackgroundThe volume-outcome relationship is well-known in health care. The Experience Curve, initially developed by the Boston Consulting Group for manufacturing, offers insight on this relationship and has never before been applied to health care. ObjectivesThe purpose of this study was to determine the effect of experience on cost and resource utilization for the Cone procedure. MethodsWe performed a retrospective review of patients who underwent Cone reconstruction for Ebstein’s anomaly at Boston Children’s Hospital between October 2010 and October 2021. Cardiopulmonary bypass time and aortic cross clamp time over time were evaluated using exponential regression to assess the surgeon-level learning curve. At the hospital level, length of stay and cost over time were assessed using exponential regression. ResultsThere were 115 patients included in the study. Median hospital length of stay was 7.9 days (IQR: 6.4-10.2 days) with a decline of 3.3% per year. Median intensive care unit [ICU] length of stay was 3.2 days (IQR: 2-5.7 days) with a decline of 10.5% per year. Adjusted direct costs indexed to 2020 prices fell by 4% per year. There was no statistically significant change in cardiopulmonary bypass or aortic cross clamp time. In mediation analysis, the reduction in cost was completely accounted for in the decline in ICU length of stay. ICU length of stay was correlated with duration of intubation. ConclusionsIncreasing familiarity with Ebstein’s anomaly and Cone reconstruction led to a reduction in resource utilization.

Health care resource utilization and direct costs incurred over 24 months after initiating galcanezumab or standard-of-care preventive migraine treatments in the United States.

Health care resource utilization (HCRU) and direct costs incurred over 12 months following initiation of galcanezumab (GMB) or standard-of-care (SOC) preventive migraine treatments have been evaluated. However, a gap in knowledge exists in understanding longer-term HCRU and direct costs. To compare all-cause and migraine-related HCRU and direct costs in patients with migraine initiating GMB or SOC preventive migraine treatments over a 24-month follow-up. This retrospective study used Optum deidentified Market Clarity Data. The study included adults diagnosed with migraine, with at least 1 claim for GMB or SOC preventive migraine therapy (September 2018 to March 2020), with continuous enrollment for 12 months before and 24 months after (follow-up) the index date (date of first GMB or SOC claim). Propensity score (PS) matching (1:1) was used to balance cohorts. All-cause and migraine-related HCRU and direct costs for GMB vs SOC cohorts were reported as mean (SD) per patient per year (PPPY) over a 24-month follow-up and compared using a Z-test. Costs were inflated to 2022 US$. After PS matching, 2,307 patient pairs (mean age: 44.4 years; female sex: 87.3%) were identified. Compared with the SOC cohort, the GMB cohort had lower mean (SD) PPPY all-cause office visits (17.9 [17.7] vs 19.1 [18.7]; P = 0.023) and migraine-related office visits (2.6 [3.3] vs 3.0 [4.7]; P = 0.002) at follow-up. No significant differences were observed between cohorts in other all-cause and migraine-related events assessed including outpatient visits, emergency department (ED) visits, inpatient stays, and other medical visits. The mean (SD) costs PPPY were lower in the GMB cohort compared with the SOC cohort for all-cause office visits ($4,321 [7,518] vs $5,033 [7,211]; P < 0.001) at follow-up. However, the GMB cohort had higher mean (SD) PPPY all-cause total costs ($24,704 [30,705] vs $21,902 [28,213]; P = 0.001) and pharmacy costs ($9,507 [12,659] vs $5,623 [12,605]; P < 0.001) compared with the SOC cohort. Mean (SD) costs PPPY were lower in the GMB cohort for migraine-related office visits ($806 [1,690] vs $1,353 [2,805]; P < 0.001) compared with the SOC cohort. However, the GMB cohort had higher mean (SD) PPPY migraine-related total costs ($8,248 [11,486] vs $5,047 [9,749]; P < 0.001) and migraine-related pharmacy costs ($5,394 [3,986] vs $1,761 [4,133]; P < 0.001) compared with the SOC cohort. There were no significant differences between cohorts in all-cause and migraine-related costs for outpatient visits, ED visits, inpatient stays, and other medical visits. Although total costs were greater for GMB vs SOC following initiation, changes in a few categories of all-cause and migraine-related HCRU and direct costs were lower for GMB over a 24-month follow-up. Additional analysis evaluating indirect health care costs may offer insights into further cost savings incurred with preventive migraine treatment.

Cost-utility Analysis of Navigate, a Treatment Decision Aid for Men with Prostate Cancer and Their Partners, in Comparison to Usual Care

Background and objectiveEvidence on the cost effectiveness of decision aids to guide management decisions for men with prostate cancer is limited. We examined the cost utility of the Navigate online decision aid for men with prostate cancer in comparison to usual care (no decision aid). MethodsA Markov model with a 10-yr time horizon was constructed from a government health care perspective. Data from the Navigate trial (n = 302) and relevant published studies were used for model inputs. Incremental costs and quality-adjusted life-years (QALYs) were calculated for the two strategies. One-way and probabilistic sensitivity analyses were undertaken to address model uncertainty. Key findings and limitationsOn average, the Navigate strategy was estimated to cost AU$8899 (95% uncertainty interval [UI] AU$7509–AU$10438) and produce 7.08 QALYs (95% UI 6.73–7.36) in comparison to AU$9559 (95% UI AU$8177–AU$11017) and 7.03 QALYs (95% UI 6.67–7.31) or usual care. The Navigate strategy dominated usual care as it produced cost-savings and higher QALYs, although differences for both outcomes were small over 10 yr. The likelihood of Navigate being cost effective at a conventionally acceptable threshold of AU$50000 per QALY gained was 99.7%. This study is limited by the availability, quality, and choice of the data used in the model. Conclusions and clinical implicationsUse of an online decision aid for men with prostate cancer appears to be cost effective relative to usual care in Australia, driven by the higher acceptance and uptake of active surveillance. Wider implementation of decision aids may better inform men diagnosed with prostate cancer about their management options. Patient summaryWe looked at the cost effectiveness of an online decision aid for guiding Australian men with prostate cancer in choosing a management option. We found that this decision aid was cost effective, mainly because more men chose active surveillance. Decision aids that inform patients about their management options should be more widely used in health care.

Numerical simulation study on solidification proceoss of titanium slab ingot by electron beam cold hearth melting

Abstract Titanium and titanium alloys are key basic support materials in the field of engineering technology and high technology, and are widely used in the fields of natural gas transportation, chemical corrosion, and marine development. Titanium alloy ingots are often prepared with more solidification defects such as surface cracks and cold shuts, resulting in lower utilization of titanium metal and higher cost of titanium products. The root of this is the lack of in-depth knowledge of the ingot melting and casting process, and the failure to control the thermal conditions of the billet in the molding process within a reasonable range. In this study, based on the Lagrange Euler algorithm, combined with ProCAST finite element software to establish a numerical model, revealing the solid-liquid interface morphology, the length of the transition region, and the change rule of thermal stress under the influence of different process parameters in the solidification process of titanium slab ingot. The results show that with the increase in pulling speed, the depth of the solid-liquid phase line and the width of the mushy zone of slab ingot increase, and the length of the transition region grows. With the increase in casting temperature, the depth of the solid-liquid phase line of the slab ingot decreases, and the mushy zone gradually becomes narrower. The casting temperature and pulling speed are positively correlated with the value of the thermal stress equivalent stress in slab ingots, and the probability of cracks in the corners and ingot surface is higher. This study provides effective theoretical guidance for the realization of stable mass production of high-quality titanium slab ingot.

Assessing economic investment required to scale up bariatric surgery capacity in England: a health economic modelling analysis

ObjectivesTo quantify the economic investment required to increase bariatric surgery (BaS) capacity in National Health Service (NHS) England considering the growing obesity prevalence and low provision of BaS in England...

Economic model predictive control for building HVAC system: A comparative analysis of model-based and data-driven approaches using the BOPTEST Framework

Model Predictive Control (MPC) has demonstrated its capability to significantly enhance energy efficiency while ensuring indoor comfort. This study focuses on the development and fair comparison of two Economic Model Predictive Control(EMPC) frameworks with the goal of optimizing demand response for utility cost reduction and ensuring thermal comfort in residential buildings. The first framework, known as RC-MPC, utilizes a reduced-order thermal Resistance–Capacitance network model to represent the thermal dynamics of the building. It formulates the optimization problem as a Linear Programming (LP) task, which is solved using CPLEX. The second framework, known as ANN-MPC, employs an Artificial Neural Network model capture the thermal behavior of the building, It addresses a non-convex optimization problem through projected stochastic gradient descent. To evaluate the performance of these frameworks, experiments are conducted using a single-zone dwelling within the BOPTEST framework. The results demonstrate that both approaches effectively reduce operational costs and enhance comfort, achieving comparable performance and outperforming the baseline Rule-Based Control (RBC) method. The discomfort reductions range from 30% to 95%, and energy expense savings range from 17% to 34%. Furthermore, the study examines the impact of various MPC hyperparameters. The findings highlight that a proper control horizon and formulating the objective function accurately are crucial for achieving optimal control performance. Additionally, tightening the comfort range is found to be important in managing the comfort violations, and the choice of solver can influence both the control performance and computational efficiency.

Point-of-care Testing HbA1c screening for type 2 diabetes in urban and rural areas of China: a cost-effectiveness analysis.

Point-of-care Testing (POCT) glycosylated hemoglobin (HbA1c) is a convenient, cheap, effective and accessible screening method for type 2 diabetes in rural areas and community settings that is widely used in the European region and Japan, but not yet widespread in China. The study is the first to evaluate the cost-effectiveness of POCT HbA1c, fasting capillary glucose (FCG), and venous blood HbA1c to screen for type 2 diabetes in urban and rural areas of China, and to identify the best socio-economically beneficial screening strategy. Based on urban and rural areas in China, economic models for type 2 diabetes screening were constructed from a social perspective. The subjects of this study were adults aged 18-80 years with undiagnosed type 2 diabetes. Three screening strategies were established for venous blood HbA1c, FCG and POCT HbA1c, and cost-effectiveness analysis was performed by Markov models. One-way sensitivity analysis and probabilistic sensitivity analysis were performed on all parameters of the model to verify the stability of the results. Compared with FCG, POCT HbA1c was cost-effective with an incremental cost-utility ratio (ICUR) of $500.06/quality-adjusted life year (QALY) in urban areas and an ICUR of $185.10/QALY in rural areas, within the willingness-to-pay threshold (WTP = $37,653). POCT HbA1c was cost-effective with lower cost and higher utility compared with venous blood HbA1c in both urban and rural areas. In the comparison of venous blood HbA1c and FCG, venous blood HbA1c was cost-effective (ICUR = $20,833/QALY) in urban areas but not in rural areas (ICUR = $41,858/QALY). Sensitivity analyses showed that the results of the study were stable and credible. POCT HbA1c was cost-effective for type 2 diabetes screening in both urban and rural areas of China, which could be considered for future clinical practice in China. Factors such as geographic location, local financial situation and resident compliance needed to be considered when making the choice of venous blood HbA1c or FCG.

Health economic evaluation of an electronic mindfulness-based intervention (eMBI) to improve maternal mental health during pregnancy – a randomized controlled trial (RCT)

BackgroundAnxiety and depression are the most prevalent psychiatric diseases in the peripartum period. They can lead to relevant health consequences for mother and child as well as increased health care resource utilization (HCRU) and related costs. Due to the promising results of mindfulness-based interventions (MBI) and digital health applications in mental health, an electronic MBI on maternal mental health during pregnancy was implemented and assessed in terms of transferability to standard care in Germany. The present study focused the health economic outcomes of the randomized controlled trial (RCT).MethodsThe analysis, adopting a payer’s and a societal perspective, included women of increased emotional distress at < 29 weeks of gestation. We applied inferential statistics (α = 0.05 significance level) to compare the intervention group (IG) and control group (CG) in terms of HCRU and costs. The analysis was primarily based on statutory health insurance claims data which covered the individual observational period of 40 weeks.ResultsOverall, 258 women (IG: 117, CG: 141) were included in the health economic analysis. The results on total health care costs from a payer’s perspective indicated higher costs for the IGi compared to the CG (Exp(ß) = 1.096, 95% CI: 1.006–1.194, p = 0.037). However, the estimation was not significant after Bonferroni correction (p < 0.006). Even the analysis from a societal perspective as well as sensitivity analyses did not show significant results.ConclusionsIn the present study, the eMBI did neither reduced nor significantly increased health care costs. Further research is needed to generate robust evidence on eMBIs for women suffering from peripartum depression and anxiety.Trial registrationGerman Clinical Trials Register: DRKS00017210. Registered on 13 January 2020. Retrospectively registered.