Cost Variability Research Articles

Cost of provision of essential health Services in Public Health Centers of Jimma zone, Southwest Ethiopia; a provider perspective, the pointer for major area of public expenditure

BackgroundProvision of up-to-date cost information is crucial for not only addressing knowledge gap on the cost of essential health services (EHS) but also budgeting, allocating adequate resources and improving institutional efficiency at public health centers where basic health services are delivered the most.ObjectiveTo analyze the costs of essential health services at public health centers in Jimma Zone.MethodsA facility based cross-sectional study was conducted in public health centers of Jimma zone from April 10, 2018 to May 9, 2018. The study was conducted from a provider perspective using retrospective standard costing approach of one fiscal year time horizon. Step-down allocation was used to allocate costs to final services. All costs for provision EHS were taken into account and expressed in United States dollar (USD). Sixteen public health centers located in eight districts were randomly selected for the study.ResultsThe Average annual cost of providing essential health services at health centers in Jimma zone was USD 109,806.03 ± 50,564.9. Most (83.7%) of the total Annual cost was spent on recurrent items. Nearly half (45%) of total annual cost was incurred by personnel followed by drugs and consumables that accounted around one third (29%) of the total Annual cost. Around two third (65.9%) of the total annual cost was incurred for provision of EHS at the final cost center. The average overall unit cost was USD 7.4 per EHS per year.ConclusionCost providing an EHS at public health centers was low and so, necessitating funding of significant resources to provide standard health care. The variability in unit costs and cost components for EHS also suggest that the potential exists to be more efficient via better use of both human and material resources.

Understanding Ridesplitting Behavior with Interpretable Machine Learning Models Using Chicago Transportation Network Company Data

As congestion levels increase in cities, it is important to analyze people’s choices of different services provided by transportation network companies (TNCs). Using machine learning techniques in conjunction with large TNC data, this paper focuses on uncovering complex relationships underlying ridesplitting market share. A real-world dataset provided by TNCs in Chicago is used in analyzing ridesourcing trips from November 2018 to December 2019 to understand trends in the city. Aggregated origin–destination trip-level characteristics, such as mean cost, mean time, and travel time reliability, are extracted and combined with origin–destination community-level characteristics. Three tree-based algorithms are then utilized to model the market share of ridesplitting trips. The most significant factors are extracted as well as their marginal effect on ridesplitting behavior, using partial dependency plots for interpretation of the machine learning model results. The results suggest that, overall, community-level factors are as or more important than trip-level characteristics. Additionally, the percentage of White people highly affects ridesplitting market share as well as the percentage of bachelor’s degree holders and households with two people residing in them. Travel time reliability and cost variability are also deemed more important than travel time and cost savings. Finally, the potential impact of taxes, crimes, cultural differences, and comfort is discussed in driving the market share, and suggestions are presented for future research and data collection attempts.

The need for cardiac surgery differential tariffs in Israel at the era of aging population and emerging technology: Importance of procedure type and patient complexity as assessed by EuroSCORE

BackgroundReimbursement for cardiac surgical procedures in Israel is uniform and does not account for diversity in costs of various procedures or for diversity in patient mix. In an era of new and costly technology coupled with higher risk patients needing more complex surgery, these tariffs may not adequately reflect the true financial burden on the caregivers. In the present study we attempt to determine whether case mix and complexity of procedures significantly affect cost to justify differential tariffs.MethodsWe included all patients undergoing cardiac surgery at Shaare Zedek Medical Center between the years 1993–2016. Patients were stratified according to (1) type of surgery and (2) clinical profile as reflected by the predicted operative risk according to the European System for Cardiac Operative Risk Evaluation (EuroSCORE). Approximate cost of each group of patients was estimated by the average number of days in the Intensive Care Unit and days in the postoperative ward multiplied by the respective daily costs as determined by the Ministry of Health. We then added the fixed cost of the components used in the operating room (manpower and disposables). The final estimated cost (the outcome variable) was then evaluated as it relates to type of surgery and clinical profile. ANOVA was used to analyze cost variability between groups, and backward regression analysis to determine the respective effect of the abovementioned variables on cost. Because of non-normal distribution, both costs and lengths of stay were Log-transformed.ResultsAltogether there were 5496 patients: 3863, 836, 685 and 112 in the isolated CABG, CABG + valve, 1 valve and 2 valves replacement groups. By ANOVA, the costs in all EuroSCORE subgroups were significantly different from each other, increasing with increased EuroSCORE subgroup. Cost was also significantly different among procedure groups, increasing from simple CABG to single valve surgery to CABG + valve surgery to 2-valve surgery. In backward stepwise multiple regression analysis, both type of procedure and EuroSCORE group significantly impacted cost. ICU stay and Ward stay were significantly but weakly related while EuroSCORE subgroup was highly predictive of both ICU stay and ward stay.ConclusionsThe cost of performing heart surgery today is directly influenced by both patient profile as well as type of surgery, both of which can be quantified. Modern day technology is costly yet has become mandatory. Thus reimbursement for heart surgery should be based on differential criteria, namely clinical risk profile as well as type of surgery. Our results suggest an urgent need for design and implementation of a differential tariff model in the Israeli reimbursement system. We suggest that a model using a fixed, average price according to the type of procedure costs, in addition to a variable hospitalization cost (ICU + ward) determined by the patient EuroSCORE or EuroSCORE subgroup should enable an equitable reimbursement to hospitals, based on their case mix.

Modeling cost variability in a bottleneck model with degradable capacity

Valuing travel time reliability is an important element of travel choice modeling. In this paper, we introduce the notion of variation cost in the utility function, capturing the variations in both queuing cost and scheduling cost endogenously under degradable capacity, and develop a theoretical framework to derive the departure choice. We then define the value of capacity reliability to be the marginal influence of capacity degradation on the overall system generalized cost. Through this framework, a single-step tolling scheme is proposed to reduce the queuing cost and cost variability. The study illustrates the combined impact of cost variability, capacity degradation, and how road pricing will impact on travelers' departure profile and the overall system generalized cost.

Determining Variable Costs in the Acute Urolithiasis Cycle of Care Through Time-Driven Activity-Based Costing

ObjectiveTo characterize full cycle of care costs for managing an acute ureteral stone using time-driven activity-based costing. MethodsWe defined all phases of care for patients presenting with an acute ureteral stone and built an overarching process map. Maps for sub-processes were constructed through interviews with providers and direct observation of clinical spaces. This facilitated calculation of cost per minute for all aspects of care delivery, which were multiplied by associated process times. These were added to consumable costs to determine cost for each specific step and later aggregated to determine total cost for each sub-process. We compared costs of eight common clinical pathways for acute stone management, defining total cycle of care cost as the sum of all sub-processes that comprised each pathway. ResultsCost per sub-process included $920 for emergency department (ED) care, $1665 for operative stent placement, $2368 for percutaneous nephrostomy tube placement, $106 for urology clinic consultation, $238 for preoperative center visit, $4057 for ureteroscopy with laser lithotripsy (URS), $2923 for extracorporeal shock wave lithotripsy, $169 for clinic stent removal, $197 for abdominal x-ray, and $166 for ultrasound. The lowest cost pathway ($1388) was for medical expulsive therapy, whereas the most expensive pathway ($8002) entailed a repeat ED visit prompting temporizing stent placement and interval URS. ConclusionWe found a high degree of cost variation between care pathways common to management of acute ureteral stone episodes. Reliable cost accounting data and an understanding of variability in clinical pathway costs can inform value-based care redesign as payors move away from pure fee-for-service reimbursement.

Metabolic trade-offs in tropical and subtropical marine mammals: unique maintenance and locomotion costs in West Indian manatees and Hawaiian monk seals.

ABSTRACTUnlike the majority of marine mammal species, Hawaiian monk seals (Neomonachus schauinslandi) and West Indian manatees (Trichechus manatus latirostris) reside exclusively in tropical or subtropical waters. Although potentially providing an energetic benefit through reduced maintenance and thermal costs, little is known about the cascading effects that may alter energy expenditure during activity, dive responses and overall energy budgets for these warm-water species. To examine this, we used open-flow respirometry to measure the energy expended during resting and swimming in both species. We found that the average resting metabolic rates (RMRs) for both the adult monk seal (753.8±26.1 kJ h−1, mean±s.e.m.) and manatees (887.7±19.5 kJ h−1) were lower than predicted for cold-water marine mammal species of similar body mass. Despite these relatively low RMRs, both total cost per stroke and total cost of transport (COTTOT) during submerged swimming were similar to predictions for comparably sized marine mammals (adult monk seal: cost per stroke=5.0±0.2 J kg−1 stroke−1, COTTOT=1.7±0.1 J kg−1 m−1; manatees: cost per stroke=2.0±0.4 J kg−1 stroke−1, COTTOT=0.87±0.17 J kg−1 m−1). These lower maintenance costs result in less variability in adjustable metabolic costs that occur during submergence for warm-water species. However, these reduced maintenance costs do not appear to confer an advantage in overall energetic costs during activity, potentially limiting the capacity of warm-water species to respond to anthropogenic or environmental threats that require increased energy expenditure.

Adaptive functions of neurobehavioral plasticity in language learning and processing

AbstractThis article presents a large scope of issues on early and late language plasticity that increase our understanding of the neurobehavioral dynamics of change, the main property of the learning brain. In their pioneering work, Bates and Kuhl have convincingly demonstrated that plasticity is intrinsic to development. Bates has provided new data on the impressive recovery of language in children with focal brain injury, highlighting that both hemispheres support the early phases of this change, contrary to previous assumptions. The fundamental reorganization of the early phonemic system around the age of 8 months proposed by Kuhl, combining neural commitment and social abilities, has powerful cascading effects for subsequent word learning. Our developmental crosslinguistic research on online sentence processing in monolinguals and simultaneous bilinguals has revealed distinctive linguistic patterns of “cue cost”, a multifactorial concept relevant for capturing the microplasticity of the processing system. Whatever the language, the shift around the age of 9 towards the canonical adult pattern indicates an efficient adaptive processing occurring with a small delay in bilinguals. Most salient, from childhood, bilinguals exhibit specific cue cost patterns with interactions. In older French adults, cue cost variability is mediated by processing speed which preserves online syntactic abilities but reveals plasticity limits in Alzheimer’s patients.

Relative efficiency of demand creation strategies to increase voluntary medical male circumcision uptake: a study conducted as part of a randomised controlled trial in Zimbabwe

BackgroundSupply and demand-side factors continue to undermine voluntary medical male circumcision (VMMC) uptake. We assessed relative economic costs of four VMMC demand creation/service-delivery modalities as part of a randomised controlled...

Costs of integrating HIV self-testing in public health facilities in Malawi, South Africa, Zambia and Zimbabwe

IntroductionAs countries approach the UNAIDS 95-95-95 targets, there is a need for innovative and cost-saving HIV testing approaches that can increase testing coverage in hard-to-reach populations. The HIV Self-Testing Africa-Initiative...

Selecting cost management models in post-pandemic settings

The article discusses the features of cost management in post-pandemic conditions. The introduction justifies the relevance of the study of the cost management process and the problem of choosing appropriate management models in the modern economy, including in post-pandemic conditions. The methods used in the post-pandemic cost management study are indicated. The result of their practical implementation is determined. As the results of the study, the essence of the costs is determined, their types are described. In addition, factors are established that determine the variability of costs. The cost management process is characterized. Planning is considered as one of the stages of cost management, as well as key aspects of budgeting as a form of planning. Budget objectives and objectives are defined. Measures are being established to achieve the goal of an integrated cost reduction system. The principles and methods of cost management are described. Key ways to achieve competitive advantage in post-pandemic settings are identified. There are negative and positive consequences of the COVID-19 pandemic, which determine how to manage costs in the post-pandemic period. The pandemic-driven changes in the accounting of expenditures, which contribute to the spread of the motivation approach and new business models and corporate governance models, are being discussed. The conclusion concludes that it is possible to choose cost management models in post-pandemic settings.

The cost of CO2 transport and storage in global integrated assessment modeling

This paper assesses the range of CO2 transport and storage costs and evaluates their impact on economy-wide modeling results of decarbonization pathways. Much analytic work has been dedicated to evaluating the cost and performance of various CO2 capture technologies, but less attention has been paid to evaluating the cost of CO2 transport and storage. Many integrated assessment modeling studies assume a combined cost for CO2 transport and storage that is uniform in all regions, commonly estimated at $10/tCO2. Realistically, the cost of CO2 transport and storage is not fixed at $10/tCO2 and varies across geographic, geologic, and institutional settings. We surveyed the literature to identify key sources of variability in transport and storage costs and developed a method to quantify and incorporate these elements into a cost range. We find that onshore pipeline transport and storage costs vary from $4 to 45/tCO2 depending on key sources of variability including transport distance, scale (i.e. quantity of CO2 transported and stored), monitoring assumptions, reservoir geology, and transport cost variability such as pipeline capital costs. Using the MIT Economic Projection and Policy Analysis (EPPA) model, we examined the impact of variability in transport and storage costs by applying a range of uniform costs in all regions in a future where global temperature rise is limited to 2°C. We then developed three modeling cases where transport and storage costs vary regionally. In these latter cases, global cumulative CO2 captured and stored through 2100 ranges from 290 to 377 Gt CO2, compared to 425 Gt CO2 when costs are assumed to be uniformly $10/t CO2 in all regions. We conclude that the widely used assumption of $10/tCO2 for the transport and storage of CO2 is reasonable in some regions, but not in others. Moreover, CCS deployment is more sensitive to transport and storage costs in some regions than others, particularly China. More analysis is needed to further quantify CO2 transport and storage costs at a regional level.

How would real-time electricity pricing affect the Saudi power sector in the long-run?

This paper shows the effects of real-time electricity pricing (RTP) on the long-run marginal costs of power generation in Saudi Arabia. To do this, it links a multi-sector energy system model with a residential electricity use model. The energy system model contains an economic power dispatch optimization component. The residential framework embeds households, whose decisions are governed by microeconomic principles, in a physical building energy model. The analysis entails liberalizing fuel prices for the power utilities and setting the dynamic prices of electricity equal to the long-run marginal electricity supply costs. The electricity prices are solely offered to households. The key takeaways from this analysis are:•RTP, a form of dynamic electricity pricing, reduces the variability of the marginal costs for Saudi power utilities throughout the day.•Lowered capital spending by the Saudi power sector results from RTP and consequently lower power loads. Moreover, the curtailed investment in power plants would more than cover the costs of residential smart meter replacements.

Evolving Cost-Quality Relationship in Pediatric Heart Surgery

BackgroundFor the more than 40,000 children in the United States undergoing congenital heart surgery annually, the relationship between hospital quality and costs remains unclear. Prior studies report conflicting results and clinical outcomes have continued to improve over time. We examined a large contemporary cohort, aiming to better inform ongoing initiatives seeking to optimize health care value in this population. MethodsClinical information (The Society of Thoracic Surgeons Congenital Database) was merged with standardized cost data (Pediatric Health Information Systems) for children undergoing heart surgery from 2010 to 2015. In-hospital cost variability was analyzed using Bayesian hierarchical models adjusted for case-mix. Quality metrics examined included in-hospital mortality, postoperative complications, postoperative length of stay (PLOS), and a composite. ResultsOverall, 32 hospitals (n = 45,315 patients) were included. Median adjusted cost per case varied across hospitals from $67,700 to $51,200 in the high vs low cost tertile (ratio 1.32; 95% credible interval, 1.29 to 1.35), and all quality metrics also varied across hospitals. Across cost tertiles, there were no significant differences in the quality metrics examined, with the exception of PLOS. The PLOS findings were driven by high-risk The Society of Thoracic Surgeons-European Association for Cardiothoracic Surgery categories 4 and 5 cases (adjusted median length of stay 16.8 vs 14.9 days in high vs low cost tertile [ratio 1.13, 1.05 to 1.24]), and intensive care unit PLOS. ConclusionsContemporary congenital heart surgery costs vary across hospitals but were not associated with most quality metrics examined, highlighting that performance in one area does not necessarily convey to others. Cost variability was associated with PLOS, particularly related to intensive care unit PLOS and high-risk cases. Care processes influencing PLOS may provide targets for value-based initiatives in this population.

Prioritization framework for improving the value of care for very low birth weight and very preterm infants

ObjectiveCreate a prioritization framework for value-based improvement in neonatal care.Study designA retrospective cohort study of very low birth weight (<1500 g) and/or very preterm (<32 weeks) infants discharged between 2012 and 2019 using the Pediatric Health Information System Database. Resource use was compared across hospitals and adjusted for patient-level differences. A prioritization score was created combining cost, patient exposure, and inter-hospital variability to rank resource categories.ResultsResource categories with the greatest cost, patient exposure, and inter-hospital variability were parenteral nutrition, hematology (lab testing), and anticoagulation (for central venous access and therapy), respectively. Based on our prioritization score, parenteral nutrition was identified as the highest priority overall.ConclusionsWe report the development of a prioritization score for potential value-based improvement in neonatal care. Our findings suggest that parenteral nutrition, central venous access, and high-volume laboratory and imaging modalities should be priorities for future comparative effectiveness and quality improvement efforts.

Pengaruh Likuiditas, Financial Leverage, Margin Laba Kotor, Variabilitas Harga Pokok Penjualan, dan Ukuran Perusahaan terhadap Pemilihan Metode Penilaian Persediaan pada Perusahaan Manufaktur yang Terdaftar di BEI Periode 2015–2019

This study aims to determine the effect of liquidity, financial leverage, gross profit margins, variability of cost of goods sold, and firm size on inventory valuation methods on manufacturing companies listed on the IDX. This research is a descriptive study with a quantitative approach. The population in this study were companies that registered on the IDX totaling 169 companies. The sample used in this study is to use data collection techniques (purposive sampling) consisting of 29 companies. This research uses logistic regression analysis method with SPSS Version 22 program. The results showed that liquidity affected the inventory valuation method with a significant value of 0.030, financial leverage had no effect on the inventory valuation method with a significant value of 0.699, the gross profit margin affected the inventory valuation method with a significance value of 0,001, the variability in cost of goods sold did not affect the valuation method inventories with a significance value of 0.502, company size has no effect on the inventory valuation method with a significance value of 0.799.

The Assessment of Daily Energy Expenditure of Commercial Saturation Divers Using Doubly Labelled Water.

Commercial saturation divers are exposed to unique environmental conditions and are required to conduct work activity underwater. Consequently, divers’ physiological status is shown to be perturbed and therefore, appropriate strategies and guidance are required to manage the stress and adaptive response. This study aimed to evaluate the daily energy expenditure (DEE) of commercial saturation divers during a 21-day diving operation in the North Sea. Ten saturation divers were recruited during a diving operation with a living depth of 72 metres seawater (msw) and a maximum working dive depth of 81 msw. Doubly labelled water (DLW) was used to calculate DEE during a 10-day measurement period. Energy intake was also recorded during this period by maintaining a dietary log. The mean DEE calculated was 3030.9 ± 513.0 kcal/day, which was significantly greater than the mean energy intake (1875.3 ± 487.4 kcal; p = 0.005). There was also a strong positive correction correlation between DEE and total time spent performing underwater work (r = 0.7, p = 0.026). The results suggested saturation divers were in a negative energy balance during the measurement period with an intraindividual variability in the energy cost present that may be influenced by time spent underwater.

Variability and contributions to cost associated with anterior versus posterior approaches to lumbar interbody fusion

ObjectiveLumbar interbody fusions are being performed with increased frequency in the last decade. Anterior and posterior interbody techniques have demonstrated relatively similar success rates. Nonetheless, despite increased attention to cost-effective care delivery, approach-related differences in procedural cost and predictors for these differences remain poorly defined. The purpose of this investigation was to characterize the variability in cost for anterior versus posterior-based lumbar interbody fusions and to identify key predictors of procedural cost. MethodsWe evaluated the records of all patients who underwent a primary anterior (ALIF) or posterior/transforaminal (PLIF/TLIF) lumbar interbody fusion with concomitant posterior fusion from 2016 to 2020 at four hospitals in a major metropolitan area. We reviewed the records of all included patients and abstracted demographics, insurance status, approach, operative time, diagnosis, surgeon, institution, open versus minimally invasive technique, and components of procedural costs. Costs based upon interbody approach were compared via multivariable adjusted analyses using negative binomial regression. ResultsWe included 139 interbody fusion procedures; 98 were performed via posterior approach (TLIF/PLIF) and 41 using an anterior approach. Anterior techniques were associated with significantly increased costs as compared to posterior procedures (anterior, $16316 [SE 556] vs. posterior, $9415 [SE 345]; p < 0.001). This determination remained significant following multivariable adjusted analysis (regression coefficient −0.22, 95% CI −0.34, −0.10, p < 0.001). Multivariable analysis also indicated that surgeon, invasiveness, and procedure time were significant predictors of total cost. ConclusionOur findings demonstrate that anterior interbody techniques are, on average, 173% (anterior, $16316 [SE 556] vs. posterior, $9415 [SE 345]; p < 0.001) more expensive than posterior-based procedures. Given the relative equipoise of these different approaches for many clinical applications, these findings should be considered in an ecosystem increasingly attentive to cost effective care delivery. This work has also provided specific procedural variables for surgeons and systems to target when optimizing procedural costs.

Modifying the SERVPERF to assess paratransit minibus taxis trotro in Ghana and the relevance of mobility-as-a-service features to the service

In Ghana, minibus taxis (trotros) are an important mode of transport that commute about 60% of the traveling public. In spite of their popularity, minibuses are generally inefficient, disorganized and have low service quality. In an attempt to assess service quality of the service, a modified SERVPERF tool was developed. Differences in perceptions of service quality between male and female respondents were also assessed, and the attractiveness of certain technological features as possible remedies to service quality issues were determined. Using an online Google forms version of the modified SERVPERF, responses from nearly one thousand commuters were collected. The link to the questionnaire was dispersed via social media (Whatsapp and Telegram) since the data was collected during the outbreak of COVID-19 in Ghana. Following a factor reduction, the most important service quality factors determined to affect trotro users were (i) Reliability of the service, (ii) Variability in cost and (iii) Responsiveness. Respondents also identified technologies that could help them (a) book, (b) report driver misbehavior, (c) make safe e-payments and (d) track the location of trotros, as most likely to improve their trotro service quality. The findings suggest that some mobility as a service features could have possible benefit for the trotro. The study is however limited in its ability to determine the exact impact of these technologies since it uses a stated preference approach. Future research could explore the willingness of other stakeholder groups such as operators in adopting these technologies since their participation would be key to the success of any such scheme.

Evaluation of the Implementation and Effectiveness of Community-Based Brain-Computer Interface Cognitive Group Training in Healthy Community-Dwelling Older Adults: Randomized Controlled Implementation Trial.

BackgroundCognitive training can improve cognition in healthy older adults.ObjectiveThe objectives are to evaluate the implementation of community-based computerized cognitive training (CCT) and its effectiveness on cognition, gait, and balance in healthy older adults.MethodsA single-blind randomized controlled trial with baseline and follow-up assessments was conducted at two community centers in Singapore. Healthy community-dwelling adults aged 55 years and older participated in a 10-week CCT program with 2-hour instructor-led group classes twice a week. Participants used a mobile app to play games targeting attention, memory, decision making, visuospatial abilities, and cognitive flexibility. Implementation was assessed at the participant, provider, and community level (eg, reach, implementation, and facilitators and barriers). Effectiveness measures were the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), Color Trails Test 2 (CTT-2), Berg Balance Scale, and GAITRite walkway measures (single and dual task gait speed, dual task cost, and single and dual task gait variability index [GVI]).ResultsA total of 94 healthy community-dwelling adults participated in the CCT program (mean age 68.8 [SD 6.3] years). Implementation measures revealed high reach (125/155, 80.6%) and moderate adherence but poor penetration of sedentary older adults (43/125, 34.4%). The effectiveness data were based on intention-to-treat (ITT) and per-protocol (PP) analysis. In the ITT analysis, single task GVI increased (b=2.32, P=.02, 95% CI [0.30 to 4.35]) and RBANS list recognition subtest deteriorated (b=–0.57, P=.01, 95% CI [–1.00 to –0.14]) in both groups. In the PP analysis, time taken to complete CTT-2 (b=–13.5, P=.01, 95% CI [–23.95 to –3.14]; Cohen d effect size = 0.285) was faster in the intervention group. Single task gait speed was not statistically significantly maintained in the intervention group (b=5.38, P=.06, 95% CI [–0.30 to 11.36]) and declined in the control group (Cohen d effect size = 0.414). PP analyses also showed interaction terms for RBANS list recall subtest (b=–0.36, P=.08, 95% CI [–0.75 to 0.04]) and visuospatial domain (b=0.46, P=.08, 95% CI [–0.05 to 0.96]) that were not statistically significant.ConclusionsCCT can be implemented in community settings to improve attention and executive function among healthy older adults. Findings help to identify suitable healthy aging programs that can be implemented on a larger scale within communities.Trial RegistrationClinicalTrials.gov NCT04439591; https://clinicaltrials.gov/ct2/show/NCT04439591

Treatment of central disorders of hypersomnolence: an American Academy of Sleep Medicine clinical practice guideline.

This guideline establishes clinical practice recommendations for the treatment of central disorders of hypersomnolence in adults and children. The American Academy of Sleep Medicine commissioned a task force of experts in sleep medicine to develop recommendations and assign strengths to each recommendation, based on a systematic review of the literature and an assessment of the evidence using the GRADE process. The task force provided a summary of the relevant literature and the quality of evidence, the balance of benefits and harms, patient values and preferences, and resource use considerations that support the recommendations. The AASM Board of Directors approved the final recommendations. The following recommendations are intended to guide clinicians in choosing a specific treatment for central disorders of hypersomnolence in adults and children. Each recommendation statement is assigned a strength ("strong" or "conditional"). A "strong" recommendation (ie, "We recommend…") is one that clinicians should follow under most circumstances. A "conditional" recommendation (ie, "We suggest…") is one that requires that the clinician use clinical knowledge and experience and strongly consider the individual patient's values and preferences to determine the best course of action. Under each disorder, strong recommendations are listed in alphabetical order followed by the conditional recommendations in alphabetical order. The section on adult patients with hypersomnia because of medical conditions is categorized based on the clinical and pathological subtypes identified in ICSD-3. The interventions in all the recommendation statements were compared to no treatment. We recommend that clinicians use modafinil for the treatment of narcolepsy in adults. (STRONG). We recommend that clinicians use pitolisant for the treatment of narcolepsy in adults. (STRONG). We recommend that clinicians use sodium oxybate for the treatment of narcolepsy in adults. (STRONG). We recommend that clinicians use solriamfetol for the treatment of narcolepsy in adults. (STRONG). We suggest that clinicians use armodafinil for the treatment of narcolepsy in adults. (CONDITIONAL). We suggest that clinicians use dextroamphetamine for the treatment of narcolepsy in adults. (CONDITIONAL). We suggest that clinicians use methylphenidate for the treatment of narcolepsy in adults. (CONDITIONAL). We recommend that clinicians use modafinil for the treatment of idiopathic hypersomnia in adults. (STRONG). We suggest that clinicians use clarithromycin for the treatment of idiopathic hypersomnia in adults. (CONDITIONAL). We suggest that clinicians use methylphenidate for the treatment of idiopathic hypersomnia in adults. (CONDITIONAL). We suggest that clinicians use pitolisant for the treatment of idiopathic hypersomnia in adults. (CONDITIONAL). We suggest that clinicians use sodium oxybate for the treatment of idiopathic hypersomnia in adults. (CONDITIONAL). We suggest that clinicians use lithium for the treatment of Kleine-Levin syndrome in adults. (CONDITIONAL). We suggest that clinicians use armodafinil for the treatment of hypersomnia secondary to dementia with Lewy bodies in adults. (CONDITIONAL). We suggest that clinicians use modafinil for the treatment of hypersomnia secondary to Parkinson's disease in adults. (CONDITIONAL). We suggest that clinicians use sodium oxybate for the treatment of hypersomnia secondary to Parkinson's disease in adults. (CONDITIONAL). We suggest that clinicians use armodafinil for the treatment of hypersomnia secondary to traumatic brain injury in adults. (CONDITIONAL). We suggest that clinicians use modafinil for the treatment of hypersomnia secondary to traumatic brain injury in adults. (CONDITIONAL). We suggest that clinicians use modafinil for the treatment of hypersomnia secondary to myotonic dystrophy in adults. (CONDITIONAL). We suggest that clinicians use modafinil for the treatment of hypersomnia secondary to multiple sclerosis in adults. (CONDITIONAL). We suggest that clinicians use modafinil for the treatment of narcolepsy in pediatric patients. (CONDITIONAL). We suggest that clinicians use sodium oxybate for the treatment of narcolepsy in pediatric patients. (CONDITIONAL). Maski K, Trotti LM, Kotagal S, et al. Treatment of central disorders of hypersomnolence: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med. 2021;17(9):1881-1893.