Variation In Costs Research Articles

Substantial increase of heat-induced labor and economic loss in China under rapid economic and environmental temperature growth

Exposure to heat stress causes diminished work performance and leads to economic loss. In the last two decades, China has experienced both rapid economic development and environmental warming; however, the spatiotemporal variations of association between environmental heat and labor loss have been rarely investigated behind this double impact. Here, we evaluated the variation in China's heat-induced labor productivity loss and related economic cost from 2001 to 2019 and investigated the effect of economic development and regional warming. We found that decline in labor productivity because of heat stress increased significantly (p < 0.05 for heavy-intensity work), and the corresponding economic loss also exhibited a drastic increase by 6- to 9-fold. The relative economic loss showed a slight but nonsignificant increase with an average value of 0.54% of the annual total earnings. At the sub-regional and sectoral level, adverse effects were more prominent in the southeast region, and the secondary industry sectors, such as construction and manufacturing, contributed to larger proportions of economic losses. The transformation of industrial structure made economic sectors more vulnerable to heat exposure, and increasingly preventive effects of air-conditioning use were noted on economic damage due to heat-induced productivity decline (36.0% relative economic benefits in 2019 compared to 9.7% in 2001). Our findings could provide a deep insight into heat burden on occupational health and heat adaptation strategies regionally under climate change, especially in developing areas with higher temperature and humidity environment.

A community hospital cancer services approach to the reduction of OP-35 rule hospitalizations.

e23036 Background: Acute inpatient hospital care contributes substantially to variation in cancer care costs across the United States. The CMS Hospital Outpatient Quality Reporting Program’s OP-35 rule penalizes health systems for having higher-than-expected rates of emergency department (ED) visits or inpatient admissions for ten potentially preventable conditions within 30 days of receiving chemotherapy. To commence a systematic, automated, risk-adapted program to maximize safety outcomes, we identified independent risk factors specific to cancer patients in the Inova Health System (a 5-hospital, 5 million-patients hospital system in Virginia/greater metropolitan DC). Methods: We identified all cancer patients who received chemotherapy within the previous 30 days and presented to the ED or were admitted between 1/1/2018 to 12/31/2021 for one of the OP-35 toxicities as their primary or secondary diagnoses at the time of the acute care evaluation. Data included demographics, insurance coverage, cancer diagnosis, co-morbidities, and status (alive/dead) at last follow up. A zero-truncated Poisson regression analysis was performed in R v4.1.1. We further performed risk analysis within comorbid conditions by creating a matched cohort of patients by sex, age at first treatment, race, and cancer type who did not have an ED or admission visit due to OP-35 events during this same period. Propensity score matching was performed using R package MatchIt v4.5.1. Results: Among the 1,618 patients identified, the most frequent events were pain, sepsis, and fever. 56% of patients were female with an overall median age of 64 (range = [20, 95]). Men were predicted to have 16% more visits than females. 45% had commercial insurance, 39% were on Medicare, and 15% were on Medicaid or charity care. 39% had two or more visits during the 4 years of the study, and among those patients, the most frequent cancer types were gastrointestinal (32%) and breast (22%). Self-reported latino patients constituted 4% of all patients but had the highest average number of events (median = 2.07, range = [1, 9]). Patients who reported more-than-one-race or Asian ancestry had the lowest median number of events (1.56 and 1.64, respectively). In the matched cohort analysis, five co-morbidities were statistically significant (p &lt; 0.05): a previous history of coagulopathy/pulmonary emboli, myocardial infarction, cardiac arrhythmias, depression, and weight loss (concordance = 0.58). 46% of all patients with an event had at least one of these 5 comorbidities. Conclusions: Demographic factors and specific comorbid conditions were associated with risk for requiring acute care intervention for chemotherapy toxicities. Future interventions will include introduction of risk-reducing monitoring in the outpatient setting for higher risk patients identified in this investigation to reduce the need for ED visits and inpatient hospitalizations.

The annual cost of cancer screening in the U.S.

11051 Background: Cancer screening can decrease cancer incidence, mortality, and treatment costs. However, the annual cost of screening to the U.S. healthcare system is unknown. Methods: We used data from national healthcare surveys and standard costing sources to model the healthcare system cost of breast, cervical, colorectal, lung, and prostate cancer screening in the U.S. in 2021. Models projected the number of individuals in the U.S. eligible for each screening test based on current guidelines/recommendations; the number of eligible individuals screened by insurance status; and the costs associated with screening (in 2021 US dollars). Multiple sensitivity analyses were performed to examine the effects of changing model population parameters and costs on projected outcomes. Results: Total 2021 cancer screening costs to the U.S. healthcare system were estimated to be $57 billion; approximately 88% of the costs were attributable to private insurance, 9% to Medicare, and 3% to Medicaid, other government programs, and uninsured individuals. Most screened individuals had private insurance except for lung cancer screening, where a majority of individuals screened had Medicare coverage. Individuals with private insurance accounted for the majority of costs for each screening modality. Screening for colorectal cancer represented approximately two-thirds of the total cost; screening colonoscopy was approximately 60% of the total cost of cancer screening. Breast and cervical cancer screening represented the second and third largest screening costs, 15.4% and 14.7% (respectively) of total screening costs. Facility costs (amounts paid to facilities where testing occurred) were generally larger components of the total estimated costs of screening than were physician costs. Cost estimates were robust to a range of variations in eligible populations and screening costs. Conclusions: The $57 billion estimated annual cost for cancer screening in the U.S. in 2021 is similar to the estimated annual cost of cancer treatment in the U.S. in the first 12 months following diagnosis. Screening may have been suboptimal in 2021, with higher screening rates and costs in subsequent years. Identification of cancer screening costs and their drivers is critical to help inform policy and develop programmatic priorities. The model can be used to estimate the increased costs of enhanced access to recommended cancer screening services among underscreened populations, which would provide population-wide benefits.

A critical evaluation of contents, labeling, and cost of hand sanitizers marketed in India during COVID-19 pandemic

ABSTRACT Background: Antiseptics were introduced a long time ago, but their significance was noteworthy during the COVID-19 pandemic. Hand sanitizer plays a pivotal role as a preventive measure. Multiple national authorities have advocated for the application of Alcohol-Based Hand Sanitizers (ABHS). During the pandemic, a surge in demand and limited supply prompted numerous manufacturers to ramp up production. Consequently, it is imperative to scrutinize the composition, labeling, and price of hand sanitizers. Aims and Objective: To assess the contents, labeling, and price of hand sanitizers available in the Indian market. Methodology: Hand sanitizers, both online and offline, marketed in India between May 2019 and May 2022 were included. Hand sanitizers by local manufacturers without labeling were excluded. Contents and labeling of hand sanitizers were evaluated as per World Health Organization (WHO) recommendations. Price was assessed as a percentage cost variation. Result: Out of 79, the majority (98.73%) were ABHS, and 28.20% of them met the recommended criteria for “Adequate” alcohol concentration. Ethyl alcohol emerged as the most prevalent (69.23%), often accompanied by emollients, humectants, fragrances, and color additives. Notably, 69.62% of the hand sanitizers featured comprehensive labeling, while incomplete labels lacked essential details under “Warning and Cautions.” The average price of hand sanitizers was Rs 505.11 ± 255.36. Conclusion: Choosing ABHS with appropriate alcohol concentrations in line with recommendations is crucial. To ensure the proper and safe use of hand sanitizers, individuals should follow the instructions provided on the product labels; both manufacturers and regulators are responsible for adhering to standards for hand sanitizers made available to the public.

Location-dependent flight cost difference from the lunar surface to an orbital fuel depot and its influence on in situ resource utilisation location selection

Given the increasing relevance of lunar activities, the location selection for in situ resource utilisation (ISRU) facilities is necessary for identifying the most suitable configuration during mission planning. To gather information about the dominant location dependencies, a scenario is established wherein an ISRU product is exported to an orbital depot and its mass costs are used for classification. In the selected scenario, oxygen is produced in an ilmenite reduction plant and subsequently exported to the lunar gateway via an oxygen–hydrogen fuelled launcher operated in a round-trip to refuel oxygen at the lunar surface and hydrogen at the lunar gateway. This showed that the transport cost variations could be avoided entirely or have a recessive influence on the mission’s total costs over an extended period of time, such as 20 years. The identification of the top-10 most optimal locations for various resolutions was altered only slightly upon consideration of flight costs as compared to considering only the ISRU factors; this indicates the insignificance of flight cost dependencies for the analysed case.

A geographically disaggregated approach to integrate low-carbon technologies across local electricity networks

Meeting climate targets requires widespread deployment of low-carbon technologies such as distributed photovoltaics, heat pumps and electric vehicles. Without mitigating actions, changing power flows associated with these technologies would adversely impact some local networks. The extent of these impacts, and the optimal means of avoiding them, remains unclear. Here we use local-level data and network simulation to estimate variation in future network upgrade costs in over 40,000 geographical regions comprising all of Great Britain. We find that costs vary substantially between localities, and are typically highest in urban areas, and areas with highest deployment of heat pumps and electric vehicles. We estimate reductions in required upgrades associated with local flexibility, which vary substantially between localities. We show that using geographically disaggregated data to inform flexibility deployment across the country could reduce network upgrade costs by hundreds of millions of pounds relative to an approach that treats localities as homogeneous.

Carbon Neutral Design of Waste Energy Recovery System for LNG Power Plant Using Organic Rankine Cycle

In liquefied natural gas (LNG) power plants, a significant amount of heat and cold energy is consumed to capture and store carbon dioxide (CO2) emitted during the combustion of fossil fuels. The proposed system addresses this problem by utilizing the temperature difference between waste heat and cold energy as a power source to generate electricity. In this study, a novel waste heat and cold energy recovery system for a postcombustion LNG power plant was developed using an organic Rankine cycle (ORC). To design the proposed system, a process model was developed with the following five parts: (i) LNG vaporization, (ii) natural gas combined cycle (NGCC), (iii) amine scrubbing, (iv) CO2 liquefaction, and (v) CO2 injection. In the proposed system, waste LNG cold energy is used for lean amine cooling and CO2 liquefaction. The liquefied CO2 was pressurized to meet the injection pressure requirements. The ORC uses high-temperature exhaust gas from the NGCC as the heat source and high-pressure liquefied CO2 as the heat sink. The economic feasibility of the proposed system was demonstrated by an economic assessment, with the net profit evaluated by a sensitivity analysis considering variations in water, electricity, and equipment costs. Consequently, the proposed system exhibited an 18.6% increase in net power production compared to the conventional system. In addition, the net profit of the proposed system exhibited a 76.7% increase compared to the conventional system, confirming its economic feasibility.

Analysis of the Teslas Sustainable Supply Chain Management

Tesla, a prominent company in electric vehicles and renewable energy technology, prioritizes environmental sustainability, social responsibility, and economic rewards in its supply chain management alongside cost and efficiency. The paper uncovers Tesla's methods in resource usage and conservation, environmental impact assessment, social responsibility management, and economic benefit management through literature analysis and case analysis. The study determined that Tesla has made notable advancements in environmental performance throughout its supply chain by implementing innovative technologies and management strategies, including battery technology improvements, automated production processes, supplier responsibility evaluations, and life cycle assessments (LCA). Tesla encounters obstacles including worldwide chip shortages and variations in raw material costs, affecting the stability and efficiency of its supply chain. The paper suggests that governments, enterprises, and industries collaborate to enhance supply chain sustainability. This can be achieved by implementing policies, fostering technological innovation, and utilizing sharing platforms to support the global sustainable development goals.

Variation in the Cost of Hip Arthroscopy for Labral Pathological Conditions: A Time-Driven Activity-Based Costing Analysis.

Despite growing interest in delivering high-value orthopaedic care, the costs associated with hip arthroscopy remain poorly understood. By employing time-driven activity-based costing (TDABC), we aimed to characterize the cost composition of hip arthroscopy for labral pathological conditions and to identify factors that drive variation in cost. Using TDABC, we measured the costs of 890 outpatient hip arthroscopy procedures for labral pathological conditions across 5 surgeons at 4 surgery centers from 2015 to 2022. All patients were ≥18 years old and were treated by surgeons who each performed ≥20 surgeries during the study period. Costs were normalized to protect the confidentiality of internal hospital cost data. Descriptive analyses and multivariable linear regression were performed to identify factors underlying cost variation. The study sample consisted of 515 women (57.9%) and 375 men (42.1%), with a mean age (and standard deviation) of 37.1 ± 12.7 years. Most of the procedures were performed in patients who were White (90.6%) or not Hispanic (93.4%). The normalized total cost of hip arthroscopy per procedure ranged from 43.4 to 203.7 (mean, 100 ± 24.2). Of the 3 phases of the care cycle, the intraoperative phase was identified as the largest generator of cost (>90%). On average, supply costs accounted for 48.8% of total costs, whereas labor costs accounted for 51.2%. A 2.5-fold variation between the 10th and 90th percentiles for total cost was attributed to supplies, which was greater than the 1.8-fold variation attributed to labor. Variation in total costs was most effectively explained by the labral management method (partial R2 = 0.332), operating surgeon (partial R2 = 0.326), osteoplasty type (partial R2 = 0.087), and surgery center (partial R2 = 0.086). Male gender (p < 0.001) and younger age (p = 0.032) were also associated with significantly increased costs. Finally, data trends revealed a shift toward labral preservation techniques over debridement during the study period (with the rate of such techniques increasing from 77.8% to 93.2%; Ptrend = 0.0039) and a strong correlation between later operative year and increased supply costs, labor costs, and operative time (p < 0.001 for each). By applying TDABC to outpatient hip arthroscopy, we identified wide patient-to-patient cost variation that was most effectively explained by the method of labral management, the operating surgeon, the osteoplasty type, and the surgery center. Given current procedural coding trends, declining reimbursements, and rising health-care costs, these insights may enable stakeholders to design bundled payment structures that better align reimbursements with costs. Economic and Decision Analysis Level IV. See Instructions for Authors for a complete description of levels of evidence.

Ethnic variation in access to publicly funded care for unintentional injuries in older adults in Aotearoa New Zealand: a retrospective study

BackgroundMāori (the Indigenous people of Aotearoa New Zealand (NZ)) are more likely to experience injury than non-Māori, but less likely to have effective access to publicly funded injury care services....

Effectiveness of Home Health Care Services in the Qassim Region

This study aimed to assess the effectiveness of home healthcare services provided by both governmental and private sectors in the Qassim Region, Saudi Arabia, during 2021. A survey was conducted involving 210 participants, comprising 2,304 patients from 20 governmental home health care (HHC) sections in hospitals and 199 patients from one private home health care section in private hospitals in the Qassim Region. The majority of respondents were married Saudi men who preferred home visits and faced literacy challenges. Home health care (HHC) was found to be a viable and cost-effective alternative to hospital care, with an average visit duration of approximately 65 minutes and costs amounting to about $400.5 for the private sector and $1,622.694 for the government sector per patient monthly. Despite higher perceived costs, home healthcare remained more economical than hospital-based care. Noteworthy is the continued cost difference between governmental and private sectors on a per-patient monthly basis, indicating potential non-financial factors influencing service delivery. Participants rated HHC services as effective, particularly in assisting with transitions and identifying nutritional deficiencies, although patient deterioration and re-admission received lower ratings. In conclusion, home healthcare services in the Qassim Region were effective across both sectors, highlighting HHC as a cost-effective alternative despite variations in costs between governmental and private providers. It is essential to note the exclusion of home health care coverage from the Council of Cooperative Health Insurance (CCHI) policy. Keywords: Home health care, Care systems, Quality, Costs

Total knee arthroplasty: Quality assurance and improved longevity costs less

BackgroundThere is an accepted variation in the financial cost of total knee arthroplasty (TKA) implants but it is not known whether this cost is reflected by the evidence in support of their use. A cost analysis study was carried out to determine the total cost of consumables of a TKA, and whether this was related to the supporting evidence and survivorship data. MethodsIntra-operative data for all unilateral, cemented, primary TKA over a 13 month period at a high-volume Orthopaedic Centre was collected. Level of evidence for each model was taken from the Orthopaedic Data Evaluation Panel (ODEP) website, and data from the UK National Joint Registry was used to assign survivorship (failure rates). Correlation was calculated using the Spearman rank correlation (r). ResultsA total of 1301 TKA were performed at the study centre during the data collection period. The mean cost of consumables for a TKA with patella resurfacing (n = 816) was £1969.08 (range of £1061.46 and £5143.89), and without resurfacing (n = 485) was £1846.62 (range of £1118.98 and £4196.81). There was a negative correlation between price of implant and ODEP rating (r = −0.47), with increasing level of evidence being associated with a lower cost. There was a positive correlation between price of implant and rate of implant failure at the1-, 3- and 5-year time-points (r = 0.55, 0.44, 0.28 respectively), with increasing cost being associated with a higher failure rate. ConclusionHigher financial cost of TKA prostheses was associated with a weaker level of supporting evidence and a higher failure rate. The increased financial cost of new implants may be justified as more data and evidence becomes available to support an advantage in its use over currently established implants.

Integrated assessment of green hydrogen production in California: Life cycle Greenhouse gas Emissions, Techno-Economic Feasibility, and resource variability

This study explores green hydrogen production, focusing on life cycle assessment (LCA) and techno-economic feasibility; specifically, life cycle greenhouse gas emissions and hydrogen production cost. Existing literature lacks a comprehensive exploration of the impact of solar and wind resource variations, ambient conditions, and proton exchange membrane (PEM) electrolyzer sizing on the carbon intensity (CI) and hydrogen production cost. This work explores the relationship between the performance of photovoltaic (PV) and wind systems and the CI of renewable electricity in the U.S. Secondly, this study incorporates the hourly variations in solar and wind resources to assess the variation in hydrogen CI and production costs across California. The study examines how reductions in PEM and Renewable Energy Systems (RES) costs, technological advancements, and the inclusion of co-products’ carbon dioxide equivalent (CO2eq) credits and revenues impact hydrogen CI and production costs. Wind-based systems consistently demonstrate lower CI (0.35 − 1.9 kg CO2eq/kg H2) except for the central regions (CI can reach up to 4.34 kg CO2eq/kg H2), with geographical variations larger than solar-based systems (1.58 − 2.95 kg CO2eq/kg H2). Similar trends are observed for the hydrogen production cost which varies between 1.5 and 15 USD/kg H2 for wind-based systems and between 3.0 and 5.2 USD/kg H2 for the PV-based systems. This study highlights the importance of optimal sizing of PEM electrolyzer to maximize its utilization for hydrogen production and the use of hourly-based models to assess the CI and production costs of hydrogen. Additionally, the geographical variation in the renewable energy resources and the ambient conditions are important factors that affect the hydrogen cost and the CI of both renewable electricity and green hydrogen.

Energetic cost of biosynthesis is a missing link between growth and longevity in mammals

The comparative studies of aging have established a negative correlation between Gompertz postnatal growth constant and maximum lifespan across mammalian species, but the underlying physiological mechanism remains unclear. This study shows that the Gompertz growth constant can be decomposed into two energetic components, mass-specific metabolic rate and the energetic cost of biosynthesis, and that after controlling the former as a confounder, the negative correlation between growth constant and lifespan still exists due to a 100-fold variation in the latter, revealing that the energetic cost of biosynthesis is a link between growth and longevity in mammals. Previously, the energetic cost of biosynthesis has been thought to be a constant across species and therefore was not considered a contributor to the variation in any life history traits, such as growth and lifespan. This study employs a recently proposed model based on energy conservation to explain the physiological effect of the variation in this energetic cost on the aging process and illustrates its role in linking growth and lifespan. The conventional life history theory suggested a tradeoff between growth and somatic maintenance, but the findings in this study suggest that allocating more energy to biosynthesis may enhance the somatic maintenance and extend lifespan and, hence, reveal a more complex nature of the tradeoff.

Location and caller familiarity influence mobbing behaviour and the likely ecological impact of noisy miners around colony edges

Mobbing is a widespread, vocally coordinated behaviour where species approach and harass a threat. The noisy miner (Manorina melanocephala) is a notorious native Australian honeyeater, well‐known for its hyperaggressive mobbing. Numerous studies have identified negative impacts of their mobbing behaviour, highlighting the exclusion of competitors from colony areas and the resulting loss of woodland‐bird biodiversity. Despite this, few studies have investigated mobbing itself, and our understanding of the factors which influence its expression remains limited. Here, we use a field‐based playback experiment to investigate whether mobbing responses vary in relation to colony borders and caller familiarity. Noisy miners were more likely to respond, reacted more quickly and responded more strongly to mobbing calls broadcast inside as opposed to outside the colony. These behavioural differences likely arise from variation in the relative costs and benefits of responding. When noisy miners did mob outside the colony, more individuals joined in response to unfamiliar as opposed to familiar callers. Our results reveal that noisy miner mobbing may not be as indiscriminate as often assumed, with caller familiarity and location influencing this behaviour. We suggest there are benefits to greater consideration of the factors impacting noisy miner mobbing behaviour.Keywords: Avian biodiversity, interspecific aggression, mobbing behaviour, noisy miner, vocal communication

Enhancing the economic viability and reliability of renewables based electricity supply through Power-to-Gas-to-Power with green hydrogen

This study explores the role of green hydrogen in the Power-to-Gas-to-Power process as a solution to grid instability caused by the rise of volatile renewable energy sources. A comprehensive numerical model is developed to evaluate the economic viability and reliability of electricity supply, using key performance indicators such as system levelized cost of electricity and loss of power supply probability. Through simulations based on hourly renewable energy production profiles for a scenario with an average power demand of 100 MW, the effectiveness of batteries and green hydrogen is compared. Findings indicate that while batteries are suited to photovoltaic systems, green hydrogen excels in wind energy applications, particularly in wind-solar hybrid setups. Here, green hydrogen substantially enhances the power supply reliability (loss of probability reduced from 0.23 to 0.06) and achieves a competitive system levelized cost of electricity at 0.157 USD/kWh. Sensitivity analysis regarding system size and cost variations further highlights green hydrogen's potential, providing strategic insights for improving grid stability and economic efficiency.

What explains regional variation in privately provided out-of-area residential placement costs for people with intellectual disability in Ireland?

Expenditure on residential placements for people with intellectual disability (ID) in Ireland is considerable and expected to increase. Despite this, there is limited evidence on the factors driving variation in privately provided 'out-of-area' residential placement costs, including across Community Health Organisations (CHOs)/regions. This is important to help inform the delivery of services at best value. We analyse unit cost data from 2019 for a sample of 278 high-cost publicly funded privately provided out-of-area residential placements for people with ID in Ireland. We undertake univariate analysis of the relationship between costs and a wide range of variables using t-tests and one-way analysis of variance. We employ multivariable regression analysis to examine how raw differentials in unit costs across regions can be accounted for by individual-level characteristics. We estimate average unit costs of €264170 per annum in our sample. The univariate analysis shows considerable variation in costs across a range of personal, disability, psychiatry/psychological, forensic issues, behaviour and supports and plans related variables. We also find wide variation in average unit costs across CHOs/regions (F=4.58, P<0.001), ranging from €213380 to €331880. The multivariable analysis shows that regional differences remain even after accounting for a wide range of individual characteristics that influence costs. Our analysis shows that while the majority of differences in costs across regions can be explained, there is potential for cost savings in the provision of high-cost publicly funded out-of-area residential placements in Ireland. Overall this can help to develop and implement a more sustainable disability residential funding model in a context of rising demand for services. It also has potential implications for the approach to procurement of services.

Economic and environmental benefits of natural treatment systems for sewage treatment: A life cycle perspective

Sewage treatment involves a trade-off of land vs. energy and the location of installing Sewage Treatment Plants (STPs) strongly impacts the decisions regarding treatment technologies. In the wake of rapid urbanization, deteriorating freshwater quality and water scarcity, it is crucial to plan adequate and low-cost sewerage infrastructure that can improve the quality of life in rural and urban areas. The present work involves a novel life cycle analysis through six scenarios generated from a holistic perspective that can aid urban planners and urban local bodies in planning the sewage treatment facilities in their cities, towns or villages. Instead of planning sewerage infrastructure for a long-term period of thirty years, it is suggested to create and operate the STPs only for the upcoming decade. Further, owing to the drawbacks of mechanized and natural treatment systems, adopting a mix of these treatment approaches in planning infrastructure is suggested and the benefits of implementing the same are quantified and discussed. Implementing these strategies results in almost 30 % cost savings and 40 % reduction in greenhouse gas emissions, hence, investing in land for natural treatment systems is suggested instead of incurring heavy electricity bills for mechanized treatment systems. The land cost significantly affects the decision-making regarding treatment technology selection; hence, the variation in the life cycle cost of different sewage treatment approaches is assessed for varying land rates in India.

Variation in partial direct costs of dry cow therapy on 37 large dairy herds

The objective of this observational study was to estimate partial direct costs of dry cow antibiotic therapy (DCT) protocols used on 37 large dairy herds in Wisconsin and to estimate the potential monetary savings and reduction in antimicrobial usage (AMU) if selective DCT was used. Partial direct costs of DCT were calculated using costs of intramammary (IMM) antimicrobials and teat sealants. Data were retrospectively collected on 37 large dairy farms for a period of one year and included the total number of cows dried-off, types of IMM antimicrobial used, and product prices (obtained from farm invoices). A single farm visit was performed to verify data. Clinical mastitis (CM) and SCC history across lactation were used as the criteria to identify cows eligible to receive only teat sealants (no antibiotic DCT) based on adoption of a hypothetical selective DCT program. Descriptive statistics were performed using PROC MEANS to summarize continuous herd and cow characteristics. Differences in costs among IMM antibiotic products and eligibility to not receive antibiotics at dry off by parity were analyzed using ANOVA. Differences in milk yield at the last test day and DIM at dry-off based on eligibility for selective DCT were analyzed using PROC MIXED. A total of 35,691 cows were dried-off across all herds (n = 37) and most of the herds used IMM antibiotic DCT at dry-off in most of the cows. Teat sealant was used as part of the dry-off protocol in all but 3 herds. Of the enrolled farms, 30 used blanket antibiotic DCT in all quarters of all cows and 7 herds used selective DCT with no administration of antibiotics given to 0.8% to 58% of the dry cows within herd. Across all farms, the average cost of products given per dried cow was $19.57 ± 0.64 and ranged from $8.72 to $24.04. As expected, the cost per dried cow was greater ($23.45 ± 0.38) in herds that used higher-cost intramammary antibiotics as compared with herds that used lower-cost intramammary antibiotics ($16.64 ± 0.40). When using an algorithm based on udder health records to hypothetically select cows that would be eligible to receive teat sealants only (no antibiotic DCT), eligibility ranged from 27.3% to 93.3% within-herds and varied by parity, milk yield at last test day, and DIM at dry-off. If a selective DCT program based on udder health records was used, an overall reduction of $5.37 (27% of total costs) per dry cow would be expected. Likewise, adoption of selective DCT based on udder health records would reduce AMU at dry off by approximately 51%. However, neither of these estimates included potential adverse health complications (such as increased clinical mastitis) that can occur if selective DCT programs are not effectively performed. Variations in partial direct costs at dry-off were observed among herds based on treatment protocols. In herds that have good udder health management and contagious mastitis pathogens controlled, adoption of selective DCT based on SCC and history of clinical mastitis can reduce AMU and partial direct costs of dry cow management.

D90. Investigation into Medicare’s Price Transparency Law: Influence of Hospital Factors on Peripheral Nerve Procedure Costs and Price Variation among these Procedures

D90. Investigation into Medicare’s Price Transparency Law: Influence of Hospital Factors on Peripheral Nerve Procedure Costs and Price Variation among these Procedures