Variation In Costs Research Articles

Power sector impacts of the Inflation Reduction Act of 2022

The Inflation Reduction Act (IRA) is regarded as the most prominent piece of federal climate legislation in the U.S. thus far. This paper investigates potential impacts of IRA on the power sector, which is the focus of many core IRA provisions. We summarize a multi-model comparison of IRA to identify robust findings and variation in power sector investments, emissions, and costs across 11 models of the U.S. energy system and electricity sector. Our results project that IRA incentives accelerate the deployment of low-emitting capacity, increasing average annual additions by up to 3.2 times current levels through 2035. CO2 emissions reductions from electricity generation across models range from 47%–83% below 2005 in 2030 (68% average) and 66%–87% in 2035 (78% average). Our higher clean electricity deployment and lower emissions under IRA, compared with earlier U.S. modeling, change the baseline for future policymaking and analysis. IRA helps to bring projected U.S. power sector and economy-wide emissions closer to near-term climate targets; however, no models indicate that these targets will be met with IRA alone, which suggests that additional policies, incentives, and private sector actions are needed.

The Quest for Improving Sickle Cell Care: Creating High-Level Quality Improvement Goals with a Care Process Team

Background: A Care Process Team (CPT) is an interdisciplinary team focused on improvement effort across systems or a population cohort with high degree of variation in care, high volume, high cost, or institutional priority. The Texas Children's Hospital Quality & Safety Department has implemented CPTs for several disease populations including, asthma, diabetes, and pain management. In 2021, the sickle cell CPT (SCCPT) was launched in partnership with the Texas Children's Cancer and Hematology Center. An early step in developing a CPT is delineating goals via a balanced scorecard, a comprehensive framework that translates the team's strategic objectives into a coherent set of performance measures. After establishing priority quality metrics, the SCCPT sought to establish an operational structure and to define and implement specific quality improvement (QI) initiatives to improve outcomes. Methods: The SCCPT assembled a multi-disciplinary expert panel which included providers, nurses, division leadership, data architects, analysts, and quality specialists. After a systematic review of the literature identified metrics with best practice evidence, a modified-Delphi process was used to rank quality metrics according to standards set forth by the National Quality Forum. High-priority metrics were organized into a balanced scorecard. Goals were developed based on Institute of Healthcare QI methodology. A QlikView® dashboard was created to abstract patient data from the electronic medical record. Results: The expert panel met 7 times between January to October 2021. The systematic review found 26 quality measures for SCD and subsequently panel review expanded the list to 34 measures. Expert consensus was reached and 5 metrics were selected for the final SCCPT balanced scorecard. The SCCPT initiated routine meetings in January 2022. Three goals and SMART aims were prioritized from balanced scorecard metrics relating to stroke screenings, disease-modifying drug education and prescriptions, and assignment of a primary Hematology team. Baseline data revealed that 60% of eligible children with SCD had obtained a transcranial Doppler ultrasound within the last 15 months. Hydroxyurea was prescribed to 70% of patients with Hb SS or S/beta-0-thalassemia disease. Primary Hematologist and nurse coordinator teams were assigned to 50% and 23%, respectively. To design and implement QI projects, two teams were created: one focused on prevention-related metrics and the other on treatment-related metrics. Discussion: The successful launch of the SCCPT involved the convening a team of multi-disciplinary members, creation of a balanced scorecard, prioritizing goals, and analyzing baseline data to set SMART aims related to improving SCD care. Two operational teams were created and have proceeded to design and implement QI projects related to SMART aims.

Elective THA for Indications Other Than Osteoarthritis Is Associated With Increased Cost and Resource Use: A Medicare Database Study of 135,194 Claims.

Under Medicare's fee-for-service and bundled payment models, the basic unit of hospital payment for inpatient hospitalizations is determined by the Medicare Severity Diagnosis Related Group (MS-DRG) coding system. Primary total joint arthroplasties (hip and knee) are coded under MS-DRG code 469 for hospitalizations with a major complication or comorbidity and MS-DRG code 470 for those without a major complication or comorbidity. However, these codes do not account for the indication for surgery, which may influence the cost of care.Questions/purposes We sought to (1) quantify the differences in hospital costs associated with six of the most common diagnostic indications for THA (osteoarthritis, rheumatoid arthritis, avascular necrosis, hip dysplasia, posttraumatic arthritis, and conversion arthroplasty), (2) assess the primary drivers of cost variation using comparisons of hospital charge data for the diagnostic indications of interest, and (3) analyze the median length of stay, discharge destination, and intensive care unit use associated with these indications. This study used the 2019 Medicare Provider Analysis and Review Limited Data Set. Patients undergoing primary elective THA were identified using MS-DRG codes and International Classification of Diseases, Tenth Revision, Procedure Coding System codes. Exclusion criteria included non-fee-for-service hospitalizations, nonelective procedures, patients with missing data, and THAs performed for indications other than the six indications of interest. A total of 713,535 primary THAs and TKAs were identified in the dataset. After exclusions were applied, a total of 135,194 elective THAs were available for analysis. Hospital costs were estimated using cost-to-charge ratios calculated by the Centers for Medicare and Medicaid Services. The primary benefit of using cost-to-charge ratios was that it allowed us to analyze a large national dataset and to mitigate the random cost variation resulting from unique hospitals' practices and patient populations. As an investigation into matters of health policy, we believe that assessing the surgical cost borne by the "average" hospital was most appropriate. To analyze estimated hospital costs, we performed a multivariable generalized linear model controlling for patient demographics (gender, age, and race), preoperative health status, and hospital characteristics (hospital setting [urban versus rural], geography, size, resident-to-bed ratio, and wage index). We assessed the principal drivers of cost variation by analyzing the median hospital charges arising from 30 different hospital revenue centers using descriptive statistics. Length of stay, intensive care use, and discharge to a nonhome location were analyzed using multivariable binomial logistic regression. The cost of THA for avascular necrosis was 1.050 times (95% confidence interval 1.042 to 1.069; p < 0.001), or 5% greater than, the cost of THA for osteoarthritis; the cost of hip dysplasia was 1.132 times (95% CI 1.113 to 1.152; p < 0.001), or 13% greater; the cost of posttraumatic arthritis was 1.220 times (95% CI 1.193 to 1.246; p < 0.001), or 22% greater; and the cost of conversion arthroplasty was 1.403 times (95% CI 1.386 to 1.419; p < 0.001), or 40% greater. Importantly, none of these CIs overlap, indicating a discernable hierarchy of cost associated with these diagnostic indications for surgery. Rheumatoid arthritis was not associated with an increase in cost. Medical or surgical supplies and operating room charges represented the greatest increase in charges for each of the surgical indications examined, suggesting that increased use of medical and surgical supplies and operating room resources were the primary drivers of increased cost. All of the orthopaedic conditions we investigated demonstrated increased odds that a patient would experience a prolonged length of stay and be discharged to a nonhome location compared with patients undergoing THA for osteoarthritis. Avascular necrosis, posttraumatic arthritis, and conversion arthroplasty were also associated with increased intensive care unit use. Posttraumatic arthritis and conversion arthroplasty demonstrated the largest increase in resource use among all the orthopaedic conditions analyzed. Compared with THA for osteoarthritis, THA for avascular necrosis, hip dysplasia, posttraumatic arthritis, and conversion arthroplasty is independently associated with stepwise increases in resource use. These cost increases are predominantly driven by greater requirements for medical and surgical supplies and operating room resources. Posttraumatic arthritis and conversion arthroplasty demonstrated substantially increased costs, which can result in financial losses in the setting of fixed prospective payments. These findings underscore the inability of MS-DRG coding to adequately reflect the wide range of surgical complexity and resource use of primary THAs. Hospitals performing a high volume of THAs for indications other than osteoarthritis should budget for an anticipated increase in costs, and orthopaedic surgeons should advocate for improved MS-DRG coding to appropriately reimburse hospitals for the financial and clinical risk of these surgeries. Level IV, economic and decision analysis.

Structural variation and forecasting of medical costs of public hospitals in China

Structural variation and forecasting of medical costs of public hospitals in China

Identifying variation in the cost of abdominally based breast reconstruction in the UK

To understand variation in the cost of autologous breast reconstruction in the UK, including identifying key areas of cost variability, differences between and within units and the impact of enhanced recovery protocols (ERAS). A micro-costing study was designed based on the responses to a national survey of clinical preferences completed by the majority of plastic surgeons and anaesthetists involved in the UK. Detailed costs were estimated from macro elements such as ward and theatre running costs, down to that of surgical meshes, anaesthetic drugs and flap monitoring devices. The largest variation in cost arose from postoperative location and length of stay, preoperative imaging and flap monitoring strategies. Plastic surgeon costs varied from £1282 to £3141, whereas anaesthetic costs were between £32 and £151 (not including salary). Estimated cost variation within units was up to £893 per case. Units with ERAS had significantly lower total costs than those without (p < 0.05). This study reveals significant cost variation in breast reconstruction in the UK based on clinician preferences. Many areas of practice driving this variation lack strong evidence of any clinical advantage. The total cost of a deep inferior epigastric perforator in the majority, if not all units, likely surpasses the national tariff for reimbursement, particularly when considering additional resource demand for immediate and bilateral breast reconstruction, as well as future symmetrisation procedures. Whilst units should look to streamline costs through ERAS, there should also be a realistic tariff that promotes excellent care.

Cost-effectiveness of hypothetical miRNA biomarker testing for post-treatment surveillance of HPV-negative OPSCC

ObjectiveTo determine the theoretical cost-effectiveness of a miRNA-biomarker test for HPV– oropharyngeal squamous cell carcinoma surveillance compared to current National Comprehensive Cancer Network (NCCN) guidelines. Study designCost-effectiveness modeling using a hypothetical patient cohort. SettingThe participants in the model were disease-free patients aged 18+ in the United States who are in remission after completing treatment for HPV- OPSCC. MethodsA Markov model simulated the different post-treatment surveillance options available and probabilities for recurrence at various time-points. A sensitivity analysis adjusted for variations in cost and biomarker test characteristics. ResultsThe NCCN pathway was $4028.38 more costly and 0.05 QALY more effective than the miRNA pathway. The Extra Imaging pathway was $16,619.83 more costly and 0.18 QALY more effective than the miRNA pathway. The ICER between the miRNA and NCCN strategy was $81,074/QALY and $100,815/QALY between the NCCN and Extra Imaging pathways. The biomarker serum surveillance pathway is more cost-effective than the NCCN approach until the willingness to pay (WTP) threshold exceeds ∼$82,000. At the standard WTP threshold of $50,000/QALY, the serum test pathway is more cost-effective. We also determined the theoretical characteristics of a cost-effective miRNA test. Probabilistic analysis revealed a cost-effective miRNA test should cost less than $451.80, have a sensitivity of greater than 57 %, and a specificity greater than 50 %. ConclusionThe miRNA biomarker strategy is a cost-effective surveillance option for HPV- oropharyngeal cancer. By reducing the reliance on repeated imaging, radiation and in-person follow-up, this strategy can provide more equitable and accessible healthcare.

Time-Driven Activity-Based Costing Analysis Identifies Use of Consumables and Operating Room Time as Factors Associated With Increased Cost of Outpatient Primary Hip Arthroscopic Labral Repair

To use time-driven, activity-based costing (TDABC) methodology to investigate drivers of cost variation and to elucidate preoperative and intraoperative factors associated with increased cost of outpatient arthroscopic hip labral repair. A retrospective analysis of data from January 2020 to October 2021 was performed. Patients undergoing primary hip arthroscopy for labral repair in the outpatient setting were included. Indexed TDABC data from Avant-garde Health's analytics platform were used to represent cost-of-care breakdowns. Patients in the top decile of cost were defined as high cost, and cost category variance was determined as a percent increase between high and low cost. Analyses tested for associations between preoperative and perioperative factors with total cost. Surgical procedures performed concomitantly to labral repair were included in subanalyses. Data from 151 patients were analyzed. Consumables made up 61% of total outpatient cost with surgical personnel costs (30%) being the second largest category. The average total cost was 19% higher for patients in the top decile of cost compared to the remainder of the cohort. Factors contributing to this difference were implants (36% higher), surgical personnel (20% higher), and operating room (OR)consumables (15% higher). Multivariate linear regression modeling indicated that OR time (Standardized β= 0.504; P < .001) and anchor quantity (standardized β= 0.443; P < .001) were significant predictors of increased cost. Femoroplasty (Unstandardized β= 15.274; P= .010), chondroplasty (Unstandardized β= 8.860; P= .009), excision of os acetabuli (unstandardized β= 13.619; P= .041), and trochanteric bursectomy (Unstandardized β= 21.176; P= .009) were also all independently associated with increasing operating time. TDABC analysis showed that OR consumables and implants were the largest drivers of cost for the procedure. OR time was also shown to be a significant predictor of increased costs. Level IV, economic analysis.

Estimating the economic burden of influenza on the older population in Malaysia

Background Influenza is a contagious respiratory illness that can cause life-threatening complications among high-risk groups. Estimating the economic burden of influenza is essential to guide policy‐making on influenza vaccination programmes, especially in resource‐limited settings. This study aimed to estimate the economic burden of influenza on older adults (those aged ≥60 years) in Malaysia from the provider’s perspective. Methods The main data source in this study was the MY-DRG Casemix database of a teaching hospital in Malaysia. Cases with principal and secondary diagnoses coded in the International Classification of Diseases version 10 (ICD-10) as J09, J10.0, J10.1, J10.8, J11.0, J11.1, J11.8, J12.8, and J12.9, which represent influenza and its complications, were included in the study. The direct cost of influenza at all severity levels was calculated from the casemix data and guided by a clinical pathway developed by experts. The effect of the variations in costs and incidence rate of influenza for both the casemix and clinical pathway costing approaches was assessed with sensitivity analysis. Results A total of 1,599 inpatient and 407 outpatient influenza cases were identified from the MY-DRG Casemix database. Most hospitalised cases were aged &lt;18 years (90.6%), while 77 cases (4.8%) involved older people. Mild, moderate, and severe cases comprised 56.5%, 35.1%, and 8.4% of cases, respectively. The estimated average annual direct costs for managing mild, moderate, and severe influenza were RM2,435 (USD579), RM6,504 (USD1,549), and RM13,282 (USD3,163), respectively. The estimated total annual economic burden of influenza on older adults in Malaysia was RM3.28 billion (USD782 million), which was equivalent to 10.7% of the Ministry of Health Malaysia budget for 2020. The sensitivity analysis indicated that the influenza incidence rate and cost of managing severe influenza were the most important factors influencing the total economic burden. Conclusions Overall, our results demonstrated that influenza imposes a substantial economic burden on the older Malaysian population. The high cost of influenza suggested that further efforts are required to implement a preventive programme, such as immunisation for older people, to reduce the disease and economic burdens.

Alternative Energy Options for a Thai Durian Farm: Feasibility Study and Experiments for the Combination of Solar Photovoltaics and Repurposed Lithium-Ion Batteries

This research examines the viability of incorporating a second-life lithium-ion battery energy storage system with a solar photovoltaic power source to facilitate energy acquisition in two irrigation scenarios at a durian farm located in Thailand. The first option entails selecting the battery with suitable dimensions to effectively harness solar energy following morning irrigation, while the second option involves sizing the battery specifically for storing solar energy solely for the purpose of powering the motor pump. This study conducts an analysis on the degradation of the battery, focusing on the influence of specific environmental conditions and its specification. The degradation analysis employs polynomial functions as an alternative to exponential semi-empirical stress models for fitting stress models. This approach demonstrates a robust fit, as evidenced by a high R-squared value of approximately 1. The economic analysis considers various factors, including solar irradiance derating factors, battery deterioration rate, and photovoltaic power ratings for all scenarios. The sensitivity analysis evaluates the variations in irradiance and costs associated with the battery. When solar radiation levels surpass 500 W/m2 and the cost of the battery remains below $100/kWh, the estimated payback period is approximately 5 years over the duration of the 10-year project lifespan.

Examining the Relationship Between Screening for Postpartum Depression and Associated Child Health Service Utilization and Costs: A Study Using the All Our Families Cohort and Administrative Data

IntroductionDespite a recognized association between maternal postpartum depression (PPD) and adverse child health outcomes, evidence examining the relationship between PPD symptoms and associated child health service utilization and costs remains unclear. In addition, there is a paucity of evidence describing the relationship between early identification of maternal PPD and associated health service utilization and costs for children. This study aims to address this gap by describing the secondary associations of screening for maternal PPD and annual health service utilization and costs for children over their first five years of life.MethodsMothers and children enrolled in the prospective All Our Families cohort were linked to provincial administrative data in Alberta, Canada. Multivariable generalized linear models were used to estimate the average annual inpatient, outpatient, physician, and total health service utilization and costs from a public health system perspective for children of mothers screened high risk for PPD, low/moderate risk for PPD, or unscreened.ResultsTotal mean costs were greatest for children during their first year of life than other years. Those whose mothers were not screened had significantly lower costs compared to those whose mothers were screened low/moderate risk, despite equivalent health service utilization.DiscussionFindings from this study describe the secondary associations of screening for maternal PPD using a public health system perspective. More research is required to fully understand variations in health costs for children across maternal PPD screening categories.

Abstract 16082: Racial Differences Among Patients Undergoing Nuclear Myocardial Perfusion Imaging

Introduction: Noninvasive cardiac stress testing is valuable for early diagnosis and optimizing management of patients with coronary artery disease (CAD). Historically, Black patients have experienced both underdiagnosis and undertreatment of CAD. We evaluated racial disparities in patients undergoing nuclear myocardial perfusion imaging (MPI). Different modalities (MPI (SPECT, PET) vs. stress echocardiography) have variations in accuracy, cost and radiation exposure, which may reflect provider biases. Methods: Patient-reported demographics, clinician-reported cardiac risk factors and MPI study characteristics from a large Connecticut health system (2016 - 2022) were compared for Black and White patients in both general and matched cohorts (1:1 matched for demographics and risk factors). Results: The study included 123,069 cardiac stress tests from 10.5% Black and 76.2% White patients (largely similar to overall Connecticut population: 12.7% Black, 78.8% White). Black patients were younger (56.7±13.3 vs. 62.1±13.4 years, p&lt; 0.001), more likely female (58.7 vs. 44.7%, p&lt;0.001) and had more risk factors (Table 1). Black patients were more likely to undergo MPI (66.6 vs. 50.5%, p&lt;0.001), inpatient or observation status testing (17.0 vs. 8.4%, p&lt; 0.001), with pharmacological rather than exercise stress (53.9 vs. 37.0%, p&lt;0.001) than White patients. On analysis of the 1:1 matched cohort, Black patients younger than 65 years were more likely to undergo MPI than White patients (62.1 vs. 57.4%, p&lt;0.001), while the reverse is seen for patients over 65 years old (37.5 vs. 42.5%, p&lt;0.001). Conclusion: Significant demographic and stress testing pattern differences were found between Black and White patients. These findings may reflect racial disparities in cardiovascular care, including access and clinical referral patterns. Further studies are needed to determine if these differences in stress testing strategies impact downstream clinical outcomes.

Health care costs of cardiovascular disease in China: a machine learning-based cross-sectional study.

Cardiovascular disease (CVD) causes substantial financial burden to patients with the condition, their households, and the healthcare system in China. Health care costs for treating patients with CVD vary significantly, but little is known about the factors associated with the cost variation. This study aims to identify and rank key determinants of health care costs in patients with CVD in China and to assess their effects on health care costs. Data were from a survey of patients with CVD from 14 large tertiary grade-A general hospitals in S City, China, between 2018 and 2020. The survey included information on demographic characteristics, health conditions and comorbidities, medical service utilization, and health care costs. We used re-centered influence function regression to examine health care cost concentration, decomposing and estimating the effects of relevant factors on the distribution of costs. We also applied quantile regression forests-a machine learning approach-to identify the key factors for predicting the 10th (low), 50th (median), and 90th (high) quantiles of health care costs associated with CVD treatment. Our sample included 28,213 patients with CVD. The 10th, 50th and 90th quantiles of health care cost for patients with CVD were 6,103 CNY, 18,105 CNY, and 98,637 CNY, respectively. Patients with high health care costs were more likely to be older, male, and have a longer length of hospital stay, more comorbidities, more complex medical procedures, and emergency admissions. Higher health care costs were also associated with specific CVD types such as cardiomyopathy, heart failure, and stroke. Machine learning methods are useful tools to identify determinants of health care costs for patients with CVD in China. Findings may help improve policymaking to alleviate the financial burden of CVD, particularly among patients with high health care costs.

Analisis Earned Value Pada Proyek Pembangunan Gedung Kantor Polsek Kedungwuni Kabupaten Pekalongan Jawa Tengah

Abstract In the implementation of construction projects requires a good management in order to realize the success of the project being implemented. Cost accuracy, time and quality are very influential on the success of a project. Among the factors that are considered are the cost factor and the time factor. From these two aspects, project control can be carried out using the earned value method. The object of this research was carried out on the Kedungwuni Police Office Building Project located in Kedungwuni District, Pekalongan Regency which aims to determine the value of cost variations, schedule variations, cost performance index, schedule performance index, estimated remaining work time, estimated costs for remaining work, estimated total project time and estimated total project cost. This study uses data from week 1 to week 15 with a total work duration of 21 weeks. From the results of the analysis using the earned value method for the 1st to 15th period, the cost variance value did not find a negative value. Then the schedule variance value has a negative value in the 1st to 3rd week and a positive value in the 4th to 15th week. The cost performance index value is not found &lt;1 but in the 1st to 2nd week the CPI value is 0 and the SPI value has a value of &lt;1 in the 1st to 3rd period and has a value of &gt;1 in the 4th to 15th period. After that, the estimated total cost is Rp. 2,453,103,5841.00 with an estimated total processing time of 6 weeks. Keywords: Cost, Time, and Earned Value

A Cost-Benefit Analysis of Foreign Direct Investment in Balochistan: A Study on Saindak Project

Pakistan has received one of the biggest foreign investments in its history, however it failed many times in managing and resolving disputes domestically related to foreign investment, as in Saindak case. There is a need of Cost Benefit Analysis (CBA) of these projects and to make indigenous people informed about the pros and cons and benefits of the projects operating in their region. This research examines Foreign Direct Investment in Balochistan by conducting Cost Benefit Analysis of Saindak project under different government regimes. A qualitative and exploratory research has been conducted. The study uses secondary data of Saindak project from period 2001-2022. Content analysis technique is used to analyze variations in outcome, success, costs and benefits of Saindak Project across different time periods. The research concludes that Saindak Project has failed to fulfill CSR (Corporate Social Responsibility) activities and the resources had been exploited many times. The government must engage in negotiations with the rebel groups, free political detainees, and uphold the rights to freedom of speech guaranteed by the constitution. The only way out of internal quagmires and unrests is to give more voice to the indigenous people and the Federal and provincial governments should accept the idea of true democracy.

Hybrid emperor penguin glowworm swarm optimiser for techno-economical optimisation with demand side management in microgrid using multi-objective function

Recently, microgrids have been engaged with Demand Side Management (DSM), which helps to save more energy. Hence, the existing model suffers based on the slow response, and also it cannot restore the system voltage and frequency. Consequently, the voltage and frequency fluctuations in the microgrid become a challenging task. Thus, this research work aims to develop a new model for the microgrid. Here, a new Hybrid Emperor Penguin Glowworm Swarm Optimisation algorithm is developed with the integration of Emperor Penguin Optimiser (EPO) and Glowworm Swarm Optimisation (GSO). Moreover, the techno-economical model minimises the energy supply cost, Diesel Generator (DG), power loss and voltage variations. It implements the Wind Turbines, DG, optimal capacity of PV and Energy Storage Systems, through techno-economical optimisation for offering renewable energy sources. Moreover, the designed model helps to solve the multi-objective function regarding metrics like initial cost, operation cost, DSM, voltage fluctuations, fuel cost, Electricity Supply Costs and network power losses. The performance of the developed model shows 17.6%, 36.9%, 2.4% and 0.4% better performance than HHO, EPO, GSO and IMP-SPA in terms of voltage fluctuations. Throughout the validation, the offered model shows superior performance when compared with state-of-art models.

Optimizing Diabetes Management Using a Low-Calorie Diet in Saudi Arabia: A Cost-Benefit Analysis.

Low-calorie diets, high in protein and low in carbohydrates, are commonly recommended for patients with pre-diabetes and type 2 diabetes. The objective of this study was to carry out a cost-benefit analysis (CBA) of a low-calorie versus a standard diet from the perspective of the Saudi Arabian health system. The CBA compares costs and benefits of the two diet strategies over a 1-year time horizon. Costs included diet and diabetes treatment-related resources while benefits were measured in terms of the costs of diabetes complications avoided. Data on costs and benefits were collected from published literature and subject matter experts. Incremental costs were estimated as the cost difference between low-calorie and standard diet. Incremental benefits were estimated as cost difference from medical complications when following a low-calorie or standard diet. The incremental absolute cost-benefit ratio was calculated to show the difference between the costs and benefits of the low-calorie diet. Incremental relative cost-benefit ratio was calculated to show the cost per dollar of benefit obtained. Monte Carlo simulation modeled variability in outcomes due to variation in costs and uncertainty of diabetes complications. The 1year cost of standard diet was US$2515 ± 156 compared to US$2469 ± 107 per patient for a low-calorie diet. Incremental benefit is estimated at US$21,438 ± 7367 per patient. The estimated incremental absolute cost-benefit ratio was US$ -21,360 establishing that benefits are greater than costs, while the estimated incremental relative cost-benefit ratio is 0.0037, establishing that benefits are 270 times greater than costs. The low-calorie diet was the dominant strategy compared to the standard diet in modeled scenarios. These findings highlight the importance of a low-calorie diet as part of diabetes management programs for outpatients with type 2 diabetes.

Costs and control strategies of healthcare-associated infections in an Italian university hospital

Abstract Backgrounds Healthcare-associated infections (HAIs) increase morbidity, mortality, and costs, necessitating effective prevention strategies. This study estimates the additional costs of HAIs in a university hospital in Rome, Italy Policlinico Tor Vergata (PTV), to inform policymakers, healthcare professionals, and researchers. Methods We conducted a retrospective cohort study, including all patients admitted or discharged in 2018. We applied propensity score matching (PSM) to balance study groups and then we analysed cost differences using the average treatment effect on the treated (ATT) approach. Costs were calculated using the Diagnosis Related Groups (DRGs) system. Outcome measures included the real reimbursement cost in euros and the relative cost increment using adjusted logarithmic transformation. Results 12,033 patients were included: 6,653(55%) female, 5,380 (45%) male, with a median age of 67. In total, 1,212 (10.1%) infected patients were compared to 10,821 (89.9%) non-infected patients. Predominant infections were urinary tract infections (UTI) (48.8%) and blood stream infections (BSI) (34.4%), while Staphylococcus spp. (37.5%) and Enterococcus spp. (36.4%) were the most common pathogens. The propensity score analysis showed a 59.7% (95% CI: 48.8% to 71.3%) cost increase for infected patients. They incurred an additional €4,988 (95% CI: €4,173 to €5,804) in costs. Subgroup analyses revealed cost variations across infection sites and pathogens, with Klebsiella P. having the greatest economic impact at €7,586 (95% CI: €5,301 to €9,871) and BSI also at €9,719 (95% CI: €8,137 to €11,307). Conclusions This study highlights the significant additional cost burden of HAIs in the PTV. Interventions with an equal or lower cost per HAI averted can be considered cost-effective. Public health actions, including enhancing infection prevention, developing or revising policies, and strengthening surveillance systems, should be prioritised to address ongoing HAI challenges. Key messages • Our study reveals a significant 59.7% cost increase (€4,988in our hospital) for HAI patients, highlighting the need for cost-effective prevention strategies in healthcare settings. • Findings emphasise the importance of enhancing infection prevention measures, policy development, and strengthening surveillance systems to reduce HAI-associated costs.

Healthcare resource utilisation and economic burden attributable to back pain in primary care: A matched case-control study in the United Kingdom.

Incremental healthcare costs attributed to back pain, and characterisation by patient and clinical factors have rarely been documented. This study aimed to assess annual healthcare resource utilisation and costs associated with back pain in primary care. Using the IQVIA Medical Research Data (IMRD), patients with back pain were identified (study period: 01 January 2006 to 31 December 2015) using diagnostic records and analgesics prescriptions (n = 133,341), and propensity score matched 1:1 to patients without back pain. The annual incremental costs of back pain associated with consultations and prescriptions were estimated and extrapolated to a national level. Sensitivity analysis was conducted by restricting the study population to the most recent diagnosis of back pain. Variations in cost were assessed stratified by gender, age-groups, deprivation, and comorbidity categories. The mean age was 57years, and 62% were females in both the case and control groups. The total incremental healthcare costs associated with back pain was £32.5 million in 2015 (£35.9 million in 2020), with per-patient cost of £244 (£265 in 2020) per year. On a national level, this translated to an estimated £3.2 billion (£3.5 billion in 2020). Eighty percent of the costs were attributed to consultations; and female gender, older age, higher deprivation, and higher comorbidity were all associated with increased mean healthcare costs of patients with back pain. Our findings confirm the substantial healthcare costs attributed to back pain, even with primacy care costs only. The data also revealed significant cost variations across socio-demographic and clinical factors.

Cost variation analysis of commonly prescribed drugs in dentistry available in the Indian market

Cost variation analysis of commonly prescribed drugs in dentistry available in the Indian market

Decision support algorithm to revamp homestead vegetable production for climate resilience and nutrition security

Inadequate micronutrient diversity in diets remains a serious cause of malnutrition which is prevalent in rural areas especially in developing countries. The current study proposed a decision support algorithm for nutrition-sensitive vegetable production in semi-subsistence farming systems to improve their access to micronutrient-diverse and dense foods without compromising on economics of cultivation. Multi-dimensional nutri-economic data was modelled to compute micronutrient profiles along with the relative abundance of vegetables in diets, giving an advantage over other nutrition indices that measured diversity. Besides, a novel micro-planning algorithm was developed for climate-resilient and micronutrient-sensitive vegetable production that generated multiple production plans as per farm properties, crop preferences and consumption patterns of farm households. The algorithm consisted of a cropcombination generator, uncertainty analysis and optimization procedure. The uncertainty analysis incorporated variations in climate, market rates, yields and cost of cultivation. The algorithm was demonstrated using 8 case studies based in India and investigated whether micronutrient diversity, micronutrient density, production diversity and net returns could be improved at the production stage. The results suggested that the generated plans performed better than existing plans for all four parameters in every case study. The improvement in micronutrient diversity, micronutrient density, production diversity and net returns ranged from 5.8 to 60 %, 7.2 to 79 %, 7.8 to 31 % and 5.8 to 60 % respectively. This study provides a simple framework to process large multi-dimensional nutri-economic data to measure essential well-being indices and produces sound food policies at field and regional levels.