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Breast cancer (BC) is a global concern, with Peru experiencing a high incidence and mortality. Trastuzumab, a crucial treatment for human epidermal growth factor receptor 2-positive BC, is administered intravenously or subcutaneously (SC). This study evaluates the costs associated with both methods at Peru's Instituto Nacional de Enfermedades Neoplásicas. Real data indicate that SC administration reduces treatment costs by approximately S/15,049.09. Cross-continental comparisons highlight a global trend favouring SC administration for efficiency and cost-effectiveness. The analysis provides insights for informed decision-making in resource-constrained healthcare settings like Peru, emphasising the need to consider local contexts in optimising oncology care. [ABSTRACT FROM AUTHOR]

Objective: To explore the influence of demographic factors and flourishing on workplace distractions in a cross‐country analysis of Saudi Arabia and Jordan. Methods: This cross‐sectional comparative study was conducted in two government hospitals: one in eastern Saudi Arabia and the other in northern Jordan. Data were collected from the nurses using convenience sampling. The required sample size was determined using the G∗Power software, with a target of 242 nurses per country, resulting in 484 participants. Ultimately, the final sample consisted of 437 nurses: 222 from Saudi Arabia and 215 from Jordan. Two online instruments were used to collect data on the distractions and flourishing. Results: The study found that "using the Internet" and "using the phone" were the most time‐consuming distractions among nurses, while "watching TV" was the least time‐consuming. There were significant associations between demographics and distractions, with participants from Saudi Arabia having lower distraction scores than participants from Jordan. Younger participants were more distracted than older participants, whereas male participants were more distracted than female participants were. Smokers and individuals with less expertise exhibit higher levels of distraction. Furthermore, degree of education was associated with higher levels of distraction. Nurses in Saudi Arabia experience a much greater loss of productivity due to distractions than their Jordanian counterparts. Regression analysis revealed that experience, "Mental and Physical Health" domain scores, smoking status, and educational level all highly predicted distraction levels among Saudi Arabian and Jordanian nurses, accounting for approximately 9.6% of the differences in distraction. Conclusion: In this cross‐country study on workplace distractions among Saudi and Jordanian nurses, "using the Internet" and "using the phone" emerged as the most time‐consuming distractions. Younger age, male sex, smoking, and less experience are associated with higher distraction levels. Additionally, higher education levels were linked to increased distraction. Implementing employee flourishing activities can help reduce distractions and enhance productivity. This study offers valuable insights into improving nurses' performance and well‐being. [ABSTRACT FROM AUTHOR]

Background:. Epidermolysis bullosa (EB) is a rare genetic skin disorder characterized by fragility of skin with appearance of acute and chronic wounds. The aim of this study was to determine the economic burden and the health-related quality of life (HRQoL) of patients with epidermolysis bullosa (EB) in Spain from a societal perspective. Methods:. We conducted a cross-sectional, retrospective study including 62 patients with EB (62% dystrophic, 9.6% junctional, 3.2% Kindler syndrome, and 26% with simplex EB). Data were collected from questionnaires completed by patients or their caregivers. The costs were estimated, including not only direct healthcare costs but also direct non-healthcare costs and productivity losses. We compared severe EB (Dystrophic, Junctional EB and Kindler syndrome) to non-severe EB (simplex EB) using as reference year 2022. HRQoL was measured by generic (EQ-5D) and specific (QoLEB) questionnaires. Results: The average annual cost for an EB patient was €31,352. Direct healthcare costs represented 17.2% of the total cost, direct non-healthcare costs (mainly informal care costs) 71.3% and productivity losses 11.5% of the total cost. Participants in the severe EB group had a slightly higher average cost than participants in the non-severe EB group (€31,706 vs. €30,337). Direct healthcare costs and non-healthcare costs were higher in the severe EB group (€6,205 vs. €3,024 and €23,148 vs. €20,113) while productivity losses were higher in the non-severe EB group (€7,200 vs. €2,353). The mean utility index score, where the maximum value possible is one, was 0.45 for patients with severe EB (0.76 for their caregivers) and 0.62 for those with non-severe EB (0.77 for their caregivers). Conclusions:. The social economic burden of EB, resulting from the high direct non-healthcare cost of informal care, and from the loss of productivity, accentuates the importance of not restricting cost analysis to direct healthcare costs. This substantiates that EB, particularly severe EB represents a significant hidden cost that should be revealed to society and should be considered in the support programmes for people who suffer from this disease, and in the economic evaluation of new treatments. [ABSTRACT FROM AUTHOR]

Background: The loss of gait automaticity is a key cause of motor deficits in Parkinson's disease (PD) patients, even at the early stage of the disease. Action observation training (AOT) shows promise in enhancing gait automaticity. However, effective assessment methods are lacking. We aimed to propose a novel gait normalcy index based on dual task cost (NIDTC) and evaluate its validity and responsiveness for early-stage PD rehabilitation. Methods: Thirty early-stage PD patients were recruited and randomly assigned to the AOT or active control (CON) group. The proposed NIDTC during straight walking and turning tasks and clinical scale scores were measured before and after 12 weeks of rehabilitation. The correlations between the NIDTCs and clinical scores were analyzed with Pearson correlation coefficient analysis to evaluate the construct validity. The rehabilitative changes were assessed using repeated-measures ANOVA, while the responsiveness of NIDTC was further compared by t tests. Results: The turning-based NIDTC was significantly correlated with multiple clinical scales. Significant group-time interactions were observed for the turning-based NIDTC (F = 4.669, p = 0.042), BBS (F = 6.050, p = 0.022) and PDQ-39 (F = 7.772, p = 0.011) tests. The turning-based NIDTC reflected different rehabilitation effects between the AOT and CON groups, with the largest effect size (p = 0.020, Cohen's d = 0.933). Conclusion: The turning-based NIDTC exhibited the highest responsiveness for identifying gait automaticity improvement by providing a comprehensive representation of motor ability during dual tasks. It has great potential as a valid measure for early-stage PD diagnosis and rehabilitation assessment. Trial registration Chinese Clinical Trial Registry: ChiCTR2300067657 [ABSTRACT FROM AUTHOR]

The COVID-19 booster immunization policy is cost-effective, but evidence on additional booster doses and appropriate strategies is scarce. This research compared the cost-effectiveness of annual, twice-a-year, and biennial booster dose policies. We performed stochastic modeling using compartmental susceptible-exposed-infectious-recovered models and a system dynamic model. We evaluated four policy scenarios: (1) hypothetical no-booster immunization policy; (2) twice-a-year vaccination policy; (3) annual vaccination policy; and (4) biennial vaccination policy. In addition, we conducted a one-way sensitivity analysis by adjusting R0 from 1.8 to 3.0 in all scenarios (epidemic stage) and by decreasing the vaccination cost by 50% at the end of the first year to reflect the current policy direction to enhance domestic vaccine production. Compared to non-booster policies, all three booster strategies reduced the number of cases, hospital admissions, and severe infections remarkably. Without a booster, total cases would reach 16,220,615 (95% confidence interval [CI] 6,726,550–29,661,112) by day 1,460, whereas, with a twice-a-year booster, the total cases would reach 597,901 (95% CI 526,230–694,458) in the same period. Even though the no booster scenario exhibited the lowest cost by approximately the first 500 days, by day 1,460 the biennial booster scenario demonstrated the lowest cost at 72.0 billion baht (95% CI 68.6–79.4 billion). The most cost-saving policy was the biennial booster scenario. The annual booster scenario also stood as a cost-effective option for most outcomes. In the epidemic stage and in an assumption where the vaccination costs dropped, all booster policies became more cost-effective or cost-saving compared with the main assumption. This study underscores the significance of the COVID-19 vaccine booster policy. Implementing policies should take into consideration cost-effectiveness, feasibility, and public communication. [ABSTRACT FROM AUTHOR]

Background: Access to cardiovascular medications is severely hampered by their unavailability and high cost, particularly for the poorest households in developing nations. The availability and price range of cardiovascular medications are significantly limited in both hospital and community pharmacies. Objectives: The aim of this study is to assess the availability and price variations of commonly used cardiovascular medicines in hospital pharmacies in Gondar Town, northwest Ethiopia. Methods: From July 13 to August 6, 2022, a mixed cross‐sectional and simulated client survey was carried out at two hospital and 13 community pharmacies in Gondar Town. The analysis and data entry were performed using SPSS Version 25 and EpiData Version 4.2, respectively. The availability and pricing variations of the medications are given as percentages. The significance was examined using paired t tests. Results: On average, community retail pharmacies offered 33.22% of CVD drugs. Aspirin (81 mg), amlodipine (5 mg), atorvastatin (20 mg), and hydrochlorothiazide (25 mg) were the most readily available drugs in community pharmacies. Overall, 28.00% of the hospital pharmacies had available CVD medicines during the course of our analysis. The average cost for the 25 CVD medications in hospital pharmacies was $0.699, with a standard deviation (SD) of 1.513, which was less than the cost at community pharmacies ($2.741 with an SD of 6.015) (p = 0.045). Conclusion: CVD medications were more available in community pharmacies than in hospital pharmacies, although there were fewer CVD medications available than recommended by the WHO/HAI (80%) in both hospital and community pharmacies. There was a statistically significant difference between the two prices. Compared to that at hospital pharmacies, the mean price at community pharmacies was greater. [ABSTRACT FROM AUTHOR]

The Preventive Controls for Human Food Rule regulation under the Food Safety Modernization Act sets new food safety standards. Both food safety educators and small and medium sized food processing businesses that manufacture certain value-added or processed foods lack knowledge regarding costs to prepare, implement, and manage ongoing food safety practices under the new standards. Current food safety training materials do not acknowledge costs or provide content addressing potential costs, and food safety educators do not have information needed to guide development of relevant materials that address costs. We combine economics and food science principles and use mixed methods to identify and estimate cost barriers for food processing businesses through an interdisciplinary research and extension project in the Northeast U.S. We first modify Preventive Controls extension programming to acknowledge costs and test how modified programming improves self-reported knowledge about costs. Materials that acknowledge that costs are associated with meeting standards significantly increases participants' self-reported perceived knowledge of costs by 1.3 points on a 1-to-5-point Likert scale. Compared with programming areas in which detailed content is provided, however, improvements in knowledge of costs lags behind overall knowledge gains (3.2 for costs versus 4.1 for food safety content). To fill this content gap, we next conduct semi-structured group interviews with a subset of participants (N = 10), develop a costs analysis framework, and measure actual costs associated with Preventive Controls. We find that initial costs average $20,000 per business to plan, implement, and manage standards, and almost $8,000 in every subsequent year to manage. We demonstrate that even modest interventions can reduce cost barriers for businesses seeking to meet compliance standards. We provide food safety educators with concrete cost information to support businesses to pursue Preventive Controls standards. Study results imply that low-cost methods could improve food safety in mid-scale supply chains. [ABSTRACT FROM AUTHOR]

A rare disease is that with a low prevalence in the population. However, it is estimated that there are between 6,000 and 8,000 different types of rare diseases in the world and, generally, they are incurable and deadly. Machado-Joseph's disease (MJD) is one of these cases; of genetic origin, autosomal dominant, with a high chance of transmission between generations and without curative treatment. Given the specificities of MJD and the lack of economic studies associated with it, this article aims to estimate the direct and indirect health-related costs of lost productivity attributable to Machado-Joseph's Disease. The data used were primarily collected at the Hospital de Clínicas de Porto Alegre (HCPA), during the period between October 2019 and March 2020. The bottom-up cost methodology was used, that is to say, to estimate costs across a sample of patients to produce an annual cost per patient. Among the main results, it was found that 90.8% of the sample does not work and of these, 72.73% reported that the reason they had stopped working was due to Machado-Joseph's disease. The average age of men when they stopped working was 39.05 years of age and for women it was 39.64 years of age. In relation to direct non-medical costs, with rehabilitation and transport, it was found that these items affect about 32% of men's income and 36% of women's income, as well as medication and diapers costs affect about 15% of women's income and 14% of the income of men who are no longer able to work. The study also showed that 50% of caregivers, who are generally close relatives of the patient, do not work. Of these, 33.3% reported having left the labor market to provide assistance to the patient, which means that the cost for families is even higher than that estimated for the patient. [ABSTRACT FROM AUTHOR]

Background: Encouraging alternatives to the car such as walking, cycling or public transport is a key cross-sector policy priority to promote population and planetary health. Individual travel choices are shaped by individual and environmental contexts, and changes in these contexts – triggered by key events – can translate to changes in travel mode. Understanding how and why these changes happen can help uncover more generalisable findings to inform future intervention research. This study aimed to identify the mechanisms and contexts facilitating changes in travel mode. Methods: Prospective longitudinal qualitative cohort study utilising semi-structured interviews at baseline (in 2021), three- and six-month follow up. Participants were residents in a new town in Cambridgeshire, UK, where design principles to promote walking, cycling and public transport were used at the planning stage. At each interview, we followed a topic guide asking participants about previous and current travel patterns and future intentions. All interviews were audio recorded and transcribed. Data analysis used the framework approach based on realist evaluation principles identifying the context and mechanisms described by participants as leading to travel behaviour change. Results: We conducted 42 interviews with 16 participants and identified six mechanisms for changes in travel mode. These entailed increasing or reducing access, reliability and financial cost, improving convenience, increasing confidence and raising awareness. Participants described that these led to changes in travel mode in contexts where their existing travel mode had been disrupted, particularly in terms of reducing access or reliability or increasing cost, and where there were suitable alternative travel modes for their journey. Experiences of the new travel mode played a role in future travel intentions. Implications: Applying realist evaluation principles to identify common mechanisms for changes in travel mode has the potential to inform future intervention strategies. Future interventions using mechanisms that reduce access to, reduce reliability of, or increase the financial cost of car use may facilitate modal shift to walking, cycling and public transport when implemented in contexts where alternative travel modes are available and acceptable. [ABSTRACT FROM AUTHOR]

Background: "The hidden costs of informal caregiving" is an interdisciplinary concept. While caregivers make a significant contribution to the process of caregiving, they sacrifice their leisure time, and incur risks of dropping out of the job, impaired mental and physical health, and decreased well-being within the context of caregiving. Those invisible sacrifices are often overlooked and described as hidden costs of informal caregiving. However, the conceptualisation of hidden costs of informal caregiving has not yet been clarified and scientifically assessed. The research aimed to clarify the concept of hidden costs of informal caregiving and develop an operational definition. Methods: Walker and Avant's concept analysis was conducted. Databases of CBM, CNKI, WanFang, VIP, PubMed, Embase, CINAHL, Web of Science, MEDLINE, Cochrane Library, Econlit, CINAHL and ProQuest were searched with the term "hidden costs of informal caregiving". Information about the uses of the concept, defining attributes, model cases, antecedents, consequences and empirical referents of hidden costs of informal caregiving was extracted and synthesized. Results: A total of 25 articles were included. The six defining attributes of hidden costs of informal caregiving were identified as including "undertaken by informal caregivers", "the time costs of caregiving", "costs of career development" "physical well-being costs", "mental well-being costs" and "social relationship costs". Personal characteristics of the caregivers and care recipients, along with caregiving attributes, were among the antecedents. The consequences of hidden costs of informal caregiving resulted in negative influences which included poor quality of life, life-altering decisions, options for the type of care, some degree of economic hardship, decreased compliance with treatment plans and monetary value informal caregivers are willing to pay to be replaced. Conclusion: This concept analysis decisively illuminated the hitherto nebulous concept and expanded the contents of hidden costs of informal caregiving, which will foster a deeper appreciation of the invisible cost of caregivers. Moreover, it will provide a reference for the study of the hidden costs of informal caregiving in future, contribute to the development of assessment tools and theoretical models of hidden costs of informal caregiving, and create a basis for designing an evidence-based care program. [ABSTRACT FROM AUTHOR]

A rotary actuator effectively drives the motion of a power wheelchair, which distinguishes it from manual wheelchairs. For the design and development of a smart robotic power wheelchair (SRPW) prototype, the choice of rotary actuators (RA) is critical. However, the wide range of RA features available commercially make it challenging to choose an appropriate and valuable device for a SRPW prototype. This article employs four multi-criteria decision-making (MCDM) approaches, including (Additive Ratio Assessment) ARAS, (Complex Proportional Assessment) COPRAS, (Evaluation Based on Distance from Solution) EDAS, and (Grey Relation Analysis) GRA, along with the (Criteria Importance through Inter-Criteria Correlation) CRITIC weight assignment technique, to rank 10 alternatives RAs with 7 competing criteria such as cost, weight, voltage, current, power, torque, and speed. Due to the different rankings generated by these methods, Spearman's rank correlation coefficient is used to resolve disagreements and highlight the optimum ranking for the decision matrix. Based on the Copeland voting rule, RA-6 is the most suitable alternative, while RA-10 is found to be the least ideal of the ten alternatives. The rankings have been robustly analyzed with sensitivity analysis on cost parameters and found to be quite helpful in leading future research communities and prototype developers. [ABSTRACT FROM AUTHOR]

Currently, the development of renewable energy products (RES) encourages the search for innovative solutions that take into account key criteria from the point of view of their sustainable development. Despite efforts in this area, there is a lack of approaches and tools to support this process. Therefore, the aim of the research was to develop a decision-making model supporting eco-innovation in products based on the key criteria of sustainable development: quality (customer satisfaction with use), environmental impact in the life cycle (LCA), and the cost of investment incurred in the product development. The functioning of the model was based on the following factors: (i) obtaining the voice of customers (VoC) and processing it into product criteria as part of the development of alternative production solutions (prototypes), (ii) prospective quality assessment and subsequent life cycle assessment of prototypes, (iii) cost analysis taking into account both quality and environmental criteria, (iv) interpretation of results and search for eco-innovative product solutions. Development decision-making is additionally supported by techniques implemented in the model, e.g., the CRITIC method, the LCA method with Ecoinvent database in OpenLCA, the CEA method, and the morphology method. The model was illustrated and tested for photovoltaic (PV) panels, after which a global sensitivity analysis was performed in Statistica. The test results showed that the main factor that influenced the PV development decisions was the investment cost, followed by quality (customer satisfaction) and then environmental impact in LCA. [ABSTRACT FROM AUTHOR]

The strain-hardening geopolymer composite (SHGC) is a new type of fiber concrete with excellent ductility and environmental friendliness. However, the high cost of fibers greatly limits its widespread application. This paper proposes the use of untreated low-cost polyvinyl alcohol (PVA) fibers and polyethylene (PE) fibers to develop a low-cost, high-performance SHGC. Axial compression and axial tension tests were conducted on the SHGC with different PE fiber volume fractions (1%, 1.5%, and 2%) and different PVA fiber replacement ratios (0%, 25%, 50%, 75%, and 100%) to investigate the hybrid effects of fibers with different surface properties and to reveal the mechanism of fiber hybridization on the mechanical behavior of SHGCs. The results show that increasing the PE fiber volume fraction improves the compressive and tensile ductility of the SHGC while increasing the PVA fiber replacement rate impacts the strength indicators positively due to the good interface effect formed between its hydrophilic surface and the matrix. When the PVA fiber replacement ratio is 100%, the compressive strength (93.4 MPa) of the SHGC is the highest, with a 21.1% increase compared to the control group. However, the tensile strength shows a trend of first increasing and then decreasing with the increase in the PVA fiber replacement ratio, reaching the highest at a 25% replacement ratio, with a 12.5% increase compared to the control group. Furthermore, a comprehensive analysis of the economic and environmental performance of the SHGC indicates that a 25% PVA fiber replacement ratio results in the best overall economic benefits and relatively low actual costs, although the effect of fiber hybridization on carbon emission indicators is not significant. This paper provides new ideas and a theoretical basis for designing low-cost SHGCs. [ABSTRACT FROM AUTHOR]

OBJECTIVES: The annual mean spending measures typically used to study longitudinal trends mask distributional and seasonal variation that is relevant to patients' perceptions of health care affordability and, in turn, provider collections. This study describes shifts in the distribution and seasonality of plan and patient out-of-pocket spending from 2012 through 2021. STUDY DESIGN: Analysis of multipayer commercial claims.data. METHODS: Medical spending per enrollee was calculated by summing inpatient, outpatient, and professional services, which comprised plan payments and out-of-pocket payments (deductible, coinsurance, co-payment). To account for the long right tail of the spending distribution, enrollees were stratified by their decile of annual medical spending, and annual mean spending estimates were calculated overall and by decile. Mean spending estimates were also calculated by quarter-year. RESULTS: Inflation-adjusted medical spending grew most quickly among the highest decile of spenders, without proportional growth in their out-of-pocket expenses. Out-of-pocket spending increased for the majority of enrollees in our sample prior to the COVID-19 pandemic, in real dollars and as a share of total medical spending. Out-of-pocket spending was increasingly concentrated in the early months of the calendar year, driven by deductible spending, and was lower in 2020 and 2021, plausibly due to policies limiting cost sharing for COVID-19--related services. CONCLUSIONS: Insurance is working well to protect the highest spenders at the cost of reduced insurance generosity among spenders elsewhere in the distribution. The increasing cross-subsidization among enrollees through cost-sharing design--vs premiums--is a trend to watch among rising public concerns about underinsurance and medical debt. [ABSTRACT FROM AUTHOR]

In recent years small satellites have shifted from being secondary items to dominate the space market thanks to, but not only, the development of the large LEO constellations. For small satellites to be highly effective, particularly when arranged in such constellations, each satellite has to be placed in a specific orbital plane and orbital position. Currently, three main options are available to reach a specific orbit. The first, more straightforward solution is to employ a dedicated launch with a small launch vehicle. Plenty of small launchers are in development around the world (with few already operational); however, their cost per kilogram is predicted to be much higher than for large launchers. The second possibility is the exploitation of a rideshare option, where the satellite is transported by a large launcher together with other payloads on a general predetermined orbit. Afterwards the satellite needs to be transferred to its designed orbit. This can be done in two ways: through the use of a satellite carrier (also called self-propelled dispenser) or with the satellite own propulsion system. In both last cases, the mass transported by the launcher into the release orbit is higher than the final one necessary for the nominal mission, impacting total costs. In this paper these three possibilities are compared considering the need to reach various specific orbits, starting from a different release one in the case of the rideshare options. First of all, the change in velocity for different orbital parameters (altitude, eccentricity, phase, argument of perigee, inclination, RAAN) is computed. Afterwards the propulsion mass budget is calculated. Everything else being equal, it is demonstrated mathematically that a dispenser is inherently less efficient than a group of autonomous satellites, particularly for the RAAN change and a large number of carried satellites. However, it is not always possible or convenient to provide small satellites, particularly the smallest ones (nanosats/cubesats/microsats) with comparable propulsion capabilities of a larger dispenser, making the latter still an attractive option in several situations. A cost analysis also shows that, particularly for sophisticated small satellites, when the final orbit is far from the release one, a dedicated small launch vehicle can be cost competitive with the nominally much cheaper large launcher. • Satellites can reach a specific orbit through dedicated launch or rideshare plus orbital transfer. • Sat carriers are mathematically inherently more inefficient than autonomous propulsion. • Penalty increases particularly as the ΔV and the number of satellites increase. • Small launch vehicles are inherently more responsive and expensive than rideshare options. • Launch cost penalty impacts only a fraction of total costs, particularly for unserved orbits. [ABSTRACT FROM AUTHOR]

When loading liquefied natural gas (LNG) onto a dual-fuel LNG container ship fuelled by LNG, there is a considerable temperature difference between LNG and the fuel tank at room temperature. The current solution is to pre-cool the tank with LNG through a spray line but the cooling process, if not correctly handled, can result in excessive cooling rates and Boil-Off Gas (BOG), which can expose the tank to increased temperature stress and gas pressure. Therefore, this paper takes the Mark III fuel tank of a specific type of LNG container ship as the object and realises a real-time predictive control system by writing a UDF (User Defined Function) to simulate and analyse the influence of LNG spray rate on the change of cooling effect, cooling time and cooling cost under the unidirectional LNG spray cooling mode. Compared with the results of the fuel tank gas experiment, the deviation of numerical model simulation results is less than 5%. Under the same cooling rate, the real-time control scheme can achieve a more uniform cooling rate and reduce the total LNG consumption by 25%. With the increase in LNG cooling rate, the cooling time, LNG usage, and the total BOG exhaust volume all decrease; however, the decreased range gradually decreases as well. The results of this paper provide parameters and suggestions for optimising and improving the LNG fuel tank cooling monitoring and control system. [ABSTRACT FROM AUTHOR]

The broiler industry is crucial in Malaysia's agricultural sector, contributing significantly to meat production and the economy. However, the industry faces significant challenges, primarily stemming from high production costs, with feed costs constituting a substantial portion. Therefore, there is a need to improve domestic farm performance and competitiveness by optimizing resources and minimizing expenses to enhance overall productivity. This study aims to estimate the extent of cost efficiency in broiler farming in Peninsular Malaysia and identify key determinants influencing the inefficiency cost. A comprehensive survey involving 241 broiler farms in Peninsular Malaysia was conducted using structured questionnaires and a stratified random sampling technique. Employing the Stochastic Cost Frontier model revealed an operational inefficiency of approximately 5.7% above optimal costs among the surveyed farms, indicating substantial potential for a 5.7% reduction in production costs through enhanced management strategies. Factors such as feed prices, day-old chick prices, price of miscellaneous inputs, production output levels, and capital investment prices emerged as prominent influencers in the broiler cost function. Furthermore, the study indicated that socio-economic factors such as housing system, extension visits, credit access and contract farming are associated with lower inefficiencies, thereby enhancing cost efficiency in broiler farming operations. Conversely, higher bird mortality rates are associated with the increased inefficiency. Gaining insights into these factors is crucial for stakeholders to allocate resources wisely, plan strategically, and enhance competitiveness in broiler farming. [ABSTRACT FROM AUTHOR]

Background: The management of febrile neutropenia (FN) in pediatric cancer patients has traditionally been conducted in a hospital setting. However, recent evidence has indicated that outpatient management of FN can be equally effective compared to inpatient care. Based on this evidence, we conducted a cost-minimization analysis (CMA) specifically focused on pediatric cancer patients in Mexico. Methods: A piggy-back study was conducted during the execution of a non-inferiority clinical trial that compared outpatient treatment to inpatient treatment for FN in children with cancer. A CMA was performed from a societal perspective using patient-level data. In the previous study, we observed that step-down oral outpatient management of low-risk FN was as safe and effective as inpatient intravenous management. Direct and indirect costs were collected prospectively. The costs were adjusted for inflation and converted to US dollars, with values standardized to July 2022 costs. Statistical analysis using bootstrap methods was employed to obtain robust estimations for decision-making within the Mexican public health care system. Results: A total of 117 FN episodes were analyzed, with 60 in the outpatient group and 57 in the inpatient group; however, complete cost data were available for only 115 FN episodes. The analysis revealed an average savings of $1,087 per FN episode managed on an outpatient basis, representing a significant 92% reduction in total cost per FN episode compared to inpatient treatment. Length of hospital stay and inpatient consultations emerged as the primary cost drivers within the inpatient care group. Conclusion: This CMA demonstrates that the step-down outpatient management approach is cost-saving when compared to inpatient management of FN in pediatric cancer patients. The mean difference observed between the treatment groups provides support for decision-making within the public health care system, as outpatient management of FN allows for substantial cost savings without compromising patient health. [ABSTRACT FROM AUTHOR]

Background: Lack of evidence about the long-term economic benefits of interventions targeting underserved perinatal populations can hamper decision making regarding funding. To optimize the quality of future research, we examined what methods and costs have been used to assess the value of interventions targeting pregnant people and/or new parents who have poor access to healthcare. Methods: We conducted a scoping review using methods described by Arksey and O'Malley. We conducted systematic searches in eight databases and web-searches for grey literature. Two researchers independently screened results to determine eligibility for inclusion. We included economic evaluations and cost analyses of interventions targeting pregnant people and/or new parents from underserved populations in twenty high income countries. We extracted and tabulated data from included publications regarding the study setting, population, intervention, study methods, types of costs included, and data sources for costs. Results: Final searches were completed in May 2024. We identified 103 eligible publications describing a range of interventions, most commonly home visiting programs (n = 19), smoking cessation interventions (n = 19), prenatal care (n = 11), perinatal mental health interventions (n = 11), and substance use treatment (n = 10), serving 36 distinct underserved populations. A quarter of the publications (n = 25) reported cost analyses only, while 77 were economic evaluations. Most publications (n = 82) considered health care costs, 45 considered other societal costs, and 14 considered only program costs. Only a third (n = 36) of the 103 included studies considered long-term costs that occurred more than one year after the birth (for interventions occurring only in pregnancy) or after the end of the intervention. Conclusions: A broad range of interventions targeting pregnant people and/or new parents from underserved populations have the potential to reduce health inequities in their offspring. Economic evaluations of such interventions are often at risk of underestimating the long-term benefits of these interventions because they do not consider downstream societal costs. Our consolidated list of downstream and long-term costs from existing research can inform future economic analyses of interventions targeting poorly served pregnant people and new parents. Comprehensively quantifying the downstream and long-term benefits of such interventions is needed to inform decision making that will improve health equity. [ABSTRACT FROM AUTHOR]

Background: Indoor residual spraying (IRS) is one of the most effective malaria control tools. However, its application has become limited to specific contexts due to the increased costs of IRS products and implementation programmes. Selective spraying—selective spray targeted to particular areas/surfaces of dwellings—has been proposed to maintain the malaria control and resistance-management benefits of IRS while decreasing the costs of the intervention. Methods: A literature search was conducted to find (1) studies that assessed the resting behaviour of Anopheles mosquitoes and (2) studies that evaluated the impact of selective spraying on entomological and malaria outcomes. Additional articles were identified through hand searches of all references cited in articles identified through the initial search. A cost model was developed from PMI VectorLink IRS country programmes, and comparative cost analysis reports to describe the overall cost benefits of selective IRS. Results: In some studies, there appeared to be a clear resting preference for certain Anopheles species in terms of the height at which they rested. However, for other species, and particularly the major African malaria vectors, a clear resting pattern was not detected. Furthermore, resting behaviour was not measured in a standardized way. For the selective spray studies that were assessed, there was a wide range of spray configurations, which complicates the comparison of methods. Many of these spray techniques were effective and resulted in reported 25–68% cost savings and reduced use of insecticide. The reported cost savings in the literature do not always consider all of the IRS implementation costs. Using the IRS cost model, these savings ranged from 17 to 29% for programs that targeted Anopheles spp. and 18–41% for programmes that targeted Aedes aegypti. Conclusions: Resting behaviour is generally measured in a simplistic way; noting the resting spot of mosquitoes in the morning. This is likely an oversimplification, and there is a need for better monitoring of resting mosquitoes. This may improve the target surface for selective spray techniques, which could reduce the cost of IRS while maintaining its effectiveness. Reporting of cost savings should be calculated considering the entire implementation costs, and a cost model was provided for future calculations. [ABSTRACT FROM AUTHOR]

The past decade has witnessed a significant evolution in the role of the Internet, transitioning from individual connectivity to an integral aspect of various domains. This shift has prompted a move in IP paradigms from hierarchical to distributed architectures characterized by decentralized structures. This transition empowers efficient data routing and management across diverse networks. However, traditional distributed mobility management (DMM) protocols, reliant on tunneling mechanisms, incur overheads, costs, and delays, exacerbating challenges in managing the exponential growth of mobile data traffic. This research proposes Tunnel-Free Mobility for IPv6 (TFMIPv6) as a solution to address the shortcomings of existing DMM protocols. TFMIPv6 eliminates the need for tunneling, simplifying routing processes and reducing latency. A comprehensive cost analysis and performance evaluation are conducted, comparing TFMIPv6 with traditional protocols such as MIPv6, PMIPv6, FMIPv6, and HMIPv6. The study reveals significant improvements with TFMIPv6. Signaling costs are reduced by 50%, packet delivery costs by 23%, and tunneling costs are completely eliminated (100%). Real-world network traffic datasets are used for simulation, providing statistical evidence of TFMIPv6's efficacy in supporting an uninterrupted movement of IPv6 data across networks. [ABSTRACT FROM AUTHOR]

Vancomycin and daptomycin are frequently used in outpatient parenteral antimicrobial therapy (OPAT). We analyze health care utilization and cost to the health care system for vancomycin vs daptomycin in the outpatient setting and find that vancomycin results in significantly higher health care utilization and similar cost per course compared with daptomycin in OPAT. [ABSTRACT FROM AUTHOR]

The ongoing expansion of wolf (Canis lupus) populations in Europe has led to a growing demand for up‐to‐date abundance estimates. Non‐invasive genetic sampling (NGS) is now widely used to monitor wolves, as it allows individual identification and abundance estimation without physically capturing individuals. However, NGS is resource‐intensive, partly due to the elusive behaviour and wide distribution of wolves, as well as the cost of DNA analyses. Optimisation of sampling strategies is therefore a requirement for the long‐term sustainability of wolf monitoring programs. Using data from the 2020–2021 Italian Alpine wolf monitoring, we investigate how (i) reducing the number of samples genotyped, (ii) reducing the number of transects, and (iii) reducing the number of repetitions of each search transect impacted spatial capture‐recapture population size estimates. Our study revealed that a 25% reduction in the number of transects or, alternatively, a 50% reduction in the maximum number of repetitions yielded abundance estimates comparable to those obtained using the entire dataset. These modifications would result in a 2046 km reduction in total transect length and 19,628 km reduction in total distance searched. Further reducing the number of transects resulted in up to 15% lower and up to 17% less precise abundance estimates. Reducing only the number of genotyped samples led to higher (5%) and less precise (20%) abundance estimates. Randomly subsampling genotyped samples reduced the number of detections per individual, whereas subsampling search transects resulted in a less pronounced decrease in both the total number of detections and individuals detected. Our work shows how it is possible to optimise wolf monitoring by reducing search effort while maintaining the quality of abundance estimates, by adopting a modelling framework that uses a first survey dataset. We further provide general guidelines on how to optimise sampling effort when using spatial capture‐recapture in large‐scale monitoring programmes. [ABSTRACT FROM AUTHOR]

Engineered geopolymer composites (EGCs) exhibit excellent tensile ductility and crack control ability, making them promising for concrete structure repair. However, their widespread use is limited by high costs of reinforcement fiber and a lack of an EGC–concrete interface bonding mechanism. This study investigated a hybrid PE/PVA fiber-reinforced EGC using domestically produced unoiled PVA fibers to replace commonly used PE fibers. The bond performance of the EGC–concrete interface was evaluated through direct tensile and slant shear tests, focusing on the effects of PE fiber content (1%, 2%, and 3%), fiber hybrid ratios (2.0:0.0, 1.5:0.5, 1.0:1.0, 0.5:1.5, and 0.0:2.0), concrete substrate strength (C30, C50, and C70), and the ratio of fly ash (FA) to ground granulated blast furnace slag (GGBS) (6:4, 7:3, and 8:2) on interface bond strength. Results showed that the EGCs' compressive strength ranged from 77.1 to 108.9 MPa, with increased GGBS content significantly enhancing the compressive strength and elastic modulus. Most of the specimens exhibited strain-hardening behavior after initial cracking. Interface bonding tests revealed that a PE/PVA ratio of 1.0 increased tensile bond strength by 8.5% compared with using 2.0% PE fiber alone. Increasing the PE fiber content, PVA/PE ratio, GGBS content, and concrete substrate strength all improved the shear bond strength. This improvement was attributed to the flexible fibers' ability to restrict thermo–hydro damage and deflect and blunt microcracks, enhancing the interface's failure resistance. Cost analysis showed that replacing 50% of the PE fiber in EGC with unoiled PVA fiber reduced costs by 44.2% compared with PE fiber alone, offering the best cost–performance ratio. In summary, hybrid PE/PVA fiber EGC has promising prospects for improving economic efficiency while maintaining tensile ductility and crack-control ability. Future optimization of fiber ratios and interface design could further enhance its potential for concrete repair applications. [ABSTRACT FROM AUTHOR]

This study examined the self-cleaning and mechanical properties of basalt fiber–reinforced ground granulated blast furnace slag (GGBS)-based geopolymer mortar containing nano TiO2. The nano TiO2 and basalt fiber in mixtures were used at 0%, 0.25%, 0.5%, and 1% by weight of GGBS. The cubes (50×50×50 mm) and prisms (40×40×160 mm) samples containing nano TiO2 and basalt fiber were produced and cured in the oven for 24 h at 60°C. Then, these samples were kept at room temperature at 23°C±2°C for 28 days. Lastly, the compressive strength, flexural strength, ultrasonic pulse velocity, capillary water absorption, and self-cleaning tests of GGBS-based geopolymer mortars were carried out. In this study, the Rhodamine-B test was used to determine self-cleaning. This study showed that the compressive strength, flexural strength, and ultrasonic pulse velocity values of the GGBS-based geopolymer mortars increased as the nano TiO2 and basalt fiber ratios increased, but their capillary water absorption coefficient decreased. Also, this study found that the self-cleaning rate of GGBS-based geopolymer mortars containing 1% nano TiO2 was obtained as 50.62% at 28 days. [ABSTRACT FROM AUTHOR]

Operating rooms (ORs) use energy-intensive equipment such as anesthesia gas machines, patient monitors, and lights. They are major contributors to an institution's carbon footprint; yet ORs are unoccupied 40% of the time. Implementing an initiative to power down electrical devices can reduce energy consumption, equipment failure, and financial outlay. This quality improvement project developed and implemented a power down initiative for anesthesia staff to use in ORs. The initiative included turning off anesthesia gas machines, patient monitors, auxiliary oxygen delivery, and room lights at the end of scheduled cases in ORs that were not used for emergencies. Convenience audits were conducted. Pre- and postimplementation compliance outcomes showed that there was an increase in powering down the anesthesia gas machine, patient monitor, auxiliary oxygen, and room lights. Powering down unnecessary equipment at this facility has the potential to save approximately $50,000 and prevent the emission of over 80 metric tons of CO2 per year. Other facilities can implement a similar quality improvement project aimed at fiscal and ecological conservation. [ABSTRACT FROM AUTHOR]

In this paper, the reliability characteristics of a parallel system are investigated. The parallel system under consideration is made up of three active units that run in parallel, with two of them having to be operational in order for the system to work. The main purpose of this study is to quantify/examine the effect of online and offline preventive maintenance. Preventive maintenance is carried out on the systems in two ways: online and offline preventive maintenance. After the first unit of each system fails, online preventive maintenance is performed. Following the failure of the second unit of each system, offline preventive maintenance is performed. Partial and complete failures are the two types of failures that may occur. Both systems can undergo exponential failure and repair. Using supplementary variable technique, Laplace transform, and Copula repair approach, the system of first-order differential equations associated with system effectiveness, which are crucial to this research, is established and resolved. Tables and graphs are used to illustrate the important findings based on assumed numerical values. System designers, programmers, and maintenance supervisors will be able to create and maintain more crucial systems with the assistance of this research paper. [ABSTRACT FROM AUTHOR]

The U.S. dairy sector is a significant emitter of methane and nitrous oxide, with the US EPA estimating it produced around 90 Tg CO2 eq. in 2021. This paper reviews the literature on and evaluates various mitigation actions for reducing GHG emissions in the U.S. dairy sector, focusing on both direct and indirect emission sources. We conducted a narrative literature review based on the cradle to gate life-cycle assessment method, covering the entire dairy supply chain up until milk enters retail establishments, including dairy and feed producing farm practices, processing, transportation, and their associated emissions/costs. The papers included were selected over a three year process depending on discussions with experts and issues mentioned in the emerging literature. We review significant opportunities for the U.S. dairy sector to reduce emissions, particularly through improved enteric fermentation and manure management practices. Additionally, we cover the potential for mitigating indirect emissions from feed production, processing, and transportation, areas less frequently covered in existing studies. This review also covers a gap in the literature by integrating economic findings including cost analysis and incentives to mitigate based on the social value of emissions reductions. [ABSTRACT FROM AUTHOR]

Using biopolymers for soil stabilization is favorable compared to more conventional methods because they are more environmentally friendly, cost-effective, and long-lasting. This study analyzes the physical properties of guar gum and laterite soil mixes. A comprehensive engineering study of guar gum-treated soil was conducted with the help of a brief experimental program. This study examined the effects of soil–guar gum interactions on the strengthening behavior of guar gum-treated soil mixtures using a series of laboratory tests. The treated laterite soil's dry density increased marginally, while its optimum moisture content decreased as the guar gum increased. Treatment with guar gum significantly enhanced the strength of laterite soil mixtures. For laterite soil with 2% guar gum, the unsoaked CBR increased by 148% and the soaked CBR increased by 192.36%. The cohesiveness and internal friction angle increased by 93.33% and 31.52%, respectively. These results show that using guar gum dramatically improves the strength of laterite soil, offering a more environmentally friendly and sustainable alternative to traditional soil additives. Using guar gum in T8 subgrade soil requires a 1395 mm pavement depth and costs INR 3.83 crores, 1.52 times more than laterite soil. For T9 subgrade soil, the depth was 1495 mm, costing INR 4.42 crores, 1.72 times more than laterite soil. This study introduces a novel approach to soil stabilization by employing guar gum, a biopolymer, to enhance the physical and mechanical properties of laterite soil. Furthermore, this study provides a detailed cost–benefit analysis for pavement applications, revealing the financial feasibility of using guar gum despite it requiring a marginally higher initial investment. [ABSTRACT FROM AUTHOR]

Background: This study investigated and compared the efficacy, safety, radiation exposure, and financial compensation of two modalities for percutaneous radiologic gastrostomy (PRG): multislice computed tomography biopsy mode (MS-CT BM)-guided and fluoroscopy-guided (FPRG). The aim was to provide insights into optimizing radiologically assisted gastrostomy procedures. Methods: We conducted a retrospective analysis of PRG procedures performed at a single center from January 2018 to January 2024. The procedures were divided into two groups based on the imaging modality used. We compared patient demographics, intervention parameters, complication rates, and procedural times. Financial compensation was evaluated based on the tariff structure for outpatient medical services in Switzerland (TARMED). Statistical differences were determined using Fisher's exact test and the Mann–Whitney U test. Results: The study cohort included 133 patients: 55 with MS-CT BM-PRG and 78 with FPRG. The cohort comprised 35 women and 98 men, with a mean age of 64.59 years (±11.91). Significant differences were observed between the modalities in effective dose (MS-CT BM-PRG: 10.95 mSv ± 11.43 vs. FPRG: 0.169 mSv ± 0.21, p < 0.001) and procedural times (MS-CT BM-PRG: 41.15 min ± 16.14 vs. FPRG: 28.71 min ± 16.03, p < 0.001). Major complications were significantly more frequent with FPRG (10% vs. 0% in MS-CT BM-PRG, p = 0.039, φ = 0.214). A higher single-digit number of MS-CT BM-guided PRG was required initially to reduce procedure duration by 10 min. Financial comparison revealed that only 4% of MS-CT BM-guided PRGs achieved reimbursement equivalent to the most frequent comparable examination, according to TARMED. Conclusions: Based on our experience from a retrospective, single-center study, the execution of a PRG using MS-CT BM, as opposed to FPRG, is currently justified in challenging cases despite a lower incidence of major complications. However, further well-designed prospective multicenter studies are needed to determine the efficacy, safety, and cost-effectiveness of these two modalities. [ABSTRACT FROM AUTHOR]

Background: Health Complex Model was implemented to provide primary health care services in urban, especially in slum areas. As a pilot at a provincial level, Chamran Health Complex offers healthcare for more than 57,000 residents of Tabriz. Despite the necessity of cost information in healthcare decision-making, there was limited knowledge about the unit cost of services. This study aims to analyze the cost and efficiency of health centers. Methods: Activity-Based Costing method with direct and step-down allocation methods was adopted. We estimated unit costs in a hypothetical scenario according to national standards to quantify the gap between current and standard practice. Input-oriented Data Envelopment Analysis was administered to measure the efficiency of health centers. Results: The total cost of the complex was $2,841,897, of which 67% ($1910373) and 33% ($931523) were accounted for direct and indirect costs, respectively. The vaccination center had the lowest ($9), and the occupational health center had the highest average unit cost ($76). The average technical efficiency of the health centers was 0.519, where the HC1 and HC3 showed the best performance. Conclusion: There is remarkable variability in service costs across health centers, which must be addressed in performance management and contracting practices. Although we found a gap between current and standard practice in terms of staff and facilities according to national standards, Chamran Health Complex has an untouched capacity that can be utilized with better planning and without incurring additional costs. It raises the need for revising national standards by the Iran Ministry of Health. [ABSTRACT FROM AUTHOR]

OBJECTIVE To determine the lifetime cost of 3 treatments for canine hip osteoarthritis: (1) conservative management, (2) femoral head and neck excision (FHNE), or (3) total hip replacement. We hypothesized that FHNE would be the least expensive treatment at all ages. SAMPLE Cost estimates from 11 private and academic referral centers from 8 randomly chosen cities across the US. METHODS Costs of surgeries were collected from practices in 8 US cities. The literature was used to determine expected postoperative costs. For conservative management, costs of pain medications and diet were obtained by use of online pharmacies. A 4.5% inflation adjustment was used for costs in subsequent years. RESULTS For a dog aged 1 to 7 years, FHNE had the lowest lifetime cost. Total hip replacement had the second lowest cost until age 4, after which conservative management was lower. For dogs > 8 years, conservative management was the most cost-effective. CLINICAL RELEVANCE For dogs presenting with clinical signs at or under 1 year of age, the perceived benefits of total hip replacement may not be financially prohibitive if lifetime cost of care is considered. Femoral head and neck excision was also less expensive than long-term conservative management. This can help veterinarians inform owners on costs of treatments over the lifetime of their pet. This type of analysis is limited to financial costs alone and does not account for differences in outcomes, as these are not well established. It should be expanded in the future as better data on outcomes and impacts of care become available. [ABSTRACT FROM AUTHOR]

Background: Breastfeeding is the biological norm for feeding infants and young children. When mothers' breastmilk is unavailable, donor human milk (DHM) from a human milk bank (HMB) becomes the next option for small vulnerable newborns. A comprehensive cost analysis is essential for understanding the investments needed to establish, operate, and scale up HMBs. This study aims to estimate and analyze such costs at the first facility established in Vietnam. Methods: An activity-based costing ingredients (ABC-I) approach was employed, with the cost perspective from service provision agencies (specifically, the project conducted at Da Nang Hospital for Women and Children and Development Partners). Estimated financial costs, based on actual expenditures, were measured in 2023 local currency and then converted to 2023 US dollars (USD). We examined three scenarios: 1) direct start-up costs + indirect start-up costs + implementation costs, 2) direct start-up costs + implementation costs, and 3) capital costs + implementation costs over the 6.5 years of operation. Results: The total start-up cost was USD 616,263, with total expenditure on direct activities at USD 228,131 and indirect activities at USD 388,132. Investment in equipment accounted for the largest proportion (USD 84,213). The monthly costs of Da Nang HMB were USD 25,217, 14,565, and 9,326, corresponding to scenarios 1, 2, and 3, respectively. Over HMB's 6.5 years of operation, on average, the unit costs were USD 166, USD 96, and USD 62 for DHM received and USD 201, USD 116, and USD 74 for pasteurized DHM meeting specified criteria in the corresponding scenarios. Unit costs were highest in the initial six months, decreased, and reached their lowest levels after a year. Then, the unit costs experienced an increase in late 2020 and early 2021. Conclusion: Although the unit cost of DHM in Da Nang HMB is comparable to that in certain neighboring countries, intentional measures to reduce disposal rates, improve HMB efficiency, motivate more community-based donors, and establish an HMB service network should be implemented to lower costs. [ABSTRACT FROM AUTHOR]

Rifampicin-resistant (RR) tuberculosis (TB) in children is a major global health concern but is often neglected in economics research. Accurate cost estimations across the spectrum of paediatric RR-TB treatment regimens are critical inputs for prioritisation and budgeting decisions, and an existing knowledge gap at local and international levels. This normative cost analysis was nested in a Phase I/II pharmacokinetics, safety, tolerability, and acceptability trial of TB medications in children in South Africa, the Philippines and India. It assessed the pharmaceutical costs of 36 childhood RR-TB regimens using combinations from 16 different medicines in 34 oral formulations (adult and child-friendly) in 11 weight bands in children <15 years of age. The analysis used local and Global Drug Facility pricing, and local and international guideline recommendations, including adaptions of BPaL and BPaLM regimens in adults. Costs varied significantly between regimen length, age/weight banding, severity of disease, presence of fluroquinolone resistance, and different country guideline recommendations. WHO recommended regimen costs ranged 12-fold: from US$232 per course (short regimen in non-severe disease) to US$2,761 (long regimen in severe, fluroquinolone-resistant disease). Regimen treating fluoroquinolone-resistant infection cost US$1,090 more than comparable WHO-recommended regimen. Providing child-friendly medicine formulations in <5-year-olds across all WHO-recommended regimens is expected to cost an additional $380 (range $212-$563) per child but is expected to have wider benefits including palatability, acceptability, adherence, tolerability, and dose accuracy. There were substantial differences in regimen affordability between countries when adjusted for purchasing power and domestic spending on health. Appropriate, effective, and affordable treatment options are an important component of the fight against childhood RR-TB. A comprehensive understanding of the cost and affordability dynamics of treatment options will enable national TB programs and global collaborations to make the best use of limited healthcare resources for the care of children with RR-TB. [ABSTRACT FROM AUTHOR]

Background: The aim is to estimate age- and sex-specific direct medical costs related to diagnosed type 1 and type 2 diabetes in Germany between 2010 and 2040. Methods: Based on nationwide representative epidemiological routine data from 2010 from the statutory health insurance in Germany (almost 80% of the population's insurance) we projected age- and sex-specific healthcare expenses for type 1 and 2 diabetes considering future demographic, disease-specific and cost trends. We combine per capita healthcare cost data (obtained from aggregated claims data from an almost 7% random sample of all German people with statutory health insurance) together with the demographic structure of the German population (obtained from the Federal Statictical Office), diabetes prevalence, incidence and mortality. Direct per capita costs, total annual costs, cost ratios for people with versus without diabetes and attributable costs were estimated. The source code for running the analysis is publicly available in the open-access repository Zenodo. Results: In 2010, total healthcare costs amounted to more than €1 billion for type 1 and €28 billion for type 2 diabetes. Depending on the scenario, total annual expenses were projected to rise remarkably until 2040 compared to 2010, by 1–281% for type 1 (€1 to €4 billion) and by 8–364% for type 2 diabetes (€30 to €131 billion). In a relatively probable scenario total costs amount to about €2 and €79 billion for type 1 and type 2 diabetes in 2040, respectively. Depending on annual cost growth (1% p.a. as realistic scenario vs. 5% p.a. as very extreme setting), we estimated annual per capita costs of €6,581 to €12,057 for type 1 and €5,245 to €8,999 for type 2 diabetes in 2040. Conclusions: Diabetes imposes a large economic burden on Germany which is projected to increase substantially until 2040. Temporal trends in the incidence and cost growth are main drivers of this increase. This highlight the need for urgent action to prepare for the potential development and mitigate its consequences. [ABSTRACT FROM AUTHOR]

In mining projects and production operations, energy carrier costs (fuel, electricity) constitute the primary component of variable costs. This study outlines a methodology for projecting operating costs in a surface mine or quarry in order to find the optimal configuration of mining equipment to extract low-grade secondary deposits, taking into account volatile energy prices. For illustration, the operating costs of five variants of mining equipment deployed to mine low-grade products were analysed, with the price of energy and fuels being the key cost component and the main risk factor. There were differences between the initial investment outlays and operating costs involved in all analysed variants, whilst the starting point for estimating the technical and economic parameters involved in the respective solutions was the predefined configuration of the mining equipment. Further, the decision to commence or discontinue mining operations could be supported by the simulation procedure based on the economic model. The results provided valuable insights into the cost-effectiveness of low-grade deposit extraction scenarios, depending on the projected unit costs of fuels and energy. [ABSTRACT FROM AUTHOR]

Background: Non-communicable diseases (NCDs) are responsible for 51% of total mortality in South Africa, with a rising burden of hypertension (HTN) and diabetes mellitus (DM). Incorporating NCDs and COVID-19 screening into mass activities such as COVID-19 vaccination programs could offer significant long-term benefits for early detection interventions. However, there is limited knowledge of the associated costs and resources required. We evaluated the cost of integrating NCD screening and COVID-19 antigen rapid diagnostic testing (Ag-RDT) into a COVID-19 vaccination program. Methods: We conducted a prospective cost analysis at three public sector primary healthcare clinics and one academic hospital in Johannesburg, South Africa, conducting vaccinations. Participants were assessed for eligibility and recruited during May-Dec 2022. Costs were estimated from the provider perspective using a bottom-up micro-costing approach and reported in 2022 USD. Results: Of the 1,376 enrolled participants, 240 opted in to undergo a COVID-19 Ag-RDT, and none tested positive for COVID-19. 138 (10.1%) had elevated blood pressure, with 96 (70%) having no prior HTN diagnosis. 22 (1.6%) were screen-positive for DM, with 12 (55%) having no prior diagnosis. The median cost per person screened for NCDs was $1.70 (IQR: $1.38-$2.49), respectively. The average provider cost per person found to have elevated blood glucose levels and blood pressure was $157.99 and $25.19, respectively. Finding a potentially new case of DM and HTN was $289.65 and $36.21, respectively. For DM and DM + HTN screen-positive participants, diagnostic tests were the main cost driver, while staff costs were the main cost driver for DM- and HTN screen-negative and HTN screen-positive participants. The median cost per Ag-RDT was $5.95 (IQR: $5.55-$6.25), with costs driven mainly by test kit costs. Conclusions: We show the cost of finding potentially new cases of DM and HTN in a vaccine queue, which is an essential first step in understanding the feasibility and resource requirements for such initiatives. However, there is a need for comparative economic analyses that include linkage to care and retention data to fully understand this cost and determine whether opportunistic screening should be added to general mass health activities. [ABSTRACT FROM AUTHOR]

Background: Behaviour change interventions can result in lasting improvements in physical activity (PA). A broad implementation of behaviour change interventions are likely to be associated with considerable additional costs, and the evidence is unclear whether they represent good value for money. The aim of this study was to investigate costs and cost-effectiveness of behaviour change interventions to increase PA in community-dwelling adults. Methods: A search for trial-based economic evaluations investigating behaviour change interventions versus usual care or alternative intervention for adults living in the community was conducted (September 2023). Studies that reported intervention costs and incremental cost-effectiveness ratios (ICERs) for PA or quality-adjusted life years (QALYs) were included. Methodological quality was assessed using the Consensus Health Economic Criteria (CHEC-list). A Grading of Recommendations Assessment, Development and Evaluation style approach was used to assess the certainty of evidence (low, moderate or high certainty). Results: Sixteen studies were included using a variety of economic perspectives. The behaviour change interventions were heterogeneous with 62% of interventions being informed by a theoretical framework. The median CHEC-list score was 15 (range 11 to 19). Median intervention cost was US$313 per person (range US$83 to US$1,298). In 75% of studies the interventions were reported as cost-effective for changes in PA (moderate certainty of evidence). For cost per QALY/gained, 45% of the interventions were found to be cost-effective (moderate certainty of evidence). No specific type of behaviour change intervention was found to be more effective. Conclusions: There is moderate certainty that behaviour change interventions are cost-effective approaches for increasing PA. The heterogeneity in economic perspectives, intervention costs and measurement should be considered when interpreting results. There is a need for increased clarity when reporting the functional components of behaviour change interventions, as well as the costs to implement them. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic affected hundreds of millions of people and lives, and vaccination was the safest and most effective strategy to prevent and mitigate the burden of this disease. The implementation of COVID-19 vaccination in Vietnam in 2021 was unprecedentedly challenging in scale and complexity, yet economic evidence on the cost of delivery vaccines thought the program was lacking. Methods: This retrospective costing study utilized a bottom-up, ingredient-based approach to estimate the cost of delivering COVID-19 vaccines in Vietnam in 2021, from a payer perspective. The study included 38 study sites across all administrative and implementation level, including three geographic areas and two delivery strategies, in two provinces, Hanoi and Dak Lak. The study findings were complemented with qualitative interviews with health staff and stakeholders. Results: The economic cost to deliver one COVID-19 vaccine dose was $1.73, mostly comprised of opportunity costs ($1.14 per dose) which were driven by labor costs ($1.12 per dose). The delivery cost in urban areas was the highest ($2.02), followed by peri-urban areas ($1.45) and remote areas ($1.37). Delivery costs were higher at temporary sites ($1.78) when compared to facility-based delivery ($1.63). Comparing low-volume and high-volume periods showed that the delivery cost decreased significantly as volume increased, from $5.24 per dose to $1.65 per dose. Conclusions: The study estimates the cost of delivering COVID-19 vaccines in Vietnam in 2021. Enabling factors and challenges during the implementation of the program were explored. Study limitations may lead to underestimation of results and reduce generalizability. [ABSTRACT FROM AUTHOR]

Background: Breastfeeding is the biological norm for feeding infants and young children. When mothers' breastmilk is unavailable, donor human milk (DHM) from a human milk bank (HMB) becomes the next option for small vulnerable newborns. A comprehensive cost analysis is essential for understanding the investments needed to establish, operate, and scale up HMBs. This study aims to estimate and analyze such costs at the first facility established in Vietnam. Methods: An activity-based costing ingredients (ABC-I) approach was employed, with the cost perspective from service provision agencies (specifically, the project conducted at Da Nang Hospital for Women and Children and Development Partners). Estimated financial costs, based on actual expenditures, were measured in 2023 local currency and then converted to 2023 US dollars (USD). We examined three scenarios: 1) direct start-up costs + indirect start-up costs + implementation costs, 2) direct start-up costs + implementation costs, and 3) capital costs + implementation costs over the 6.5 years of operation. Results: The total start-up cost was USD 616,263, with total expenditure on direct activities at USD 228,131 and indirect activities at USD 388,132. Investment in equipment accounted for the largest proportion (USD 84,213). The monthly costs of Da Nang HMB were USD 25,217, 14,565, and 9,326, corresponding to scenarios 1, 2, and 3, respectively. Over HMB's 6.5 years of operation, on average, the unit costs were USD 166, USD 96, and USD 62 for DHM received and USD 201, USD 116, and USD 74 for pasteurized DHM meeting specified criteria in the corresponding scenarios. Unit costs were highest in the initial six months, decreased, and reached their lowest levels after a year. Then, the unit costs experienced an increase in late 2020 and early 2021. Conclusion: Although the unit cost of DHM in Da Nang HMB is comparable to that in certain neighboring countries, intentional measures to reduce disposal rates, improve HMB efficiency, motivate more community-based donors, and establish an HMB service network should be implemented to lower costs. [ABSTRACT FROM AUTHOR]

Adolescence is a critical period of physical, cognitive, and social development that needs to be supported with healthy diets. Dietary behaviours of adolescents can be shaped by their nutrition‐literacy and their interaction with parents and peers as well as their school food environment. Therefore, the present study aimed to assess factors that influence dietary behaviours of adolescents in urban Ethiopia. Sex‐disaggregated, focused group discussions (n = 70) were conducted in 36 private and government schools (n = 12/city) among adolescents (n = 432) 15–19 years of age in Addis Ababa, Bahir Dar, and Dire Dawa. Photovoice was applied in a subgroup of participants (n = 216) to gain further insights into adolescents' perception of their school food environment. Key informant interviews were conducted among school principals (n = 36). Adolescents had a relatively good nutrition knowledge and recognised the importance of diverse diets, but misperceptions also existed. They identified fruit and vegetables as healthy foods, but their consumption was deterred by food safety concerns. The adolescents identified foods high in salt, fat, and sugar, including processed/packaged foods as unhealthy, but still consumed them frequently due to their taste, affordability, availability and accessibility in and around schools. Both undernutrition and overweight/obesity were linked to social exclusion and bullying in school. Effective behavioural change communication is required to address common misperceptions. School nutrition programs should integrate water, sanitation and hygiene programs to ensure food safety. Regulations promoting healthy eating while discouraging unhealthy dietary behaviours are vital. Interventions to make nutrient‐dense and healthy foods available, accessible, and affordable are urgently needed to improve the nutrition and health outcome of adolescents. Key messages: Adolescents had a relatively good nutrition knowledge, but misperceptions also existedFoods high in fat, sugar, and salt, but also processed/packaged foods were considered unhealthy, but were frequently consumedUnhealthy foods were widely available/accessible in the school food environmentComprehensive food safety and nutrition interventions are needed at schoolsRegulations for availability and advertising of unhealthy foods in and around schools are needed. [ABSTRACT FROM AUTHOR]

Despite sustained nutrition education, consumption of animal source foods (ASFs) has been hindered by their low availability, accessibility and affordability. Drying eggs into powder can reduce transport/storage costs, increase shelf‐life and allow easier dosage for use of smaller portions. This study aimed to evaluate the contribution of integrating egg powder to the nutrient adequacy and affordability of diets. Using the 'cost of the diet' analysis, we simulated the incorporation of egg powder into households' and children's diet and evaluated its contribution to the nutrient adequacy and affordability of diets. Analysis of the household consumption and expenditure survey (HCES 2016) revealed that only 0.2% of the total consumption expenditure was allocated for eggs, far below the 2.2% and 4.3% required to allow the consumption of one egg a day by the average and the poorest households, respectively. However, the minimum‐cost nutritious diet required only 2.5 g of egg powder/person/day to reduce the cost of the optimized diet by 14% (0–24%), allowing an additional 1.2 million households (~4–6 million individuals) afford the optimized diet. The optimized diet for a child 6–23 months of age could be afforded by all households, except by those in the poorest wealth quintile. But, free distribution of egg powder to households in the poorest wealth quintile, if supplemented by effective nutrition education, can allow them to afford the minimum‐cost nutritious diet for their 6‐ to 23‐month child. The simple dehydration of egg into egg powder can have a substantial contribution towards increased egg consumption by increasing the affordability of the minimum‐cost nutritious diet. [ABSTRACT FROM AUTHOR]

Quantifying the cost‐effectiveness of alternative sampling methods is crucial for efficient biodiversity monitoring and detection of population trends. In this study, we compared the cost‐effectiveness of three novel sampling methods for detecting changes in koala (Phascolarctos cinereus) occupancy: thermal drones, passive acoustic recorders and camera trapping. Specifically, we fitted single‐season occupancy‐detection models to data recorded from 46 sites in eight bioregions of New South Wales, Australia, between 2018 and 2022. We explored the effect of weather variables on daily detection probability for each method and, using these estimates, calculated the statistical power to detect 30%, 50% and 80% declines in koala occupancy. We calculated power for different combinations of sites (1–200) and repeat surveys (2–40) and developed a cost model that found the cheapest survey design that achieved 80% power to detect change. On average, detectability of koalas was highest with one 24‐h period of acoustic surveys (0.32, 95% CI's: 0.26, 0.39) compared to a 25‐ha flight of drone surveys (0.28, 95% 0.15, 0.48) or a 24‐h period of camera trapping consisting of six cameras (0.019, 95% CI's: 0.014, 0.025). We found a negative quadratic relationship between detection probability and air temperature for all three methods. Our power and cost analysis suggested that 148 sites surveyed with acoustic recorders deployed for 14 days would be the cheapest method to sufficiently detect a 30% decline in occupancy with 80% power. We recommend passive acoustic recorders as the most efficient sampling method for monitoring koala occupancy compared to cameras or drones. Further comparative studies are needed to compare the relative effectiveness of these methods and others when the monitoring objective is to detect change in koala abundance over time. [ABSTRACT FROM AUTHOR]

The technical and economic challenges are enormous in developing gas wells with a high CO2 content (> 50 mol %), such as the East Natuna gas field, which has 71 mol % (86 mass %). Carbon capture technology in gas wells with high CO2 content is studied to find a more economical one. In this study, the technology for capturing high concentrations of CO2 is varied from gas wells, Controlled Freeze Zone (CFZ), and cryogenic distillation which will be analyzed based on cost. Variations in the CO2 content of gas wells are 75 %, 80 %, 85 %, 90 %, and 95 % in mass fraction simulated using Aspen Plus V.11.0. Based on this research, CFZ technology and cryogenic distillation can obtain purity up to 99 % and recovery above 78 %. However, the total annual cost (annual capital and operating costs) of CFZ technology is lower than cryogenic distillation technology, so CFZ technology is suitable for capturing CO2 in gas wells with high CO2 content. [ABSTRACT FROM AUTHOR]

Introduction: In the backdrop of escalating healthcare costs and an increasing focus on resource optimization, this audit study delves into the realm of anesthesia management, specifically exploring the application of low-flow anesthesia (LFA). The primary objective was to assess adherence to hospital standards and evaluate the economic implications of LFA (<1 L/min). Materials and Methods: This retrospective audit focused on 700 adult patients undergoing elective surgeries with general anesthesia. Data sources included anesthesia records, electronic recording systems, and audits by a dedicated team. Fresh gas flow rates (FGFRs), minimum alveolar concentration (MAC), and volatile anesthetic consumption were analyzed. Cost comparisons between low-flow and high-flow anesthesia were conducted, employing specific cost per milliliter metrics. Results: The average FGFR during the maintenance phase was found to be 0.45 ± 0.88 L/min. Adherence to hospital standards was notably high, with 94.29% of patients being maintained on low-flow gas rates. The differences in anesthetic consumption between low-flow and high-flow FGFR were statistically significant for both desflurane (12.17 ± 10.84 ml/MAC hour versus 43.12 ± 27.25 ml/MAC hour) and sevoflurane (3.48 ± 7.22 ml/MAC hour versus 5.20 ± 5.20 ml/MAC hour, P < 0.001). The calculated savings per patient with low-flow desflurane and sevoflurane anesthesia compared to high flow were found to be 109.25 AED and 6.74 AED, respectively. Conclusion: This audit advocates for the widespread adoption of LFA as a standard practice. Beyond aligning with hospital standards, the study highlights the multi-faceted benefits of LFA, encompassing economic savings, environmental safety, and enhanced patient care. [ABSTRACT FROM AUTHOR]

Background: Social prescribing link workers are non-health or social care professionals who connect people with psychosocial needs to non-clinical community supports. They are being implemented widely, but there is limited evidence for appropriate target populations or cost effectiveness. This study aimed to explore the feasibility, potential impact on health outcomes and cost effectiveness of practice-based link workers for people with multimorbidity living in deprived urban communities. Methods: A pragmatic exploratory randomised trial with wait-list usual care control and blinding at analysis was conducted during the COVID 19 pandemic (July 2020 to January 2021). Participants had two or more ongoing health conditions, attended a general practitioner (GP) serving a deprived urban community who felt they may benefit from a one-month practice-based social prescribing link worker intervention.. Feasibility measures were recruitment and retention of participants, practices and link workers, and completion of outcome data. Primary outcomes at one month were health-related quality of life (EQ-5D-5L) and mental health (HADS). Potential cost effectiveness from the health service perspective was evaluated using quality adjusted life years (QALYs), based on conversion of the EQ-5D-5L and ICECAP-A capability index to utility scoring. Results: From a target of 600, 251 patients were recruited across 13 general practices. Randomisation to intervention (n = 123) and control (n = 117) was after baseline data collection. Participant retention at one month was 80%. All practices and link workers (n = 10) were retained for the trial period. Data completion for primary outcomes was 75%. There were no significant differences identified using mixed effects regression analysis in EQ-5D-5L (MD 0.01, 95% CI -0.07 to 0.09) or HADS (MD 0.05, 95% CI -0.63 to 0.73), and no cost effectiveness advantages. A sensitivity analysis that considered link workers operating at full capacity in a non-pandemic setting, indicated the probability of effectiveness at the €45,000 ICER threshold value for Ireland was 0.787 using the ICECAP-A capability index. Conclusions: While the trial under-recruited participants mainly due to COVID-19 restrictions, it demonstrates that robust evaluations and cost utility analyses are possible. Further evaluations are required to establish cost effectiveness and should consider using the ICE-CAP-A wellbeing measure for cost utility analysis. Registration: This trial is registered on ISRCTN. Title: Use of link workers to provide social prescribing and health and social care coordination for people with complex multimorbidity in socially deprived areas. Trial ID: ISRCTN10287737. Date registered 10/12/2019. Link: https://www.isrctn.com/ISRCTN10287737 [ABSTRACT FROM AUTHOR]

Background: The Global Drug Facility (GDF) of the Stop TB Partnership was launched in 2001 with the goal of increasing access to quality-assured tuberculosis (TB) drugs and products. We aimed to describe the TB drugs and prices available from the GDF over time and to assess trends. Methods: We searched the internet, including an internet archive, for past and recent GDF Product Catalogs and extracted the listed TB drugs and prices. We calculated the lowest price for the most common drug formulations assuming drugs with similar active pharmaceutical ingredients (APIs) are substitutes for each other. We assessed time trends in the TB drugs and prices offered by the GDF in univariable regressions over the longest possible period. Results: We identified 43 different GDF Product Catalogs published between November 2001 and May 2024. These product catalogs included 122 single medicines (31 APIs), 28 fixed-dose combinations (9 API combinations), and 8 patient kits (8 API regimens and other materials). The number of TB drugs listed in the GDF Product Catalog increased from 9 (8 APIs) to 55 (32 APIs). The price decreased for 17, increased for 19, and showed no trend for 12 APIs. The price of 15 (53.6%) of 28 APIs used against drug-resistant TB decreased, including the price of drugs used in new treatment regimens. The decreasing price trend was strongest for linezolid (-16.60 [95% CI: -26.35 to -6.85] percentage points [pp] per year), bedaquiline (-12.61 [95% CI: -18.00 to -7.22] pp per year), cycloserine (-11.20 [95% CI: -17.40 to -4.99] pp per year), pretomanid (-10.47 [95% CI: -15.06 to -5.89] pp per year), and rifapentine (-10.46 [95% CI: -12.86 to -8.06] pp per year). The prices of 16 (61.5%) of 23 APIs for standard drug-susceptible TB treatment increased, including rifampicin (23.70 [95% CI: 18.48 to 28.92] pp per year), isoniazid (20.95 [95% CI: 18.96 to 22.95] pp per year), ethambutol (9.85 [95% CI: 8.83 to 10.88] pp per year), and fixed-dose combinations thereof. Conclusions: The number of TB drugs available from the GDF has substantially increased during its first 23 years of operation. The prices of most APIs for new TB treatments decreased or remained stable. The prices of most APIs for standard drug-sensitive TB treatment increased. [ABSTRACT FROM AUTHOR]

Background: The organisational care needs involved in accessing kidney transplant have not been described in the literature and therefore a detailed analysis thereof could help to establish a framework (including appropriate timing, investment, and costs) for the management of this population. The main objective of this study is to analyse the profile and care needs of kidney transplant candidates in a tertiary hospital and the direct costs of studying them. Methods: A descriptive, cross-sectional study was conducted using data on a range of variables (sociodemographic and clinical characteristics, study duration, and investment in visits and supplementary tests) from 489 kidney transplant candidates evaluated in 2020. Results: The comorbidity index was high (> 4 in 64.3%), with a mean of 5.6 ± 2.4. Part of the study population had certain characteristics that could hinder their access a kidney transplant: physical dependence (9.4%), emotional distress (33.5%), non-adherent behaviours (25.2%), or language barriers (9.4%). The median study duration was 6.6[3.4;14] months. The ratio of required visits to patients was 5.97:1, meaning an investment of €237.10 per patient, and the ratio of supplementary tests to patients was 3.5:1, meaning an investment of €402.96 per patient. Conclusions: The study population can be characterised as complex due to their profile and their investment in terms of time, visits, supplementary tests, and direct costs. Management based on our results involves designing work-adaptation strategies to the needs of the study population, which can lead to increased patient satisfaction, shorter waiting times, and reduced costs. [ABSTRACT FROM AUTHOR]