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Abstract Introduction and objectives Full blood examinations, often referred to as FBE, are commonly ordered postoperatively, despite limited utility in many of its markers in the acute phase. It is estimated that in the 2022–2023 financial year, the Australian healthcare system billed over $13 million for full blood examinations (FBEs) to Medicare. This study aims to assess the cost of using FBE following surgery. We explore potential cost savings by using a haemoglobin examination (HE) in replace of FBE, with both tests run on identical machines, producing the same result, but at a fraction of the cost. Methods A retrospective analysis was conducted at a single institution, including all patients who underwent minimally invasive laparoscopic pelvic surgeries between 1/7/2017 and 30/6/2019. Patient records were examined to identify patient demographics, postoperative pathology tests and interventions. Patients who received FBE in the first 24 h following surgery were identified and included in the study. Using national surgery and admission statistics, a potential cost‐saving analysis will be performed. Results Among 519 men who underwent robotic‐assisted pelvic surgery, 325 patients had routine postoperative investigations, with 323 receiving FBE and 2 receiving HE. Abnormal results were found in the majority of patients that underwent FBE. Eight patients received packed red blood cell transfusion, none of these meeting the hospital‐specific criteria for transfusion protocol. Twelve patients received antibiotics, none were in response to abnormal FBE, with all patients experiencing a fever, given prophylactically or in the days following the surgery. FBE and HE are both listed on the Medicare Benefits Scheme at $16.95 and $7.85, respectively, the difference being $9.10. Extrapolating the existing data, within the first 24 h following surgery, the estimated savings were $8818, with savings increasing accumulatively with longer observation intervals following surgery. When similar savings are applied to national figures, the potential savings to the Australian Public Healthcare system likely exceeds millions. Discussion Our study revealed that over half of the patients who underwent a RARP received FBE within the first 24 h postoperatively, the vast majority of which exhibited abnormal results that were not acted upon. These findings substantiate the limited utility of FBE in the postoperative setting. Cell markers observed in FBE are predominantly subjective, but consensus exists regarding the importance of evaluating haemoglobin levels postoperatively. Considering that one in four hospital admissions involves surgical procedures, and a $9.10 price differential between FBE and HE, the potential annual economic impact of utilising routine FBEs for assessing haemoglobin levels immediately after surgery is likely to reach millions. Although having obvious flaws, these results underscore the potential accumulative cost arising from everyday clinical judgement and the importance of thoughtful consideration when ordering pathology. Conclusion The routine ordering of FBE postoperatively, without properly considering its indication, incurs significant costs. This study highlights the potential cost savings by HE instead, emphasising the need for revaluation and appropriate utilisation of pathology tests in the immediate postoperative period given the physiological acute phase response expected postoperatively.

Vincent Qin,1,2 Ben LaHood,3 Ivo Guber,4 Sandro Di Simplicio Cherubini5 1Department of Ophthalmology, Delta Hospital (CHIREC), Brussels, Belgium; 2Department of Ophthalmology, Centre Medical du Val, Brussels, Belgium; 3Department of Ophthalmology, The Queen Elizabeth Hospital, Adelaïde, Australia; 4Department of Ophthalmology, University of Geneva, Geneva, Switzerland; 5The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UKCorrespondence: Vincent Qin, Centre Medical du Val, 18 rue Edouard Gersis, 1150 Woluwe Saint Pierre, Brussels, Belgium, Email vincent.qin@live.bePurpose: To estimate the economic and environmental impact of single-use instruments (SUIs) to perform standard cataract surgery in six ophthalmology centers located in Europe and in the United States.Setting: Online survey and interview.Design: Comparative cost analysis based on an online survey with follow-up questionnaire and interview. The carbon footprint calculation was made by ClimatePartner.Methods: Annual costs of reusable instruments (RUIs) were calculated based on data provided by the centers. Annual costs of SUIs were estimated based on the average-selling price of a single-use cataract set of 5 instruments and the reported annual volume of cataract surgery. The calculation carbon footprint of a cataract instrument covered the whole life cycle from production to end-of-life.Results: Annual costs for SUIs were found inferior or similar to the annual costs for RUIs for 4 out of the 6 centers included in this study. The centers where SUIs were demonstrated to be the most cost-effective were also associated with the highest costs of sterilization per instrument. The carbon footprint of 5-years usage of a cataract instrument was found to be 5478.2 kg CO2 eq for SUIs without recycling, 4639.9 kg CO2 eq for SUIs with recycling and 20.6 kg CO2 eq for RUIs.Conclusion: The study demonstrated that SUIs can be an alternative solution to using RUIs in multispecialty hospitals associated with high sterilization costs.Keywords: cost analysis, cataract surgery, surgical instruments, reusable instruments, single-use instruments, environmental impact, carbon footprint

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 Objectives To investigate the current literature on healthcare policies and cost analyses around international Voluntary Assisted Dying (VAD) laws. The study design is a mapping literature review following Preferred-Reporting-Items-for-Systematic-Reviews-and-Meta-Analyses (PRISMA) guidelines. Methods Original research articles published between January 1990 to March 2023, investigating the financial cost and healthcare budget effect of VAD laws internationally. Citations were screened for relevance and eligibility, and any non-full-text research that did not explore cost analysis was excluded. The following data sources were screened: MEDLINE, PubMed, EMBASE, CINAHL and any relevant international health authority annual reports were also reviewed. Results Of the 2790 screened articles, eight studies met the inclusion criteria and three were included in the mapping review. The reviewed studies included prospective studies, two Canadian and one US. Only one of the Canadian studies provided a cost analysis using data from current VAD laws. All three studies showed VAD laws would reduce healthcare spending, with the US approximating $627million in 1995. Canada approximating $17.1 to $77.1million in 2017 and $86.9 to $149.0million in 2021, overall, leading to an average percentage reduction in costs of approximately 87% compared to original costs of end-of-life care. Conclusion This review identifies a scarcity in cost-analysis literature and provides a summary of the latest international VAD laws, from which a potential cost reduction is apparent. The absence of retrospectively collated financial VAD data highlights a need for future research to inform policymakers of the economic factors affecting current policies with a need for annual fiscal reports and to optimise future legislative frameworks internationally.

Abstract Objective To review HIV testing services (HTS) costs in sub-Saharan Africa. Design A systematic literature review of studies published from January 2006 to October 2020. Methods We searched ten electronic databases for studies that reported estimates for cost per person tested ($pptested) and cost per HIV-positive person identified ($ppositive) in sub-Saharan Africa. We explored variations in incremental cost estimates by testing modality (health facility-based, home-based, mobile-service, self-testing, campaign-style, and stand-alone), by primary or secondary/index HTS, and by population (general population, people living with HIV, antenatal care male partner, antenatal care/postnatal women and key populations). All costs are presented in 2019US$. Results Sixty-five studies reported 167 cost estimates. Most reported only $pptested (90%), while (10%) reported the $ppositive. Costs were highly skewed. The lowest mean $pptested was self-testing at $12.75 (median = $11.50); primary testing at $16.63 (median = $10.68); in the general population, $14.06 (median = $10.13). The highest costs were in campaign-style at $27.64 (median = $26.70), secondary/index testing at $27.52 (median = $15.85), and antenatal male partner at $47.94 (median = $55.19). Incremental $ppositive was lowest for home-based at $297.09 (median = $246.75); primary testing $352.31 (median = $157.03); in the general population, $262.89 (median: $140.13). Conclusion While many studies reported the incremental costs of different HIV testing modalities, few presented full costs. Although the $pptested estimates varied widely, the costs for stand-alone, health facility, home-based, and mobile services were comparable, while substantially higher for campaign-style HTS and the lowest for HIV self-testing. Our review informs policymakers of the affordability of various HTS to ensure universal access to HIV testing.

Abstract Background Exercise Referral Schemes (ERSs) have been implemented across Western nations to stimulate an increase in adult physical activity but evidence of their effectiveness and cost-effectiveness is equivocal. Poor ERS uptake and adherence can have a negative impact on effectiveness and cost-effectiveness and, if patterned by socio-demographic factors, can also introduce or widen health inequalities. Different modes of ERS delivery have the potential to reduce costs and enhance uptake and adherence. The primary aim of this study was to examine the effect of different programmes of ERS delivery on scheme uptake and adherence. Secondary aims were to examine the effect of socio-demographic factors on scheme uptake and adherence, and the impact of delivery mode on the expected resource and corresponding costs of delivering core parts of the programme. Methods This was an observational cohort study with cost analysis. Routine monitoring data covering a three-year period (2019–2021) from one large UK ERS (number of patients = 28,917) were analysed. During this period three different programmes of delivery were operated in succession: standard (all sessions delivered face-to-face at a designated physical location), hybrid (sessions initially delivered face-to-face and then switched to remote delivery in response to the Covid-19 pandemic), and modified (sessions delivered face-to-face, remotely, or a combination of the two, as determined on a case-by-case basis according to Covid-19 risk and personal preferences). Multi-level binary logistic and linear regression were performed to examine the effect of programme of delivery and socio-demographic characteristics on uptake and adherence. Cost data were sourced from regional-level coordinators and through NERS audits supplied by national-level NERS managers and summarised using descriptive statistics. Results There was no effect of programme of delivery on scheme uptake. In comparison to those on the standard programme (who attended a mean of 23.1 exercise sessions) those on the modified programme had higher adherence (mean attendance of 25.7 sessions) while those on the hybrid programme had lower adherence (mean attendance of 19.4 sessions). Being older, or coming from an area of lower deprivation, increased the likelihood of uptake and adherence. Being female increased the chance of uptake but was associated with lower adherence. Patients referred to the programme from secondary care were more likely to take up the programme than those referred from primary care for prevention purposes, however their attendance at exercise sessions was lower. The estimated cost per person for face-to-face delivery of a typical 16-week cycle of the scheme was £65.42. The same cycle of the scheme delivered virtually (outside of a pandemic context) was estimated to cost £201.71 per person. Conclusions This study contributes new evidence concerning the effect of programme of delivery on ERS uptake and adherence and strengthens existing evidence concerning the effect of socio-economic factors. The findings direct the attention of ERS providers towards specific patient sub-groups who, if inequalities are to be addressed, require additional intervention to support uptake and adherence. At a time when providers may be considering alternative programmes of delivery, these findings challenge expectations that implementing virtual delivery will necessarily lead to cost savings.

Coffee, a significant plantation product, holds vast opportunities in both domestic and global markets. Bandung Regency is renowned for its distinctive fruit-flavored coffee, particularly from Ciwidey and Puntang, where coffee is marketed in cherry and green bean forms without branding. A value chain analysis is essential to enhance the coffee industry's added value and sustainability. This study aims to identify the coffee value chain in Bandung Regency, analyze the cost of production, total revenue, and profit of the coffee processing industry in Ciwidey and Puntang, and determine the added value of coffee products in these areas. Using descriptive analysis, results indicate that Ciwidey (MS Coffee) has a lower cost of goods produced than Puntang (Acs Siliwangi) due to higher production volumes in Puntang leading to higher costs. However, Puntang’s larger production volume also generates higher monthly revenue and profit due to a higher selling price per kilogram. Value-added analysis reveals that Puntang’s value-added per kilogram (Rp. 55,025.00/kg) surpasses that of Ciwidey (Rp. 44,647.00/kg), attributed to higher selling prices, superior product quality, and greater market presence in Puntang. Conversely, higher input prices in Ciwidey result in lower value-added.

Abstract 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 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.

Excessive consumption of refined grains harms human health and ecosystem viability. Whole grains, as a healthy and sustainable alternative to refined grains, can benefit individual health by providing dietary fiber, B vitamins, and bioactive substances. Additionally, they aid in improving the environment due to their higher extraction rate and lower carbon emission during the processing stage. However, few studies have attempted to evaluate the economic and social benefits of increasing the amount of whole grain in grain intake. This paper estimates the potential savings in healthcare costs and reduced food carbon footprints (CFs) that could result from a shift toward whole grain consumption following the Chinese Dietary Guidelines (CDG). We investigate hypothetical scenarios where a certain proportion (5–100%) of Chinese adults could increase their whole grain intakes as proposed by CDG to meet the average shortfall of 30.2 g. In that case, the healthcare costs for associated diseases (e.g., type 2 diabetes mellitus (T2DM), cardiovascular disease (CVD), and colorectal cancer (CRC)) are expected to reduce by a substantial amount, from USD 2.82 to 56.37 billion; the carbon emission levels are also projected to decrease by 0.24–5.72 million tons. This study provides compelling evidence that advocating for the transition towards greater consumption of whole grain products could benefit individual health, the environment, and society, by reducing both healthcare costs and carbon emissions.

BACKGROUND AND OBJECTIVES: Municipal solid waste emerges as a pressing concern for environmental management and sustainability, particularly in urban areas with high rates of population growth and limited infrastructure. This study aims to assess the outputs and benefits of a separate source collection system, which separates recyclable materials at their point of origin. The study highlights the consequences of separate source collection on the community''s economic, environmental and social context. The study forms part of a project that intends to upscale sustainable and efficient waste management approaches in a transition towards a circular economy model that utilizes and recycles waste and materials. The objectives encompass addressing urban challenges and providing key insights for environmental management and sustainability through separate source collection systems that improve efficiency, reduce cost and encourage sustainable community practices.METHODS: The study was implemented in the Al-Radwan neighborhood in Amman, Jordan, and included 8,460 individuals and 3,124 households. Data on waste generation from residential and commercial activities were analyzed and used to design the separate source collection system, which included public awareness campaigns for individuals in the study area, waste composition investigations and maps for routes of waste collection trucks. Yellow and grey bins were used to collect recyclable and residual waste, respectively. Data on waste amount and composition were collected and interpreted for the 2020-2023 period. Data on fuel consumption, maintenance and depreciation were used to calculate the operational costs of separate source collection and the old system of municipal solid waste collection. Ground data were analyzed in terms of the individual''s and households'' adoption of waste-sorting practices. An overall assessment was carried out for the economic benefit of separate source collection.FINDINGS: Analyses of waste generation in the study area showed that the average quantity of municipal waste was 0.89 kilogram per capita per day, and there is a trend that shows an increase in municipal solid waste quantities with respect to time. A significant amount of municipal solid waste (60 percent) has an organic composition, while recyclable waste constitutes about 12.5 percent of the total municipal solid waste. The study was a success, with a consistent increase in recyclable waste collection at 59 percent average purity and a 30 percent decrease in total yearly waste collection costs. The project contributed to job creation and improved community participation in municipal solid waste management. The beneficial impacts of awareness campaigns were the low level of required maintenance with respect to the separate source collection system and the high level of public participation and cooperation, particularly in municipal solid waste sorting.CONCLUSION: The study highlighted the importance and effectiveness of the innovative separate source collection system and showed its economic and social benefits while considering its positive environmental impacts. The findings confirmed the system''s economic viability and applicability, showing its potential for large-scale adoption in Jordan. The adoption and implementation of separate source collection will be highly emphasized as it will be needed for solving issues associated with municipal solid waste via creative solutions that promote sustainability and community well-being.

Sarah A AlManie,1 Mai S AlHazami,1 Alyah Ebrahim,2 Muhammad S Attique2 1Department of Pharmacy Practice, School of Pharmacy-Kuwait University, Kuwait City, Kuwait; 2Respiratory Department- Jaber Al-Ahmad Al-Sabah Hospital, Kuwait City, KuwaitCorrespondence: Sarah A AlManie, Email Sarah.almanie@ku.edu.kwObjective: This study aims to estimate the direct medical cost of COVID-19 hospitalizations and to utilize prevalence estimates from Jaber Al-Ahmad Hospital to estimate the direct medical cost of all hospitalized adult patients in Kuwait using a decision tree analysis.Methods: A cost-of-illness model was developed. The Ministry of Health perspective was considered, direct medical costs were estimated from July 1st to September 30th, using a bottom-up approach. The mean cost per hospitalized patient was estimated using a decision analysis model. Prevalence estimates of ambulance use, use of ER, ICU admission, and mortality were considered in the current study. Patients aged 18 years and above with a confirmed diagnosis of COVID-19 were included. One-way sensitivity analysis and probabilistic sensitivity analysis (PSA) were performed.Results: Data for 2986 patients were analyzed. The mean age was 61 (SD= 11) years old. Most of the patients were Kuwaiti (2864, 95.91%), and more than half were females (1677, 56.16%). Of the total hospital admissions, 417 patients (14%) were admitted to the ICU. The average length of the hospital stay was 11 (SD= 9) days, and among all hospital admissions, 270 (9.04%) patients died. The total estimated direct medical cost of hospitalized patients at Jaber Al-Ahmad Hospital was $47,213,768 (14,283,203.6 KD). The average cost of hospital stay per patient was estimated at $15,498 (4,688.60 KD). The weighted average cost per hospitalized patient in Kuwait was estimated at $16,373 (4,953.08 KD). The total direct medical cost of hospitalized COVID-19 patients in Kuwait during the study period was estimated at $174,372,450 (52,751,502 KD).Conclusion: The COVID-19 pandemic constituted a significant burden on the Kuwaiti healthcare system. The findings of this study urge the need for preventive care strategies to reduce adverse health outcomes and the economic impact of the pandemic.Keywords: economic impact, COVID-19, direct medical cost, cost analysis, Kuwait

Abstract 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 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 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.

Background: As a developing country that still struggles with infant mortality, Indonesia needs high-quality and efficient neonatal care. However, due to the complexity of neonatal care, the neonatal intensive care unit (NICU) still has a high cost, approximately USD 950 - 31,000, as the last line of care. Aims: This study analyzes the cost incurred due to service improvement at Fatmawati General Hospital. The cost analysis may serve as useful evidence for other hospitals with NICUs that seek to improve their service. Methods: We used cost analysis to examine pre-intervention costs in 2015 and post-intervention costs in 2021. Our data were gathered primarily in the NICU of Fatmawati General Hospital for three months in 2023. Results: The results showed an increase in total cost of IDR 1,898,040,489 (55%). The largest cost increase was personnel and supplies costs, which accounted for 83.8% of the cost increase. However, this cost increase was also followed by a significant decrease in mortality rates, from 128 deaths per 1,000 births to 17 deaths per 1,000 births. Conclusion: This study found a correlation between investment in service improvements and decreased infant mortality rates in the NICU of Fatmawati General Hospital. Although the 55% increase in total cost was associated with a significant decrease in infant mortality rates in the NICU of Fatmawati General Hospital, further studies are needed to determine the effectiveness of improvements in the NICU's services. Keywords: cost, Indonesia, LBW, NICU

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 (

Abstract Background Oncological home hospitalization (HH) was implemented in a Belgian context to evaluate the feasibility of oncological HH. In a first HH model (HH1), implemented by three Belgian hospitals, two home nursing organizations and a grouping of independent nurses, the blood draw and monitoring prior to intravenous therapy was performed by a trained home nurse at the patient’s home the day before the visit to the day hospital. In a second HH model (HH2), implemented in one hospital, the administration of two subcutaneous treatments (Azacitidine and Bortezomib) for myelodysplastic syndrome and multiple myeloma were provided at home instead of in the hospital. A previous study on this pilot showed that oncological HH is feasible and safe and improves the Quality of Life. The aim of this study is to investigate the cost and reimbursement of cancer treatment in these two HH models compared to the Standard of Care (SOC). Methods A bottom-up micro-costing study was conducted to compare the costs and revenues for the providers (hospitals and home care organizations) of the SOC and the HH models. Results Costs associated to HH were higher than the SOC in the hospital. Comparing revenues with costs, the research revealed that the reimbursement from the National Health Insurance of HH for oncological patients is insufficient. In HH1, costs were higher than in the SOC (+ €50.4). There was a reduction in costs in the hospital by moving the blood draw to the home setting (-€23.9), but the costs in home care were higher (+ €74.3). The extra revenues in home care (+ €33.6) were insufficient to cover the costs. The cost difference between the SOC and HH2 (+ €9.5 for Azacetidine) was smaller than in HH1. But, there was almost no funding for subcutaneous administration in home care. If the product is administered in a day hospital, the hospital receives a revenue of €124 per administration, while in home care the funding is €5 per visit. Conclusion Costs of HH are higher and the reimbursement from Belgian NHI is insufficient to organize HH. As a result, HH for oncology patient is still limited in Belgium.

Abstract 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 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 Background The survival of ART restorations can be influenced by the choice of the restorative material. The aim of this randomized non-inferiority controlled trial was to compare the 2-year survival rate and cost analysis of two encapsulated glass ionomer cements (GIC) as occlusoproximal restorative materials in primary molars. Methods Children from public schools in Tietê (Brazil), aged 4–8 years with occlusoproximal dentine carious lesions in primary molars were selected and randomly assigned to receive either Equia Forte (EF) or Riva Self Cure (RSC) as restorative materials. Treatment was carried out by two trained final-year dental students in schools following ART premises. Restorations were assessed by a trained and calibrated examiner after 2, 6, 12, 18, and 24 months. The primary outcome was restoration survival after 2 years, analyzed using Kaplan-Meier survival and Cox regression analysis (α = 5%). Professional and materials costs for each group were collected in Brazilian Reais (R$) and converted into US dollars (US$) and analyzed using Monte-Carlo simulation. Results A total of 152 children (76 per group) were included in the study, and 121 (79%) were evaluated after 2 years. The overall 2-year restoration survival rate was 39% (EF = 45%; RSC = 32%) with no difference between the groups. The baseline and 2-year total cost of restorations using RSC was lower when compared to EF (incremental cost: US$ 6.18). Conclusion After two years of follow-up, Riva Self Cure shows comparable restoration survival rates to Equia Forte, being more cost-effective in the Brazilian perspective. Trial Registration This randomized clinical trial was registered on ClinicalTrials.Gov - NCT02730000.

Objective With the development of blood transfusion technology, the blood testing model is relatively decentralized, inefficient and costly in blood stations in China. Blood centralized detection not only effectively improves the quality of blood testing, but is also more cost-effective in labor and equipment.The purpose of this paper is to create a minimum cost model for blood testing that integrates the transportation cost, testing cost and center operating cost. Methods A mixed-integer planning model was developed with the annual cost of blood testing as the objective function, and sample processing capacity, sample allocation, logistic relationship between transportation and center construction, and consistency of transportation decisions with transportation volume as constraints.The empirical analysis takes Sichuan province as an example, collects data through expert interviews and research, does linear processing and adjustments to the segmented data to meet the modeling needs, and carries out modeling operations and verifies the optimal solution through python coding. Results A mixed integer programming model suitable for the number and location of centralized testing laboratories in China was developed.In the empirical analysis of Sichuan, the data required for the model was collected and the segmented data was linearized. A detailed cost analysis was conducted, revealing that the most cost-effective option was to establish centralized testing laboratories in Chengdu and Suining.The least cost-effective option identified in this study involved independent testing at 21 blood stations. Compared to this baseline, the most cost-effective strategy(establishing centralized testing laboratories in Chengdu and Suining) can reduce expenses by 29.433%. To ensure the reliability of these results, multiple rounds of validation were performed. Further analysis revealed that the strategy of establishing testing centers in Chengdu and Bazhong was a suboptimal choice, which can achieve a cost reduction of 29.431%. Conclusion This paper constructs a mixed-integer planning model for the number and location of centralized testing laboratories, which for the first time provides a decision-making basis for the location of regional centralized blood testing in China from the perspective of cost, and carries out an empirical analysis of Sichuan to develop the most cost-effective option.

Focused parathyroidectomy is the preferred surgical method for treating primary hyperparathyroidism (pHPT) sustained by the pre-operatively well-localized parathyroid adenoma. We aimed to compare the effectiveness, safety, and short-term clinical outcome of minimally invasive video-assisted parathyroidectomy (MIVAP) in locoregional anaesthesia (LA) vs. general anaesthesia (GA) by means of propensity score matching (PSM) analysis. Retrospective research of patients who underwent MIVAP between January 2014 and December 2022 was carried out. Patients were divided into two groups based on the anaesthesiologic procedure (LA vs. GA). Overall, 553 patients underwent MIVAP. After PSM, 115 patients in the LA group and 230 patients in the GA group were included. MIVAP under LA was associated with shorter median operative time (16 vs. 35 min, p < 0.001), shorter median operative room occupation time (44 vs. 73 min, p < 0.001), and lesser median post-operative visual analogue scale pain, with comparable post-operative hospital stay and complication rate. MIVAP under LA is a safe and feasible procedure with significant advantages over GA in terms of post-operative pain and operative room occupation time. This last step can finally result in more efficient utilisation of the operative room and the health care system’s resources.

Aladin Aladin,1 Werry Darta Taifur,2 Syed Mohamed Aljunid,3 Dwiana Ocviyanti4 1Department of Obstetrics and Gynecology, Andalas University, Padang, West Sumatra, Indonesia; 2Department of Economics, Andalas University, Padang, West Sumatra, Indonesia; 3Department of Public Health and Community Medicine, International Medical University, Kuala Lumpur, Selangor, Malaysia; 4Department of Obstetrics and Gynecology, University of Indonesia, Jakarta, IndonesiaCorrespondence: Aladin Aladin, Email dr.aladin.spog@gmail.comIntroduction: As with several countries around the world, cesarean section rates are increasing also in Indonesia, raising issues of quality and cost-effectiveness of health care, especially with the shift from a fee-for-service to a prospective payment system. For hospital services to be effective (quality control) and efficient (cost control), clinical pathways are essential. However, no studies have been done to develop a clinical pathway for cesarean sections (CS) in the INA-CBG system that is both effective and efficient.Objective: To develop clinical pathways for CS that are both effective and efficient by determining unit costs and tariffs for CS services, reviewing procedures and outcomes, and assessing performance efficiency and effectiveness.Methods: Using a sample of 110 patients undergoing cesarean sections consecutively recruited in 11 hospitals of West Sumatra (6 public hospitals and 5 private institutions), this mixed (qualitative and quantitative) study aimed at developing clinical guidelines for childbirth delivery modes responding both to criteria of efficacy and efficiency.Results: Of 110 patients, 50 patients (45%) had efficient CS, 85 patients (77%) had effective CS, and 40 patients (36.4%) had both effective and efficient CS. A comprehensive clinical pathway for CS procedure was created by investigating 40 patients who underwent effective and efficient CS using interviews, a Delphi study, and professional advice.Discussion: Hospitals can adopt the effective and efficient clinical pathway for CS protocol to prevent cost-related losses (efficient) while retaining the quality of the service (effective).Keywords: cesarean section, cost analysis, efficiency, effectiveness

Abstract India’s cement industry is the second largest in the world, generating 6.9% of the global cement output. Polycarbonate waste ash is a major problem in India and around the globe. Approximately 370,000 tons of scientific waste are generated annually from fitness care facilities in India. Polycarbonate waste helps reduce the environmental burden associated with disposal and decreases the need for new raw materials. The primary variable in this study is the quantity of polycarbonate waste ash (5, 10, 15, 20 and 25% of the weight of cement), partial replacement of cement, water-cement ratio and aggregates. The mechanical properties, such as compressive strength, split tensile strength and flexural test results, of the mixtures with the polycarbonate waste ash were superior at 7, 14 and 28 days compared to those of the control mix. The water absorption rate is less than that of standard concrete. Compared with those of conventional concrete, polycarbonate waste concrete mixtures undergo minimal weight loss under acid curing conditions. Polycarbonate waste is utilized in the construction industry to reduce pollution and improve the economy. This study further simulated the strength characteristics of concrete made with waste polycarbonate ash using least absolute shrinkage and selection operator regression and decision trees. Cement, polycarbonate waste, slump, water absorption, and the ratio of water to cement were the main components that were considered input variables. The suggested decision tree model was successful with unparalleled predictive accuracy across important metrics. Its outstanding predictive ability for split tensile strength (R2 = 0.879403), flexural strength (R2 = 0.91197), and compressive strength (R2 = 0.853683) confirmed that this method was the preferred choice for these strength predictions.

Abstract Background To improve patient outcomes and provider team practice, the California Perinatal Quality Care Collaborative (CPQCC) created the Simulating Success quality improvement program to assist hospitals in implementing a neonatal resuscitation training curriculum. This study aimed to examine the costs associated with the design and implementation of the Simulating Success program. Methods From 2017–2020, a total of 14 sites participated in the Simulating Success program and 4 of them systematically collected resource utilization data. Using a micro-costing approach, we examined costs for the design and implementation of the program occurring at CPQCC and the 4 study sites. Data collection forms were used to track personnel time, equipment/supplies, space use, and travel (including transportation, food, and lodging). Cost analysis was conducted from the healthcare sector perspective. Costs incurred by CPQCC were allocated to participant sites and then combined with site-specific costs to estimate the mean cost per site, along with its 95% confidence interval (CI). Cost estimates were inflation-adjusted to 2022 U.S. dollars. Results Designing and implementing the Simulating Success program cost $228,148.36 at CPQCC, with personnel cost accounting for the largest share (92.2%), followed by program-related travel (6.1%), equipment/supplies (1.5%), and space use (0.2%). Allocating these costs across participant sites and accounting for site-specific resource utilizations resulted in a mean cost of $39,210.69 per participant site (95% CI: $34,094.52-$44,326.86). In sensitivity analysis varying several study assumptions (e.g., number of participant sites, exclusion of design costs, and useful life span of manikins), the mean cost per site changed from $35,645.22 to $39,935.73. At all four sites, monthly cost of other neonatal resuscitation training was lower during the program implementation period (mean = $1,112.52 per site) than pre-implementation period (mean = $2,504.01 per site). In the 3 months after the Simulating Success program ended, monthly cost of neonatal resuscitation training was also lower than the pre-implementation period at two of the four sites. Conclusions Establishing a multi-site neonatal in situ simulation program requires investment of sufficient resources. However, such programs may have financial and non-financial benefits in the long run by offsetting the need for other neonatal resuscitation training and improving practice.

In the present study, a modified pyramid-solar-still (MPSS) with new multiple stepped basin areas was investigated in the weather conditions of Qena, Egypt, at a location of (Latitude: 26.16°, Longitude: 32.71°). Boosting the output of the pyramid solar still is the primary focus of the proposed strategy. To achieve this, four basins were built and integrated into the pyramid solar still, with their size increasing in proportion to the surface area of the condensing glass. A 25% increase in basin area per square meter of solar still was achieved compared to conventional pyramid solar still (CPSS) with the same condensing cover area. The thermal performance and productivity of the suggested solar still were demonstrated by developing energy balance equations for temperature components and then analytically computing their solutions. The results showed compatibility between theoretical and experimental results. The highest yields for CPSS were 2524 mL/m2, and for MPSS, they were 3415 mL/m2. The stepped area enhanced the yield by 35.3% compared with CPSS. Moreover, the efficiency of CPSS and MPSS was recorded as 23.5% and 31.7%, respectively. Furthermore, the maximum yield of freshwater was obtained for the northern condensing cover, with the recorded value reaching 1174 mL/m2. Distilled water under the proposed system would cost $0.0179 per liter. Finally, the TDS and pH levels are in accordance with WHO recommendations for the quality of drinking water.

Abstract Background Communities That HEAL (CTH) is a novel, data-driven community-engaged intervention designed to reduce opioid overdose deaths by increasing community engagement, adoption of an integrated set of evidence-based practices, and delivering a communications campaign across healthcare, behavioral-health, criminal-legal, and other community-based settings. The implementation of such a complex initiative requires up-front investments of time and other expenditures (i.e., start-up costs). Despite the importance of these start-up costs in investment decisions to stakeholders, they are typically excluded from cost-effectiveness analyses. The objective of this study is to report a detailed analysis of CTH start-up costs pre-intervention implementation and to describe the relevance of these data for stakeholders to determine implementation feasibility. Methods This study is guided by the community perspective, reflecting the investments that a real-world community would need to incur to implement the CTH intervention. We adopted an activity-based costing approach, in which resources related to hiring, training, purchasing, and community dashboard creation were identified through macro- and micro-costing techniques from 34 communities with high rates of fatal opioid overdoses, across four states—Kentucky, Massachusetts, New York, and Ohio. Resources were identified and assigned a unit cost using administrative and semi-structured-interview data. All cost estimates were reported in 2019 dollars. Results State-level average and median start-up cost (representing 8–10 communities per state) were $268,657 and $175,683, respectively. Hiring and training represented 40%, equipment and infrastructure costs represented 24%, and dashboard creation represented 36% of the total average start-up cost. Comparatively, hiring and training represented 49%, purchasing costs represented 18%, and dashboard creation represented 34% of the total median start-up cost. Conclusion We identified three distinct CTH hiring models that affected start-up costs: hospital-academic (Massachusetts), university-academic (Kentucky and Ohio), and community-leveraged (New York). Hiring, training, and purchasing start-up costs were lowest in New York due to existing local infrastructure. Community-based implementation similar to the New York model may have lower start-up costs due to leveraging of existing infrastructure, relationships, and support from local health departments.

ObjectivesTo investigate the safety and cost analysis of oral propranolol treatment for high-risk infantile hemangiomas starting from the outpatient setting.MethodsA total of 41 high-risk infantile hemangioma patients from outpatient settings and 43 from inpatient settings were selected for the study. After routine pre-treatment examinations, patients were administered propranolol in a stepwise incremental dosing regimen over three consecutive days in the outpatient clinic. Changes in heart rate, blood pressure and PR interval before and after medication were compared. On the 10th day post-medication, liver and kidney functions, fasting blood glucose, tumor ultrasonography, and electrocardiogram were re-evaluated. The costs of treatment starting from the outpatient clinic (including pre-treatment examinations and the first three days of treatment) were calculated and compared with those of similarly managed inpatient cases.ResultsThe majority of patients exhibited a reduction in heart rate and blood pressure, as well as an extended PR interval after treatment of medication (P < 0.05), which remained within normal limits without clinical symptoms. On the 10th day post-medication, statistical differences in blood biochemistry and electrocardiograms were observed when compared to pre-treatment values (P < 0.05), but all values remained within normal ranges. No severe adverse reactions such as hypoglycemia occurred. Additionally, the cost of treatment from the outpatient clinic was significantly lower than that of inpatient care.ConclusionOral propranolol treatment for high-risk infantile hemangiomas starting from the outpatient setting is associated with few adverse reactions and significantly reduced treatment costs. It is worthy of broader application in hospitals without dermatology wards.

Summary: Background: School-based targeted preventive chemotherapy (PC), the primary strategy for soil-transmitted helminth (STH) control, typically focusing on primary schoolchildren, was expanded to secondary school students in the Philippines in 2016. This program still excludes adults, who may also suffer from considerable morbidity and can be a significant reservoir of infection. Mass drug administration (MDA), where the entire population is treated, would bring additional health benefits but will also increase implementation costs. The incremental cost of implementing MDA for STH control compared to expanded school-based targeted PC, however, is unknown. Methods: A cost survey was conducted in Zamboanga Peninsula region in 2021 to estimate the economic and financial cost of implementing MDA compared to the expanded school-based targeted PC from a government payer perspective. A budget impact analysis was conducted to estimate the financial cost to the government of implementing MDA over a five-year timeframe. Monte Carlo simulation accounted for uncertainty in cost estimates. Costs were reported in 2021 United States Dollars ($). Findings: The economic cost of MDA was $809,000 per year (95% CI: $679,000–$950,000) or $0.22 per person targeted (95% CI: $0.19–$0.26), while the expanded school-based targeted PC would cost $625,000 (95% CI: $549,000–$706,000) or $0.57 per person targeted (95% CI: $0.50–$0.64). Over five years, the financial cost to the government for MDA would be $3,113,000 (95% CI: $2,475,000–$3,810,000); $740,000 (95% CI: $486,000–$1,019,000) higher than expanded school-based targeted PC. Interpretation: Implementing MDA in the region will increase the economic and financial costs by 29% and 31%, respectively, when compared to expanded school-based targeted PC. Implementing MDA would require the Department of Health to increase their total expenditure for STH control by 0.2% and could be key in addressing the ongoing STH burden. Funding: The project was funded by the Australian Centre for the Control and Elimination of Neglected Tropical Diseases (NHMRC GA19028), and JPCDT was supported by a UNSW Scientia PhD Scholarship. SVN is funded by an NHMRC Investigator Grant (APP 2018220).

This experimental study introduces a novel approach to enhancing solar still performance through the integration of wax-filled rods, marking a significant advancement in solar desalination technology. These rods, innovatively designed to absorb and store both sensible and latent heat during peak solar radiation hours, release this stored energy gradually, particularly during the evening and night. This unique mechanism results in a notable and consistent increase in water temperature within the modified solar still after 17:00, setting it apart from conventional models. The study's findings reveal that the modified solar still achieves a 12.8 % higher cumulative distillate yield and a 16.3 % increase in efficiency compared to traditional solar stills. Furthermore, this enhancement translates into a 6.3 % reduction in distillate production costs, underscoring the economic viability and superior performance of the modified design.

ABSTRACT OBJECTIVE To investigate the costs and profile of patients who have filed a lawsuit against the Ministry of Health for the treatment of spinal muscular atrophy (SMA) with the onasemnogene abeparvovec (Zolgensma®). METHODS This is a cross-sectional, descriptive study with a census design, based on records of lawsuits filed against the Ministry of Health between January 2019 and September 2022. Data was requested from the Ministry of Health via the Access to Information Act. Information was extracted on the epidemiological profile of the beneficiaries of the lawsuits, as well as the expenses spent by the Ministry of Health in cases where the requests were granted. RESULTS 136 lawsuits were identified, of which 113 (83%) were favorable to patients at a cost of R$ 944.8 million in the period analyzed. Demographic (gender and age), clinical (SMA subtypes, use of ventilatory or nutritional support), and lawsuit (type of legal service) characteristics were not associated with the granting of lawsuits. Prior use of medication (nusinersena or ridisplam) was associated with the dismissal of lawsuits. Of the 113 lawsuits granted in favor of patients, only six (5.3%) would meet the criteria currently established by the National Committee for Health Technology Incorporation - Conitec (children up to six months without ventilatory and nutritional support). R$ 146 million was spent on supplying Zolgensma to children over the age of two, which is outside the recommendation contained in the drug’s package leaflet. CONCLUSIONS The Ministry of Health incurs a high cost with the judicialization of Zolgensma for SMA, representing 2.45% of total spending on medicines in the Unified Health System, including spending by the three administrative spheres. Some of the lawsuits have been granted in disagreement with the criteria established by health technology assessment agencies and the drug manufacturer’s recommendations.

Haemoparasitic diseases constitute a significant constraint to economic livestock farming. Diagnostic techniques that are inexpensive, rapid, reliable, and precise are crucial for the management of diseases. In this context, PCR assays are very valuable yet expensive since the samples must be processed before being included in the PCR reaction. Accordingly, the goal of the current study was to lower the PCR costs without jeopardizing the assay’s sensitivity and specificity. For that purpose, the alkaline solution was optimized for low cost and quick DNA extraction (blood lysate), and PCR reagents were modified for optimum reaction. In comparison to purified whole blood genomic DNA, the currently developed and optimized blood lysate method was found to be 95.5% less expensive, as well as being equally sensitive and specific for the molecular detection (PCR) of haemoparasites like Babesia, Theileria, Trypanosoma and rickettsiales in cattle, buffaloes, horses, and dogs. The assay was also demonstrated to be quick, less likely to cross-contaminate, and appropriate for use in laboratories with limited resources. Therefore, the currently developed and optimized blood lysate method could serve as a viable alternative to purified whole blood genomic DNA for molecular detection (PCR) of haemoparasites in animals particularly in resource-limited settings.

IntroductionInterprofessional collaboration in healthcare involves diverse professionals working together to address complex patient needs. Interprofessional training wards offer workplace-based interprofessional education in real healthcare settings, fostering collaborative learning among students. While their educational value is widely recognized, debates persist regarding their cost-effectiveness due to limited research. This study assesses the cost efficiency of the interprofessional training ward Regensburg (A-STAR) within the Department of Internal Medicine I at the University Hospital Regensburg, compared to conventional wards.MethodsFrom October 2019 to December 2022, 7,244 patient cases were assigned to A-STAR or conventional wards by case managers, with a comprehensive analysis of all associated revenues and costs.ResultsA-STAR treated 1,482 patients, whereas conventional wards treated 5,752 patients, with more males and younger patients at A-STAR. A-STAR achieved higher profit per case (€1,508.74) attributed to increased revenues and reduced material costs. It generated an average of €1,366.54 more Diagnosis Related Groups (DRG) revenue per case annually than conventional wards, due to greater medical complexity reflected in a higher case-mix index (CMI: 2.4 vs. 2.2). The increased case complexity led to longer patient stays (9.0 vs. 8.1 days) and fewer cases treated annually at A-STAR (27.4 cases/year vs. 37.8 cases/year). The higher CMI did not result in a higher proportion of patients requiring isolation. A-STAR exhibited a higher capacity utilization rate (87.1% vs. 83.9%). Personnel costs per case at A-STAR were initially elevated due to enhanced observation by the senior physician but were gradually mitigated by expanding A-STAR’s bed capacity. Material costs were consistently lower on a per-case basis at A-STAR (€1512.02 vs. €1577.12), particularly in terms of medication expenses, indicating more resource-efficient operations. From the A-STAR graduates, 18 individuals were recruited for permanent positions as doctors or nurses over 2 years.ConclusionA-STAR demonstrates economic efficiency and stability even during the COVID-19 pandemic. The substantial personnel acquisition is likely influenced by high levels of satisfaction with education and work and is economically relevant in medical staff shortages. These findings provide a compelling rationale for the broader implementation of interprofessional training wards, establishing them as vital platforms for nurturing future professionals.

IntroductionIn Italy, post-liver transplant (LT) hepatitis B virus (HBV) reinfection prophylaxis is frequently based on a combined regimen of anti-HBV immunoglobulin (HBIG) and oral antivirals. However, little information is available at the national level on the cost of LT and the contribution of HBV prophylaxis. This study aimed to quantify the direct healthcare cost for adult patients undergoing LT for HBV-related disease over a lifetime horizon and from the perspective of a National Healthcare Service.MethodsA pharmaco-economic model was implemented with a 4-tiered approach consisting of 1) preliminary literature research to define the research question; 2) pragmatic literature review to retrieve existing information and inform the model; 3) micro-simulated patient cycles; and 4) validation from a panel of national experts.ResultsThe average lifetime healthcare cost of LT for HBV-related disease was €395,986. The greatest cost drivers were post-transplant end-stage renal failure (31.9% of the total), immunosuppression (20.6%), and acute transplant phase (15.8%). HBV reinfection prophylaxis with HBIG and antivirals accounted for 12.4% and 6.4% of the total cost, respectively; however, lifetime HBIG prophylaxis was only associated with a 6.6% increase (~€422 k). Various sensitivity analyses have shown that discount rates have the greatest impact on total costs.ConclusionThis analysis showed that the burden of LT due to HBV is not only clinical but also economic.

Utilization potential of industrial by-products/wastes as construction material requires adequate workability, strength and other required properties as specified by standard codes of practice and certain sustainability criteria. Coal combustion byproduct (fly ash) and mine waste are a few of the abundantly available wastes that create a challenging task in their disposal with the current practice of dumping on-sites and landfilling. This study enumerates the suitability of utilizing magnesite mine wastes in self-compacting concrete (SCC) as binder and aggregate replacements by considering the evaluation factors such as fresh, hardened properties, life cycle assessment (LCA) and eco-efficiency. The results from the experimental investigation revealed that aggregate blended SCC performed well in terms of both fresh and mechanical properties, while cement blended mixtures exhibited satisfactory results. Additionally, fly ash and magnesite mine waste substantially reduced CO2 emissions and costs with added strength benefits. Eco-efficiency evaluation of mine waste blended SCC reported up to 75% higher efficiency than conventional SCC.

Based on the concept of ecosystem service value, this study proposes a method for estimating the net value of ecosystem services considering cost inputs, and estimates and analyzes the net value of ecosystem services in the Yellow River Estuary wetland from 2019 to 2022 through time series remote sensing monitoring. The results indicate that:(1) Among the 11 types of ecosystem services in the Yellow River Estuary coastal wetland, biodiversity, carbon sequestration, food supply, and wave attenuation and protection are the dominant ecosystem services. The nearshore waters, reed beds, salt-alkali plants, and tidal flats show strong net value capacity. The net value of ecosystem services in 2022 decreased by 4.08×108 yuan compared with that in 2021, mainly due to the disappearance of a large area of salt-alkali plants with strong net value in 2022. (2) Despite the negative net benefits observed in the first year after the construction of typical ecological restoration projects in both 2019 and 2020, the net value of ecosystem services has reached the expected level. (3) Sensitivity analysis demonstrates the significant role of wave attenuation and protection, food supply, carbon sequestration, and biodiversity among the various ecosystem services. The estimation of net value of ecosystem services enables the comparison and analysis of the maximum net value generated by different types of wetlands, providing a scientific basis for the rational planning and management of coastal wetland ecosystems.

Background: This study, using real-world data, assesses the impact of RS testing on treatment pathways and the associated economic consequences of such testing. This paper pertains to lobular breast cancer. Methods: A retrospective, observational study was undertaken between 2011 and 2019 on a cross-section of hormone receptor-positive (HR+), HER2-negative, lymph node-negative, early-stage breast cancer patients. All patients had ILC and had RS testing in Ireland. The patient population is representative of the national population. Patients were classified as low (RS ≤ 25) or high (RS > 25) risk. Patients aged ≤50 were stratified as low (RS 0–15), intermediate (RS 16–25), or high risk (RS > 25). Results: A total of 168 patients were included, most of whom had grade 2 (G2) tumors (n = 154, 92%). Overall, 155 patients (92.3%) had low RS (≤25), 12 (7.1%) had high RS (>25), and 1 (0.6%) had unknown RS status. In 29 (17.5%) patients aged ≤50 at diagnosis, RS was ≤15 in 16 (55%), 16–20 in 6 (21%), 21–25 in 5 (17%), >25 in 1 (3.5%), and unknown in 1 (3.5%). Post RS testing, 126 patients (78%) had a change in chemotherapy recommendation; all to hormone therapy. In total, only 35 patients (22%) received chemotherapy. RS testing achieved a 75% reduction in chemotherapy use, resulting in savings of €921,543.84 in treatment costs, and net savings of €387,283.84. Conclusions: The use of this test resulted in a 75% reduction in chemotherapy and a significant cost savings in our publicly funded health system.

Abstract Objective To provide an assessment of the cost burden of obesity across a spectrum of obesity-related comorbidities (ORCs) for four countries in South-Eastern Europe (SEE). Methods A micro-costing analysis from the public payer perspective was conducted to estimate direct healthcare costs associated with ten obesity-related comorbidities (ORCs) in Czech Republic, Greece, Hungary, and Romania. A survey was administered to obtain healthcare resource use and unit cost data. Cost estimates were validated by local steering committees which comprised at least one public sector clinician and a panel of independent industry experts. Results Chronic kidney disease and cardiovascular diseases were the costliest ORCs across all 4 countries, where annual cost burden per ORC exceeded 1,500 USD per patient per year. In general, costs were driven by the tertiary care resources allocated to address treatment-related adverse events, disease complications, and associated inpatient procedures. Conclusions Our findings confirm that the high prevalence of obesity and its comorbidities result in substantial financial burden to all 4 SEE public payers. By quantifying the burden of obesity from a public healthcare perspective, our study aims to support policy efforts that promote health education and promotion in combating obesity in the region.

Abstract Background The complex management of health needs in multimorbid patients, alongside limited cost data, presents challenges in developing cost-effective patient-care pathways. We estimated the costs of managing 171 dyads and 969 triads in Belgium, taking into account the influence of morbidity interactions on costs. Methods We followed a retrospective longitudinal study design, using the linked Belgian Health Interview Survey 2018 and the administrative claim database 2017–2020 hosted by the Intermutualistic Agency. We included people aged 15 and older, who had complete profiles (N = 9753). Applying a system costing perspective, the average annual direct cost per person per dyad/triad was presented in 2022 Euro and comprised mainly direct medical costs. We developed mixed models to analyse the impact of single chronic conditions, dyads and triads on healthcare costs, considering two-/three-way interactions within dyads/triads, key cost determinants and clustering at the household level. Results People with multimorbidity constituted nearly half of the study population and their total healthcare cost constituted around three quarters of the healthcare cost of the study population. The most common dyad, arthropathies + dorsopathies, with a 14% prevalence rate, accounted for 11% of the total national health expenditure. The most frequent triad, arthropathies + dorsopathies + hypertension, with a 5% prevalence rate, contributed 5%. The average annual direct costs per person with dyad and triad were €3515 (95% CI 3093–3937) and €4592 (95% CI 3920–5264), respectively. Dyads and triads associated with cancer, diabetes, chronic fatigue, and genitourinary problems incurred the highest costs. In most cases, the cost associated with multimorbidity was lower or not substantially different from the combined cost of the same conditions observed in separate patients. Conclusion Prevalent morbidity combinations, rather than high-cost ones, made a greater contribution to total national health expenditure. Our study contributes to the sparse evidence on this topic globally and in Europe, with the aim of improving cost-effective care for patients with diverse needs.

Background. The economic costs associated with chronic kidney disease (CKD) are a significant burden on the health care system. The use of dapagliflozin is a breakthrough strategy in the management of patients with CKD and type 2 diabetes mellitus (T2DM) to slow the progression of the disease and reduce healthcare costs. Aim. To evaluate the clinical and economic efficiency of dapagliflozin in patients with T2DM and CKD in the Russian Federation. Materials and methods. A cost-effectiveness/utility analysis was carried out. The calculation of direct costs was carried out in a model adapted to the conditions of healthcare in the Russian Federation by using Russian cost indicators and characteristics of the patient population. Results. Dapagliflozin in addition to standard therapy compared with standard therapy will provide an additional average of 0.253 life years and 0.219 quality-adjusted life years per patient with stage 2–4 CKD and T2DM during 10 years of therapy. Cost reduction in case of using dapagliflozin and standard therapy compared with standard therapy alone amounted to an average of 49,350 rubles per patient. Dapagliflozin and standard therapy compared with standard therapy alone on the modeling horizon of 10 years allows to extend the stay in the pre-dialysis stages of CKD by an average of 7 months per patient. The use of dapagliflozin in 1000 targeted patients for 10 years will help to avoid 26 hospitalizations for heart failure (NNT – 39), as well as prevent 44 cases of acute kidney injury (NNT – 23) and 51 deaths from all causes (NNT – 20). Probabilistic sensitivity analysis showed the robustness of the results to changes in parameters of cost of therapy, clinical efficacy and usefulness of the studied medical interventions. Conclusion. Intensification of standard CKD therapy with dapagliflozin in patients with T2DM is clinically and economically justified.

Abstract Background Continuous renal replacement therapy (CRRT) support is crucial for critically ill patients and it is underexplored in specific situations. Experimental CRRT offers a means to gain insights into these scenarios, but the prohibitive cost of CRRT machines limits their accessibility. This study aimed to develop and validate a low-cost and precise dialysate controller for experimental CRRT. Results Our results demonstrate a commendable level of precision in affluent flow control, with a robust correlation (R 2 = 0.99) for continuous flow and a strong correlation (R 2 = 0.95) for intermittent flow. Additionally, we observed acceptable agreement with a bias = 3.4 mL (upper limit 95% = 43.9 mL and lower limit 95% = − 37 mL) for continuous flow and bias = − 20.9 mL (upper limit 95% = 54 mL and lower limit 95% = − 95.7 mL) for intermittent flow, in this way, offering a precise CRRT dose for the subjects. Furthermore, we achieved excellent precision in the cumulative ultrafiltration net (UFnet), with a bias = − 2.8 mL (upper limit 95% = 6.5 mL and lower limit 95% = − 12 mL). These results remained consistent even at low affluent flow rates of 8, 12, and 20 mL/min, which are compatible with CRRT doses of 25–30 mL/kg for medium-sized animals. Moreover, the acceptable precision of our findings persisted when the dialysate controller was subjected to high filter dialysate chamber pressure for an extended duration, up to 797 min. Conclusions The low-cost dialysate controller developed and tested in this study offers a precise means of regulating CRRT in experimental settings. Its affordability and accuracy render it a valuable instrument for studying CRRT support in unconventional clinical scenarios, particularly in middle-income countries’ experimental ICU laboratories.

Abstract Background The study aimed to examine the direct medical cost and impact of tocilizumab (TOZ) versus adalimumab (ADM) and etanercept (ETC) on reducing the levels of two inflammatory markers (e.g., C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR)) among patients with rheumatoid arthritis (RA) using real-world data from Saudi Arabia. Method This was a single-center retrospective cohort study in which data for biologic-naïve RA patients aged ≥ 18 years and treated with TOZ, ADM, ETC were retrieved from the electronic medical records (EMRs) of a university-affiliated tertiary care center in Riyadh, Saudi Arabia. Patients were followed up at least one year after the treatment initiation. Bottom-up microcosting was utilized to estimate the direct medical costs. Additionally, inverse probability treatment weighting and bootstrapping with 10,000 replications were conducted to generate 95% confidence levels for costs and the mean reductions in CRP and ESR levels. Results The number of patients who met the inclusion criteria and were included in the analysis was 150 patients (TOZ (n = 56), ADM (n = 41), ETC (n = 53)). Patients on TOZ had 3.96 mg/L (95% CI: -0.229–4.95) and 11.21 mm/hr (95% CI: 10.28–18.11) higher mean reductions in the CRP and ESR levels compared to their counterparts on ADM, ETC, respectively. However, this was associated with mean annual incremental costs of USD 10,087.88 (95% CI: 9494.50–11,441.63) in all cost-effectiveness bootstrap distributions. Conclusion Tocilizumab has shown better effectiveness in reducing the levels of CRP and ESR but with higher costs. Future studies should examine whether the reduction of these two inflammatory markers is associated with quality-adjusted life years (QALYs) gains.

The output power of an ocean wave energy (WE) system has an intermittent and stochastic characteristic. WE output power can be transferred to the grid without sudden fluctuations when combined with a hybrid energy storage system (HESS) consisting of a battery pack and an ultracapacitor (UC) module. The study presented in this paper identifies the lowest-cost HESS sizing for WE systems by using a genetic algorithm (GA) optimization method. In this study, the system cost was reduced with the HESS cost and sizing study for ocean WE converter systems, and the battery was used effectively for a longer cycle. GA optimization has been applied in the field of HESS in ocean WE systems and has brought innovation to the literature with its optimum cost and sizing study. An optimum design model is presented considering the maximum/minimum voltage and current limits and the energy storage units’ temperature and depth of discharge parameters. The series and parallel connection calculations and the required number of battery and UC cells are given in the sizing section. The GA optimization was performed in Matlab, and the energy storage rate for the 625-kW system and the power and energy results of the energy storage units were given as a result of the optimum cost analysis. It has been calculated that 15936 battery cells are normally required for a 625-kW ocean WE converter system. As a result of the proposed optimally sized, cost-effective HESS, it is presented that a hybrid energy system can be used at a lower cost with 5548 battery cells and 2125 UC cells for the same performance and functionality.

Background and Aims: Multiple sources of medical oxygen, namely liquid medical oxygen (LMO) tanks, pressure swing adsorption (PSA) plants, concentrators, and gaseous cylinders, are available at different healthcare facilities. These sources of oxygen have varying installation and operational costs. In low-resource settings, it is imperative to utilise these assets optimally. This study investigated the operational costs of multiple oxygen sources available at a healthcare facility. Methods: A Microsoft (MS) Excel-based model was developed to analyse and compare the oxygen manufacturing costs (in ₹/m3) using PSA plants and procurement costs (in ₹/m3) of LMO and third-party vendor-refilled cylinders. Results: The oxygen manufacturing costs for PSA plants of different capacities and running times on electricity and diesel generators (DGs) as a power source were calculated. This study highlights the cost-benefit of using PSA plants over LMO and third-party vendor-refilled cylinders as a source of oxygen. PSA plants are most economical when they are of higher capacity and used to their maximum capacity on electricity as the power source. On the contrary, they are most expensive when used on a DG set as a power source. Furthermore, this study provides evidence of PSA plants being more cost-effective for refilling cylinders using a booster compressor unit when compared to third-party vendor-cylinder refilling. Conclusion: Given their cost-effectiveness and low third-party dependence, they should be utilised to their maximum capacity as medical oxygen sources at healthcare facilities.

Abstract Background The proportion of individuals who know their HIV status in Indonesia (66% in 2021) still remains far below the first 95% of UNAIDS 2030 target and were much lower in certain Key Populations (KPs) particularly Female Sex Workers (FSW) and Male having Sex with Male (MSM). Indonesia has implemented Oral HIV Self-testing (oral HIVST) through Community-based screening (HIV CBS) in addition to other testing modalities aimed at hard-to-reach KPs, but the implementation cost is still not analysed. This study provides the cost and scale up cost estimation of HIV CBS in Jakarta and Bali, Indonesia. Methods We estimated the societal cost of HIV CBS that was implemented through NGOs. The HIV CBS’s total and unit cost were estimated from HIV CBS outcome, health care system cost and client costs. Cost data were presented by input, KPs and areas. Health care system cost inputs were categorized into capital and recurrent cost both in start-up and implementation phases. Client costs were categorized as direct medical, direct non-medical cost and indirect costs. Sensitivity and scenario analyses for scale up were performed. Results In total, 5350 and 1401 oral HIVST test kits were distributed for HIV CBS in Jakarta and Bali, respectively. Average total client cost for HIV CBS Self testing process ranged from US$1.9 to US$12.2 for 1 day and US$2.02 to US$33.61 for 2 days process. Average total client cost for HIV CBS confirmation test ranged from US$2.83 to US$18.01. From Societal Perspective, the cost per HIVST kit distributed were US$98.59 and US$40.37 for FSW and MSM in Jakarta andUS$35.26 and US$43.31 for FSW and MSM in Bali. Conclusions CBS using oral HIVST approach varied widely along with characteristics of HIV CBS volume and cost. HIV CBS was most costly among FSW in Jakarta, attributed to the low HIV CBS volume, high personnel salary cost and client cost. Future approaches to minimize cost and/or maximize testing coverage could include unpaid community led distribution to reach end-users, integrating HIVST into routine clinical services via direct or secondary distribution and using social media network.

Objectives: Due to its long half-life, dalbavancin offers benefits for long-duration treatments, especially osteoarticular and infective endocarditis (IE). We evaluated the efficacy and costs of IE treatment, comparing dalbavancin with standard of care (SOC). Methods: Retrospective multicenter cohort study of adult patients with Gram-positive cocci definite IE. Dalbavancin was used as a sequential therapy before discharge. Efficacy was a combined variable of clinical cure and absence of recurrence in 12-month follow-up. Length of hospital stay and the associated costs were analyzed in both groups of treatment. Results: Twenty-two patients received dalbavancin and 47 SOC. The efficacy was similar between the groups (dalbavancin 18 [72%] vs SOC 44 [94%], P = 0.198). Hospital stay was shorter in the dalbavancin group (dalbavancin 22 days [16-34] vs SOC 37 days [23-49], P = 0.001), especially in those with E. faecalis IE (dalbavancin 30 days [20-36] vs SOC 65 days [46-74], P

Cutting fluid is a major concern in conventional cooling methods because of its high cost, effects on operator health, and environmental consequences. Microlubrication (MQL) is a better cooling method than traditional cooling. MQL can be used for machines with a high metal removal rate, such as those used in metal turning, milling, drilling, and boring. MQL has a lower lubrication consumption, a higher cooling rate, and a cleaner production than do conventional flooded lubrication. This study performed a cost-benefit analysis to compare MQL with conventional flood cooling methods. For both traditional flood cooling at 35 L/min and MQL cooling at 50 mL/h, face and slot milling techniques with constant machining settings were used. The quantity of components that must be produced to recoup the fixed and variable costs of MQL and conventional cooling were calculated by performing a breakeven point (BEP) analysis. The MQL methodology used 20% fewer components to recoup all expenses compared with conventional cooling. The findings indicated that MQL is more economical than traditional cooling. Moreover, the BEP for both cooling systems exhibited variances, and the BEP can be reached sooner for MQL than flood cooling lubricant.

The field of transportation has undergone changes due to the advancements in technology and the pressing need for mobility solutions. As cities worldwide struggle with the challenges posed by population growth and environmental sustainability, it becomes imperative to introduce adaptive transportation options. The increasing traffic congestion in areas and concerns regarding air quality and carbon emissions emphasize the importance of finding sustainable solutions. In this regard we present the ''On demand shared use bike sharing system (OSABS)'' as an eco-friendly on-demand mobility alternative that has the potential to revolutionize transportation from its core. Self-driving bikes provide a solution by reducing traffic congestion and promoting sustainable modes of transport. Customers can easily reserve a bike through their smartphones and it comes directly to their location within the given time. The user will ride it manually and release it after usage. The bike then drives autonomously to the next destination. This service allows an environment-friendly door-to-door mobility solution.This scientific paper focuses on examining the viability of autonomous cargo bike-sharing as a solution for urban transportation. A simulation model has been built to reproduce the OSABS operation using a case study for the city of Magdeburg. Through a set of experiments with different demand scenarios, we analysed and discussed the profitability and feasibility of this new service. These findings would be valuable, in the conversation about the future of transportation through providing important insights into how autonomous bike-sharing systems could be effectively implemented.

ABSTRACTIntroduction Diabetes increases preventative sickness and costs healthcare and productivity. Type 2 diabetes and macrovascular disease consequences cause most diabetes-related costs. Type 2 diabetes greatly costs healthcare institutions, reducing economic productivity and efficiency. This cost of illness (COI) analysis examines the direct and indirect costs of treating and managing type 1 and type 2 diabetes mellitus.Methodology According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, Cochrane, PubMed, Embase, CINAHL, Scopus, Medline Plus, and CENTRAL were searched for relevant articles on type 1 and type 2 diabetes illness costs. The inquiry returned 873 2011–2023 academic articles. The study included 42 papers after an abstract evaluation of 547 papers.Results Most articles originated in Asia and Europe, primarily on type 2 diabetes. The annual cost per patient ranged from USD87 to USD9,581. Prevalence-based cost estimates ranged from less than USD470 to more than USD3475, whereas annual pharmaceutical prices ranged from USD40 to more than USD450, with insulin exhibiting the greatest disparity. Care for complications was generally costly, although costs varied significantly by country and problem type.Discussion This study revealed substantial heterogeneity in diabetes treatment costs; some could be reduced by improving data collection, analysis, and reporting procedures. Diabetes is an expensive disease to treat in low- and middle-income countries, and attaining Universal Health Coverage should be a priority for the global health community.