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This study aimed to quantify the health and economic impacts of alcohol consumption in Brazil for 2019. Ecological study using secondary data sources. We calculated the disease burden using estimates from the Global Burden of Disease study, which incorporated data from health surveys and hospital records. Costs were estimated based on direct expenses recorded in the Hospital and Outpatient Information System of the Unified Health System, with data by sex, age group, cause, and Federative Units. Alcohol consumption was a necessary cause for 30,355 deaths and approximately 1.69 million disability-adjusted life years in Brazil, representing 2.2% and 2.6% of the national totals, respectively. The impact was more pronounced among men, in the Northeast region and within the 40- to 64-year-old age group. The total costs attributed to these outcomes reached approximately Int$43.1 million, with hospital admissions accounting for 94.16% of these expenses. In 2019, alcohol consumption had a significant impact on both the health of Brazilians and the expenses of the health system. As a preventable risk factor, alcohol consumption necessitates effective intersectoral strategies to mitigate its burden. [ABSTRACT FROM AUTHOR]

With limited healthcare resources, it is important to provide the right level and form of care. The aim of this study was to determine whether selected single-jaw orthognathic surgery in outpatient care (OPC) generates lower healthcare costs than in inpatient care (IPC). The costs of surgically assisted rapid maxillary expansion (SARME), Le Fort I osteotomy (LFI), and bilateral sagittal split osteotomy (BSSO) were calculated for 165 patients, 107 treated in OPC and 58 in IPC. Additionally, costs for revisits, emergency visits, emergency phone calls, re-operations, and plate removal during the first 12 months postoperatively were recorded. The total mean costs of the different operations including revisits, emergency visits, and phone calls were 34.2–48.8% lower in OPC than in IPC at 12 months postoperatively. Operation costs were lower for LFI in OPC (P = 0.009) and for SARME in IPC (P = 0.007). Anaesthesia costs were lower for LFI (P < 0.001) and BSSO (P < 0.001) in OPC, and there were fewer revisits (P = 0.001) and lower costs (P = 0.002) after LFI in OPC compared to IPC. This study showed that selected single-jaw orthognathic surgeries in outpatient care are associated with lower healthcare costs compared to inpatient care. [ABSTRACT FROM AUTHOR]

Hydrogen emerges as a promising energy carrier in achieving carbon neutrality, especially in countries such as South Korea and Japan, where renewable energy resources are scarce. Consequently, economically importing hydrogen from overseas is paramount to a stable supply. However, previous studies have often oversimplified the estimation of hydrogen import costs with optimistic assumptions, raising doubts about their reliability. This study comprehensively assesses costs incurred from green hydrogen production to liquefaction and transportation. The cost analysis includes detailed design considerations for hydrogen liquefaction and re-conditioning plants, alongside thermodynamic simulations to estimate the boil-off gas rate of liquid hydrogen during transport. Focusing on a case study of importing liquefied green hydrogen from Australia to South Korea, our findings reveal that the levelized cost of hydrogen is approximately 30.2 USD/kgH 2 as of 2023. Projections suggest a decrease to around 18.3 USD/kgH 2 by 2050, assuming technological advancements, significantly exceeding values reported in the existing literature. Sensitivity analysis highlights the renewable electricity price in Australia and the boil-off rate during shipping as key factors that significantly influence the levelized cost of hydrogen. • Costs for producing and transporting liquified green hydrogen are rigorously analyzed. • Detailed process design and thermodynamic simulation are conducted for realistic analysis. • A case of importing hydrogen from Australia to South Korea is studied. • LCOH for 2023 and 2050 are 30.2 and 18.3 USD/kgH 2 , which exceed literature values. [ABSTRACT FROM AUTHOR]

The clinical impact of the surgical approach in total hip arthroplasty (THA) has been widely reviewed. This study evaluated the total encounter and 90-day costs of THA for 2 surgical approaches (posterior [P] and direct anterior [DA]) in 1 tertiary health system. This is a retrospective review of 2,101 THAs (1,092 P and 1,009 DA) by 4 surgeons (2 with the highest volume of DA and P, respectively) from 2017 to 2022 at 1 academic center. Demographics, comorbidities, operative time, length of hospital stay, 90-day hospital returns, and complications were compared. The total encounter cost and 90-day postoperative cost were itemized. Multivariable regression analyses evaluated associations with increased cost at each time point. The DA cohort had a higher median encounter cost ($8,348.66 versus 7,332.42, P <.01), resulting from higher intraoperative (P <.01) and radiology (P <.01) expenses. Regression analyses demonstrated the DA was independently associated with increased encounter costs (odds ratio 1.1; 95% confidence interval 1.1 to 1.1; P <.01). There was a higher incidence of 90-day emergency department visits in the DA cohort (16 versus 12%, P =.02), with a trend toward increased readmissions. There was no difference in 90-day reoperations. Median 90-day cost was higher in the DA cohort ($126.99 versus 0.00, P <.01), and regression analyses demonstrated the DA had an association with increased 90-day cost (odds ratio 2.2; 95% confidence interval 1.5 to 3.0; P <.01). Despite a younger patient population, the DA was independently associated with increased encounter and 90-day costs in a single academic hospital system. This study may underestimate the cost difference, as capital costs such as specialized tables were not analyzed. [ABSTRACT FROM AUTHOR]

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

As value-based health care arrangements gain traction in spine care, understanding the true cost of care becomes critical. Historically, inaccurate cost proxies have been used, including negotiated reimbursement rates or list prices. However, time-driven activity-based costing (TDABC) allows for a more accurate cost assessment, including a better understanding of the primary drivers of cost in 1-level lumbar fusion. To determine the variation of total hospital cost, differences in characteristics between high-cost and nonhigh-cost patients, and to identify the primary drivers of total hospital cost in a sample of patients undergoing 1-level lumbar fusion. Retrospective, multicenter (one academic medical center, one community-based hospital), observational study. A total of 383 patients undergoing elective 1-level lumbar fusion for degenerative spine conditions between November 2, 2021 and December 2, 2022. Total hospital cost of care (normalized); preoperative, intraoperative, and postoperative cost of care (normalized); ratio of most to least expensive 1-level lumbar fusion. Patients undergoing a 1-level lumbar fusion between November 2, 2021 and December 2, 2022 were identified at two hospitals (one quaternary referral academic medical center and one community-based hospital) within our health system. TDABC was used to calculate total hospital cost, which was also broken up into: pre-, intra-, and postoperative timeframes. Operating surgeon and patient characteristics were also collected and compared between high- and nonhigh-cost patients. The correlation of surgical time and cost was determined. Multivariable linear regression was used to determine factors associated with total hospital cost. The most expensive 1-level lumbar fusion was 6.8x more expensive than the least expensive 1-level lumbar fusion, with the intraoperative period accounting for 88% of total cost. On average. the implant cost accounted for 30% of the total, but across the patient sample, the implant cost accounted for a range of 6% to 44% of the total cost. High-cost patients were younger (55 years [SD: 13 years] vs 63 years [SD: 13 years], p=.0002), more likely to have commercial health insurance (24 out of 38 (63%) vs 181 out of 345 (52%), p=.003). There was a poor correlation between time of surgery (ie, incision to close) and total overall cost (ρ:.26, p<.0001). Increase age (RC: -0.003 [95% CI: -0.006 to -0.000007], p=.049) was associated with decreased cost. Surgery by certain surgeons was associated with decreased total cost when accounting for other factors (p<.05). A large variation exists in the total hospital cost for patients undergoing 1-level lumbar fusion, which is primarily driven by surgeon-level decisions and preferences (eg, implant and technology use). Also, being a "fast" surgeon intraoperatively does not mean your total cost is meaningfully lower. As efforts continue to optimize patient value through ensuring appropriate clinical outcomes while also reducing cost, spine surgeons must use this knowledge to lead, or at least be active participants in, any discussions that could impact patient care. [ABSTRACT FROM AUTHOR]

Treatment for head and neck cancer (HNC) can lead to decreased oral intake which often requires gastrostomy tube (g-tube) placement to provide nutritional support. A multidisciplinary team (MDT) consisting of interventional radiology (IR), HNC oncology and surgery, nutrition, and speech language pathology departments implemented an expedited outpatient g-tube placement pathway to reduce hospital stays and associated costs, initiate feeds sooner, and improve communication between care teams. This single center study investigates differences in complications, time to procedure and costs savings with implementing this pathway. 142 patients with HNC who underwent elective image guided g-tube placement by IR from 2015 to 2022 were identified retrospectively. 52 patients underwent the traditional pathway, and 90 patients underwent the expedited pathway. Patient demographics, procedure characteristics, periprocedural costs and 90-day complication rates were collected and compared statistically. The 90-day complication rate was comparable between groups (traditional = 32.7%; expedited = 22.2%; p-value = 0.17). The expedited pathway decreased the time from consult to procedure by 11.1 days (95% CI 7.6 – 14.6; p < 0.001) and decreased charge per procedure by $2940 (95% CI $989–$4891; p < 0.001). A MDT for the treatment of patients with HNC successfully provided enteral nutrition support faster, with fewer associated costs, and in a more patient centered approach than previously done at this institution. [ABSTRACT FROM AUTHOR]

Total shoulder arthroplasty (TSA) is a common orthopedic procedure that can be performed as an anatomic total shoulder arthroplasty (aTSA) or reverse total shoulder arthroplasty (rTSA). These are effective procedures that are being performed with increasing frequency. Understanding the overall 90-day reimbursement variability and their drivers may help the health care systems better understand related considerations to reduce health-care expenditure. The current study predicts there will be large variability in reimbursement highlighting the need for further understanding. Using the 2015-2021 Q1 M151 PearlDiver dataset, patients who underwent aTSA or rTSA were isolated. Patients were excluded if they were aged less than 18 years, had an indication of traumatic, infectious, or oncologic diagnoses within 90-days of surgery, or were not in the dataset for at least 90 days before and after surgery. Patient demographics, comorbidities, 90-day postoperative events, insurance type, and geographic region were abstracted. The overall 90-day reimbursements were then assessed and correlated with these variables having multivariable linear regression. A total of 112,188 TSA patients (aTSA: 36,164 [32.2%]; rTSA: 76,024 [67.8%]) were identified. The average ± standard deviation 90-day overall postoperative reimbursement for aTSA was $6714.26 ± 9587.46 and rTSA was $6246.45 ± 9506.59. The total reimbursement for aTSA was $242,814,515 and for rTSA was $474,836,301. Variables independently associated with greater 90-day overall reimbursement were mostly related to 90-day postoperative events, including hospital readmission [+$6694.51], emergency department visit [+$2129.89], and adverse events [+$2055.84]), geographic region of the country where the procedure was performed (relative to West, South [+$4302.88], Midwest [+$3428.84], and Northeast [+$530.92]), and insurance plan (relative to commercial, Medicare [-$1268.01], and Medicaid [-$901.79]) (P <.0001 for each). Lesser factors included male sex (relative to female +$207.30), Elixhauser-Comorbidity Index (+$51.93 per point increase), age (-$77.16 per year increase), and rTSA surgery type (relative to aTSA -$556.17). The current study leveraged a large, administrative database to evaluate over 100,000 TSA patients and found large variations in 90-day overall reimbursements. The variables mostly associated with increased reimbursement were related to 90-day postoperative events (as might be expected and underscoring the need to minimize such events) and geographic regions and insurance plan (highlighting differences that might be able to be addressed). Interestingly, while patient demographics, comorbidities, and anatomic vs. reverse total shoulder were associated with reimbursements, these were to lesser extents. Understanding these results may help health-care systems further target variables associated with greater cost/reimbursement to the system. [ABSTRACT FROM AUTHOR]

Significant resources and diligent research have been dedicated to the investigation and enhancement of energy storage devices utilising hydrogen, lithium, or sodium. Efforts of this nature strive to offer sustainable energy storage solutions that are both dependable and environmentally friendly. This report presents a review a thorough an examination of the aforementioned technologies, with a particular emphasis on cost-effectiveness and State of Charge (SoC) administration. Furthermore, it comprehensively assesses their specific advantages and downsides. Sodium-based systems, such as sodium-sulfur batteries, exhibit remarkable stability and efficiency in sustaining desired charge levels, starting from the control of SoC. Lithium-based alternatives, such as Lithium-ion batteries (LIBs) have gained extensive usage adopted in several industries because to their enhanced energy density and improved SoC accuracy. The complexity associated with SoC is a challenge for hydrogen-based systems, including hydrogen fuel cells, due to their dependence on gas storage and conversion techniques. The assessment places significant emphasis on cost analysis, which evaluates the economic feasibility of each storage method. Sodium-based systems, known for their well-established technology and ample availability of raw materials, frequently present a financially viable option, especially for large-scale grid implementations. The pricing of lithium-based systems, particularly in the domains of portable devices and electric cars, is competitive because to their quick improvements and decreasing costs. Hydrogen-based systems, despite their initial expensive capital expenditure, exhibit potential through continuous advancements and the expansion of production capacity. [ABSTRACT FROM AUTHOR]

Burn injuries pose a significant burden on both patients and healthcare systems. Yet, costs arising from the consumption of resources by these patients are rarely examined in Canada. The objective of this study was to assess real-world costs resulting from the initial hospitalization of patients admitted to a major burn unit in Quebec, Canada. A cost study based on a retrospective cohort was undertaken using in-hospital economic data matched to hospital chart data. Our cohort included all burn-injured patients admitted between April 1, 2017, and March 31, 2021, to the hospital's major burn unit during their initial hospitalization. Descriptive statistics were tabulated for sociodemographic and economic data. Costing data were analyzed unstratified and stratified according to burn severity (i.e., ≥ 20% of total body surface area [TBSA] vs. < 20%). Costs were presented in CAD 2021. Our cohort included 362 patients, including 65 (18%) with TBSA ≥ 20%. The average initial hospitalization cost was $32,360 ($22,783 for < 20% TBSA and $76,121 for ≥ 20% TBSA). Conclusion: Findings reveal that the total cost of the initial hospitalization, from a public hospital perspective, was $11,714,348. Our study underlines the substantial burden associated with burns and highlights the need for long-term cost evaluations. • Burn injuries are resource intensive but their exact cost is unknown in Canada. • Real-world cost of the index hospitalization was estimated at $32,360 (CAD 2021). • Heterogeneity of burn patients contributed to a high variability in costs. • Cost of long-term burn injury care remains unknown. [ABSTRACT FROM AUTHOR]

The study assessed the direct medical costs of the cochlear implantation pathway from the healthcare payer's perspective, in children with bilateral severe to profound hearing loss, from diagnosis to 3 years' follow-up after first implantation. We also compared costs between two populations: congenital and progressive deafness. A retrospective costs analysis was performed for 56 children who received a cochlear implant in one French pediatric ENT center. The children had severe to profound hearing loss, and were implanted before the age of 10 years. We calculated direct medical costs in 3 phases: diagnosis to pre-implantation assessment, surgical and hospital management of implantation, and 3 years' follow-up. Mean costs were €64,675 (range, €38,709–113,954) per child from diagnosis to 3 years after first implantation. Mean costs in congenital deafness detected on neonatal screening and on progressive deafness were respectively €65,420 and €63,930 (P = 0.7). The global cost was €64,675 per child from diagnosis to 3 years after first implantation. There was no difference in cost according to congenital versus progressive hearing loss. [ABSTRACT FROM AUTHOR]

The aim of this paper is to discuss the controversies surrounding the most recent European regulations, as well as the cost, for a 3D printing workflow using free-source software in the context of a tertiary level university hospital in the Spanish public health system. Computer-aided design and manufacturing (CAD/CAM) for head and neck oncological surgery with the printing of biomodels, cutting guides, and patient-specific implants has made it possible to simplify and make this type of highly complex surgery more predictable. This technology is not without drawbacks, such as increased costs and the lead times when planning with the biomedical industry. A review of the current European legislation and the literature on this subject was performed, and comparisons made with the authors' in-house 3D printing setup using free software and different 3D printers. The cost analysis revealed that for the cheapest setup with free software, it would be possible to amortize the investment from case 2, and in all cases the initial investment would be amortized before case 9. The timeframe ranged from 2 weeks with the biomedical industry to 72 h with point-of-care 3D printing. It is now possible to develop point-of-care 3D printing in any hospital with almost any budget. [ABSTRACT FROM AUTHOR]

Iodine-125 (I-125) seeds, commonly used in low-dose rate brachytherapy for ocular malignancies, are often discarded after a single use. This study examines the potential cost savings at an institution with high ocular melanoma referrals, by re-using I-125 seeds for eye-plaque brachytherapy. In this single-institutional retrospective analysis, data was collected from I-125 seed orders from 8/2019 through 10/2022. Information including number of seeds ordered per lot, number of plaques built per lot, and number of seeds used per lot were collected. Cost per lot of seed was assumed to be the current cost from the most recent lot of 35 seeds. During the study, 72 I-125 seed lots were ordered bi-weekly, with a median of 35 seeds per lot (Range: 15–35). Each seed was used on average 2.26 times prior to being discarded. The average duration of each seed lot used was 62.2 days (Range: 21–126). Each seed lot contributed to the construction of an average of 8.4 eye plaques (Range: 2–20). With seed recycling, 2,475 seeds were used to construct 608 eye-plaques. Without re-using practice this would require 5,694 seeds. This resulted in a percentage cost savings of 56.5%, with a total seed cost reduction of $344,884, or $559 per eye-plaque on average. This is the first study to evaluate cost savings relative to re-using I-125 seeds for eye plaques. The data demonstrates how an institution can decrease costs associated with I-125 radiation seeds used for eye-plaque brachytherapy by re-using them. [ABSTRACT FROM AUTHOR]

We explored the early impact of changes to the UK alcohol tax system, implemented in August 2023, on the strength and price of alcoholic products available for sale on the website of the largest supermarket in England. Our comparative descriptive study using longitudinal brand-level data was not preregistered and should be considered exploratory. Data were collected weekly (May to October 2023) using automated web scraping tools. Outcomes were product strength (% alcohol by volume [ABV]) and price (per 10 mL of pure alcohol and per litre of product). We undertook paired t -tests, two-sample Kolmogorov–Smirnov tests, and quantile regression to compare outcomes before and after the tax changes. Beer, cider, spirits, and ready-to-drinks (RTDs) were analysed separately. There was a reduction in the mean strength of beer, driven by manufacturers reformulating a small number of weaker beers, moving them into a lower tax band (<3.5%ABV). The mean price per 10 mL of alcohol and per litre of product was significantly higher after the new tax system for beer, cider, and spirits and significantly lower for RTDs. Increases in the price of beer tended to occur across the entire distribution, whereas increases in the price of cider occurred among more expensive products. Changes to product strength tended to occur among weaker products near the new lowest tax band, suggesting tax bands may be a potential stimulus for change. Reformulation of stronger products would have better public health potential. Longer term monitoring, including data on purchasing/consumption, is required. [ABSTRACT FROM AUTHOR]

The aim of this study was to determine what is considered a long oral surgery and conduct a cost-effective analysis of sedative agents used for intravenous sedation (IVS) and sedation protocols for such procedures. Pubmed and Google Scholar databases were used to identify human studies employing IVS for extractions and implant-related surgeries, between 2003 and July/2023. Sedation protocols and procedure lengths were documented. Sedative satisfaction, operator satisfaction, and sedation assessment were also recorded. Cost estimation was based on The British National Formulary (BNF). To assess bias, the Cochrane Risk of Bias tools were employed. This review identified 29 randomised control trials (RCT), six cohorts, 14 case-series, and one case-control study. The study defined long procedures with an average duration of 31.33 minutes for extractions and 79.37 minutes for implant-related surgeries. Sedative agents identified were midazolam, dexmedetomidine, propofol, and remimazolam. Cost analysis revealed midazolam as the most cost-effective option (<10 pence per procedure per patient) and propofol the most expensive option (approximately £46.39). Bias analysis indicated varying degrees of bias in the included studies. Due to diverse outcome reporting, a comparative network approach was employed and revealed benefits of using dexmedetomidine, propofol, and remimazolam over midazolam. Midazolam, dexmedetomidine, propofol, and remimazolam demonstrated safety and efficacy as sedative agents for conscious IVS in extended procedures like extractions or implant-related surgeries. While midazolam is the most cost-effective option, dexmedetomidine, propofol, and remimazolam offer subjective and clinical benefits. The relatively higher cost of propofol may impede its widespread use. Dexmedetomidine and remimazolam stand out as closely priced options, necessitating further clinical investigations for comparative efficacy assessment. [ABSTRACT FROM AUTHOR]

To assess the outcomes, total healthcare utilization, and cost savings for same-day discharge (SDD) vs inpatient robotic-assisted partial nephrectomy (RAPN) and robotic-assisted radical nephrectomy (RARN). We compared 146 RAPNs and 65 RARNs consecutively performed as SDD (RAPN = 21, RARN = 9) vs inpatient (RAPN = 125, RARN = 56) from April 2015 to May 2023 at two academic medical centers. We collected baseline demographics, perioperative characteristics, and 30-day complications. We applied the Time-Driven Activity-Based Costing analysis to compare total costs of RAPN and PARN throughout the cycle of care, including inpatient vs SDD. Baseline demographics and comorbidities were similar between patients undergoing inpatient vs SDD RAPN and RARN. One Clavien-Dindo grade II complication (3.3%) requiring readmission due to wound infection for antibiotics occurred after SDD RAPN; no complications occurred after SDD RARN. Two unscheduled office or emergency department visits (6.7%) occurred after SDD RAPN for surgical-site infection and urinary retention. SDD vs inpatient RAPN and RARN demonstrated a $3091 (18%) and $4003 (25%) overall cost reduction, respectively. SDD RAPN and RARN result in cost savings of 18%-25% without a difference in complications, and thereby improves value-based care for appropriately selected patients. [ABSTRACT FROM AUTHOR]

To conduct a comparative cost analysis between single-use and reusable cystoscopes from a national healthcare system perspective and assess the environmental footprint. Single-center micro-cost analysis of reusable vs single-use cystoscopes used institutional data. The cost breakdown included capital, reprocessing, repair, procedure, and environmental impact expenses. Data collection occurred in 2022, utilizing registered data, observations, and expert opinions. Depreciation was applied over 5 years for reusable cystoscopes and 8 years for the automated endoscope reprocessor. Deterministic sensitivity analyses gauged result robustness to input variations. Lastly, an assessment of the environmental footprint, focusing on water consumption and waste generation, was conducted. Per-procedure cost associated with reusable cystoscopes was €332.46 vs €220.19 associated with single-use, resulting in savings of €112.27. When projecting these costs per procedure with the number of procedures performed in 2022 (1186), comparing the costs of procedures performed in 1 year with reusable endoscopes (€394,295.86) to the costs of the exact number of procedures performed with disposable endoscopes (€261,149.37), a saving of €133,146.49 could be achieved. Additionally, after continuous use of single-use endoscopes, procedures were scheduled every 20 minutes instead of every 30 minutes. This adjustment allowed for 15 daily procedures instead of 10 while maintaining the same shift. This suggests potential advantages in terms of improved organizational impact and reduced waiting lists. Ultimately, the decreased environmental impact favored the adoption of single-use cystoscopes. Our study presents an opportunity for organizational development in response to the evolving external environment, considering user needs, market dynamics, and competition with other facilities. [ABSTRACT FROM AUTHOR]

The demands for efficiency and stability in space missions have necessitated the development of sequence planning schemes for on-orbit robotic assembly of space structures. A sequence planning method is proposed in this work based on robotic kinematic analysis and Symbiotic Organisms Search (SOS) algorithm with a diversification strategy. With feasibility as the constraint and assembly cost as the objective function, the assembly sequence planning is regarded as an optimization problem. The assembly relationship constraint is depicted as the dependency between assembly steps represented by a directed acyclic graph. An abstract modeling method based on robotic kinematics is proposed to construct geometric feasibility constraint, accommodating the interference stemming from the multi-degree-of-freedom motion of the robotic system. A diversification strategy is exploited to address the issue of local optima arising from solving the optimal sequence based on SOS. A cost prediction method using previously calculated populations as samples is proposed to reduce the reliance on robotic dynamic analysis for cost calculation. Finally, simulations are carried out to validate the practicability of the proposed method. • The on-orbit robotic assembly sequence planning is modeled as an optimization problem with feasibility constraints. • The dependencies and priorities between steps are considered in the feasibility constraints of multi-DOF robotic motions. • The optimal sequence determination based on Symbiotic Organisms Search is speeded up by a cost prediction method. [ABSTRACT FROM AUTHOR]

A previous cost-effectiveness analysis published in 2022 found that the Total Posterior Spine (TOPSTM) system was dominant over transforaminal lumbar interbody fusion (TLIF). This analysis required updating to reflect a more complete dataset and pricing considerations. To evaluate the cost-effectiveness of TOPSTM system as compared with TLIF based on an updated and complete FDA investigational device exemption (IDE) data set. Cost-utility analysis of the TOPSTM system compared to TLIF. A multicenter, FDA IDE, randomized control trial (RCT) investigated the efficacy of TOPSTM compared to TLIF with a current population of n=305 enrolled and n=168 with complete 2-year follow-up. Cost and quality adjusted life years (QALYs) were calculated to determine our primary outcome measure, the incremental cost-effectiveness ratio. Secondary outcome measures included: net monetary benefit as well at willingness-to-pay (WTP) thresholds. The primary outcome of cost-effectiveness is determined by incremental cost-effectiveness ratio. A Markov model was used to simulate the health outcomes and costs of patients undergoing TOPSTM or TLIF over a 2-year period. alternative scenario sensitivity analysis, one-way sensitivity analysis, and probabilistic sensitivity analysis were conducted to assess the robustness of the model results. The updated base case result demonstrated that TOPSTM was immediately and longitudinally dominant compared with the control with an incremental cost-effectiveness ratio of −9,637.37 $/QALY. The net monetary benefit was correspondingly $2,237, both from the health system's perspective and at a WTP threshold of 50,000 $/QALY at the 2-year time point. This remained true in all scenarios tested. The Alternative Scenario Sensitivity Analysis suggested cost-effectiveness irrespective of payer type and surgical setting. To remain cost-effective, the cost difference between TOPSTM and TLIF should be no greater than $1,875 and $3,750 at WTP thresholds of $50,000 and 100,000 $/QALY, respectively. This updated analysis confirms that the TOPSTM device is a cost-effective and economically dominant surgical treatment option for patients with lumbar stenosis and degenerative spondylolisthesis compared to TLIF in all scenarios examined. [ABSTRACT FROM AUTHOR]

With global policies targeting greenhouse gas emission reduction, renewable hydrogen produced by water electrolysis powered with renewable electricity appears a promising alternative to fossil fuels. However, still high capital costs, reliance on intermittent renewable electricity sources, and high electricity cost hinder the economic viability of electrolyzers. This work develops a comprehensive analysis for assessing the need of an incentive to make renewable hydrogen economically viable, identifying different archetypes of electrolysis plant representative of a wide range of applications. A techno-economic optimization model is set up that minimize the average hydrogen production cost and compute the cost gap that makes hydrogen economically competitive with the fossil alternative, defining the optimal size and operation of the plant components while satisfying the hydrogen demand. The model is applied to the Italian case study. Sensitivity analyses investigate the impact of economy of scales, renewable electricity availability and introduction of the emission trading system. Cost gaps ranging between 8.1 €/kg and 29.9 €/kg highlights the need of an incentive to allow the deployment of this technology, thus meeting the hydrogen penetration targets. • A cost optimization model was developed to evaluate the Levelized Cost Of green Hydrogen (LCOH). • Archetypal study cases for the hydrogen value chain were identified. • Cost gap making renewable hydrogen competitive with fossil fuels is evaluated in different scenario. • Model application to the Italian case study shows the need of a financial support to launch the hydrogen market. [ABSTRACT FROM AUTHOR]

The cost effectiveness of childhood varicella vaccination is uncertain, as evidenced by variation in national health policies. Within the European Economic Area (EEA), only 10 of 30 countries offer universally funded childhood varicella vaccination. This study estimates the cost effectiveness of universal childhood varicella vaccination for one EEA country (Ireland), highlighting the difference in cost effectiveness between alternative vaccination strategies. An age-structured dynamic transmission model, simulating varicella zoster virus transmission, was developed to analyse the impact of three vaccination strategies; one-dose at 12 months old, two-dose at 12 and 15 months old (short-interval), and two-dose at 12 months and five years old (long-interval). The analysis adopted an 80-year time horizon and considered payer and societal perspectives. Clinical effectiveness was based on cases of varicella and subsequently herpes zoster and post-herpetic neuralgia avoided, and outcomes were expressed in quality-adjusted life-years (QALYs). Costs were presented in 2022 Irish Euro and cost effectiveness was interpreted with reference to a willingness-to-pay threshold of €20,000 per QALY gained. From the payer perspective, the incremental cost-effectiveness ratio (ICER) for a one-dose strategy, compared with no vaccination, was estimated at €8,712 per QALY gained. The ICER for the next least expensive strategy, two-dose long-interval, compared with one-dose, was estimated at €45,090 per QALY gained. From a societal perspective, all three strategies were cost-saving compared with no vaccination; the two-dose short-interval strategy dominated, yielding the largest cost savings and health benefits. Results were stable across a range of sensitivity and scenario analyses. A one-dose strategy was highly cost effective from the payer perspective, driven by a reduction in hospitalisations. Two-dose strategies were cost saving from the societal perspective. These results should be considered alongside other factors such as acceptability of a new vaccine within the overall childhood immunisation schedule, programme objectives and budget impact. [ABSTRACT FROM AUTHOR]

Spine surgeons are often unaware of drivers of cost variation for anterior cervical discectomy and fusion (ACDF). We used time-driven activity-based costing to assess the relationship between body mass index (BMI), total cost, and operating room (OR) times for ACDFs. Total cost was divided into direct and indirect costs. Individual costs were obtained by direct observation, electronic medical records, and through querying multiple departments. Timestamps for all involved personnel and material resources were documented. Total intraoperative costs were estimated for all ACDFs from 2017 to 2022. All patients were categorized into distinct BMI-based cohorts. Linear regression models were performed to assess the relationship between BMI, total cost, and OR times. A total of 959 patients underwent ACDFs between 2017 and 2022. The average age and BMI were 58.1 ± 11.2 years and 30.2 ± 6.4 kg/m2, respectively. The average total intraoperative cost per case was $7120 ± $2963. Multivariable regression analysis revealed that BMI was not significantly associated with total cost (P = 0.36), supply cost (P = 0.39), or personnel cost (P = 0.20). Higher BMI was significantly associated with increased time spent in the OR (P = 0.018); however, it was not a significant factor for the duration of surgery itself (P = 0.755). Rather, higher BMI was significantly associated with nonoperative OR time (P < 0.001). Time-driven activity-based costing is a feasible and scalable methodology for understanding the true intraoperative costs of ACDF. Although higher BMI was not associated with increased total cost, it was associated with increased preparatory time in the OR. [ABSTRACT FROM AUTHOR]

To evaluate the comparative effectiveness and cost-effectiveness of peripherally inserted central catheters (PICCs) compared with centrally inserted central catheters (CICCs). Prospective cohort study was followed by an economic analysis over a 30-day time horizon. Propensity score matching was used to select hospitalized adults with similar indications for PICC or CICC. The composite outcome was device removal or replacement because of complications before the end of treatment. The economic evaluation was based on a decision tree model for cost-effectiveness analysis, with calculation of the incremental cost-effectiveness ratio (ICER) per catheter removal avoided. All costs are presented in Brazilian reais (BRL) (1 BRL = 0.1870 US dollar). A total of 217 patients were followed in each group; 172 (79.3%) of those receiving a PICC and 135 (62.2%) of those receiving a CICC had no device-related complication, respectively. When comparing the events leading to device removal, the risk of composite endpoint was significantly higher in the CICC group (hazard ratio 0.20; 95% CI 0.11-0.35). The cost of PICC placement was BRL 1290.98 versus BRL 467.16 for a CICC. In the base case, the ICER for placing a PICC instead of a CICC was BRL 3349.91 per removal or replacement avoided. On univariate sensitivity analyses, the model proved to be robust within an ICER range of 2500.00 to 4800.00 BRL. PICC placement was associated with a lower risk of complications than CICC placement. Although the cost of a PICC is higher, its use avoided complications and need for catheter replacement before the end of treatment. • For hospitalized patients who need a central venous access device for up to 30 days, a centrally inserted central catheter (CICC) is most often placed; however, it has higher rates of primary bloodstream infection than other devices used for the same purpose, such as the peripherally inserted central catheter (PICC). • Despite the higher cost of these devices (PICC), there has been exponential growth in indications in the last decade, with corresponding financial impact on the health system, especially in publicly funded settings. • This study presents effectiveness and cost-effectiveness of 2 vascular devices (PICC versus CICC) carried out with primary data from a prospective cohort conducted in a public hospital; the CICC presented a greater need for replacement than the PICC. [ABSTRACT FROM AUTHOR]

This article focuses on how data from completed projects can be applied to uncertainty analysis. Cost estimates and risk assessments in public construction projects rely on expert opinions and, by little extent, historical figures. By analysing the relationship between project features and budget deviation through statistical methods, we find that total area and estimated square meter price is significantly negatively correlated to cost overruns. Smaller projects tend to have higher cost overruns than larger ones. We argue that cost risk analyses can be improved by such insight. [ABSTRACT FROM AUTHOR]

This study describes program implementation through a research-restaurant partnership and assesses participant satisfaction, program costs, and percent body weight changes. Participants (n = 60) in a virtual synchronous (n = 43) or virtual asynchronous (n = 17) 12-week plant-based nutrition program received restaurant vouchers. Class satisfaction data were collected weekly. Assessments were completed at baseline, 3 months, and 9 months, along with interviews (n = 13) between 3 and 9 months. The costing approach estimated costs per participant. Interviews were coded using a content analysis and constant comparative method. Participants rated the intervention favorably. Program costs were $198.63/participant, and participants' willingness to pay postintervention was $101.50 ± $63.90. Participants shared satisfaction with course content, the restaurant partnership, and suggestions for future delivery. No changes in participants' percent body weight were observed between 3 and 9 months (P = 0.98), indicating maintenance of 3-month weight loss. A research-restaurant partnership successfully implemented a nutrition program and generated positive feedback. With the lifting of coronavirus disease 2019 pandemic restrictions, future research can now test alternative implementation methods (in person vs online) in other restaurants. [ABSTRACT FROM AUTHOR]

Little is known about the partnerships formed between early care and education (ECE) programs and the Child and Adult Care Food Program (CACFP) and other organizations to continue to feed young children during the COVID-19 pandemic. Such information can provide important lessons to build ECE capacity for feeding children during future emergencies and has the potential strengthen the ECE food systems. This study aimed to identify the unique partnerships that CACFP state agencies established to provide nutrition to young children during the COVID-19 pandemic Qualitative semi-structured interviews with 24 participants representing 21 states across the United States. Virtual interviews with CACFP directors from December 2020 through May 2021. Following the realist method, transcripts were analyzed using thematic analysis. Codes were developed inductively and grouped to identify themes and subthemes. Four themes were identified: (1) CACFP partnerships that supported children and families directly; (2) CACFP partnerships that built the capacity of ECE providers to provide food to children in their own settings; (3) CACFP systems-level partnerships that improved coordination of efforts to continue to feed children in ECE; and (4) CACFP directors encouraged other CACFP state agencies to build nontraditional, diverse partnerships that can be leveraged during pandemics and other natural disasters. Within these themes (subthemes), the purpose of the partnerships focused on improving waiver utilization (eg, Department of Transportation, state health departments), improving food access (eg, Summer Food Service Program [SFSP], food banks, grocery stores, dairy councils), supporting ECE programs to participate in food reimbursement programs (eg, SFSP, CACFP sponsors), and resource sharing (eg, coalitions, CACFP sponsors). The CACFP state directors reported that existing and new partnerships between CACFP state agencies and external entities successfully facilitated feeding young children in ECE during the COVID-19 pandemic. States may consider developing a road map to proactively explore potential partners in their state to meet specific needs such as accessibility, availability, and affordability for feeding young children in ECE. [ABSTRACT FROM AUTHOR]

The objective of this systematic review of the literature is to compare a selection of currently utilized disposable and reusable laparoscopic medical devices in terms of safety (1st criteria), cost and carbon footprint. A search was carried out on electronic databases for articles published up until 6 May 2022. The eligible works were prospective (randomized or not) or retrospective clinical or medical-economic comparative studies having compared disposable scissors, trocars, and mechanical endoscopic staplers to the same instruments in reusable. Two different independent examiners extracted the relevant data. Among the 2882 articles found, 156 abstracts were retained for examination. After comprehensive analysis concerning the safety and effectiveness of the instruments, we included four articles. A study on trocars highlighted increased vascular complications with disposable instruments, and another study found more perioperative incidents with a hybrid stapler as opposed to a disposable stapler. As regards cost analysis, we included 11 studies, all of which showed significantly higher costs with disposable instruments. The results of the one study on carbon footprints showed that hybrid instruments leave four times less of a carbon footprint than disposable instruments. The literature on the theme remains extremely limited. Our review demonstrated that from a medical and economic standpoint, reusable medical instruments, particularly trocars, presented appreciable advantages. While there exist few data on the ecological impact, those that do exist are unmistakably favorable to reusable instruments. [ABSTRACT FROM AUTHOR]

Compare the cost of performing an osteoid osteoma ablation using cone beam CT (CBCT) with overlay fluoroscopic guidance to ablation using conventional CT (CCT) guidance and microwave ablation (MWA) to radiofrequency ablation (RFA). An 11-year retrospective study was performed of all patients undergoing osteoid osteoma ablation. Ablation equipment included a Cool tip RFA probe (Covidien, Minneapolis, Minnesota) or a Neuwave PR MWA probe (Ethicon, Rariton, New Jersey). The room times as well as immediate recovery time were recorded for each case. Cost analysis was then performed using time-driven activity-based costing for rate-dependent variables including salaries, equipment depreciation, room time, and certain supplies. Time-independent costs included the disposable interventional radiology supplies and ablation systems. Costs were reported for each service providing care and using conventional cost accounting methods with variable and fixed expenditures. A total of 91 patients underwent 96 ablation procedures in either CBCT (n = 66) or CCT (n = 30) using either MWA (n = 51) or RFA (n = 45). The anesthesia induction (22.7 ± 8.7 min versus 15.9 ± 7.2 min, P <.001), procedure (64.7 ± 27.5 min versus 47.3 ± 15.3 min; P =.001), and room times (137.7 ± 33.7 min versus 103.9 ± 22.6. min; P <.001) were significantly longer for CBCT procedures. The procedure time did not differ significantly between MWA and RFA (62.1 ± 27.4 min versus 56.1 ± 23.3 min; P =.27). Multiple regression analysis demonstrated lower age (P =.046), CBCT use (P =.001), RFA use (P =.02), and nonsupine patient position (P =.01) significantly increased the total procedural cost. After controlling for these variables, the total cost of CBCT ($5,981.32 ± $523.93 versus $5,378.93 ± $453.12; P =.001) remained higher than CCT and the total cost of RFA ($5,981.32 ± $523.93 versus $5,674.43 ± $549.14; P =.05) approached a higher cost than MWA. The use of CBCT with overlay fluoroscopic guidance for osteoid osteoma ablation resulted in longer in-room times and greater cost when compared with CCT. These cost considerations should be weighed against potential radiation dose advantage of CBCT when choosing an image guidance modality. Younger age, RFA use, and nonsupine patient position additionally contributed to higher costs. [Display omitted] [ABSTRACT FROM AUTHOR]

In the current study, sulfonic acid functionalized steam-activated char catalyst was prepared from Cocos nucifera (coconut) husk (named as ACH-SO 3 H) at low temperatures for the pre-treatment of Kanuga oil to its methyl ester. This catalyst is attempted reportedly first time for Kanuga oil-derived biodiesel production. An ester yield of 99.51% was achieved over parametric states optimized by response surface methodology of catalyst loading 4.9 wt%, methanol concentration of wt%, for 83 min at 55.75 °C. Based on the proximate analysis, the feedstock Kanuga oil exhibited a high free fatty acid suggesting that the fuel production require the usage of an acid catalyst. Catalyst developed was examined using BET, SEM, EDAX, FTIR, and XRD. Fuel characterization of the produced methyl ester demonstrated that it has physico-chemical properties acceptable for biodiesel according to ASTM standards. The esterification reaction with ACH-SO 3 H exhibited kinetics that resembled pseudo-first-order behaviour, with an Ea of 68.83 kJ mol−1. Endothermic nature and non-spontaneity of the esterification reaction were confirmed through the thermodynamic study. Despite repeated use, the catalyst demonstrated outstanding stability, with the capacity to be reused thrice without notable decay in catalytic action. Catalyst production cost of $6.74/kg was estimated in the work. [Display omitted] • Esterification was carried out to produce biodiesel from Kanuga oil. • Waste Cocos nucifera husk was used for –SO 3 H doped catalyst (ACH-SO 3 H) preparation. • The highest free fatty acid conversion to fatty acid methyl ester was 98.99%. • Esterification was endothermic and non-spontaneous with activation energy of 68.83 kJ mol− 1. • Low catalyst production cost of $6.44/kg validates the economic feasibility of the process. [ABSTRACT FROM AUTHOR]

The present work studied electroplating wastewater treatment by the electro-oxidation (EO) method through a new Ti/TiO 2 -GO-SnO 2 electrode in a once-through continuous mode. The Ti/TiO 2 -GO-SnO 2 electrode was synthesized using an anodic oxidation technique and characterized by electrochemical characterizaftion. Response Surface Methodology (RSM) employing a Box-Behnken Design (BBD) model was utilized to optimize pH (3−7), current density (j = 16.72–50.16 mA/cm2), and time (t = 30–130 min) for removal of electroplating effluents and energy consumption. At the optimum condition, the values of the responses R 1 (% Cr(VI) removal), R 2 (% Zn removal), R 3 (% COD removal), and R 4 (energy consumption) were found to be 97.55%, 95.66%, 87.32%, and 14.97 kWh/m3, respectively. The effect of reactive species scavengers on removing electroplating effluents has been studied. The kinetics and cost analysis were also carried out under optimal conditions. Once-through continuous experiments were carried out at different flow rates to determine the viability of the process at industrial or pilot scale applications. The synthesized electrode proved highly reusable, maintaining durability even after sixty cycles of usage. Toxicity analysis showed that EO has the potential to detoxify electroplating effluents. The observed results confirm that the EO with Ti/TiO 2 -GO-SnO 2 electrode is low-cost and effective for removing electroplating effluents. [Display omitted] [ABSTRACT FROM AUTHOR]

This study explores the effects of using industrial-grade raw materials on the hydrogen storage properties of body-centered cubic (BCC) solid solution alloys. Industrial scrap metals were chosen as the raw material, and the desired alloys were synthesized using a vacuum arc melting furnace. Instead of using pure vanadium (V), different inexpensive industrial substitutes such as low-grade vanadium (V), vanadium nitride (VN), vanadium oxide (VO), and ferrovanadium (FeV) were utilized. The crystal structure, morphology, first hydrogenation, thermodynamics, and cyclability of the prepared alloys were analyzed by using XRD, SEM-EDS, and XPS methods. The crystal structure and morphology analysis revealed multiphase alloys in all the prepared alloys and a Ti rich third phase in the VN sample, which was absent otherwise. The first hydrogenation was performed at room temperature under a hydrogen pressure of 2 MPa without any prior heat treatment. The VO alloy displayed negligible hydrogen absorption during first hydrogenation, while the V, VN, and FeV alloys showed maximum hydrogen storage capacities of 3.49 wt%, 2.47 wt%, and 2.18 wt%, respectively. The presence of oxygen hinders the activation of the VO alloy and requires two activation cycles to activate the sample. A short-term cyclability analysis showed a reversible hydrogen storage capacity of 2 wt%. The change in enthalpy of hydrogen absorption and desorption for V alloy were calculated to be −36.73 ± 8.6 and 57.34 ± 8.3 kJ/mol H 2, respectively. One of the prominent advantages of utilizing scrap raw materials was the substantial reduction in overall raw material costs, which saw an impressive 95% decrease when compared to using pure raw materials. These results highlight the economic benefits of incorporating recovered industrial scrap into hydrogen storage alloys. • 52Ti–12V–36Cr + 4 wt% Zr alloy was prepared from industrial-grade raw material using arc melting. • Effect of the substitution of V with industrial scrap metal VN, FeV, and VO was studied. • Hydrogen storage capacity and the incubation period are affected by the impurities present. • Substitution with industrial raw materials can reduce the cost of hydrogen storage alloy by up to 95%. [ABSTRACT FROM AUTHOR]

Nephrotic syndrome (NS) is a commonly encountered chronic kidney disease in pediatric populations, with South Asian children being at high risk and requiring long-term pharmacological management. Thus, identifying medication discrepancies and evaluating the appropriateness of therapy and its economic burden are vital for inpatient management. The aim of the study was to assess medication reconciliation, medication appropriateness, and cost analysis in NS cases. An ambispective cohort observational study was carried out with 150 NS patients where medication discrepancies were identified retrospectively and prospectively using the best possible medication history and following up patients correspondingly. Further, the Medication Appropriateness Index and cost variation analysis were used to assess the prescribed therapy and cost analysis, respectively. Out of 150 patients with NS included, 67.3% were male and the mean age was 7.2 years. In total, 36.7% medication discrepancies were found at baseline and 6% discrepancies at follow-up. The majority of discrepancies were unintentional and due to dosing error both at baseline and follow-up. Further, in only 2% of the patients was there inappropriately prescribed medication, and the majority of patients spent between INR (Indian Rupees) 500 and 1000. Chronic conditions like NS require continuous monitoring by the specialist pediatric clinical pharmacist, who can contribute significantly by minimizing the medication discrepancies, by assessing the appropriateness of therapy, and lessening the economic burden. [ABSTRACT FROM AUTHOR]

• This research examined the effectiveness of the point-to-point speed cameras in Thailand. • After speed detection through point-to-point cameras had been employed together with warning tickets, the 85th percentile average speed in the controlled area decreased by 10 km/hr. • Drivers commuting passed the area with point-to-point cameras would drive at a constant speed throughout the average speed detection area. • The cost-effectiveness of a point-to-point camera was determined and found that it the camera is quite cost-effective. Introduction : This research examines the effectiveness of point-to-point speed cameras in Thailand compared with spot speed camera enforcement, which is widely used in the country. Method: The evaluation includes the speed control's efficiency by observing the 85th percentile average speed of drivers on the road; the speed detection rate; conducting a comparison with spot speed camera enforcement; and a cost effectiveness analysis of this measure. Results: After speed detection using point-to-point cameras were employed during which warning tickets were issued in many days of experiment, the 85th percentile average speed in the controlled area decreased by 10 km/hr, with a maximum decrease of 20 km/hr. When comparing the detection rate of the two camera models, point-to-point cameras could detect 95% of drivers' driving speed, with 45% of the detected drivers identified as speeding drivers, while spot speed cameras were only able to detect 10% to 20% of speeders. Drivers traveling through the area with point-to-point cameras were more likely to drive at a constant speed throughout the average speed detection area. Practical Applications: The point-to-point camera system is determined to be quite cost-effective. [ABSTRACT FROM AUTHOR]

/Objectives: This study aimed to evaluate the frequency, clinical impact, and risk factors of post-pancreatectomy acute pancreatitis (PPAP) after pancreatoduodenectomy (PD) according to the definition proposed by the International Study Group for Pancreatic Surgery (ISGPS). patients undergoing PD between 2010 and 2021 were retrospectively analyzed. PPAP was defined according to the ISGPS criteria, including elevated serum amylase for 48 h and concurring pancreatitis alterations on a CT scan. 272 patients were finally included in the study. PPAP occurred in 40 (14.7 %) patients, and it was significantly related to higher rates of clinically-relevant postoperative pancreatic fistula (CR-POPF) (p < 0.001), post-pancreatectomy hemorrhage (PPH) (p < 0.001) and major complications (Clavien-Dindo ≥ 3a) (p < 0.001). Moreover, PPAP in the absence of CR-POPF (n = 18) was significantly related to longer hospital stay (p < 0.001), PPH (p < 0.001), major complications (Clavien-Dindo≥ 3a, p = 0.001) and higher intensive care unit costs (p = 0.029) compared to patients not developing PPAP. In the univariable and multivariable analysis, the duct size (p = 0.004) and high-risk pathologies (p = 0.004) but not intraoperative bleeding (p = 0.066) represented independent risk factors for PPAP. In the same analysis, patients receiving a bridging therapy with low molecular-weight heparin showed significantly lower rates of PPAP (p = 0.045). PPAP represents a relevant complication after PD. Its risk factors are similar to those for CR-POPF, while anticoagulants could represent a possible prevention strategy. [ABSTRACT FROM AUTHOR]

The transition towards carbon-free transportation is only possible by the adoption of renewable energy alternatives. Hydrogen-based transportation is an attractive option considering the availability of the required refuelling infrastructure. A well-established network of hydrogen refuelling infrastructure is important for the widespread commercialization of fuel-cell electric vehicles. The most expensive H 2 refuelling components originate from hydrogen compression. Due to their ability to run on solar thermal energy, a metal hydride hydrogen compressor is used in this study. In this communication, the aim is to present a study on solar thermal based hydrogen compressors for a hydrogen refuelling station. An analytical study is presented on the energy assessment of a metal hydride compressor by considering three candidate pairs of metal hydrides (Pair 1: Ti 0.95 Zr 0.05 Cr 0.8 Mn 0.8 V 0.2 Ni 0.2 /Ti 0.8 Zr 0.2 Cr 0.95 Fe 0.95 V 0.1 ; Pair 2: TiCr 1.55 Mn 0.2 Fe 0.2 /Ti 0.9 Zr 0.1 Mn 1.4 Cr 0.35 V 0.2 Fe 0.05 , Pair 3: La 0.35 Ce 0.45 Ca 0.2 Ni 4.95 Al 0.05 /Ti 0.8 Zr 0.2 Cr 0.95 Fe 0.95 V 0.1) to achieve refuelling pressure of 700 bar. The variation in thermal efficiency of the compressor and thermal energy requirements with changes in heat source temperature, supply pressure and heat losses are presented. Furthermore, the economics of three pairs of alloys for high-pressure compression is compared. It was found that Ti 0.95 Zr 0.05 Cr 0.8 Mn 0.8 V 0.2 Ni 0.2 /Ti 0.8 Zr 0.2 Cr 0.95 Fe 0.95 V 0.1 pair has the maximum compressor efficiency of 7.2% at supply pressure and heat source temperature of 25 bar and 150 °C, respectively. In addition, the study revealed that heat losses from the reactor could reduce efficiency by around 12.5%. The economic study revealed that the Ti 0.95 Zr 0.05 Cr 0.8 Mn 0.8 V 0.2 Ni 0.2 /Ti 0.8 Zr 0.2 Cr 0.95 Fe 0.95 V 0.1 pair has the least cost for hydrogen compression among the other chosen pairs. • Energy analysis of a solar based metal hydride compressor for refuelling station is presented. • Three candidate alloy pairs are compared for compression in the temperature range of 150–170 °C. • Effect of key parameters on the performance of solar thermal based compressor is investigated. • Maximum thermal efficiency of metal hydride compressor is reported to be 7.2%. • Economic study shows that pair 1 is a cheaper alternative for hydrogen compression in refuelling stations. [ABSTRACT FROM AUTHOR]

Different strategies to prepare H 2 -selective composite-membranes demonstrate promising performances, although the selection of the optimum alternative must consider environmental and economic concerns. These aspects, scarce in the available literature, are addressed here to analyze the convenience of using diverse CeO 2 -based intermediate layers in composite Pd-membranes and recommend a maximum membrane length for scaling-up. The replacement of raw dense-CeO 2 by porous or Pd-doped particles in the intermediate layer clearly improves the membrane performance, saving around 50% of required Pd-thickness while increasing the H 2 -permeance. However, porous-CeO 2 almost doubles the major environmental impacts and support modification costs, overcoming the potential saving costs in palladium. On the contrary, dense Pd-doped CeO 2 mitigates the environmental impacts by 27% and simultaneously saves 24% of expenses. Further reductions in environmental impacts and costs were reached after increasing the membrane-length up to 25 cm, becoming further improvements almost negligible for longer membranes. • Environmental impacts and costs for diverse Electroless Pore-Plating membranes. • Porous CeO 2 improves membrane performance and cost but not the environmental impacts. • Dense Pd–CeO 2 improves membrane performance, cost, and environmental impacts. • Reduction of environmental impacts if scaling-up membrane length up to 25 cm. [ABSTRACT FROM AUTHOR]

We estimate construction and operation costs of gigawatt-scale solid oxide electrolysis (SOE) facilities for producing high purity hydrogen gas from water. Manufacturing and assembly costs for two types of SOE cell stacks are estimated using a detailed design for manufacture and assembly (DFMA®) analysis. Modular balance of plant (BOP) process equipment is designed and sized with Aspen®, and cost estimated using equipment vendor quotes. Factory and on-site assembly and installation costs for SOEC stack and BOP equipment integration into modular SOE process units are calculated using a simplified DFMA® method. Total stack costs on a stack input power (SIP) basis reduce to <$100/kW e DC SIP for >500 MW e DC SIP /year production rates with electrode cermet, interconnects, and high-temperature heat treatments dominating the total cost. Integration of stacks with larger BOP equipment operating at higher pressures offers ∼36% cost reduction in total facility capital cost due to an economies of physical scale effect since BOP equipment comprises >50% of facility costs. Optimized H 2 prices decrease from ∼$4/kgH 2 to ∼$2/kgH 2 for 1 GW e DC SIP facilities using $0.025/kWh electricity price. All costs are reported in 2021 US dollars. • Estimation of SOEC stack, BOP, and installation costs of modular SOE facilities. • 50 kW e DC SOEC stack costs <$100/kW e DC at production rates >500 MW e DC/year. • BOP equipment contributes >50% of facility total capital investment. • ∼36% reduction in total capital investment from BOP economies of physical size. • ∼$2/kgH 2 for 1 GW e DC modular SOE facilities with $0.025/kWh e electricity. [ABSTRACT FROM AUTHOR]

Frontotemporal dementia (FTD) may impose substantial psychological and social burdens on caregivers and family members that are unique from other forms of dementia due to its distinctive clinical characteristics. This systematic review investigated these impacts on caregivers and family members. A systematic search was conducted in the PubMed, Cochrane Library and Embase databases for relevant articles published from database inception to 23 March 2023. The methodological quality of the articles was evaluated using a checklist. Thirty-six articles (six qualitative and thirty quantitative), including 5129 participants, were included in this review. Like other forms of dementia, FTD caregivers had significant caregiver burden levels and psychological impacts. Caregiver burden was associated with behavioural symptoms (e.g., apathy and disinhibition) and motor symptoms. The costs of caring for a patient with FTD were found to be higher than those for Alzheimer's disease. FTD patients often face challenges in obtaining a correct diagnosis and experience significant delays and multiple misdiagnoses. Healthcare professionals may also be less familiar with FTD than with Alzheimer's, leading to delayed diagnosis. This can cause considerable stress and deprive patients and caregivers of early intervention. FTD is associated with significant costs and caregiver burden levels, and the difficulties faced by caregivers and family members can be unique and challenging in different aspects when compared to other forms of dementia. Better education about FTD for family members and healthcare professionals is required to improve the quality of life for both patients and caregivers, and more support needs to be provided at all stages of the disease. [ABSTRACT FROM AUTHOR]

Our primary objective was to compare the intraoperative costs of 3 different surgical visualization techniques for anterior cervical discectomy and fusion (ACDF). Specifically, we used time-driven activity-based costing (TDABC) methodology to compare costs between ACDFs performed with operative microscopes (OM-ACDF), exoscopes (EX-ACDF), and loupes (loupes-ACDF). Total cost was divided into direct and indirect costs. Individual costs were obtained by direct observation, electronic medical records, and through querying multiple departments (business operations, sterile processing, plant operations, and pharmacy). Timestamps for all involved personnel and material resources were documented. We identified all instances of loupes-ACDF (n = 882), EX-ACDF (n = 26), and OM-ACDF (n = 52) performed at our institution. We performed multivariable linear regression analyses to compare costs between these modalities, accounting for patient-specific factors as well as number of levels fused, surgeon, and hospital site. The average total intraoperative costs per loupes-ACDF, EX-ACDF, and OM-ACDF cases were $7081 +/− $2,942, $7951 +/− $3,488, and $6557 +/− $954, respectively. Regression analysis revealed no difference in intraoperative cost between loupes-ACDF and EX-ACDF (P = 0.717), loupes-ACDF and OM-ACDF (0.954), or OM-ACDF and EX-ACDF (0.217). On a more granular level, however, EX-ACDF was associated with increased cost of consumables, including drapes, compared to both OM-ACDF (β-coefficient: $369 +/− $121, P = 0.002) and loupes-ACDF (β-coefficient: $284 +/− $86, P = 0.001). Although hospitals may be aware of the purchasing fees associated with microscopes and exoscopes, there is no clear documentation of how these technologies affect intraoperative cost. We demonstrate a novel use of TDABC for this purpose. [ABSTRACT FROM AUTHOR]

Computeed tomography (CT) is a cornerstone of the identification and management of acute changes in neurosurgery patients. In addition to the monetary expense of CT scans, further costs are incurred due to the time of patient transport and radiation exposure. Ultrasounds (USs)offer a safe, inexpensive, and bedside alternative to CT but obstacles remain due to decreased penetrance in the adult skull. Sonolucent Cranial Implants (SCIs) offer a window for USs to view intracranial architectures. The authors performed a PRISMA guidelines-based systematic review of the literature. Information was extracted from included articles in regards to illness pathology, US imaging feasibility, comparison to standard imaging, infections, and revisions. Costs were collected in regards to price of implant and follow-up imaging. A total of 226 articles resulted, of which 5 were included in the study. Ninety non-duplicate patients who received SCIs were analyzed. The pathologies of included patients is as follows: 51 patients were after extracranial-intracranial bypass, 37 after ventriculoperitoneal shunt placement for hydrocephalus, 1 after tumor resection, and 1 after cranioplasty following decompressive hemicraniectomy. All studies noted feasibility of US and comparability to standard imaging following SCI placement. Follow-up imaging with trans-sonolucent cranial implant ultrasound was estimated to save up to $4,000 per patient depending on the procedure. Initial studies suggest that US imaging through SCIs is a safe and efficacious alternative to CT imaging in neurosurgical patients. Cost analysis suggests that SCI and subsequent US can offer a cost savings compared with current treatment. [ABSTRACT FROM AUTHOR]

To comprehensively analyze the cumulative costs associated with Foley consultations throughout their event lifespan. Urologic consultation for Foley catheter (Foley) management is common. Such consultations are heterogeneous, with some requiring only simple catheter placement. Others (eg, traumatic Foley) necessitate more complex procedural intervention and may also result in downstream care and/or intervention needs. This study analyzed a retrospective database of consecutive urologic Foley consultations at a single academic institution (2017-2019), collecting comprehensive data on patient characteristics, related procedures/materials, and downstream care (eg, hospitalization, laboratory/radiology testing, evaluation and management services). A process map and related modeling were used to assess categorical and cumulative event costs. Allocated costs and charges were utilized for materials/institutional resources and for services rendered, respectively. Statistical analysis performed using SAS and statistical inferences were based on significance level of 10%. A total of 244 patient encounters were included in the analysis. The mean overall cost of all care related to Foley consultation was $2389.23 (±$4045.89). A total of 62 (25.4%) patients required only consultation/Foley without additional intervention, with a total cost of $738.90 (±$94.10). The remaining 182 (75.6%) patients required additional intervention and related cost (total cost $3413.27 (±$4850.41)). Traumatic catheterization was associated with higher cost compared with atraumatic cases ($3201.50 (±$6158.4) vs $1926.40 (±$1776.20), respectively, P =.05). Downstream care comprised a significant portion of overall cost. In 61 (25%) cases no nurse attempt was performed prior to consultation. Urologic Foley consultation is associated with significant health system cost. Quality initiatives to optimizing Foley placement and management are critical to improving quality of care and associated downstream costs. [ABSTRACT FROM AUTHOR]

To perform a cost analysis of generic and brand-name Phosphodiesterase Type 5 (PDE5) inhibitors at different dosages and pharmacies across the US. Using an all-payer retail pharmacy-claims database, we analyzed prescription drug data for three generic and six brand-name oral PDE5 inhibitors at different dosages across US chain and independent pharmacies in 2019. We obtained cash price data from 60,186 pharmacies (35,976 chain and 24,210 independent). The nationwide mean cash price per unit (PPU) ranged from $8.6 ± 5.2 (sildenafil 20 mg at chain pharmacies) to $107.1 ± 71 (Adcirca 20 mg at independent pharmacies) equal to 1145.3% difference. Chain pharmacies provided significantly lower average prices for one brand-name and six generic PDE5 inhibitors. Tadalafil PPU was cheaper at higher quantities, however, PPU increased with quantity prescribed for sildenafil. Looking at the top 10 metropolitan statistical areas, the highest PPUs were observed for tadalafil (Cialis) 10 mg and sildenafil (Viagra) 50 mg in Atlanta ($67.4 ± 8.7) and Los Angeles ($50.3 ± 24.0), while New York ($9.7 ± 2.6) and Miami ($27.9 ± 16.4) had the lowest PPUs for tadalafil (Cialis) 5 mg and sildenafil (Viagra) 100 mg, respectively. A substantial variability in PDE5 inhibitor cash prices exists across manufacturer, dosage, quantity, pharmacy type, and location. In addition, the pricing does not necessarily correlate with the regional socioeconomic factors. This highlights the importance of provider awareness and patient counseling on drug price including potentially assisting patients in identifying opportunities for cost savings. [ABSTRACT FROM AUTHOR]

In this study, an integrated energy system is deployed to generate electricity, heating, cooling, and domestic hot water for a community considering three fully renewable energy source scenarios: biofuel (Case I), solar-biofuel (Case II), and geothermal energy (Case III). The proposed systems are modeled, assessed, optimized, and compared thermodynamically, economically, and environmentally; in addition, a proton exchange membrane electrolyzer (PEME) is utilized to convert the surplus electricity to stored hydrogen to raise the exergy efficiency and package value-added. Mathematical models are fully developed from thermodynamic and economic perspectives, taking a cumulative inflation rate into account via the Consumer Price Index (CPI). The novelty of the study is to focus on the comparison of the proposed renewable resources as energy inputs for the same condition (community loads), as there is a gap in this regard in the literature. Presented systems are optimized using Non-dominated Sorting Genetic Algorithm-II (NSGA-II) for minimum net costs as well as maximum exergy efficiency to reach the optimum operating conditions for each case during the peak cooling and heating loads. Moreover, for a more precise comparison of the proposed cases from an exergetic, economic, and environmental point of view, dynamic (hourly) behaviors of systems are analyzed over a year. A comprehensive parametric study is carried out to reckon the influence of borehole drilling depth, geofluid mass flow rate, and soil temperature gradient on case III to appraise its competitiveness in different locations, as well as the effects of the number of collectors on total cost rate and exergy efficiency for case II. Results indicate the annual net costs of $107.1k, $99.5k, and -$505.1k (where the negative sign stands for "income" instead of "cost") and average exergy efficiencies of 19.1 %, 26.3 %, and 41.3 % for cases I, II and III respectively. [ABSTRACT FROM AUTHOR]

• Dalbavancin has been shown to be a safe option in the therapy of infective endocarditis. • A lower hospital stay was observed in patients who received dalbavancin. • Dalbavancin use was associated with a reduction in costs and hospital stay. 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). 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. 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 <0.001). A reduction of cost was observed between both groups (dalbavancin, 12,206 € [8998-17,283] vs SOC 16,249 € [11,496-22,367], P = 0.032). Dalbavancin could be a safe and effective option in the sequential treatment of patients with IE. Also, a cost reduction was detected, due to a significant shortness of hospital stay. [ABSTRACT FROM AUTHOR]

Frequent intake of sugar-sweetened beverages (SSBs) among US adults is a public health concern because it has been associated with increased risks for adverse health outcomes such as obesity, type 2 diabetes, and cardiovascular disease. In contrast, drinking plain water (such as tap, bottled, or unsweetened sparkling water) instead of drinking SSBs might provide health benefits by improving diet quality and helping prevent chronic diseases. However, there is limited information on estimated expenditures on SSBs or bottled water among US households. This study examined differences in SSB and bottled water purchasing according to household and geographic area characteristics and estimated costs spent on purchasing SSB and bottled water from retail stores among a nationally representative sample of US households. This study is a secondary analysis of the 2015 Circana (formerly Information Resources Inc) Consumer Network Panel data, which were merged with the US Department of Agriculture nutrition data using the US Department of Agriculture Purchase-to-Plate Crosswalk-2015 dataset (the latest available version of the Purchase-to-Plate Crosswalk at the time the study began), and the Child Opportunity Index 2.0 data. A total of 63,610 households, representative of the contiguous US population, consistently provided food and beverage purchase scanner data from retail stores throughout 2015. The included demographic and socioeconomic variables were household head's age, marital status, highest education level, race and ethnicity of the primary shopper in the household, family income relative to the federal poverty level, and presence of children in the household. In addition, descriptors of households' residential areas were included, such as the county-level poverty prevalence, urbanization, census region, and census tract level Child Opportunity Index. Annual per capita spending on SSB and bottled water and daily per capita SSB calories purchased. Unadjusted and multivariable adjusted mean values of the main outcome measures were compared by household demographic, socioeconomic, and geographic characteristics using linear regression analysis including Circana's household projection factors. Nearly all households reported purchasing SSBs at least once during 2015 and spent on average $47 (interquartile range = $20) per person per year on SSBs, which corresponded to 211 kcal (interquartile range = 125 kcal) of SSBs per person per day. About seven in 10 households reported purchasing bottled water at least once during 2015 and spent $11 (interquartile range = $5) per person on bottled water per year. Both annual per capita SSB and bottled water spending, and daily per capita SSB calories purchased was highest for households whose heads were between 40 and 59 years of age, had low household income, or lived in poor counties, or counties with a low Child Opportunity Index. Annual per capita spending was also higher for households with never married/widowed/divorced head, or at least 1 non-Hispanic Black head, and households without children, or those living in the South. Daily per capita SSB calorie purchases were highest for households where at least 1 head had less than a high school degree, households with at least 1 Hispanic or married head, and households with children or those living in the Midwest. These findings suggest that households that had lower socioeconomic status had higher annual per capita spending on SSBs and bottled water and higher daily per capita total SSB calories purchased than households with higher socioeconomic status. [ABSTRACT FROM AUTHOR]

To assess the quality of care, effectiveness, and cost-effectiveness over 12 months after implementing a structured model of care for hip and knee osteoarthritis (OA) in primary healthcare as compared to usual care. In this pragmatic cluster-randomized, controlled trial with a stepped-wedge cohort design, we recruited 40 general practitioners (GPs), 37 physiotherapists (PTs), and 393 patients with symptomatic hip or knee OA from six municipalities (clusters) in Norway. The model included the delivery of a 3-hour patient education and 8–12 weeks individually tailored exercise programs, and interactive workshops for GPs and PTs. At 12 months, the patient-reported quality of care was assessed by the OsteoArthritis Quality Indicator questionnaire (16 items, pass rate 0–100%, 100%=best). Costs were obtained from patient-reported and national register data. Cost-effectiveness at the healthcare perspective was evaluated using incremental net monetary benefit (INMB). Of 393 patients, 109 were recruited during the control periods (control group) and 284 were recruited during interventions periods (intervention group). At 12 months the intervention group reported statistically significant higher quality of care compared to the control group (59% vs. 40%; mean difference: 17.6 (95% confidence interval [CI] 11.1, 24.0)). Cost-effectiveness analyses showed that the model of care resulted in quality-adjusted life-years gained and cost-savings compared to usual care with mean INMB €2020 (95% CI 611, 3492) over 12 months. This study showed that implementing the model of care for OA in primary healthcare, improved quality of care and showed cost-effectiveness over 12 months compared to usual care. ClinicalTrials.gov NCT02333656 [Display omitted] [ABSTRACT FROM AUTHOR]

Cost performance problems and overruns were common and considered the major cause of projects due to not gaining the expected profit margin, With an 86% likelihood of overrun in international buildings projects, and at least 30%- 40% of global projects experiencing subpar cost performance and overruns. The poor performance of project costs was attributed to inadequacies of project control systems, as they were responsible for monitoring project costs. Inadequate controlling systems suggest that established controlling tools fail to execute their function. Therefore, a successful control system was crucial to reducing project failure. Thus, The question that drives this study is 'What were the successful cost practices and techniques commonly utilized in controlling construction expenditures and conserving project anticipated profit?'. Following PRISMA protocol guidelines, the study systematically reviewed the previous literature by searching academic databases for relevant articles. The study aimed to examine successful controlling strategies and tools commonly utilized. Fifteen common techniques were identified and found that budgeting monitoring, resources monitoring, interim valuation, unit costing, and cost variance analysis were successful, provided a comprehensive outline of each method, identified the fundamental ideas underlying technique differentiation, and summarized their benefits and drawbacks. Two controlling system implementation strategies were discussed, they were corrective and proactive approaches. A project development stage-based technique selection guide was proposed. The paper also proposed a control framework that integrated proactive and corrective measures into project control to inhibit overruns. The research also examined project controlling technique selection factors that should be considered when choosing the one. [ABSTRACT FROM AUTHOR]

Complex endovascular juxta-, para- and suprarenal abdominal aortic aneurysm repair (comEVAR) is frequently accomplished with commercially available fenestrated (FEVAR) devices or off-label use of aortoiliac devices with parallel branch stents (chEVAR). We sought to evaluate the implantable vascular device costs incurred with these procedures as compared with standard Medicare reimbursement to determine the financial viability of comEVAR in the modern era. Five geographically distinct institutions with high-volume, complex aortic centers were included. Implantable aortoiliac and branch stent device cost data from 25 consecutive, recent, comEVAR in the treatment of juxta-, para-, and suprarenal aortic aneurysms at each center were analyzed. Cases of rupture, thoracic aneurysms, reinterventions, and physician-modified EVAR were excluded, as were ancillary costs from nonimplantable equipment. Data from all institutions were combined and stratified into an overall cost group and two, individual cost groups: FEVAR or chEVAR. These groups were compared, and each respective group was then compared with weighted Medicare reimbursement for Diagnosis-Related Group codes 268/269. Median device costs were obtained from an independent purchasing consortium of >3000 medical centers, yielding true median cost-to-institution data rather than speculative, administrative projections or estimates. A total of 125 cases were analyzed: 70 FEVAR and 53 chEVAR. Two cases of combined FEVAR/chEVAR were included in total cost analysis, but excluded from direct FEVAR vs chEVAR comparison. Median Medicare reimbursement was calculated as $35,755 per case. Combined average implantable device cost for all analyzed cases was $28,470 per case, or 80% of the median reimbursement ($28,470/$35,755). Average FEVAR device cost per case ($26,499) was significantly lower than average chEVAR cost per case ($32,122; P <.002). Device cost was 74% ($26,499/$35,755) of total reimbursement for FEVAR and 90% ($32,122/$35,755) for chEVAR. Results from this multi-institutional analysis show that implantable device cost alone represents the vast majority of weighted total Medicare reimbursement per case with comEVAR, and that chEVAR is significantly more costly than FEVAR. Inadequate Medicare reimbursement for these cases puts high-volume, high-complexity aortic centers at a distinct financial disadvantage. In the interest of optimizing patient care, these data suggest a reconsideration of previously established, outdated, Diagnosis-Related Group coding and Medicare reimbursement for comEVAR. [ABSTRACT FROM AUTHOR]

Incidental finding (IF) follow-up is of critical importance for patient safety and is a source of malpractice risk. Laboratory, imaging, or other types of IFs are often uncovered incidentally and are missed, not addressed, or only result after hospital discharge. Despite a growing IF notification literature, a need remains to study cost-effective non–electronic health record (EHR)–specific solutions that can be used across different types of IFs and EHRs. The objective of this study was to evaluate the utility and cost-effectiveness of an EHR-independent emergency medicine–based quality assurance (QA) follow-up program in which an experienced nurse reviewed laboratory and imaging studies and ensured appropriate follow-up of results. A QA nurse reviewed preceding-day abnormal studies from a tertiary care hospital, a community hospital, and an urgent care center. Laboratory values outside preset parameters or radiology over-reads resulting in clinically actionable changes triggered contact with an on-call emergency physician to determine an appropriate intervention and its implementation. Of 104,125 visits with 1,351,212 laboratory studies and 95,000 imaging studies, 6530 visits had IFs, including 2659 laboratory and 4004 imaging results. The most common intervention was contacting a primary care physician (5783 cases [88.6%]). Twenty-one cases resulted in a patient returning to the ED, at an average cost of $28,000 per potential life-/limb-saving intervention. Although abnormalities in laboratory results and imaging are often incidental to patient care, a dedicated emergency department QA follow-up program resulted in the identification and communication of numerous laboratory and imaging abnormalities and may result in changes to patients' subsequent clinical course, potentially increasing patient safety. [ABSTRACT FROM AUTHOR]