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Introduction: In‐hospital falls represent significant health and economic concerns, but previous studies regarding the economic cost of falls do not account for other cofounders (comorbidities and clinical aspects) in this cost evaluation. Aim: The aim of this study is to analyse the cost of in‐hospital falls comparing those who had falls to nonfalls patients while accounting for several risk factors associated with falls. Methods: Data were collected from January 2020 to December 2022, in a private hospital in Brazil. The sample was divided into two groups: one with patients who fell and the other with nonfallers on a 1:2 ratio, and these groups were matched to avoid confounding variables. Results: The median cost for patients who experienced falls was US$7520.26 compared to US$6144.24 for those without falls (p < 0.01). This trend was especially marked in men aged 20–40 who suffered falls and showed a significantly elevated median cost of US$29 722.02 distinguishing them from those without falls with a median cost of US$1179.48 (p < 0.01). Conclusion: Hospital falls significantly increase financial costs compared to nonfall cases, irrespective of comorbidities, length of stay or case‐mix variations. The findings recommend a universal precautions approach to fall prevention in hospitals, targeting all hospitalised patients to effectively minimise the economic burden associated with in‐hospital falls. [ABSTRACT FROM AUTHOR]

The high cost of gluten‐free products (GFPs) is being discussed as a potential barrier to adherence to a gluten‐free diet, rendering monitoring of their pricing an ongoing demand in a market subject to continuous fluctuations. The current study aimed to assess the current pricing status of GFPs in the Greek retail market, with a focus on differences between staple and non‐staple foods. The retail price and packaging weight of all available GFPs and their gluten‐containing (GCPs) counterparts of a GFP‐shopping basket (formulated based on the results of a preceding online survey) were recorded by visiting one store of the five most popular reported supermarket chains. The food categories were grouped into staple (e.g. breads, pasta and flours) and non‐staple (e.g. chips, sweets and sauces) foods. Adjusting for supermarket chain and product type, a quantile mixed regression model was applied to assess the extent to which median product price (per 100 g) differed between GFPs and GCPs. The unique products recorded were 1058 (of which 408 GFPs), with a total of 2165 retail price recordings. While the overall median price/100 g of GFPs was not found to be significantly different from that of GCPs, the median price of staple GFPs was estimated to be higher than staple GCPs (+€1.03 [95% CI: €0.93; €1.13] per 100 g), whilst that of non‐staple GFPs was slightly lower (−€0.20 [95% CI: −€0.37; −€0.02] per 100 g). In conclusion, the persisting higher cost of staple GFPs suggests the need for ongoing financial support for people with coeliac disease. [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]

Objectives: Novel interventions (axicabtagene ciloleucel [axi‐cel], lisocabtagene maraleucel [liso‐cel], tafasitamab‐lenalidomide [Tafa‐L], polatuzumab‐rituximab‐bendamustine [pola‐BR]) improve clinical outcomes in second‐line (2 L) treatment of transplant‐ineligible patients with early relapse or refractory (R/R) diffuse large B cell lymphoma (DLBCL). The costs vary depending on the respective treatment regimen and the treatment duration, difficult comparability in reimbursement decisions. The objective was to analyze the health economic impacts of novel 2 L interventions and conventional immunochemotherapies (bendamustine‐rituximab [BR], rituximab‐gemcitabine‐oxaliplatin [R‐GemOx]) from a German healthcare payer's perspective as a function of treatment duration. Methods: An economic model was developed to compare treatment costs of 2 L interventions depending on the treatment duration. Treatment duration was measured by progression‐free survival (PFS), identified based on a systematic review. Total and average costs were calculated over 5 years to evaluate incremental costs at median PFS for each intervention. Results: Average costs per month at median PFS ranged from €2846 (95% CI: 5067‐1641) to €40 535 (95% CI: 91180‐N/A) for BR and liso‐cel, respectively. Incremental costs at the lowest median PFS (R‐GemOx: 5.3 months) revealed −€664, €5560, €11 817, €53 145, and €67 745 for BR, Tafa‐L, pola‐BR, axi‐cel, and liso‐cel as compared to R‐GemOx, respectively. Conclusions: Analyses uncovered a variation of incremental costs of 2 L transplant‐ineligible DLBCL interventions as a function of time leading to amortization of high‐priced interventions. [ABSTRACT FROM AUTHOR]

In a hydrogen economy, the primary energy source for industry, transportation, and power production is hydrogen gas. Green hydrogen can be generated and utilized in an environmentally friendly and sustainable manner; it seeks to displace fossil fuels. Finding a clean alternative energy source is becoming more crucial due to the depletion of fossil fuels and the major environmental pollution issues they bring when utilized extensively. The paper's objective is to analyze the factors affecting the economy of green hydrogen production pathways for sustainable development to decarbonize the world and the associated challenges faced in terms of technological, social, infrastructure, and people's perceptions while adopting green hydrogen. To achieve this, the research looked at a variety of areas relevant to green hydrogen, such as production techniques, industry applications, benefits for society and the environment, and challenges that need to be overcome before the technology is widely used. The most recent methods of producing hydrogen from fossil fuels, such as steam methane, partial oxidation, autothermal, and plasma reforming, as well as renewable energy sources including biomass and thermochemical reactions and water splitting. Grey hydrogen is now the least expensive type of hydrogen, but, in the future, green hydrogen's levelized cost of hydrogen (LCOH) is expected to be less than $2 per kilogram of hydrogen. [ABSTRACT FROM AUTHOR]

Objective: Telepsychiatry items in the Australian Medicare Benefits Schedule (MBS) were expanded following the COVID-19 pandemic. However, their out-of-pocket costs have not been examined. We describe and compare patient out-of-pocket payments for face-to-face and telepsychiatry (videoconferencing and telephone) MBS items for outpatient psychiatric services to understand the differential out-of-pocket cost burden for patients across these modalities. Methods: out-of-pocket cost information was obtained from the Medical Costs Finder website, which extracted data from Services Australia's Medicare claims data in 2021–2022. Cost information for corresponding face-to-face, video, and telephone MBS items for outpatient psychiatric services was compared, including (1) Median specialist fees; (2) Median out-of-pocket payments; (3) Medicare reimbursement amounts; and (4) Proportions of patients subject to out-of-pocket fees. Results: Medicare reimbursements are identical for all comparable face-to-face and telepsychiatry items. Specialist fees for comparable items varied across face-to-face to telehealth options, with resulting differences in out-of-pocket costs. For video items, higher proportions of patients were not bulk-billed, with greater out-of-pocket costs than face-to-face items. However, the opposite was true for telephone items compared with face-to-face items. Conclusions: Initial cost analyses of MBS telepsychiatry items indicate that telephone consultations incur the lowest out-of-pocket costs, followed by face-to-face and video consultations. [ABSTRACT FROM AUTHOR]

Background and Aims: Nicotine vaping products (NVPs) can potentially help adult tobacco users quit smoking. This study evaluated how adult consumers compare the costs between NVPs and cigarettes. Method: We used data from the US arm of the 2016–2020 International Tobacco Control Four Country Smoking and Vaping (ITC 4CV) surveys to perform a multinomial logit model with two‐way fixed effects to measure how perceived cost comparisons are associated with NVP and cigarette taxes, use patterns, NVP device types and individual sociodemographic factors. Results: Higher cigarette taxes are associated with a greater likelihood of perceiving NVPs and cigarettes as costing the same for the overall population and among people who exclusively smoke, and a lower likelihood of perceiving NVPs as more expensive among people who exclusively vape, compared with lower cigarette taxes. Pre‐filled cartridge and tank users are more likely to perceive NVPs as less expensive than cigarettes, compared with people who use other types of NVPs. The associations between taxes and perceived cost comparison were more pronounced among males, younger and low‐income populations. Conclusions: Higher cigarette taxes are associated with perceived financial incentives for nicotine vaping products (NVPs) over cigarettes, whereas NVP taxes are not associated with perceived cost comparison between NVPs and cigarettes. [ABSTRACT FROM AUTHOR]

Based on the oil and gas component data of an offshore gas field in West Africa, the steady‐state models of the triethylene glycol (TEG) dehydration process and the low‐temperature separation dehydration process are established. The adaptability of two kinds of processes to the disturbance of pressure, temperature, and flow of imported natural gas source is studied, and the sensitivity analysis is carried out. In addition, the investment cost and operating cost of the two types of processes are compared. The low temperature separation dehydration process is more adaptable to the disturbance of inlet gas source than the TEG dehydration process. The former is more expensive to build than the latter, but less expensive to run. The low temperature separation dehydration is preferred as the natural gas dehydration process which is more suitable for floating production storage and offloading. [ABSTRACT FROM AUTHOR]

Freight transport with heavy trucks has emerged as a significant energy-intensive sector and a major contributor to carbon emissions in China's transportation industry. The diesel consumption in this field represents approximately 40 % of China's total annual diesel consumption, while the CO2 emissions account for approximately 50 % of the total annual CO2 emissions in the transportation industry. Under the background of carbon peaking and carbon neutrality goals and energy revolution, it has become an inevitable trend to build a green, secure and efficient road freight mode and promote the low-carbon and clean transformation of heavy freight transport. So far, the electrification options of freight transport with heavy trucks mainly include charging, battery swapping, hydrogen heavy trucks, and electrified highways. This paper mainly introduces the hydrogen heavy truck and electrified highway options. Based on a dedicated coal transport route, the economic efficiency and application scenarios were compared and analyzed between these two options from a perspective of cost estimates. The analysis results show that, for this dedicated coal transport route, when the annual traffic volume is greater than 2.0483 million tons, the electrified highway option is more economical, while on the contrary, the cost of the hydrogen heavy truck option is lower.

To reduce the healthcare burden, the clinical results of arthroscopic rotator cuff repair and the cost of the implants used have recently been focused upon. This study compared implant cost, surgical time, short-term clinical results, and cuff repair integrity 2 years postoperatively between arthroscopic transosseous rotator cuff repair using lateral cortical augmentation (TOA) and arthroscopic transosseous-equivalent suture bridge (TOE). This study included 220 patients with rotator cuff repairs performed by a single surgeon between December 2013 and December 2018. Overall, 70 TOA and 68 TOE cases met the inclusion criteria. The same surgeon performed the procedures at two different hospitals, and the techniques differed between the facilities. A total of 42 TOA patients were matched with 42 TOE patients. The patients were matched using a propensity score analysis by gender, age, and cuff tear size. The minimum follow-up period was 2 years. Implant cost and surgical time were compared between the two methods. The range of motion, clinical outcomes, and visual analog scale were evaluated. Magnetic resonance imaging was performed to examine cuff repair integrity 2 years postoperatively. The follow-up rate was 81% (112/138 patients). Implant cost was significantly lower with TOA ($1,396 vs. $2,165; p < 0.001) than with TOE. The average surgical time in the TOA method was significantly shorter than that in the TOE method (82 vs. 109 min; p = 0.001). At a minimum 2-year follow-up, the mean active elevation, abduction, and clinical outcomes improved with both methods, although no improvements in external and internal rotations were observed with either method. There were no significant differences in the postoperative variables and retear rate (TOA, 12%; TOE, 19%; p = 0.548) between the two methods. TOA and TOE achieved comparable clinical results; however, TOA was more cost-effective and had a shorter surgical time than TOE. Level Ⅲ, retrospective matched control study. [ABSTRACT FROM AUTHOR]

This paper presents a techno-economic analysis of the impact of distributed generation (DG) integration for power loss reduction and reliability of two 33 kV radial outgoing feeders at the Motta distribution substation in Ethiopia. Transient earth faults and permanent short-circuits were identified to be the most common causes of interruptions. The substation's system average interruption frequency index (SAIFI) is 806 and its system average interruption duration index (SAIDI) is 1394.145 for planned outages. This necessitates the pursuit of effective methods to increase the reliability of the distribution system. The results show that the distribution system is more reliable with the SAIFI and customer average interruption frequency index (CAIFI) reduced by 97.8%, SAIDI reduced by 76%, average service availability index (ASAI) increased by 14.38%, and average service unavailability index (ASUI) reduced by 76%, resulting in a total power loss reduction of 0.32 MW. The cost analysis was performed using the Monte Carlo (MC) reliability analysis and the DG net present cost analysis results in a payback period of less than five years indicating that the system is profitable.

Abstract Aims We aimed to conduct a clinical process cost analysis to evaluate all upcoming costs of mitral valve transcatheter edge-to-edge repair (M-TEER) treatment using the MitraClip and the PASCAL repair system. Methods First, we prospectively enrolled 107 M-TEER patients treated with either the PASCAL or MitraClip system and compared all upcoming costs during the M-TEER procedure and the associated in-hospital stay. Second, we retrospectively analysed 716 M-TEER procedures with regard to the occurrence of complications and their associated costs. All materials used in the catheterization laboratory for the procedures were evaluated. The cost analysis considered various expenses, such as general in-hospital costs, device costs, catheter laboratory and material costs. Results In the prospective study, 51 patients were treated using the PASCAL system, and 56 were treated using the MitraClip system. The two groups had comparable baseline characteristics and comorbidities. The total in-hospital costs were 25 414 (Interquartile range (IQR) 24 631, 27 697) € in the PASCAL group and 25 633 (IQR 24 752, 28 256) € in the MitraClip group (p = 0.515). The major cost driver was initial material expenditure, mostly triggered by device costs, which were similar to the PASCAL and MitraClip systems. Overall intensive care unit and general ward costs did not differ between the PASCAL and MitraClip groups. In the retrospective analysis, M-TEER-related complications were rare but were associated with higher costs, mainly due to prolonged hospitalisation. Conclusion The major cost driver of M-TEER was the material expenditure, which was mostly triggered by high device costs. The costs of treating patients were similar for the PASCAL and MitraClip systems. M-TEER-related complications are associated with higher costs, mainly due to prolonged hospitalisation. This analysis provides valuable insights into reducing expenses by modifying the process of M-TEER.

This paper presents a techno-economic analysis of the impact of distributed generation (DG) integration for power loss reduction and reliability of two 33 kV radial outgoing feeders at the Motta distribution substation in Ethiopia. Transient earth faults and permanent short-circuits were identified to be the most common causes of interruptions. The substation's system average interruption frequency index (SAIFI) is 806 and its system average interruption duration index (SAIDI) is 1394.145 for planned outages. This necessitates the pursuit of effective methods to increase the reliability of the distribution system. The results show that the distribution system is more reliable with the SAIFI and customer average interruption frequency index (CAIFI) reduced by 97.8%, SAIDI reduced by 76%, average service availability index (ASAI) increased by 14.38%, and average service unavailability index (ASUI) reduced by 76%, resulting in a total power loss reduction of 0.32 MW. The cost analysis was performed using the Monte Carlo (MC) reliability analysis and the DG net present cost analysis results in a payback period of less than five years indicating that the system is profitable. [ABSTRACT FROM AUTHOR]

Background: The presence of pleural effusions and ascites in patients is often considered a marker of illness severity and a poor prognostic indicator. This study aims to compare inpatient and outpatient costs of alternative invasive treatments for ascites and pleural effusions. Methods: The retrospective single-institution study included inpatient cases treated for pleural effusion (J90 and J91) or ascites (R18) at the University Hospital Cologne (UHC) in Germany between January 01, 2020, and December 31, 2021. Costs for punctures and indwelling catheter systems (ICSs) as well as pleurodesis were analyzed in different comparator treatment pathways. Real-world data from the UHC tertiary care center were based on diagnosis-related group fees from 2020 to 2021. A simulation of outpatient expenses was carried out to compare inpatient and outpatient costs for each pathway from a payer perspective. Results: A total of 4323 cases (3396 pleural effusions and 1302 ascites) were analyzed. For ascites, inpatient implantation with home care drainage was found to be the most expensive option, with total costs of €1,918.58 per procedure, whereas outpatient puncture was the least expensive option at €60.02. For pleural effusions, the most expensive treatment pathway was pleurodesis at €8,867.84 compared with the least costly option of outpatient puncture resulting in total costs per procedure of €70.03. A break-even analysis showed that outpatient puncture remains the most inexpensive treatment option, and the ICS comprises a cost-saving potential. Longevity of several months with the use of ICSs results in both enhanced quality of life for patients and increased cost savings. [ABSTRACT FROM AUTHOR]

The existence of road infrastructure such as bridges that do not meet current design criteria, the deterioration of these due to use, environmental factors and extraordinary or unforeseen conditions, and the increase in seismic and gravitational design loads due to regulatory updates, generate the need for search of new design and retrofitting alternatives for this type of structure. Thus, the conditions of these structures need to be assessed and corresponding interventions need to be identified. It is important to implement alternatives that are both economically and functionally efficient. For example, base isolation can reduce direct construction costs by using devices designed and built in the country of origin, but the unfamiliarity and importation costs of these devices are the main obstacles to mass use. In this article, a comparative analysis is performed of a conventional design and an integrated design for base isolation using low-cost unbonded fiber-reinforced elastomeric isolators (U-FREIs) made in Colombia. A methodology is proposed for the analysis of new and existing isolated structures, in which the isolators are placed between the substructure and superstructure. This methodology is used to design and strengthen a typical prestressed concrete girder bridge, and the results are compared against those obtained using a conventional scheme. Finally, an existing bridge is analyzed using on-site measurements to determine the dynamic properties and modify the numerical model used for analysis, design, and retrofitting. The effectiveness of the proposed methodology as a tool for the design of new bridges and the retrofitting of existing structures was verified for all cases. Economic and structural benefits were evidenced by reductions in direct costs of up to 15% and the seismic force of up to 20%, respectively. [ABSTRACT FROM AUTHOR]

Aims: We aimed to conduct a clinical process cost analysis to evaluate all upcoming costs of mitral valve transcatheter edge-to-edge repair (M-TEER) treatment using the MitraClip and the PASCAL repair system. Methods: First, we prospectively enrolled 107 M-TEER patients treated with either the PASCAL or MitraClip system and compared all upcoming costs during the M-TEER procedure and the associated in-hospital stay. Second, we retrospectively analysed 716 M-TEER procedures with regard to the occurrence of complications and their associated costs. All materials used in the catheterization laboratory for the procedures were evaluated. The cost analysis considered various expenses, such as general in-hospital costs, device costs, catheter laboratory and material costs. Results: In the prospective study, 51 patients were treated using the PASCAL system, and 56 were treated using the MitraClip system. The two groups had comparable baseline characteristics and comorbidities. The total in-hospital costs were 25 414 (Interquartile range (IQR) 24 631, 27 697) € in the PASCAL group and 25 633 (IQR 24 752, 28 256) € in the MitraClip group (p = 0.515). The major cost driver was initial material expenditure, mostly triggered by device costs, which were similar to the PASCAL and MitraClip systems. Overall intensive care unit and general ward costs did not differ between the PASCAL and MitraClip groups. In the retrospective analysis, M-TEER-related complications were rare but were associated with higher costs, mainly due to prolonged hospitalisation. Conclusion: The major cost driver of M-TEER was the material expenditure, which was mostly triggered by high device costs. The costs of treating patients were similar for the PASCAL and MitraClip systems. M-TEER-related complications are associated with higher costs, mainly due to prolonged hospitalisation. This analysis provides valuable insights into reducing expenses by modifying the process of M-TEER. [ABSTRACT FROM AUTHOR]

Introduction: For individuals with lumbar spinal stenosis (LSS), minimally invasive procedures such as an interspinous spacer device without decompression or fusion (ISD) or open surgery (i.e., open decompression or fusion) may relieve symptoms and improve functions when patients fail to respond to conservative therapies. This research compares longitudinal postoperative outcomes and rates of subsequent interventions between LSS patients treated with ISD and those with open decompression or fusion as their first surgical intervention. Methods: This retrospective, comparative claims analysis identified patients age ≥ 50 years with LSS diagnosis and with a qualifying procedure during 2017–2021 in the Medicare database which includes healthcare encounters in inpatient and outpatient settings. Patients were followed from the qualifying procedure until end of data availability. The outcomes assessed during the follow-up included subsequent surgical interventions, including subsequent fusion and lumbar spine surgeries, long-term complications, and short-term life-threatening events. Additionally, the costs to Medicare during a 3-year follow-up were calculated. Cox proportional hazards, logistic regression, and generalized linear models were used to compare outcomes and costs, adjusted for baseline characteristics. Results: A total of 400,685 patients who received a qualifying procedure were identified (mean age 71.5 years, 50.7% male). Compared to ISD patients, patients receiving open surgery (i.e., decompression and/or fusion) were more likely to have a subsequent fusion [hazard ratio (HR), 95% confidence intervals (CI): 1.49 (1.17, 1.89)–2.54 (2.00, 3.23)] or other lumbar spine surgery [HR (CI): 3.05 (2.18, 4.27)–5.72 (4.08, 8.02)]. Short-term life-threatening events [odds ratio (CI): 2.42 (2.03, 2.88)–6.36 (5.33, 7.57)] and long-term complications [HR (CI): 1:31 (1.13, 1.52)–2.38 (2.05, 2.75)] were more likely among the open surgery cohorts. Adjusted mean index costs were lowest for decompression alone (US$7001) and highest for fusion alone ($33,868). ISD patients had significantly lower 1-year complication-related costs than all surgery cohorts and lower 3-year all-cause costs than fusion cohorts. Conclusions: ISD resulted in lower risks of short- and long-term complications and lower long-term costs than open decompression and fusion surgeries as a first surgical intervention for LSS. [ABSTRACT FROM AUTHOR]

Small and medium-sized firms in developing countries perform the majority of all reporting tasks in Microsoft excel. The material cost comparative analysis (MCCA) report took the user 58.51 minutes to complete and there was also a higher likelihood of calculation error. The report was created in Microsoft excel by the Lahore-based ABC footwear business. This used to take a lot of time to produce and there was a higher chance that the report would contain errors. This is because Microsoft excel visual basic for applications was used to automate the report. This report's manual preparation method was compiled by the company’s planning and costing division. Each activity was listed, followed by the completion of a time study. VBA macros were built in Excel to automate all manual report-related tasks and reduce the possibility of human error. Conditional statements were applied to help automated decision-making. To enable command buttons to run macros, one user form was created. There were various worksheets included in the MCA template. The automated template was found to consume only 16.26 minutes and it was quicker than the current technique.

Objectives: This study aimed to determine the agreement between a rapid diagnostic test (RDT) and a dried blood spot (DBS)-based electrochemiluminescence immunoassay (ECLIA) of hepatitis B surface antigen and to compare the costs of conducting serosurveys using RDTs and DBS in a field setting. Methods: A serosurvey was conducted in the South Central Coast region of Vietnam in May 2019. Participants aged 1-39 years were recruited using a four-stage random sampling method and tested for hepatitis B surface antigen using an RDT kit (Alere Determine) and a DBS-based ECLIA. The agreement between the RDT and the DBS-based ECLIA was assessed using cross-tabulation and Cohen kappa. Cost data were categorized by input (personnel, transportation, field consumables, laboratory consumables, and capital item/overhead) and survey phase (survey preparation, data/biospecimen collection, laboratory testing, and coordination). Results: A total of 2072 participants were analyzed. There was a 99% agreement between the RDT and the DBS-based ECLIA results, with a Cohen kappa of 0.9. The estimated cost of conducting a serosurvey by DBS was UD $75,291, whereas RDT was $53,182. Conclusion: RDTs and DBS-based ECLIA provide test results with high agreements. RDTs are a better option in terms of cost, whereas the DBS-based ECLIA may be useful when evaluating multiple infectious diseases.

Background: Postoperative rehabilitation after primary total hip arthroplasty (p-THA) differs between the Netherlands and Germany. Aim is to compare clinical effectiveness and to get a first impression of cost effectiveness of Dutch versus German usual care after p-THA. Methods: A transnational prospective controlled observational trial. Clinical effectiveness was assessed with self-reported questionnaires and functional tests. Measurements were taken preoperatively and 4 weeks, 12 weeks, and 6 months postoperatively. For cost effectiveness, long-term economic aspects were assessed from a societal perspective. Results: 124 working-age patients finished the measurements. German usual care leads to a significantly larger proportion (65.6% versus 47.5%) of satisfied patients 12 weeks postoperatively and significantly better self-reported function and Five Times Sit-to-Stand Test (FTSST) results. German usual care is generally 45% more expensive than Dutch usual care, and 20% more expensive for working-age patients. A scenario analysis assumed that German patients work the same number of hours as the Dutch, and that productivity costs are the same. This analysis revealed German care is still more expensive but the difference decreased to 8%. Conclusions: German rehabilitation is clinically advantageous yet more expensive, although comparisons are less straightforward as the socioeconomic context differs between the two countries. Trial registration: The study is registered in the German Registry of Clinical Trials (DRKS00011345, 18/11/2016). [ABSTRACT FROM AUTHOR]

In this study, we examined the feasibility of employing zero-valent iron (ZVI) as a heterogeneous reactant in the photo-Fenton degradation of Rhodamine B (RhB) in water, utilizing solar energy. ZVI was implemented as a heterogeneous reactant for Fenton degradation of RhB in water, while solar energy-driven photo-Fenton degradation was carried out to assess the impacts of varying H2O2 and ZVI concentrations on these processes. Our experimental findings revealed that the photodegradation reaction rate of RhB, powered by solar energy at a light intensity of 1200–1400 W/m2, was 1.7 times greater than that of the Fenton reaction, facilitating more rapid degradation of dye wastewater. Solar energy photo-Fenton necessitated merely 0.5 mM H2O2 and 8.92 mM ZVI to fully decompose RhB within 30 min, with the chemical oxygen demand (COD) removal efficiency being twice as high as the Fenton reaction. A cost analysis demonstrated that reusing ZVI for 33 times decreased the dose cost by 0.68 USD per ton in comparison with use of conventional homogeneous Fe2+ as a catalyst. The application of ZVI as a heterogeneous reactant for RhB degradation in water by solar energy photo-Fenton has significantly lower dose costs and offers potential for practical implementations. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to compare the cost per use of video-rhinolaryngoscopy using reusable and disposable devices in a tertiary referral centre. Methods: A cost-comparison study was performed that utilised retrospective cost data and prospective utilisation data to compare the total costs of using reusable video-rhinolaryngoscopes versus a single-use alternative. Results: It was estimated that 4776 and 1821 procedures were performed annually with reusable and disposable video-rhinolaryngoscopes, respectively. The cost per use was £66.61 for reusable devices versus £150.00 for disposable devices. The break-even point (i.e. when cost per use was equal, occurred at 1374 procedures per year). Thereafter, it was cheaper to use reusable devices. Conclusion: Disposable rhinolaryngoscopes may present a cheaper solution to services with low rates of rhinolaryngoscope utilisation. However, for larger services considering replacement of their reusable rhinolaryngoscopes with disposable units, it is likely that the recurring costs will be prohibitive in the medium to long term. [ABSTRACT FROM AUTHOR]

Background: Intramedullary screw fixation is a relatively new technique for fixation of metacarpal and phalangeal fractures. The objective of this study was to compare health care–associated costs and outcomes for intramedullary screw versus Kirschner wire (K-wire) fixation of hand fractures. Methods: A retrospective review of patients undergoing intramedullary screw fixation of hand fractures at a single center during 2016-2019 inclusive was conducted. Health care–associated costs were compared with age-matched and fracture pattern–matched controls who underwent K-wire fixation. Results: Fifty patients met the study inclusion criteria, incorporating 62 fractures (29 K-wire, 33 intramedullary screw fixation). The median age was 34.6 years (18.0-90.1 years). There was no significant difference in primary operative costs (£1130.4 ± £162.7 for K-wire vs £1087.0 ± £104.2 for intramedullary screw), outpatient follow-up costs (£958.7 ± £149.4 for K-wire vs £782.4 ± £143.8 for intramedullary screw), or total health care–associated costs (£2089.1 ± £209.0 for K-wire vs £1869.4 ± £195.3 for intramedullary screw). However, follow-up costs were significantly lower for the uncomplicated intramedullary screw cohort (£847.1 ± £109.1 for K-wire vs £657.5 ± £130.8 for intramedullary screw, P =.05). Subgroup analysis also revealed that overall costs were significantly higher for buried K-wire techniques. Complication rates, time to return to active work, and Disabilities of the Arm, Shoulder, and Hand scores were similar. Conclusions: This study identified significantly lower outpatient follow-up costs for uncomplicated intramedullary screw fixation of hand fractures compared with K-wires, along with a trend toward lower overall health care–associated costs. In addition, buried K-wire techniques were also found to carry a significantly higher financial burden. Higher powered prospective studies are required to determine indirect costs. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic impacts on working routines and workload of palliative care (PC) teams but information is lacking how resource use and associated hospital costs for PC changed at patient-level during the pandemic. We aim to describe differences in patient characteristics, care processes and resource use in specialist PC (PC unit and PC advisory team) in a university hospital before and during the first pandemic year. Methods: Retrospective, cross-sectional study using routine data of all patients cared for in a PC unit and a PC advisory team during 10–12/2019 and 10–12/2020. Data included patient characteristics (age, sex, cancer/non-cancer, symptom/problem burden using Integrated Palliative Care Outcome Scale (IPOS)), information on care episode, and labour time calculated in care minutes. Cost calculation with combined top-down bottom-up approach with hospital's cost data from 2019. Descriptive statistics and comparisons between groups using parametric and non-parametric tests. Results: Inclusion of 55/76 patient episodes in 2019/2020 from the PC unit and 135/120 episodes from the PC advisory team, respectively. IPOS scores were lower in 2020 (PCU: 2.0 points; PC advisory team: 3.0 points). The number of completed assessments differed considerably between years (PCU: episode beginning 30.9%/54.0% in 2019/2020; PC advisory team: 47.4%/40.0%). Care episodes were by one day shorter in 2020 in the PC advisory team. Only slight non-significant differences were observed regarding total minutes/day and patient (PCU: 150.0/141.1 min., PC advisory team: 54.2/66.9 min.). Staff minutes showed a significant decrease in minutes spent in direct contact with relatives (PCU: 13.9/7.3 min/day in 2019/2020, PC advisory team: 5.0/3.5 min/day). Costs per patient/day decreased significantly in 2020 compared to 2019 on the PCU (1075 Euro/944 Euro for 2019/2020) and increased significantly for the PC advisory team (161 Euro/200 Euro for 2019/2020). Overhead costs accounted for more than two thirds of total costs. Direct patient cost differed only slightly (PCU: 134.7 Euro/131.1 Euro in 2019/2020, PC advisory team: 54.4 Euro/57.3 Euro). Conclusions: The pandemic partially impacted on daily work routines, especially on time spent with relatives and palliative care problem assessments. Care processes and quality of care might vary and have different outcomes during a crisis such as the COVID-19 pandemic. Direct costs per patient/day were comparable, regardless of the pandemic. [ABSTRACT FROM AUTHOR]

Disposal or incineration of waste low-density polyethylene (LDPE) bags is a major problem, as it causes pollution. The pavement over time gets deteriorated by vehicular traffic, which mostly results in rutting and other distresses. This research is based on the performance evaluation of hot mix asphalt (HMA) modified with LDPE. Aggregates National Highway Authority Pakistan (NHA) gradation B, bitumen grade 60/70 and waste LDPE bags from the dump yards of Islamabad (Pakistan) were used in this study. Penetration, ductility and softening-point tests were conducted with bitumen modified with different contents of waste LDPE bag flakes; i.e., 0%, 2%, 4%, 6% and 8% to figure out the optimum modifier content (OMC). Marshall testing was performed for the determination of optimum bitumen content (OBC). Using OBC and incorporating LDPE contents as a replacement for OBC, HMA samples were tested for performance evaluation, including rutting resistance and moisture susceptibility and compared with the performance of unmodified HMA. It was observed that 4% of LDPE as a replacement for OBC in the HMA can be used as OMC and yielded better performance results than unmodified asphalt mix. Rutting resistance was improved by 20.86% and tensile strength ratio (TSR) for moisture susceptibility evaluation was above the specified limit of 80%. [ABSTRACT FROM AUTHOR]

Chronic subdural hematoma (cSDH) can be treated with conventional surgery or middle meningeal artery embolization (MMAE). The cost profiles of open surgery versus MMAE have never been studied. Therefore, we sought to compare the costs of surgical and MMAE treatment of cSDH. Patients treated with open surgery (2006–2019) and MMAE (2018–2020) were identified from the institutional database. Propensity score matching analysis was used to assemble a balanced group of subjects. Detailed hospitalization costs in each group were collected and compared. A total of 341 conventionally treated and 52 MMAE cases were identified. After propensity score matching, 33 patients were included in each group, for a total of 66 patients for analysis. Direct procedural cost was significantly greater in the MMAE group compared with the open surgery group ($38,255 ± $11,859 vs. $11,206 ± $7888; P < 0.001). Medication cost also was greater in the MMAE group ($6888 ± $6525 vs. $4291 ± $3547; P = 0.048). No significant difference was found in costs for intensive care unit care, pharmacy, therapy, laboratory values, and the emergency department. Imaging costs and other miscellaneous costs (e.g., wound care, preoperative, and postanesthesia care unit) were greater in the open surgery group (P < 0.05). Total hospitalization cost was not significantly different between the 2 groups ($60,598 ± 61,315 vs. $71,569 ± $37,813 for open surgery and MMAE respectively, P = 0.385). No significant differences in number of follow ups or total costs for follow up were found (P > 0.05). Open surgery and MMAE offer an overall equivalent cost-profile for cSDH treatment when matching for potential cost confounders. Direct procedural costs are greater in MMAE; however, total hospitalization costs and follow up costs are not significantly different. [ABSTRACT FROM AUTHOR]

Rationale and Objective: Recent initiatives aim to improve patient satisfaction and autonomy by increasing the use of peritoneal dialysis (PD) in the United States. However, limited knowledge is available about the costs of different dialysis modalities, particularly those incurred by private insurers. In this study, we compared the costs of injectable dialysis drugs (and their oral equivalents) paid by insurers between privately insured patients receiving hemodialysis and PD. Study Design: A retrospective cohort study. Setting and Participants: From a private insurance claims database, we identified patients who started receiving PD or in-center hemodialysis between January 1, 2017, and December 31, 2020. Exposure: Patients started receiving PD. Outcomes: Average annual injectable drug and aggregate expenditures and expenditure subcategories. Analytical Approach: Patients who started receiving PD were propensity matched to similar patients who started receiving hemodialysis based on the year of dialysis initiation, patient demographics, health, geography, and comorbidities. Cost ratios (CRs) were estimated from generalized linear models. Results: We matched 284 privately insured patients who started receiving PD 1:1 with patients started receiving in-center hemodialysis. The average annual injectable drug expenditures for hemodialysis were 2-fold higher (CR: 1.99; 95% CI, 1.62-2.44) than that for PD. Compared those receiving PD, patients receiving hemodialysis incurred significantly lower nondrug dialysis-related expenditures (0.85; 95% CI, 0.76-0.94). The average annual expenditures for non–dialysis-dependent outpatient services were significantly higher among patients who underwent in-center hemodialysis (CR: 1.44; 95% CI, 1.10-1.90). Although aggregate and inpatient hospitalization expenditures were higher for in-center hemodialysis, these differences did not reach statistical significance. Limitations: Small sample sizes may have restricted our ability to identify differences in some cost categories. Conclusions: Compared with privately insured patients who started receiving PD, patients starting in-center hemodialysis incurred higher expenditures for injectable dialysis drugs, whereas differences in other expenditure categories varied. Recent increases in the use of PD may lead to reductions in injectable dialysis drug costs among privately insured patients. Plain Language Summary: Recent initiatives aim to improve patient satisfaction and autonomy by increasing the use of peritoneal dialysis (PD) in the United States. However, limited knowledge is available about the costs of different dialysis modalities, particularly those incurred by private insurers. In this study, we compared the costs of injectable dialysis drugs (and their oral equivalents) provided by insurers between privately insured patients receiving hemodialysis and PD. We found that the average annual injectable drug expenditures for hemodialysis were 2.0-fold higher compared with those for PD. These findings suggest that the recent increase in the use of PD may lead to reductions in injectable dialysis drug costs among privately insured patients.

To address previous limitations of belled piers embedded in expansive soils, a numerical investigation is performed using the finite element-based software Abaqus. A parametric study, cost comparison, and trend line development (for design) were conducted. The parametric investigations indicated that when designing belled piers in expansive soils, increasing the shaft diameter is preferred to increasing the length, or the bell size; the limiting diameter for belled piers is much higher than that for straight shaft piers; most belled piers in expansive soils in Ethiopia do not need tensile reinforcement; and the applied load needed to fully eliminate tensile stresses in belled piers is less than that needed in straight shaft piers. The cost comparison indicated that for smaller values of the swelling pressure and the depth of the swelling zone, straight shaft piers are more cost-effective; while for medium to large values of the swelling pressure and the depth of the swelling zone, large bell size belled piers are more cost-effective. The trend lines indicated that in Ethiopia belled piers with the minimum sizes can be used.

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Robotic-assisted pyeloplasty (RAP) is a mainstay in the treatment of ureteropelvic junction obstruction (UPJO) in children. At our institution, to limit planned operating rooms visits we have placed a ureteral stent with an external string (SWES) immediately prior to RAP. In this study, we sought to quantify the operative time, complications, and costs associated with this approach compared to the traditional approach, requiring subsequent stent removal in the operating room. We hypothesized the SWES cohort would have decreased cost, yet with similar operative time and complications. We retrospectively collected all RAPs performed at our institution using the SWES approach (Aug 2012–July 2017). We excluded those with a redo pyeloplasty, and/or a percutaneous nephrostomy tube for post-operative drainage. We collected 30-day costs linked to the patients' MRN using the Pediatric Health Information System (PHIS) database. We compared 30-day healthare costs for all patients following RAP. We compared our SWES group to a national cohort of all pediatric RAP during the same time period. Lastly, we sent an anonymous, electronic survey to urologists of all PHIS institutions to identify the predominant postoperative drainage, nationally. Within our institution, we reviewed all those treated with SWES (n = 85) (Table 1). The median 30-day cost was $10,548 among those with SWES (Table 2). This was significantly less than the overall, national cohort of all pediatric RAP during the same period ($14,119, p < 0.001). There was a 15.5 % rate of unplanned return to the hospital in the SWES group. Of those unplanned returns, 8.2 % (7/85) had unplanned return for a procedure (3 for unplanned stent removal, 2 for nephrostomy tube for persistent obstruction, 1 for omental hernia, and 1 for stent replacement). With a 42.5 % (37/87) response rate, our nationwide survey found 84.6 % primarily leave stents WITHOUT a string, 7.7 % left nephrostomy tubes, and 7.7 % stents with strings. During pediatric RAP, placement of a SWES takes little time, carries a risk of unplanned visit to the operating room, saves the patient a certain, second anesthetic for stent removal, and amounts to a cost savings of approximately 25 %. [ABSTRACT FROM AUTHOR]

This study investigates the performance of a newly developed technology, known as simultaneous anaerobic oxidation/partial nitrification–denitrification (SAO/PND), for treating strong wastewater under laboratory conditions. Excellent results are achieved, with maximum chemical oxygen demand (COD) and nitrogen removal of 98% and 96%, respectively, when treating synthetic wastewater with influent 4120 mg/L COD and 210 mg/L NH4+–N. Appropriate living environment in this single‐process technology favoured the co‐existence of various bacterial communities, and removal mechanisms by these organisms are identified and confirmed. The results showed that the single‐process SAO/PND technology required 95% and 90% less oxygen compared to conventional aerobic processes and combined systems, respectively. Furthermore, this newly developed technology produced 60% and 44% less sludge, respectively, in comparison with the mentioned conventional systems. This study shows that the single‐process SAO/PND technology is a promising sustainable alternative to conventional systems, as it combines high efficiency and cost‐effectiveness with simple operation and maintenance requirements. [ABSTRACT FROM AUTHOR]

The current study focuses on the structure cost and the energy efficiency for a five-storey building located in Timisoara, Romania. A cost comparison and the energy demand between two types of structures was concluded, namely a concrete structure and a masonry structure. The study focuses only on the building's structure because the building's finishes and the installation are the same for both cases. Regarding the energy efficiency, the difference appears for the exterior walls, in the first case, for the concrete structure building the walls are realized with autoclaved cellular concrete (ACC) and in the second case for the masonry structure the exterior walls are realized with brick masonry. The walls insulation is the same in both cases. [ABSTRACT FROM AUTHOR]

Electrocatalytic reduction is a promising alternative to remove nitrate (NO 3 –) from water and potentially recover value-added ammonia, but advancements are needed to reduce costs and promote technology adoption. Five monometallic catalysts on activated carbon cloth (ACC) electrodes were evaluated for electrocatalytic NO 3 – treatment in a previously developed scalable flow reactor. We report Cu and, for the first time, In (as In 2 O 3) are the best performing catalysts regarding NO 3 – reduction activity (0.45–2.4 L g metal –1 min–1), Faradaic efficiency (FE), and NH 4 + selectivity, with intermediate NO 2 – accumulation using Cu and NH 2 OH using In. We discovered trace Pd addition (i.e., 0.01 wt%) to Cu eliminates NO 2 – accumulation, while approximately doubling activity, and boosting FE and NH 4 + selectivity (99 %). Activity of Cu–Pd/ACC decreased with repeated treatment cycles but was easily recovered in situ via electrochemical regeneration. Electrocatalytic NO 3 – reduction costs with the Cu–Pd electrode were estimated less than IX or catalytic treatment, indicating economic viability. [Display omitted] • In 2 O 3 electrode showed the highest electrocatalytic nitrate reduction activity. • Cu 0.01 % Pd electrode showed the best activity, FE, and NH 4 + selectivity combination. • Cu–Pd electrodes can be electrochemically regenerated in situ to restore activity. • Electroreduction with Cu–Pd electrodes is economically competitive with ion exchange. [ABSTRACT FROM AUTHOR]

Objective To establish a routine screening method for unexpected antibodies of blood donors, analyze the results of centralized screening for unexpected antibody of blood donors in the blood center, and compare the cost of centralized and decentralized screening modes. Methods A total of 35 591 blood donors were screened for unexpected antibodies from March 31, 2021 to July 31, 2021, using microcolumn gel method. Unexpected antibody screening reactive samples were further confirmed by the Transfusion Research Institute of Shenzhen Blood Center, and the demographic characteristics were further determined through the analysis of unexpected antibody positive population. The direct cost and indirect cost of centralized and decentralized unexpected antibody screening mode were compared. Results Forty unexpected antibody positive samples were confirmed in Shenzhen, with the positive rate at 0.11%(40/35 591), among which MNS, Rh and Lewis system accounted for 35% (14/40), 32.5% (13/40) and 17.5% (7/40), respectively. Males and females accounted for 45% (18/40) and 55% (22/40), respectively (P0.05). Unexpected antibody screening in a centralized way saved about 1.16 million yuan per year. Conclusion It is necessary to carry out unexpected antibody screening for all blood donors, and centralized screening is more economical than decentralized screening.

Abstract Background A superior analgesic method in perioperative pain-management of patients receiving total knee arthroplasty is the subject of controversial debate. Although higher cost-efficiency is claimed for the local infiltration analgesia (LIA), there is a lack of data on its costs compared to peripheral nerve block anaesthesia (PNBA). The goal of this study was to investigate the differences in immediate perioperative costs between the LIA and PNBA in treatment of patients receiving total knee arthroplasty. Methods The comparison was conducted based on a randomized controlled clinical trial examining 40 patients with elective, primary total knee arthroplasty (TKA, 20 patients with LIA and 20 patients with PNBA). The analysis included surgical case costs, anaesthesiological case costs, material, costs of postoperative opioid requirements and catheter review visits for patients receiving PNBA. Results The overall mean costs for the LIA-group were 4328.72€ and 4368.12€ for the PNBA (p = 0.851). While there was no statistically significant difference in surgical case costs, the anaesthesiological costs were lower with the LIA procedure (1370.26€ vs. 1542.45€, p = 0.048). Material costs in the LIA group were 4.18€/patient and 94.64€/patient with the PNBA. Costs for postoperative opioid requirements showed no statistically significant difference between the two procedures. Conclusions There is no relevant difference in immediate perioperative costs between LIA and PNBA. Shorter induction times lead to lower anaesthesiological case costs with the LIA. Overall economic aspects seem to play a less important role for determining an adequate procedure for perioperative pain management. Trial registration The study was approved by the ethics-review-board of Charité Hospital Berlin (Ethikausschuss 4, Charité – Universitätsmedizin Berlin, on 16th February 2017) and registered with data safety authorities. Study patients provided written informed consent to participate in the trial. Study registry: ClinicalTrials.gov, NCT03114306 .

Background: Containing expenditure and efficient resource use is essential to limit the increasing costs of health research. Electronic data collection (EDC) is thought to reduce the costs compared to paper-based data collection (PDC). Objectives: As economic evidence in this area is scanty, especially in low- and middle-income countries, the objectives of the study are to perform an economic evaluation and compare the cost between EDC and PDC. Methods: A cost-comparison study was conducted to compare between EDC and PDC from the institutional perspective for the year 2018, based on a community-based survey. Step-down cost accounting was adopted with a bottom-up approach for cost estimation. Total and unit costs were estimated with the base case comparison between EDC and PDC while using SPSS software (e-SPSS and p-SPSS, respectively). We conducted scenario analyses based on the usage of different software, R and STATA for both EDC and PDC (e-R, p-R, e-STATA, and p-STATA, respectively). One-way and probabilistic sensitivity analysis (PSA) was performed to examine the robustness of the observed results. Results: In the base-case analysis, total costs of EDC and PDC were ₹72,617 ($1060.9) and 87,717 ($1281.5), respectively, with estimated cost reduction of ₹15,100 ($220.6). In other scenarios, the estimated cost reduction for e-R, e-STATA, p-R, p-STATA was ₹−274 ($4.0), 98 ($1.4), 14826 ($216.6), and 15,002 ($219.2), respectively, when compared to EDC-SPSS. On one-way and PSA, the results of the cost-comparison analysis were robust. Conclusion: EDC minimizes institutional cost for conducting health research. This finding will help researchers in efficiently planning for the budget for their research.

• Hepatitis B surface antigen was measured by two tests from representative samples. • Rapid diagnosic test and dried blood spot-based immunoassay had a high agreement. • Rapid diagnosic test is less costly, but dried blood spot test allows testing for multiple diseases. • The cost and advantages of each testing method should be considered. This study aimed to determine the agreement between a rapid diagnostic test (RDT) and a dried blood spot (DBS)-based electrochemiluminescence immunoassay (ECLIA) of hepatitis B surface antigen and to compare the costs of conducting serosurveys using RDTs and DBS in a field setting. A serosurvey was conducted in the South Central Coast region of Vietnam in May 2019. Participants aged 1-39 years were recruited using a four-stage random sampling method and tested for hepatitis B surface antigen using an RDT kit (Alere Determine) and a DBS-based ECLIA. The agreement between the RDT and the DBS-based ECLIA was assessed using cross-tabulation and Cohen kappa. Cost data were categorized by input (personnel, transportation, field consumables, laboratory consumables, and capital item/overhead) and survey phase (survey preparation, data/biospecimen collection, laboratory testing, and coordination). A total of 2072 participants were analyzed. There was a 99% agreement between the RDT and the DBS-based ECLIA results, with a Cohen kappa of 0.9. The estimated cost of conducting a serosurvey by DBS was UD $75,291, whereas RDT was $53,182. RDTs and DBS-based ECLIA provide test results with high agreements. RDTs are a better option in terms of cost, whereas the DBS-based ECLIA may be useful when evaluating multiple infectious diseases. [ABSTRACT FROM AUTHOR]

Featured Application: In this work, a methodology for the quantitative assessment of additive manufacturing and conventional manufacturing technology value chains is presented for the production of injection molding tools. The development of injection molding tools is an expensive, time-consuming, and resource-intensive process offering little to no flexibility to adapt to variations in product design. Metal additive manufacturing can be used to produce these tools in a cost-effective way. Nevertheless, in an industrial context, effective methods are missing for the selection of the most suitable technology for the given tooling project. This paper presents a method to compare process chains based on additive and conventional subtractive technologies for the manufacturing of metal tooling for injection molding. The comparison is based on a technology focused-performance analysis (TFPA) through computer simulation performed using Tecnomatix Plant Simulation developed by Siemens Digital Industries Software combined with a customized cost–benefit economic analysis tool. The analysis of the technology comparison highlights potential bottlenecks for production, such as the printing phase and the heat treatment. It also gives a deeper understanding of the technology maturity level of conventional milling machines against laser powder bed fusion machines. The result is that the total costs for an insert made by AM and CM are indeed rather similar (the cost difference between the two tooling process chains is lower than 5%). The cost analysis reveals major costs drivers in the production of high-performance molding tools, such as the cutting tools employed for the milling steps and their changeover frequency. The industrial case of a 32-cavity mold insert for plastic injection molding is used to perform the study, develop the analysis, and validate the results. [ABSTRACT FROM AUTHOR]

Truck platooning is defined as a convoy of freight vehicles operated using an electronic coupling system, and has several advantages, particularly in terms of cost savings for fuel consumption and labor. Platooning technology is introduced by discussing several issues: the distance between trucks, number of trucks convoyed, waiting time at the platooning center, and distance between the origin and destination, all of which are variables that influence the transport costs. Important is to identify the extent to which these factors affect borderline conditions for single or platooning freight transport operations. Therefore, this study aims to develop a cost function of platooning operations, compare transport costs between single and platooning operations, determine the factors that affect the transport costs and identify the borderline conditions for single or platooning operations. The cost functions in the hypothetical network were developed by considering the important factors that contribute to the transport costs in Japanese road freight transport. A scenario analysis was conducted to investigate the impact of the inter-vehicle distance and the number of platooned trucks on the borderline conditions. Our results revealed that the platooning operation would offer a comparative advantage with a shorter inter-vehicle distance. For example, for an inter-vehicle distance of 49 m and a distance of 800 km between the origin and destination, the platooning operation is not advantageous compared with manned driving unless the waiting time at the platooning center is less than 30 min. In addition, a platooning operation is feasible even with a travelling distance of 100 km if the trailing vehicles are unmanned. The highest cost contributor is the cost of labor, the reduction of which can significantly reduce the total transport costs.

OBJECTIVE Comparison of the actual cost of hospitalization in a pediatric intensive care unit (ICU) and in an adult ICU with the reimbursement paid by the National Organization for the Provision of Health Services (EOPYY) to each hospital for ICU expenses. METHOD A retrospective observational study was carried out. The actual cost was estimated using the bottom-up cost analysis methodology. The hospital compensation from the EOPYY was calculated, taking into account the length of hospitalization of the patients. Sociodemographic and clinical characteristics were retrieved from the patients' files. The financial daily deficit per ICU bed was calculated as the difference between the actual cost of hospitalization and EOPYY hospital compensation, in order to evaluate the hospital expense. The actual cost of hospitalization and the hospital compensation from EOPYY were estimated for the patients admitted to one adult ICU and one pediatric ICU in hospitals located in Attica, Greece, for four calendar years (January 2016-December 2019). RESULTS A total number of 928 pediatric and 718 adult ICU patients were admitted during the study period and their expenses constitute the basis of this study. The actual hospital ICU costs were higher than the amount compensated by EOPYY, for both the adult and the pediatric ICU population. The financial daily deficit per ICU bed was remarkably higher in the pediatric ICU. The most significant contributor to the actual cost of ICU care was personnel reimbursement. CONCLUSIONS The introduction in Greece of the diagnosis-related system for estimation of care costs (KEN-DRGs) does not appear to provide adequate compensation for public hospitals regarding hospitalization of patients in the ICU. [ABSTRACT FROM AUTHOR]

To address previous limitations of belled piers embedded in expansive soils, a numerical investigation is performed using the finite element-based software Abaqus. A parametric study, cost comparison, and trend line development (for design) were conducted. The parametric investigations indicated that when designing belled piers in expansive soils, increasing the shaft diameter is preferred to increasing the length, or the bell size; the limiting diameter for belled piers is much higher than that for straight shaft piers; most belled piers in expansive soils in Ethiopia do not need tensile reinforcement; and the applied load needed to fully eliminate tensile stresses in belled piers is less than that needed in straight shaft piers. The cost comparison indicated that for smaller values of the swelling pressure and the depth of the swelling zone, straight shaft piers are more cost-effective; while for medium to large values of the swelling pressure and the depth of the swelling zone, large bell size belled piers are more cost-effective. The trend lines indicated that in Ethiopia belled piers with the minimum sizes can be used. [ABSTRACT FROM AUTHOR]

The drive towards smart and sustainable manufacturing is leading companies to opt for environmentally conscious technologies. This study assesses the environmental and financial feasibility of using additive manufacturing, in this case, fused filament fabrication (FFF), instead of injection moulding (IM) to mass-produce cosmetic plastic packaging. Using a life cycle assessment (LCA), the environmental impacts of the raw material production and manufacturing processes were assessed for both technologies. The results showed that using FFF creates a five times greater environmental impact, with printing energy consumption generating 80% of the impact. Using costing models, the cost per product produced using IM and FFF was evaluated, and the models showed that the raw material costs comprise the highest share in both cases. A net present value (NPV) model over twelve years indicated that the FFF NPV was seventeen times higher than that of IM. When testing for quality, the packages produced using IM were superior overall. This study concludes that FFF is more expensive and environmentally impactful when compared to IM.