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Psycholeptic and specifically antipsychotic prescribing is increasing worldwide each year. This study aims to investigate the prevalence and cost of antipsychotic prescribing, within the wider frame of psycholeptic prescribing, in the Irish context. Quantitative analysis of a dataset from the Primary Care Reimbursement Service relating to cost and prescribing frequency of ATC Class N05 psycholeptic drugs from January 2020–August 2022 inclusive was conducted using Microsoft® Excel® for Microsoft 365 MSO (Version 2311) and STATA 18. Descriptive statistics and time-trend regression analysis were used to investigate the prescribing prevalence of psycholeptics and antipsychotics licensed for use in the Republic of Ireland, and the total cost per funding scheme. The prevalence of psycholeptic prescribing increased yearly from 2020–2022, peaking at 328,572 prescriptions in December 2020 with a total cost of psycholeptic drugs to the State in 2021 of €57,886,250, which was 0.5% of an increase on 2020. Over the 32-month time period, the average monthly cost of psycholeptic drugs was €4,436,469 on the General Medical Services (GMS) scheme and €369,154 on the Drug Payment Scheme (DPS). In 2021, quetiapine, olanzapine, and risperidone were the most prescribed antipsychotics, accounting for 66.58% of antipsychotics prescribed on the GMS scheme. This study identified the large expenditure on psycholeptics and antipsychotics in Ireland, with a higher proportion of the Irish healthcare budget spent on antipsychotics than that of the UK and the USA. The development of Irish antipsychotic prescribing guidelines may allow for structured, cost-effective prescribing. [ABSTRACT FROM AUTHOR]

Simple Summary: There is a scarcity of economic analysis on the use of non-invasive biomarkers to inform policy-making with respect to their application in population-based colorectal cancer (CRC) screening programs. The objective of this study is to conduct a comparative cost-effectiveness analysis on using M3CRC (m3 + Fn + Ch + Bc + FIT) as a primary test for population-based screening, when compared with FIT and colonoscopy. The study can provide economic analysis regarding the use of non-invasive biomarkers in population-based CRC screening programs. This study aimed to examine the cost-effectiveness of fecal biomarker M3 panel compared to fecal immunochemical test (FIT) and colonoscopy in an Asian population. In a hypothetical population of 100,000 persons aged 50 years who received FIT yearly, M3 biomarker yearly, or colonoscopy every 10 years until the age of 75 years. Participants with positive FOBT or a result of "high risk" identified using the M3 biomarker are offered colonoscopy. We assumed surveillance colonoscopy is repeated every 3 years, and examined the treatment cost. A comparison of various outcome measures was conducted using Markov modelling. The incremental cost-effectiveness ratio (ICER) of FIT, M3 biomarker, and colonoscopy was USD108,176, USD133,485 and USD159,596, respectively. Comparing with FIT, the use of M3 biomarker could lead to significantly smaller total loss of cancer-related life-years (2783 vs. 5279); a higher number of CRC cases prevented (1622 vs. 146), a higher proportion of CRC cases prevented (50.2% vs. 4.5%), more life-years saved (2852 vs. 339), and cheaper total costs per life-year saved (USD212,553 vs. 773,894). The total costs per life-year saved is more affordable than that achieved by colonoscopy as a primary screening tool (USD212,553 vs. USD236,909). The findings show that M3 biomarkers may be more cost-effective than colonoscopy. [ABSTRACT FROM AUTHOR]

With the rapid growth in industrial development, there is a particular need for new environmentally balanced energy source utilization. Ethanol produced from biomass, especially lignocellulosic waste products, represents an attractive, sustainable energy source for fuel production. Until now, in Poland, bioethanol has been produced from edible plants containing sugars susceptible to fermentation. Due to the growing technical and economical needs for alternative biomass source utilization, in the present work, an attempt has been made to identify the most cost-effective strategy to analyze ethyl alcohol production from different lignocellulose sources. The concept of an installation for the first and second stages of bioethanol production was proposed. All of the most relevant elements of the bioethanol production cost analysis were identified and characterized. Cost analyses of all important production process elements showed their relative effects on the production cost and potential for the competitive advantage of applied raw material. The study demonstrates the importance of renewable energy source utilization and the cost-effectiveness of bioethanol production. Furthermore, the proposed less energy- and labor-demanding process, primarily achieved via the implementation of technological medium recovery and recirculation, reduces the production cost and results in higher production efficiency, and therefore has a significant effect on the overall process economy. [ABSTRACT FROM AUTHOR]

Cataract is a major cause of blindness worldwide. In particular, in low-income countries, the burden of disease as well as its direct and indirect economic cost are a major challenge for the population and economy. In many cases, it would be possible to prevent or cure blindness with a comparably simple cataract surgery, but many countries lack the resources to strengthen healthcare systems and implement broad cataract surgery programs reaching, in particular, the rural poor. In this paper, we analyse whether such an intervention could be cost-effective or even cost-saving for the respective health systems. We calculate the net value of the lifelong costs of cataract with and without surgery. This calculation includes direct costs (e.g., treatment, glasses, surgery) as well as indirect cost of the caregiver and the patient. We total all costs from the year of onset of cataract until death and discount the respective values to the year of onset. We define the surgery as cost-saving if the net-value of costs with surgery is lower than without surgery. If the cost per quality adjusted life year is lower than one gross national product per capita, we define the intervention as highly cost-effective. We find that the cost-effectiveness of cataract surgery depends on the age of onset of the disease and the age of surgery. If the surgery is performed with the beginning of severe impairment, even surgery of a 78-year-old patient is still cost-saving. Almost all possible constellations are highly cost-effective, only for the very old it is questionable whether the surgery should be performed. The simulations show that cataract surgery is one of the most cost-effective interventions. However, millions of people in low-income countries still have no chance to prevent or cure blindness due to limited resources. The findings of this paper clearly call for a stronger effort to reach poor and rural populations with this cost-effective service. [ABSTRACT FROM AUTHOR]

Purpose: Pediatric head traumas constitute the majority of admissions to emergency departments (ED) due to trauma. This study aims to draw attention to the use of cranial computerized tomography (CT) scans in the evaluation of children with head trauma under the age of 18, and to determine CT scans' usefulness in terms of cost-effectiveness. Materials and Methods: Age, gender, mechanism of trauma and Glasgow Coma Scale (GCS), diagnosis, time of admission to hospital, hospitalization and operation, cranial computerized tomography and hospitalization costs of all cases were retrospectively analyzed. Results: A total of 26,412 patients younger than 18 years old who were admitted to the emergency department due to head trauma and who had a cranial tomography were analyzed. They had a mean age of 7.74 ± 5.66 years. In total, 26,363 (99.8%) of these patients had a GCS greater than 14. Out of these patients, only 402 (1.5%) had brain injury revealed by cranial CT, 41 (0.2%) of these patients were operated and 3 of the patients lost their lives. The total cost of patients admitted to the emergency department with a head injury amounts to USD 583,317. Furthermore, 75.78% of this cost comes from negative cranial CTs. A cost analysis according to different age groups did not show a meaningful difference between 0–2 years and 3–5 years (p = 1.000), but there was a meaningful difference for all the other age groups. Conclusion: Our findings show that applying algorithms to predict traumatic brain injury in children with mild head injury rather than scanning all patients with cranial CT will enable more reliable and cost-effective patient care. Current practices should be reviewed to avoid unnecessary radiation exposure and expense in the ED. It is also necessary to inform and educate parents about the risk/benefit ratio of cranial CT scans. [ABSTRACT FROM AUTHOR]

The sustainability index, waste energy ratio and improvement potential of a staggered air jet impingement on the staggered spherical protrusions of a roughened absorber plate were derived for the present study to evaluate exergy losses and irreversibility in the system. The experimental analysis was carried out for selected parameters: relative streamwise pitch, relative spanwise pitch and relative jet diameter to hydraulic diameter ratio. The flow Reynolds number ranged from 4000–18,000. The augmentation in Nusselt number and friction factor compared to a smooth surface was 4.9 and 12.4 times, respectively. The statistical correlation developed determined the maximum thermohydraulic performance parameter and exergetic efficiency be 3.02 and 3.87%, respectively. The magnitude of the sustainability index, waste energy ratio and improvement potential was found to be 1.0347, 0.962 and 10.84, respectively, for the entire range of tested parameters. A cost analysis was also performed to evaluate the cost-effectiveness of the solar thermal system with and without turbulent promoters. [ABSTRACT FROM AUTHOR]

There has been a growing trend of using local anesthesia (LA) compared to general anesthesia (GA) over the last two decades in VR surgery. We aim to answer the following question: what is the institutional benefit of LA versus GA use in operation-room time, anesthesia duration, earlier discharge from an outpatient surgery facility, and the estimated cost savings? We conducted a retrospective analysis of 1476 eyes that underwent vitreoretinal surgery over a 6-year period from a single site; 61.8% of patients received GA and 38.2% received LA for VR surgery. Anesthesia, surgical, and recovery times were significantly shorter with LA (100.49, 66.47, 66.47 mins) vs. GA (145.53, 100.14, 75.08 mins). Anesthesia, surgical, and recovery costs were significantly lower for eyes that received LA, with an estimated adjusted cost reduction of USD 1516 per surgery using LA instead of GA. Use of LA for vitreoretinal surgery is associated with better operational efficiency, earlier patient discharge, and significant cost reduction. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to evaluate and compare the clinical effectiveness and costs of using the Caterpillar Arterial Embolization Device (Caterpillar) and fibered coils in arterial embolization cases. Methods: In this multicenter retrospective study, demographic, laboratory, and procedural data were collected on a total of 48 patients between February 2020 and September 2020. Data were collected on 16 Caterpillar placements and matched with 32 controls who underwent coil embolization of the same vessel with a similar size. Clinical and procedural outcomes including type and size of vessels, time to vessel occlusion, fluoroscopy time, total procedure time, and costs were analyzed and compared. Results: Relative time to occlusion was significantly decreased in the Caterpillar group compared to the controls (57 ± 34 s vs. 11 min 44 s ± 8 min 13 s, p = 0.00001611). Fluoroscopy time (6.9 ± 15 min vs. 19.2 ± 14, p = 0.017) and total procedure time (81.0 ± 36 min vs. 111.5 ± 49 min, p = 0.015) were significantly reduced compared to the coil group. Lastly, overall cost of embolic materials was 1050 ± 0 USD for the Caterpillar group compared to 2312.75 ± 1382.84 USD in the coil group (p = 0.000532). Conclusion: The Caterpillar embolic devices appear safe and effective in arterial occlusion. Compared to fibered coils, the Caterpillar device results in decreased time to vessel occlusion, decreased fluoroscopy and procedural time, and decreased costs, making the Caterpillar an appealing choice for arterial embolization. [ABSTRACT FROM AUTHOR]

Background: Health economic evaluations are needed to assess the impact on the healthcare system of emerging treatment patterns for advanced prostate cancer. The objective of this study is to review the scientific literature identifying cost-effectiveness and cost analyses that are assessing treatments for metastatic hormone-sensitive prostate cancer (mHSPC) and nonmetastatic castration-resistant prostate cancer (nmCRPC). Methods: On 29 June 2021, we searched the scientific (MEDLINE, Embase, and EBSCO) and grey literature for health economic studies targeting mHSPC and nmCRPC. We used the CHEC-extended checklist and the Welte checklist for risk-of-bias assessment and transferability analysis, respectively. Results: We retained 20 cost-effectiveness and 4 cost analyses in the mHSPC setting, and 14 cost-effectiveness and 6 cost analyses in the nmCRPC setting. Docetaxel in combination with androgen deprivation therapy (ADT) was the most cost-effective treatment in the mHSPC setting. Apalutamide, darolutamide, and enzalutamide presented similar results vs. ADT alone and were identified as cost-effective treatments for nmCRPC. An increase in costs as patients transitioned from nmCRPC to mCRPC was noted. Conclusions: We concluded that there is an important unmet need for health economic evaluations in the mHSPC and nmCRPC setting incorporating real-world data to support healthcare decision making. [ABSTRACT FROM AUTHOR]

Guided waves-based SHM systems are of interest in the aeronautic sector due to their lightweight, long interrogation distances, and low power consumption. In this study, a bottom-up framework for the estimation of the initial investment cost (C O T C ) and the added weight (W A W ) associated with the integration of a SHM system to an aircraft is presented. The framework provides a detailed breakdown of the activities and their costs for the sensorization of a structure using a fully wired approach or the adoption of the printed diagnostic film. Additionally, the framework considers the difference between configuring the system for Manual or Remote data acquisition. Based on the case study presented on the sensorization of a regional aircraft composite fuselage, there is a trade-off between C O T C and W A W for the SHM options considered. The Wired–Manual case leads to the lowest C O T C with the highest W A W , while the combination of diagnostic film with a Remote system leads to the highest C O T C and the lowest W A W . These estimations capture the characteristics of each system and can be integrated into cost–benefit analyses for the final selection of a particular configuration. [ABSTRACT FROM AUTHOR]

Introduction: Dry needling is a non-pharmacological approach that has proven to be effective in different neurological conditions. Objective: The aim of this study was to evaluate the cost-effectiveness of a single dry needling session in patients with chronic stroke. Methods: A cost-effectiveness analysis was performed based on a randomized controlled clinical trial. The results obtained from the values of the EuroQol-5D questionnaire and the Modified Modified Ashworth Scale were processed in order to obtain the percentage of treatment responders and the quality-adjusted life years (QALYs) for each alternative. The cost analysis was that of the hospital, clinic, or health center, including the equipment and physiotherapist. The cost per respondent and the incremental cost-effectiveness ratio of each alternative were assessed. Results: Twenty-three patients with stroke were selected. The cost of DN treatment was EUR 14.96, and the data analysis showed a favorable cost-effectiveness ratio of both EUR/QALY and EUR/responder for IG, although the sensitivity analysis using limit values did not confirm the dominance (higher effectiveness with less cost) of the dry needling over the sham dry needling. Conclusions: Dry needling is an affordable alternative with good results in the cost-effectiveness analysis—both immediately, and after two weeks of treatment—compared to sham dry needling in persons with chronic stroke. [ABSTRACT FROM AUTHOR]

Nowadays, roll-on/roll-off (Ro-Ro) is an important mode for short sea shipping (SSS) due to its advantages of fast and convenient load and unloading system. Despite the advantages, the market share of Ro-Ro is insignificant compared with lift-on/lift-off (Lo-Lo) in the Northeast Asian region that is geographically suitable for fostering SSS. Therefore, it is of utmost importance to have a better understanding of the effectiveness or Ro-Ro and Lo-Lo in the regional SSS market. For this purpose, this paper develops a model to estimate the total logistics cost of the two transportation modes. The total logistics costs of Ro-Ro and Lo-Lo are calculated on three major SSS routes between Korea and Japan. The results show that Lo-Lo outperforms Ro-Ro on most routes in terms of the cost effectiveness, and Ro-Ro is competitive only for high-priced and time-sensitive cargo. However, it is also documented that Ro-Ro transport has a significant impact on reduction in the total logistics costs when companies integrate the supply chain and improve the cooperative relationship to a high level. [ABSTRACT FROM AUTHOR]

Endoscopic procedures such as ureteroscopy (URS) have seen a recent increase in single-use devices. Despite all the advantages provided by disposable ureteroscopes (sURSs), their cost effectiveness remains questionable, leading most teams to use a hybrid strategy combining reusable (rURS) and disposable devices. Our study aimed to create an economic model that estimated the cut-off value of rURS procedures needed to support the profitability of a hybrid strategy (HS) for ureteroscopy. We used a budget impact analysis (BIA) model that estimated the financial impact of an HS compared to 100% sURS use. The model included hospital volume, sterilization costs and the private or public status of the institution. Although the hybrid strategy generally remains the best economic and clinical option, a predictive BIA model is recommended for the decision-making. We found that the minimal optimal proportion of rURS procedures in an HS was mainly impacted by the activity volume and overall number of sterilization procedures. Private and public institutions must consider these variables and models in order to adapt their HS and remain profitable. [ABSTRACT FROM AUTHOR]

Background: The Dietary Approach to Stop Hypertension (DASH) and potassium supplementation have been shown to reduce the risk of death with a functioning graft (DWFG) and renal graft failure in renal transplant recipients (RTR). Unfortunately, a key problem for patients is the adherence to these diets. The aim of this study is to evaluate the cost-effectiveness and budget impact of higher adherence to either the DASH or potassium supplementation. Methods: A Markov model was used to simulate the life course of 1000 RTR in the Netherlands. A societal perspective with a lifetime time horizon was used. The potential effect of improvement of dietary adherence was modelled in different scenarios. The primary outcomes are the incremental cost-effectiveness ratio (ICER) and the budget impact. Results: In the base case, improved adherence to the DASH diet saved 27,934,786 and gained 1880 quality-adjusted life years (QALYs). Improved adherence to potassium supplementation saved €1,217,803 and gained 2901 QALYs. Both resulted in dominant ICERs. The budget impact over a five-year period for the entire Dutch RTR population was €8,144,693. Conclusion: Improving dietary adherence in RTR is likely to be cost-saving and highly likely to be cost-effective compared to the current standard of care in the Netherlands. [ABSTRACT FROM AUTHOR]

Non-structural measures for flood risk mitigation are often more economically accessible, easier to implement, and are highly effective, especially in view of the pursuit of risk resilience objectives. Among the non-structural measures, more importance is increasingly being attributed to flood proofing interventions. There are two main types of flood proofing: dry proofing and wet proofing. An example of dry proofing is shielding, which involves the use of flood barriers that can be installed in the entrances of buildings or outside the buildings in order to avoid contact with the houses and deviate the water flow. Their use must be supported by a detailed hydraulic analysis to ensure the correct design is used. This kind of intervention also avoids inducing a feeling of false security (the levee effect) in the exposed population, and therefore contributes to increasing their resilience. The aim of the work presented here is to determine an optimal combination of and choice between different types of structural and non-structural measures through the development of a methodology for assessing the real efficiency levels of different measures, using a cost–benefit analysis (CBA) and starting from the estimation of the direct flood damage. The application of the CBA to a case study of the Mela river in northeastern Sicily, which suffered a flooding event in October 2015, is supported by the determination of the real damages after the flood and the modeling of the same damages for alternative scenarios. The results affirm the possibility of reducing or avoiding some of the damage using the proposed flood proofing measures instead of classical ones. [ABSTRACT FROM AUTHOR]

This study is focused on the reduction of CO2 emissions and costs associated with ultra-low viscosity (ULV) engine oils for passenger vehicles. Specifically, the reduction in life cycle CO2 (LCCO2) emissions from lower-viscosity engine oil and the oil drain interval (ODI) extension were estimated taking into account both mineral engine oil and synthetic engine oil. Furthermore, the cost-effectiveness of ULV engine oils were investigated by performing base-stock cost analysis. When the volatility limit of the Noack test (American Society for testing and materials (ASTM) D5800) was set to 15 wt %, the results indicated that the lower limit of kinematic viscosity at 100 °C (KV100) for mineral engine oil (with Group-III base-stock) and synthetic engine oil (with polyalphaolefin (PAO) base-stock) were approximately 5.3 and 4.5 mm2/s, respectively. Compared to conventional 0W-16 mineral engine oil (KV100 6.2 mm2/s), the effect of reducing LCCO2 emissions on ULV mineral engine oil (ULV-Mineral, KV100 5.3 mm2/s) was estimated at 0.6%, considering 1.5–1.8 L gasoline engines in New European Driving Cycles (NEDC) mode. ULV-Mineral, which continues to use a mineral base-stock, is considered highly cost-effective since its cost is similar to the conventional 0W-16 mineral engine oil. On the other hand, compared with ULV-Mineral, the vehicle fuel efficiency improvement from the use of ULV synthetic engine oil (ULV-PAO, KV100 4.5 mm2/s) was estimated to be 0.5%. However, considering CO2 emissions during engine oil production, the reduction of LCCO2 emission from ULV-PAO compared with ULV-Mineral was estimated to be only 0.1% or less using 2030 standards (assuming a vehicle fuel efficiency of 66.5 g-CO2/km) when ODI is set equivalent (7500 km) to mineral engine oil. As a result, ULV-PAO's cost-effectiveness, considering the cost increase of PAO base-stock, was found to be nominal. Contrariwise, when the characteristics of PAO base-stock with higher oxidation stability are used comparatively with the mineral base-stock while extending the ODI to 15,000 km, the effect of reducing LCCO2 emissions of ULV-PAO was estimated to be 0.7% in 2030, making ULV-PAO a competitive and cost-effective alternative. In other words, the popularization of synthetic engine oil toward 2030 will require the consideration of both viscosity reduction and ODI extension. [ABSTRACT FROM AUTHOR]

This paper presents the feasibility of using solar photovoltaics (Solar PV) as the energy source for cooking with special focus on the loss mechanisms and possible remedial measures. If the heat loss is minimized, to reduce the temperature losses, it is possible to cook with a low power source less than 500 W. A slogan has been adopted by the researchers—'It is temperature that cooks food not heat', meaning that it is not the flow of energy that cooks food, but rather, that food is cooked when held at a key temperature for a time. The slogan draws attention to the core concept that if heat loss is minimized, maintaining the temperature inside the cooker and the cooking pan, then the cooking process becomes very energy efficient. The paper considers ways to maintain temperature, but with due reference to the 'art of cooking', those all-important cultural processes that determine how meals are made. A prototype solar home system e-cooker was designed, fabricated and tested for cooking different foods in Bangladesh. Experimental results are presented to show that cooking is possible using much less power and energy than is commonly thought. A cost analysis is also presented to show that such a cooker can be cost effective in off-grid areas if connected to a properly designed Solar Home System. [ABSTRACT FROM AUTHOR]