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

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]

Two cable logging systems were reviewed to compare the efficiency of potential biomass extraction from remote forest sites in Ireland based on productive machine hour (PMH) and unit cost of operation (€/m3). Three operational scenarios (SC) were analysed where SC I was a three man crew operation (choker setter, the carriage operator and unhooking chokers). SC II was a variation of this with a two man crew operation. SC III was operating radio controlled chokers there was a two man crew (choker setter and carriage operator). The study aims to assess how operations in Ireland perform against previous known cable studies to determine whether the cost of timber extraction on remote forest sites inaccessible for mechanised felling, has a future given the increased demand for wood fibre in Ireland, both from the saw milling industries and the wood for energy sector. The volume per PMH was recorded at 17.97 for SC I, 15.09 for SC II and 20.58 m3 for SC III. The difference in productivity versus SC III remote controlled chokers is 5.49 m3/PMH for SC II crew and 2.61 m3/PMH for SC I. The decrease in total volume extracted from SCs I and II versus SC III was recorded at 15.69 m3 (15%) and 32.97 m3 (36%) product respectively. In value terms, the unit cost (€/m3) varied from 6.29 (SC I) to 6.43 (SC II) to 4.57 (SC III). When looking at the production unit costs of normal wood energy supply chains in Ireland, the figures are similar ranging from 3.17 €/m3 to 8.01 €/m3. The value of the end product of course will always determine which market the eventually goes to but given that cable log wood fibre has been unthinned and unmaintained then the biomass sector may be an ever increasing demand point in the search for increased woody biomass given that the unit costs can be competitive with other wood energy supply chains. [ABSTRACT FROM AUTHOR]