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Recent economics of knowledge studies have highlighted the strong positive effects that the limited exhaustibility of knowledge and its cumulability exert on the recombinant generation of new technological knowledge. While existing empirical investigations primarily focus on the knowledge generation and technology production functions, the analysis of the cost of knowledge has received less attention. This paper aims to fill this gap by investigating the dynamics and determinants of patent costs in the European Union in the period 1992–2012. The analysis of patent unit costs in European countries, measured as the amount of research and development (R&D) expenditure per patent application to the European Patent Office (EPO), shows a steady decline and clear convergence toward lower levels, both in time and across countries. We find that a larger stock of patents and a higher technological variety and coherence of its composition are associated with a sharper reduction in patent costs. Our findings suggest that, in Europe, ideas have been getting cheaper. [ABSTRACT FROM AUTHOR]

Purpose Real-time prescription benefits (RTPB) shows prescribers patient-, medication-, and pharmacy-specific information on medication pricing, prior authorization requirements, and lower-cost alternatives. RTPB is intended to improve patient satisfaction and prescription fill rates by decreasing out-of-pocket costs for prescriptions. Therefore, we evaluated how RTPB affects prescribing patterns by examining acceptance and subsequent fill rates for RTPB alternative suggestions. Methods RTPB was implemented in February 2022 using external vendor interfaces. Prescribing data from March 2022 to March 2023 were analyzed. RTPB displayed alerts for medications requiring prior authorization or when alternative medications would result in cost savings. Patients were included if their prescription received an RTPB response and they had a subsequent encounter with pharmacy fill data. Primary outcomes were alert acceptance rates and prescription fill rates across RTPB alert groups, with a secondary outcome of monthly copay savings for accepted alerts. Results RTPB requests received a response for 88% of prescriptions, with price estimates provided for 77.9% of them. Lower-cost alternatives accounted for 67.2% of alerts, while prior authorization requirements represented 15% of alerts. Prescribers selected a lower-cost alternative 32% of the time. For those with an RTPB alert, patients filled prescriptions 68% of the time when an alternative was chosen, compared to 59% of the time when the original prescription was retained (odds ratio, 1.5; 95% confidence interval, 1.5-1.6; P < 0.001). Patients saved an average of $27.77 per month on copay costs when alternatives were selected. Conclusion Implementation of RTPB was found to result in significant improvements in prescription fill rates and decrease patient copay costs, despite low alert acceptance rates. [ABSTRACT FROM AUTHOR]

Background The financial implications of central nervous system (CNS) cancers are substantial, not only for the healthcare service and payers, but also for the patients who bear the brunt of direct, indirect, and intangible costs. This study sought to investigate the impact of healthcare spending on CNS cancer survival using recent US data. Methods This study used public data from the Disease Expenditure Project 2016 and the Global Burden of Disease Study 2019. The primary outcome was the annual healthcare spending trend from 1996 and 2016 on CNS tumors adjusted for disease prevalence, alongside morbidity and mortality. Secondary outcomes included drivers of change in healthcare expenditures for CNS cancers. Subgroup analysis was performed stratified by age group, expenditure type, and care type provided. Results There was a significant increase in total healthcare spending on CNS cancers from $2.72 billion (95% CI: $2.47B to $2.97B) in 1996 to $6.85 billion (95% CI: $5.98B to $7.57B) in 2016. Despite the spending increase, the mortality rate per 100 000 people increased, with 5.30 ± 0.47 in 1996 and 7.02 ± 0.47 in 2016, with an average of 5.78 ± 0.47 deaths per 100 000 over the period. The subgroups with the highest expenditure included patients aged 45 to 64, those with private insurance, and those receiving inpatient care. Conclusions This study highlights a significant rise in healthcare costs for CNS cancers without corresponding improvements in mortality rate, indicating a mismatch of healthcare spending, contemporary advances, and patient outcomes as it relates to mortality. [ABSTRACT FROM AUTHOR]

The advent of fluoroscopically guided cardiology procedures has greatly improved patient outcomes but has also increased occupational radiation exposure for healthcare professionals, leading to adverse health effects such as radiation-induced cataracts, alopecia, and cancer. This emphasizes the need for effective radiation safety training. Traditional training methods, often based on passive learning, fail to simulate the dynamic catheterization laboratory environment adequately. Virtual Reality (VR) offers a promising alternative by providing immersive, interactive experiences that mimic real-world scenarios without the risks of actual radiation exposure. Our study aims to assess the effectiveness of VR-based radiation safety training compared to traditional methods. We conducted a prospective cohort study involving 48 healthcare professionals in a catheterization lab setting. Participants underwent a 1-hour self-directed VR training session using Virtual Medical Coaching's RadSafe VR software, which simulates real-world clinical scenarios. Pre- and post-intervention radiation dose levels were measured using personal dosimeters at the eye, chest, and pelvis. Knowledge and skills were assessed through tests, and feedback was gathered through surveys and interviews. Statistical analysis revealed significant reductions in radiation exposure across all professional groups after VR training. For cardiologists, the eye dose dropped by 21.88% (from 2.88 mSv to 2.25 mSv), the chest dose decreased by 21.65% (from 4.11 mSv to 3.22 mSv), and the pelvis dose went down by 21.84% (from 2.06 mSv to 1.61 mSv). Perioperative nurses experienced similar reductions, with eye doses decreasing by 14.74% (from 1.56 mSv to 1.33 mSv), chest doses by 26.92% (from 2.6 mSv to 1.9 mSv), and pelvis doses by 26.92% (from 1.3 mSv to 0.95 mSv). Radiographers saw their eye doses reduced by 18.95% (from 0.95 mSv to 0.77 mSv), chest doses by 42.11% (from 1.9 mSv to 1.1 mSv), and pelvis doses by 27.63% (from 0.76 mSv to 0.55 mSv).Participants reported enhanced engagement, improved understanding of radiation safety, and a preference for VR over traditional methods. A cost analysis also demonstrated the economic advantages of VR training, with significant savings in staff time and rental costs compared to traditional methods. Our findings suggest that VR is a highly effective and cost-efficient training tool for radiation safety in healthcare, offering significant benefits over traditional training approaches. [ABSTRACT FROM AUTHOR]

Objective Despite evidence-based guidelines stating that lipase alone should be used in the diagnosis of suspected acute pancreatitis, health care providers continue to order amylase or amylase and lipase together. The purpose of this study was to assess the utilization of appropriate laboratory testing related to the diagnosis of acute pancreatitis. Methods The study used a retrospective cross-sectional design. The timeframe was from January 1, 2020, to December 31, 2020. A retrospective chart review was used to collect data for the following: patient-provider encounter notes, patient demographics, provider demographics, differential and final diagnosis, and laboratory test results. Data analysis include stratification of categorical variables and calculation of cost savings. Results For the 12-month period, this study found 2567 (9.3%) of all amylase and lipase tests to be unnecessary. Amylase tests (1881; 73.2%) made up the most unnecessary tests followed by lipase tests (686; 26.7%). An analysis of test-ordering behavior by providers revealed that 81.5% of all unnecessary tests were ordered by MDs. Finally, this study estimated a total cost savings of $128,350 if all unnecessary tests were eliminated. Conclusion Our study demonstrated that amylase and lipase tests have been overutilized in the diagnosis of acute pancreatitis. [ABSTRACT FROM AUTHOR]

Recent studies consistently showed that making cash visible with a windowed envelope during mail contact increases response rates in surveys. The visible cash aims to pique interest and encourage sampled households to open the envelope. This article extends prior research by examining the effect of additional interventions implemented during mail recruitment to a survey panel on recruitment rates and costs. Specifically, we implemented randomized experiments to examine size (small, large) and location (none, front, back) of the window displaying cash, combined with what part of the cash is shown through the window envelope (numeric amount, face/image), and various prepaid incentive amounts (two $1, one $2, one $5). We used the recruitment effort for NORC's AmeriSpeak Panel as the data source for this study. The probability-based AmeriSpeak Panel uses an address-based sample and multiple modes of respondent contact, including mail, phone, and in-person outreach during recruitment. Our results were consistent with prior research and showed significant improvement in recruitment rates when cash was displayed through a window during mail contact. We also found that placing the window on the front of the envelope, showing $5 through the envelope compared to $2 and $1, and showing the tender amount compared to the image on the cash through the window were more likely to improve the recruitment rates. Our cost analyses illustrated that the cost difference in printing window versus no window envelope is small. There is no difference in printing cost between front window and back window as they both require custom manufacturing. There is also no cost difference in printing envelopes with small windows versus large windows. Lastly, we found no evidence of mail theft based on our review of the United States Postal Service's "track and trace" reports, seed mailings sent to staff, and undeliverable mailing rates. [ABSTRACT FROM AUTHOR]

Purpose This report describes the step-by-step process that led to expansion of ambulatory care pharmacy services at a newly established internal medicine clinic within a patient-centered medical home in North Carolina. Summary Implementation of clinical pharmacist services at the clinic was led by a postgraduate year 2 (PGY2) pharmacy resident and guided by the 9 steps described in the book Building a Successful Ambulatory Care Practice: A Complete Guide for Pharmacists. After a needs assessment and review of the demographics and insurance status of the clinic's target population, it was determined that pharmacist services would focus on quality measures including diabetes nephropathy screening, diabetes eye examination, blood glucose control in diabetes, discharge medication reconciliation, annual wellness visits, and medication adherence in diabetes, hypercholesterolemia, and hypertension. Clinic appointments were conducted under 3 models: a pharmacist-physician covisit model, a "floor model" of pharmacist consultation on drug information or medication management issues during medical resident sign-out sessions with supervising physicians (medical residents could also see patients along with the pharmacist at a covisit appointment), and a covisit model of stacked physician and pharmacist appointments. The pharmacist's services were expanded from 2 half-day clinic sessions per week initially to 5 or 6 half-day clinic sessions by the end of the residency year. Conclusion By the fourth quarter of the first PGY2 residency year in which ambulatory care pharmacy services were provided in the clinic, the clinical and financial impact of those services justified the addition of a second full-time pharmacist to the clinic team. [ABSTRACT FROM AUTHOR]

A study of 2 health care claims databases (commercial, Medicaid) was undertaken to estimate the episodic cost of lower respiratory tract illness due to respiratory syncytial virus among infants aged <12 months overall, by age, and by birth gestational age. Among commercial-insured infants, mean costs were $28 812 for hospitalized episodes, $2575 for emergency department episodes, and $336 for outpatient clinic episodes. Costs were highest among infants aged <1 month and infants with a gestational age ≤32 weeks and were comparable among Medicaid-insured infants, albeit somewhat lower. The cost of lower respiratory tract illness due to respiratory syncytial virus during the acute phase of illness is high, especially among the youngest infants and those born premature. [ABSTRACT FROM AUTHOR]

Vancomycin and daptomycin are frequently used in outpatient parenteral antimicrobial therapy (OPAT). We analyze health care utilization and cost to the health care system for vancomycin vs daptomycin in the outpatient setting and find that vancomycin results in significantly higher health care utilization and similar cost per course compared with daptomycin in OPAT. [ABSTRACT FROM AUTHOR]

Background Healthcare seeking behavior (HSB) and community perception on cholera can influence its management. We conducted a cross-sectional survey to generate evidence on cholera associated HSB and disease perception in populations living in cholera hotspots in Ethiopia. Methods A total of 870 randomly selected households (HHs) in Shashemene Town (ST) and Shashemene Woreda (SW) participated in our survey in January 2022. Results Predominant HHs (91.0%; 792/870) responded "primary health center" as the nearest healthcare facility (HCF). Around 57.4% (247/430) of ST HHs traveled <30 minutes to the nearest HCF. In SW, 60.2% (265/440) of HHs travelled over 30 minutes and 25.9% (114/440) over 4 km. Two-thirds of all HHs paid

Prescription drug costs within oncology remain a challenge for many patients with cancer. The Mark Cuban Cost Plus Drug Company (MCCPDC) launched in 2022, aiming to provide transparently priced medications at reduced costs. In this study, we sought to describe the potential impact of MCCPDC on Medicare Part-D oncology spending related to cancer-directed (n  = 7) and supportive care (n  = 26) drugs. We extracted data for drug-specific Part-D claims and spending for 2021. Using 90-count purchases from MCCPDC, we found potential Part-D savings of $857.8 million (91% savings) across the 7 cancer-directed drugs and $28.7 million (67% savings) across 21/26 (5/26 did not demonstrate savings) supportive care drugs. Collectively, our findings support that alternative purchasing models like MCCPDC may promote substantial health care savings. [ABSTRACT FROM AUTHOR]

Purpose Persons who inject drugs (PWID) are at risk for severe gram-positive infections and may require prolonged hospitalization and intravenous (IV) antibiotic therapy. Dalbavancin (DBV) is a long-acting lipoglycopeptide that may reduce costs and provide effective treatment in this population. Methods This was a retrospective review of PWID with severe gram-positive infections. Patients admitted from January 1, 2017, to November 1, 2019 (standard-of-care [SOC] group) and from November 15, 2019, to March 31, 2022 (DBV group) were included. The primary outcome was the total cost to the healthcare system. Secondary outcomes included hospital days saved and treatment failure. Results A total of 87 patients were included (37 in the DBV group and 50 in the SOC group). Patients were a median of 34 years old and were predominantly Caucasian (82%). Staphylococcus aureus (82%) was the most common organism, and bacteremia (71%) was the most common type of infection. Compared to the SOC group, the DBV group would have had a median of 14 additional days of hospitalization if they had stayed to complete their therapy (P = 0.014). The median total cost to the healthcare system was significantly lower in the DBV group than in the SOC group ($31,698.00 vs $45,093.50; P = 0.035). The rate of treatment failure was similar between the groups (32.4% in the DBV group vs 36% in the SOC group; P = 0.729). Conclusion DBV is a cost-saving alternative to SOC IV antibiotics for severe gram-positive infections in PWID, with similar treatment outcomes. Larger prospective studies, including other patient populations, may demonstrate additional benefit. [ABSTRACT FROM AUTHOR]

Purpose This project aimed to determine whether a supportive calculator that automates the vial selection process might offer a practical and efficient method of reducing pharmaceutical expenditures through minimizing preventable drug waste in outpatient pharmacy settings. Summary Drug waste is a substantial target of cost-saving efforts in the areas of oncology and autoimmune therapy, which involve use of a vast number of high-cost medications packaged in single-dose vials of varying strength. To facilitate selection of the optimal combination of medication vials and thereby minimize preventable drug waste, a Microsoft Excel–based calculator was developed for use by staff of a large oncology pharmacy network. Twenty-three high-cost chemotherapy and monoclonal antibody medications were identified as initial targets for the drug waste prevention initiative. After dissemination and implementation of the calculator and provision of monthly pharmacy staff education, the dollar value of preventable drug waste and the number of suboptimal vial combination selections were reduced by 51% ($412,300) and 54% (315 selections), respectively, in fiscal year 2022 and further reduced by 46% ($183,400) and 27% (71 selections), respectively, in fiscal year 2023. Conclusion After implementation of an automated vial selection tool, preventable drug waste and the quantity of suboptimal vial combination selections were markedly reduced across 11 outpatient compounding pharmacies. [ABSTRACT FROM AUTHOR]

Daptomycin use for gram-positive infections has increased. This cost minimization analysis aimed to determine cost and/or time savings of daptomycin over vancomycin. The estimated hospital cost savings was US$166.41 per patient, and pharmacist time saved of almost 20 minutes per patient. Daptomycin has the potential to save both time and money. [ABSTRACT FROM AUTHOR]

Background The aims of this study were to (1) evaluate the time between onset of occipital neuralgia symptoms and nerve decompression surgery, (2) perform a cost comparison analysis between surgical and nonsurgical treatment of occipital neuralgia, and (3) report postoperative results of nerve decompression for occipital neuralgia. Methods Subjects (n  = 1112) who underwent screening for nerve decompression surgery were evaluated for occipital neuralgia. Of those, 367 patients (33%) met the inclusion criteria. Timing of occipital neuralgia symptom onset and pain characteristics were prospectively collected. Cost associated with the nonsurgical treatment of occipital neuralgia was calculated for the period between onset of symptoms and surgery. Results A total of 226 patients (73%) underwent occipital nerve decompression. The average time between onset of occipital neuralgia and surgery was 19 years (7.1–32). Postoperatively, the median number of pain days per month decreased by 17 (0–26, 57%) (P  < .001), the median pain intensity decreased by 4 (2–8, 44%) (P  < .001), and median pain duration in hours was reduced by 12 (2–23, 50%) (P  < .001). The annual mean cost of nonsurgical occipital neuralgia treatment was $28 728.82 ($16 419.42–$41 198.41) per patient. The mean cost during the 19-year time frame before surgery was $545 847.75($311 968.90–$782 769.82). Conclusion This study demonstrates that patients suffer from occipital neuralgia for an average of 19 years before undergoing surgery. Nerve decompression reduces symptom severity significantly and should be considered earlier in the treatment course of occipital neuralgia that is refractory to conservative treatment to prevent patient morbidity and decrease direct and indirect health care costs. [ABSTRACT FROM AUTHOR]

Probability sample (PS) surveys are considered the gold standard for population-based inference but face many challenges due to decreasing response rates, relatively small sample sizes, and increasing costs. In contrast, the use of nonprobability sample (NPS) surveys has increased significantly due to their convenience, large sample sizes, and relatively low costs, but they are susceptible to large selection biases and unknown selection mechanisms. Integrating both sample types in a way that exploits their strengths and overcomes their weaknesses is an ongoing area of methodological research. We build on previous work by proposing a method of supplementing PSs with NPSs to improve analytic inference for logistic regression coefficients and potentially reduce survey costs. Specifically, we use a Bayesian framework for inference. Inference relies on a probability survey with a small sample size, and through the prior structure we incorporate supplementary auxiliary information from a less-expensive (but potentially biased) NPS survey fielded in parallel. The performance of several strongly informative priors constructed from the NPS information is evaluated through a simulation study and real-data application. Overall, the proposed priors reduce the mean-squared error (MSE) of regression coefficients or, in the worst case, perform similarly to a weakly informative (baseline) prior that does not utilize any nonprobability information. Potential cost savings (of up to 68 percent) are evident compared to a probability-only sampling design with the same MSE for different informative priors under different sample sizes and cost scenarios. The algorithm, detailed results, and interactive cost analysis are provided through a Shiny web app as guidance for survey practitioners. [ABSTRACT FROM AUTHOR]

With the implementation of China's carbon-peaking and carbon-neutrality strategy, new energy will achieve leapfrog growth. Due to the good economics of distributed new-energy generation, it can not only save users' own investment, but also help to achieve local consumption of new energy. However, it will also bring about a series of incremental costs to the power grid. This paper first enumerates the concept, development status and scheduling mode of a distributed new-energy storage system. Based on the above, it establishes a new-energy power generation model and an energy storage system charging and discharging model, and proposes a global optimization scheduling model for a distributed new-energy storage system, considering the time-of-use electricity price and taking the lowest total operating cost of the distributed new-energy power generation system as the objective function. Finally, it proposes a distribution network incremental cost analysis model based on the penetration of distributed new energy. The calculation results show that the incremental cost of grid-connected distributed new energy is 1.0849, 1.2585 and 1.3473 yuan/kWh, respectively, which indicates that the global dispatching model can optimize the power consumption structure of a distributed power generation system, and has the function of peak shaving and valley filling, but the incremental cost of the distribution network will also increase. [ABSTRACT FROM AUTHOR]

Background A small share of patients account for a large proportion of costs to the healthcare system in Denmark as in many Western countries. A telephone-based self-management support, proactive health support (PaHS), was suggested for prevention of hospitalisations for persons at risk of hospital admission. These persons have chronic diseases, unplanned hospitalisations and age ≥ 65 years. However, evidence is limited on whether this type of intervention is cost-effective. Aim The aim of this study was to assess the incremental cost-utility ratio (ICER) of PaHS, compared with standard care. Methods The economic evaluation was nested within a randomised controlled trial, and was based on a health system perspective, with follow-up and time horizon of 12 months. We measured incremental costs per quality-adjusted life years (QALY) gained. Total average costs per patient included PaHS programme costs, and costs in hospitals, primary care and municipalities. We analysed differences by generalised linear models with Gamma distribution for costs and mixed models for QALY. Results We analysed data on 6,139 patients, where 3,041 received PaHS and 3,098 received usual care. We found no difference in healthcare costs, and programme costs were on average €1,762 per patient, providing incremental costs of €2,075. Incremental effects on QALY were 0.007, resulting in an ICER of €296,389 per QALY gained. Conclusion We found no evidence of PaHS being cost-effective in this study, but the results will be used to identify new ways to organise similar interventions and identify patients with the objective to reduce health system costs per patient. [ABSTRACT FROM AUTHOR]

Background A substantial number of Emergency Department (ED) attendances by care home residents are potentially avoidable. Health Call Digital Care Homes is an app-based technology that aims to streamline residents' care by recording their observations such as vital parameters electronically. Observations are triaged by remote clinical staff. This study assessed the effectiveness of the Health Call technology to reduce unplanned secondary care usage and associated costs. Methods A retrospective analysis of health outcomes and economic impact based on an intervention. The study involved 118 care homes across the North East of UK from 2018 to 2021. Routinely collected NHS secondary care data from County Durham and Darlington NHS Foundation Trust was linked with data from the Health Call app. Three outcomes were modelled monthly using Generalised Linear Mixed Models: counts of emergency attendances, emergency admissions and length of stay of emergency admissions. A similar approach was taken for costs. The impact of Health Call was tested on each outcome using the models. Findings Data from 8,702 residents were used in the analysis. Results show Health Call reduces the number of emergency attendances by 11% [6–15%], emergency admissions by 25% [20–39%] and length of stay by 11% [3–18%] (with an additional month-by-month decrease of 28% [24–34%]). The cost analysis found a cost reduction of £57 per resident in 2018, increasing to £113 in 2021. Interpretation The introduction of a digital technology, such as Health Call, could significantly reduce contacts with and costs resulting from unplanned secondary care usage by care home residents. [ABSTRACT FROM AUTHOR]

Background Adolescent mental health (AMH) needs in England have increased dramatically and needs exceed treatment availability. This study undertook a comparative assessment of the health and economic return on investment (ROI) of interventions to prevent and treat mental disorders among adolescents (10–19 years) and examined intervention affordability and readiness. Methods Interventions were identified following a review of published and grey literature. A Markov model followed a simulated adolescent cohort to estimate implementation costs and health, education, and economic benefits. Intervention affordability was assessed, comparing annual cost per adolescent with NHS England per capita spending, and an expert panel assessed intervention readiness using a validated framework. Results Over 10- and 80-year horizons, interventions to treat mild anxiety and mild depression were most cost-effective, with the highest individual lifetime ROI (GBP 5822 GBP 1 and GBP 257: GBP 1). Preventing anxiety and depression was most affordable and 'implementation ready' and offered the highest health and economic benefits. A priority package (anxiety and depression prevention; mild anxiety and mild depression treatment) would avert 5 million disability-adjusted life-years (DALYS) and achieve an ROI of GBP 15: GBP 1 over 10 years or 11.5 million DALYs (ROI of GBP 55: GBP 1) over 80 years. Conclusion The economic benefits from preventing and treating common adolescent mental disorders equivalent to 25% of NHS England's annual spending in 2021 over 10 years and 91% over 80 years. Preventing and early treatment for anxiety and depression had the highest ROIs and strong implementation readiness. [ABSTRACT FROM AUTHOR]

Background The application of antiseptic skin agents prior to incision minimizes the rate of surgical site infection. Despite their ubiquity, the optimal skin preparation agent remains uncertain. A retrospective economic analysis was conducted to complement the results from the NEWSkin Prep trial which prospectively compared three preparation agents. Methods A cost and cost-effectiveness analysis was performed from a healthcare service perspective to compare chlorhexidine with 70% ethanol, and aqueous povidone-iodine, against povidone-iodine with 70% ethanol. Resource use estimates accounted for hospital admissions, readmissions associated with surgical site infection, outpatient and general practitioner attendances, visits from community nurses and therapeutic consumables. The measure of effectiveness comprised the net difference in number of patients with surgical site infections per 1000 patients. Costs were compared using a two-sample Welch's t -test. Deterministic and probabilistic sensitivity analyses were performed to evaluate the incremental cost-effectiveness ratio. Results The null hypothesis that the mean costs for the trial arms were significantly different was not rejected (Welch's t -test P value: 0.771 for chlorhexidine with 70% ethanol against povidone-iodine with 70% ethanol; and 0.955 for aqueous povidone-iodine against povidone-iodine with 70% ethanol). Based on bootstrap averages, the chlorhexidine with 70% ethanol intervention generated 8.0 fewer surgical site infections per 1000 patients and net cost savings of €151,698 (Euros) per 1000 patients compared with povidone-iodine with 70% ethanol, and aqueous povidone-iodine produced a net cost saving of €37,494 per 1000 patients but generated an additional 11.6 surgical site infections per 1000 patients compared with povidone-iodine with 70% ethanol. The comparison of chlorhexidine with 70% ethanol to povidone-iodine with 70% ethanol was sensitive to the inclusion of cost outliers, while the comparison of aqueous povidone-iodine to povidone-iodine with 70% ethanol was sensitive to the estimated cost per surgical site infection. Conclusion Based on the outcomes from the NEWSkin Prep study, this economic analysis found no definitive evidence in favour of any one of the study comparators. Future model-based economic analyses of alternative skin preparations should critically address the quality of evidence and integrate the results from the NEWSkin Prep study. [ABSTRACT FROM AUTHOR]

Introduction In high-burden settings, low-complexity screening tests for tuberculosis (TB) could expand the reach of community-based case-finding efforts. The potential costs and cost-effectiveness of approaches incorporating these tests are poorly understood. Methods We developed a microsimulation model assessing 3 approaches to community-based case-finding in hypothetical populations (India-, South Africa-, The Philippines-, Uganda-, and Vietnam-like settings) with TB prevalence 4 times that of national estimates: (1) screening with a point-of-care C-reactive protein (CRP) test, (2) screening with a more sensitive "Hypothetical Screening test" (95% sensitive for Xpert Ultra-positive TB, 70% specificity; equipment/labor costs similar to Xpert Ultra, but using a $2 cartridge) followed by sputum Xpert Ultra if positive, or (3) testing all individuals with sputum Xpert Ultra. Costs are expressed in 2023 US dollars and include treatment costs. Results Universal Xpert Ultra was estimated to cost a mean $4.0 million (95% uncertainty range: $3.5 to $4.6 million) and avert 3200 (2600 to 3900) TB-related disability-adjusted life years (DALYs) per 100 000 people screened ($670 [The Philippines] to $2000 [Vietnam] per DALY averted). CRP was projected to cost $550 (The Philippines) to $1500 (Vietnam) per DALY averted but with 44% fewer DALYs averted. The Hypothetical Screening test showed minimal benefit compared to universal Xpert Ultra, but if specificity were improved to 95% and per-test cost to $4.5 (all-inclusive), this strategy could cost $390 (The Philippines) to $940 (Vietnam) per DALY averted. Conclusions Screening tests can meaningfully improve the cost-effectiveness of community-based case-finding for TB but only if they are sensitive, specific, and inexpensive. [ABSTRACT FROM AUTHOR]

Background: Repair of thoracic aortic aneurysms with either endovascular repair (TEVAR) or open surgical repair (OSR) represents major surgery, is costly and associated with significant complications. The aim of this study was to establish accurate costs of delivering TEVAR and OSR in a cohort of UK NHS patients suitable for open and endovascular treatment for the whole treatment pathway from admission and to discharge and 12-month follow-up. Methods: A prospective study of UK NHS patients from 30 NHS vascular/cardiothoracic units in England aged ≥18, with distal arch/descending thoracic aortic aneurysms (CTAA) was undertaken. A multicentre prospective cost analysis of patients (recruited March 2014–July 2018, follow-up until July 2019) undergoing TEVAR or OSR was performed. Patients deemed suitable for open or endovascular repair were included in this study. A micro-costing approach was adopted. Results: Some 115 patients having undergone TEVAR and 35 patients with OSR were identified. The mean (s.d.) cost of a TEVAR procedure was higher £26 536 (£9877) versus OSR £17 239 (£8043). Postoperative costs until discharge were lower for TEVAR £7484 (£7848) versus OSR £28 636 (£23 083). Therefore, total NHS costs from admission to discharge were lower for TEVAR £34 020 (£14 301), versus OSR £45 875 (£43 023). However, mean NHS costs for 12 months following the procedure were slightly higher for the TEVAR £5206 (£11 585) versus OSR £5039 (£11 994). Conclusions: Surgical procedure costs were higher for TEVAR due to device costs. Total in-hospital costs were higher for OSR due to longer hospital and critical care stay. Follow-up costs over 12 months were slightly higher for TEVAR due to hospital readmissions. Detailed micro-costing of endovascular stent grafting (TEVAR) and open surgical repair (OSR) in a cohort of UK NHS patients for whole of treatment pathway up to 12 months follow-up. Overall costs are higher for OSR, driven by length of stay and critical care post-procedure, compared to TEVAR, with costs driven by stent graft devices. These detailed micro-costing estimates exceed current NHS tariffs for reimbursement. [ABSTRACT FROM AUTHOR]

Due to limited resources and constant, ever-changing healthcare challenges, health economics is essential to support healthcare decisions while improving health outcomes. Economic evaluation methodology facilitates informed decision-making related to the efficient allocation of resources while positively impacting clinical practice. In this paper, we provide an overview of economic evaluation methods and a real-world example applying one method of economic evaluation (cost-utility analysis) in nursing research. [ABSTRACT FROM AUTHOR]

STUDY QUESTION Are cumulative pregnancy rates better if supernumerary embryos are vitrified on Day 5/6 instead of Day 3? SUMMARY ANSWER The results do not show a significant difference in cumulative pregnancy rates between the Day 3 and Day 5/6 vitrification groups. WHAT IS KNOWN ALREADY Pregnancy and live birth rates following IVF or ICSI treatment are higher after extended embryo culture and blastocyst transfer (Day 5/6) compared to cleavage-stage (Day 3) transfer. Cumulative pregnancy rates from one oocyte retrieval (OR) cycle show no significant difference after fresh and frozen embryo transfers, but only one study has used vitrification for the cryopreservation of supernumerary embryos while four studies have used a slow freezing protocol. STUDY DESIGN, SIZE, DURATION Our prospective randomized controlled trial was performed in an academic centre between January 2018 and August 2020. Patients were randomized into vitrification Day 3 (n = 80) or Day 5/6 (n = 81) groups. The primary outcome was the cumulative ongoing pregnancy rate (cOPR), considering only the first pregnancy for each couple. The power calculation revealed that 75 patients were required in each group, when assuming a 50% cOPR with four embryo transfers in the vitrification Day 3 group vs two transfers in the vitrification Day 5/6 group. PARTICIPANTS/MATERIALS, SETTING, METHODS Patients <38 years undergoing their first or second OR cycles were randomized at the start of the first cycle. Up to two cycles were included in the analysis. A fresh embryo transfer was performed on Day 3. Supernumerary embryos (with ≥6 cells, <25% fragmentation, and equal blastomeres) or blastocysts (with expansion grade ≥2 with inner cell mass and trophectoderm score A/B) were vitrified on Day 3 or Day 5/6, respectively, and then transferred at a later date. A time-to-event analysis was performed with the patient's first ongoing pregnancy as the event of interest and the number of embryo transfers as the time component. The statistical comparison was performed by a Cox proportional hazards model. Cumulative costs of vitrification on Day 3 vs Day 5/6 were explored and compared using Mann–Whitney U tests. MAIN RESULTS AND THE ROLE OF CHANCE By December 2021, 233 transfers (96 fresh and 137 frozen) in 77 patients were performed in the vitrification Day 3 group and 201 transfers (88 fresh and 113 frozen) in 77 patients were performed in the vitrification Day 5/6 group. The time-to-event analysis did not show a difference between the two arms with regard to the patient's first ongoing pregnancy as the primary study outcome (hazard ratio [HR] 1.25, 95% CI 0.82; 1.92, P = 0.30). The cumulative ongoing pregnancy rate after eight transfers (from one or two ORs) was 57% in the vitrification Day 3 group vs 58% in the vitrification Day 5/6 group. The median number of embryo transfers until a pregnancy was achieved was five vs four, respectively, in the vitrification Day 3 group vs the Day 5/6 group. Similar results were found for the secondary study outcome, i.e. clinical pregnancy with foetal heart rate (HR 1.19, 95% CI 0.78; 1.80, P = 0.41). The cumulative clinical pregnancy rate (cCPR) after eight embryo transfers was 62% in the vitrification Day 3 group vs 59% in the vitrification Day 5/6 group. The median number of transfers until a pregnancy was achieved was four in both groups. The healthcare consumption pattern differed between the two groups and we observed higher costs for the vitrification Day 3 group compared to the vitrification Day 5/6 group, although these differences were not statistically significant. LIMITATIONS, REASONS FOR CAUTION Although our power calculation revealed that only 75 patients were needed in each study group (β = 0.87, α < 0.05), the numbers were low. Also, different numbers of single and double embryo transfers were performed between the two groups, which may have affected the results. The cost analysis was performed on a subset of the patients and is therefore exploratory. WIDER IMPLICATIONS OF THE FINDINGS Our study shows no difference in the cumulative pregnancy rate nor costs after fresh and frozen embryo transfers of at most two sequential OR cycles between the Day 3 and Day 5/6 vitrification groups; however, obstetric and perinatal outcomes should be taken into account to determine the best strategy. STUDY FUNDING/COMPETING INTEREST(S) This study was funded as an investigator-sponsored study of S.D. by Merck nv/sa Belgium, an affiliate of Merck KGaA, Darmstadt, Germany, and by Gedeon Richter Benelux (PA18-0162). The authors declare no conflict of interest related to this study. TRIAL REGISTRATION NUMBER NCT04196036. TRIAL REGISTRATION DATE 15 January 2018. DATE OF FIRST PATIENT'S ENROLMENT 15 January 2018. [ABSTRACT FROM AUTHOR]

Background and Objectives Discussions on age-related issues have begun taking place in earnest, but exactly what dominates public consciousness about these issues is a topic that has yet to kindle scholarly attention. This study analyzes tweets uploaded by age advocacy organizations that have attracted the highest levels of engagement on Twitter. Research Design and Methods We collected 403,426 tweets from 53 accounts. These tweets were posted over 12 years, from 2009 to 2021. After applying our exclusion criteria and collating the top 1% of tweets with the highest levels of engagement, 2,054 tweets were retained for analysis. Both inductive and deductive approaches informed our qualitative content analysis. Results Five themes emerged. "Issues Related to Alzheimer's Disease or Dementia" (Theme 1) formed the majority of tweets (62%; N = 1,278). Theme 2 "Rising Health Care or Retirement Costs" was the second largest theme (25%; N = 506). Seven percent of the tweets were on "Reframing Aging and Combating Ageism" (Theme 3; N = 138). "Matters Affecting Caregivers" surfaced in Theme 4 (4%; N = 81). Two percent of the tweets were on "Intersectional Concerns" (Theme 5; N = 51). Discussion and Implications As age advocacy organizations step up to engage the public constructively in matters regarding later life, there is a compelling need to quell public anxiety about old age and to sensitize society to the struggles confronted by older adults. In undertaking the range of activities needed to do so, age advocacy organizations should consolidate efforts even as they rethink existing strategies to effectuate change. [ABSTRACT FROM AUTHOR]

Objectives To estimate the cost-effectiveness of a cognitive behavioural approach (CBA) or a personalized exercise programme (PEP), alongside usual care (UC), in patients with inflammatory rheumatic diseases who report chronic, moderate to severe fatigue. Methods A within-trial cost-utility analysis was conducted using individual patient data collected within a multicentre, three-arm randomized controlled trial over a 56-week period. The primary economic analysis was conducted from the UK National Health Service (NHS) perspective. Uncertainty was explored using cost-effectiveness acceptability curves and sensitivity analysis. Results Complete-case analysis showed that, compared with UC, both PEP and CBA were more expensive [adjusted mean cost difference: PEP £569 (95% CI: £464, £665); CBA £845 (95% CI: £717, £993)] and, in the case of PEP, significantly more effective [adjusted mean quality-adjusted life year (QALY) difference: PEP 0.043 (95% CI: 0.019, 0.068); CBA 0.001 (95% CI: −0.022, 0.022)]. These led to an incremental cost-effectiveness ratio (ICER) of £13 159 for PEP vs UC, and £793 777 for CBA vs UC. Non-parametric bootstrapping showed that, at a threshold value of £20 000 per QALY gained, PEP had a probability of 88% of being cost-effective. In multiple imputation analysis, PEP was associated with significant incremental costs of £428 (95% CI: £324, £511) and a non-significant QALY gain of 0.016 (95% CI: −0.003, 0.035), leading to an ICER of £26 822 vs UC. The estimates from sensitivity analyses were consistent with these results. Conclusion The addition of a PEP alongside UC is likely to provide a cost-effective use of health care resources. [ABSTRACT FROM AUTHOR]

We lay out a roadmap for how the legislator could create a framework of 'sustainability corridors' that would allow relying on the ancillary restraints/ Wouters doctrine to make antitrust law more accommodating of sustainability considerations. Our analysis goes beyond the general feasibility of such corridors. It discusses different use-cases for such exemptions and methods for assessing the necessity of competitive restraints to achieve a legislatively defined sustainability goal. We show how this avoids the pitfalls of a multigoals approach, under which it would be left to antitrust authorities and courts to reconcile sustainability and competition objectives independent of a legislative specification, whereas out-of-market benefits (externalities) that would escape even a broad consumer welfare approach can still be accounted for. Our proposal sets out specific requirements for such sustainability corridors that ensure that the ensuing antitrust assessment is governed by a strict and quantifiable indispensability test. Specifically, we discuss three such instances: specific sustainability obligations placed on individual firms, which may however require collective actions; specific mandates that are targeted at the respective industry rather than individual firms; and policy objectives that are not targeted at individual firms or industries but provide a metric for the measurement of sustainability benefits (for example, by way of conducting an abatement cost analysis). [ABSTRACT FROM AUTHOR]

Objectives Cognitive flexibility declines with aging and is usually indicated by task switch costs including global and local switch costs. Cognitive flexibility in aging is associated with alterations in functional connectivity. However, whether different task-modulated connectivity mechanisms underlying global and local switch costs remain unclear. Methods Here we use the support vector machine to identify age-related functional connectivity in global and local switch costs between older (n = 32) and young adults (n = 33). Participants completed a cued task-switching task during the functional magnetic resonance imaging scan. Results Results show an age-related decline behaviorally in global but not in local switch costs. Moreover, distinct patterns of age-related alterations of connectivity were observed for each cost. Specifically, only multivariate changes in connectivity patterns were observed for local switch cost, whereas specific age-related connections were revealed for global switch cost. In older adults, the task-modulated left dorsal premotor cortex–left precuneus connectivity decreased, and the left inferior frontal junction–left inferior parietal sulcus connectivity correlated with decreased global switch cost. Discussion This study provides novel evidence for different neural patterns in global and local switch costs by illuminating connectivity mechanisms underlying cognitive flexibility in aging. [ABSTRACT FROM AUTHOR]

Background Older patients with myelodysplastic syndromes (MDS), particularly those with no or one cytopenia and no transfusion dependence, typically have an indolent course. Approximately, half of these receive the recommended diagnostic evaluation (DE) for MDS. We explored factors determining DE in these patients and its impact on subsequent treatment and outcomes. Patients and Methods We used 2011-2014 Medicare data to identify patients ≥66 years of age diagnosed with MDS. We used Classification and Regression Tree (CART) analysis to identify combinations of factors associated with DE and its impact on subsequent treatment. Variables examined included demographics, comorbidities, nursing home status, and investigative procedures performed. We conducted a logistic regression analysis to identify correlates associated with receipt of DE and treatment. Results Of 16 851 patients with MDS, 51% underwent DE. patients with MDS with no cytopenia (n = 3908) had the lowest uptake of DE (34.7%). Compared to patients with no cytopenia, those with any cytopenia had nearly 3 times higher odds of receiving DE [adjusted odds ratio (AOR), 2.81: 95% CI, 2.60-3.04] and the odds were higher for men than for women [AOR, 1.39: 95%CI, 1.30-1.48] and for Non-Hispanic Whites [vs. everyone else (AOR, 1.17: 95% CI, 1.06-1.29)]. The CART showed DE as the principal discriminating node, followed by the presence of any cytopenia for receiving MDS treatment. The lowest percentage of treatment was observed in patients without DE, at 14.6%. Conclusion In this select older patients with MDS, we identified disparities in accurate diagnosis by demographic and clinical factors. Receipt of DE influenced subsequent treatment but not survival. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this study was to evaluate the cost avoidance associated with emergency medicine pharmacist (EMP) presence in the emergency department (ED) using a novel cost avoidance framework. Summary This single-center, retrospective, observational study examined EMP interventions from November 1, 2021, through March 31, 2022. EMPs prospectively selected up to 10 shifts in which to log interventions during the study period. Interventions were categorized into 25 cost avoidance categories, 10 of which incorporated recently proposed probability variables. All categories were organized into 4 broad cost avoidance domains, including resource utilization, individualization of patient care, adverse drug event prevention, and hands-on care. During the study period, 894 interventions were logged, which accounted for $143,132 in cost avoidance (lower probability value of $124,186, upper probability value of $168,858), with a median cost avoidance per shift of $1,671 (interquartile range, $1,025 to $2,451). On the basis of 240 shifts, the estimated annual total cost avoidance per pharmacist was extrapolated to be $401,040. Conclusion While the mean cost avoidance of $161.10 per intervention observed in our study was less than that in prior cost avoidance studies due to the conservative and potentially more realistic estimates used, implementation of this cost avoidance framework still showed substantial cost avoidance associated with EMP presence in the ED. [ABSTRACT FROM AUTHOR]

Background In the face of rising obesity levels, Ireland introduced a sugar sweetened beverage tax (SSBT) in 2018, the scope of which was extended in 2019. To date, there is a dearth of research on the actual impact of the SSBT on the pricing. Method This study involved an examination of the relative cost of leading brand full-sugar and sugar-free carbonated soft drinks in a convenience sample of 14 different Irish supermarkets. In light of manufacturers' reformulation of certain brands (7UP, Sprite and Fanta), information was collected on the relative in-store pricing of three brands (Coca Cola, Pepsi and Club). Results In-store comparisons of equivalent size and unit number indicate that, in ~60% of cases, the full-sugar and sugar-free versions of the same drink are being offered at the same price. Even when full-sugar versions of these brands were more expensive than the sugar-free alternatives, the price differential was sometimes less than the SSBT rate. Conclusions The pass-through rate of the SSBT to consumers is sub-optimal. Future policy and research suggestions are outlined. [ABSTRACT FROM AUTHOR]

Objective: Measuring the cost of performing breast imaging is difficult in healthcare systems. The purpose of our study was to evaluate this cost using time-driven activity-based costing (TDABC) and to evaluate cost drivers for different exams. Methods: An IRB-approved, single-center prospective study was performed on 80 female patients presenting for breast screening, diagnostic or biopsy exams from July 2020 to April 2021. Using TDABC, data were collected for each exam type. Included were full-field digital mammography (FFDM), digital breast tomosynthesis (DBT), contrast-enhanced mammography (CEM), US and MRI exams, and stereotactic, US-guided and MRI-guided biopsies. For each exam type, mean cost and relative contributions of equipment, personnel and supplies were calculated. Results: Screening MRI, CEM, US, DBT, and FFDM costs were $249, $120, $83, $28, and $30. Personnel was the major contributor to cost (60.0%--87.0%) for all screening exams except MRI where equipment was the major contributor (62.2%). Diagnostic MRI, CEM, US, and FFDM costs were $241, $123, $70, and $43. Personnel was the major contributor to cost (60.5%--88.6%) for all diagnostic exams except MRI where equipment was the major contributor (61.8%). Costs of MRI-guided, stereotactic and US-guided biopsy were $1611, $826, and $356. Supplies contributed 40.5%--49.8% and personnel contributed 30.7%--55.6% to the total cost of biopsies. Conclusion: TDABC provides assessment of actual costs of performing breast imaging. Costs and contributors varied across screening, diagnostic and biopsy exams and modalities. Practices may consider this methodology in understanding costs and making changes directed at cost savings. [ABSTRACT FROM AUTHOR]

Background Invasive fungal infections carry a substantial risk of mortality and morbidity. Azole antifungals are used in the treatment of such infections; however, their extensive use can lead to the emergence of antifungal resistance and increased costs to patients and healthcare systems. The aim of this study is to evaluate trends in these antifungals use and costs. Methods The secular and regional trends of outpatient azole antifungals were analyzed using Medicare Part D Prescriber Public Use Files for the years 2013–2020. The total days supply (TDS), total drug cost (TDC) per 100 000 enrollees, and cost per day (CPD) were evaluated. Results The azole antifungal TDS for Medicare Part D enrollees increased by 12% between 2013 and 2020, and increases were noted for each azole. Southern US regions had the highest TDS, with Arizona having the highest TDS among US states in 2020. Cost analysis showed that TDC of all azoles has increased by 93% over the years, going up from $123 316 in 2013 to $238 336 per 100 000 enrollees in 2020. However, CPD showed an increase only for fluconazole and isavuconazole, with CPD of $1.62 per day and $188.30 per day, respectively. Conclusions Combined azole antifungal prescriptions TDS increased among Medicare Part D enrollees. The trend in CPD was mixed, whereas overall costs consistently increased over the same period. Such findings provide an insight into the impact of azole antifungal prescriptions, and increasing use could foreshadow more antifungal resistance. Continued studies to evaluate different prescribers' trends are warranted. [ABSTRACT FROM AUTHOR]

Objective Few studies within orthodontics present both economic and clinical findings. Missing maxillary lateral incisors is a frequently occurring anomaly. The treatment alternatives most used are orthodontic space closure and prosthetic replacement of the missing tooth. Our aim is to compare the total societal costs of orthodontic space closure (SC) and implant therapy (IT) in patients missing maxillary lateral incisors. Methods Records of 32 patients treated with SC (n = 18) or IT (n = 14) due to missing maxillary lateral incisors were retrieved from the archives. Direct costs and indirect costs in the short- and long-term were analysed using a cost analysis with a societal perspective up of to 12 years post-treatment. Results Comparing cases treated with SC and IT, the difference in direct short-term costs for treatment is €735.54, whereas SC is the least costly. There is no difference between SC and IT in short-term parent loss of productivity, long-term loss of productivity, costs for transportation, or direct long-term costs. A difference was found between SC and IT—in favour of SC—when comparing patients' loss of productivity (P = 0.007), short-term societal costs (P < 0.001), long-term societal costs (P = 0.037), and total societal costs (P < 0.001). Limitations There is a limited number of patient records. Local factors such as subsidies, urban versus rural areas, taxes, etc. can influence monetary variables, so the transferability to other settings may be limited. Conclusion Patients treated with SC have a lower total societal cost compared to patients treated with IT. There was a difference in productivity loss for patients between SC and IT; however, concerning other indirect parameters and direct long-term costs, there was no difference between the two treatments. [ABSTRACT FROM AUTHOR]

Integrated behavioral health (IBH) is an approach to patient care that brings medical and behavioral health providers (BHPs) together to address both behavioral and medical needs within primary care settings. A large, pragmatic, national study aimed to test the effectiveness and measure the implementation costs of an intervention to improve IBH integration within primary care practices (IBH-PC). Assess the time and cost to practices of implementing a comprehensive practice-level intervention designed from the perspective of clinic owners to move behavioral service integration from co-location toward full integration as part of the IBH-PC study. IBH-PC program implementation costs were estimated in a representative sample of 8 practices using standard micro-econometric evaluation of activities outlined in the implementation workbook, including program implementation tasks, remote quality improvement coaching services, educational curricula, and learning community activities, over a 24-month period. The total median cost of implementing the IBH-PC program across all stages was $20,726 (range: $12,381 - $60,427). The median cost of the Planning Stage was $10,258 (range: $4,625 - $14,840), while the median cost of the Implementation Stage was $9,208 (range: $6,017 – 49,993). There were no statistically significant differences in practice or patient characteristics between the 8 selected practices and the larger IBH-PC practice sample (N=34). This study aimed to quantify the relative costs associated with integrating behavioral health into primary care. Although the cost assessment approach did not include all costs (fixed, variable, operational, and opportunity costs), the study aimed to develop a replicable and pragmatic measurement process with flexibility to adapt to emerging developments in each practice environment, providing a reasonable ballpark estimate of costs associated with implementation to help guide future executive decisions. [ABSTRACT FROM AUTHOR]

In this Viewpoint, the authors explore the determinants of patients' prescription adherence behaviors as part of FIND's Advancing Access to Diagnostic Innovation essential for Universal Health Coverage and AMR Prevention (ADIP) trials (ClinicalTrials.gov identifier: NCT04081051). Research findings from Burkina Faso, Ghana, and Uganda show that basic knowledge and understanding of prescription instructions are essential for adherence and can be improved through better communication. However, there are a range of other factors that influence adherence, some of which can be influenced through tailored communication messages from healthcare workers. These messages may contribute to changes in adherence behavior but may require other reinforcing interventions to be effective. Finally, there are some drivers of nonadherence centered around costs and time pressure that require other forms of intervention. [ABSTRACT FROM AUTHOR]

Purpose Costs of hospitalization due to severe adverse drug reactions (ADRs) were previously estimated within the Veterans Health Administration (VHA), but additional analyses are needed to infer potential interventions to mitigate these negative outcomes. The objective of this study was to compare specific adverse reaction–related hospitalization costs between medications with similar indications. Methods Mean hospitalization costs associated with the same ADR symptom were compared for different drugs with similar indications using adjusted generalized linear models with a Bonferroni correction for multiple comparisons as well as a gamma distribution. Results Overall, hospitalization costs between medications with similar indications were not significantly different for specific adverse reactions. However, gastrointestinal hemorrhage–associated costs were higher for warfarin versus nonsteroidal anti-inflammatory drugs (model estimate of mean cost, $18,114 [range of lower and upper model estimates, $12,522-$26,202] vs $14,255 [estimate range, $9,710-$20,929]). Similarly, the estimated mean hospitalization cost associated with angioedema was higher for losartan versus lisinopril or lisinopril/hydrochlorothiazide: $14,591 (range, $9467-$22,488) versus $8,935 (range, $6,301-$12,669) and $8,022 (range, $5,424-$11,865), respectively. Conclusion Although we found few differences in the cost of hospitalization when comparing drugs with similar indications and the same adverse reaction, there were specific drug-ADR pairs that merit attention and consideration of interventions to improve safe and appropriate medication use. Evaluation of the effect of those interventions on the incidence of ADRs is an area for future study. [ABSTRACT FROM AUTHOR]

Promoting the use of assistive technology (AT) is crucial for the health and well-being of users, but there is a huge global problem of unmet need for AT. In this context informal (unregulated) providers of AT play a significant role of meeting AT user need, particularly in less-resourced settings. This study draws on research into formal and informal AT provision in low-income urban communities in Indonesia and Sierra Leone to explore the potential of informal providers in addressing unmet need. Specifically, it looks at the different performance of formal and informal providers regarding the availability and the adequacy of AT that they provide. The study concludes by proposing further research into the scope for coproduction of AT between formal and informal providers. [ABSTRACT FROM AUTHOR]

Background Tuberculosis (TB) drugs and their import are costly. We assessed how shorter TB drug regimens, which were non-inferior or superior in recent TB trials, can affect the costs for purchasing and importing TB drugs. Methods We estimated the drug costs and import costs of 39 longer and shorter TB drug regimens using TB drug prices from the Global Drug Facility and import cost estimates for a TB program in Karakalpakstan, Uzbekistan. Drug regimens from recent TB trials were compared with TB drug regimens following present or past World Health Organization recommendations. Results We estimated an import cost of $4.19 and a drug cost of $43 per standard 6-month drug-sensitive (DS)-TB regimen. A new 17-week DS-TB regimen from the TBTC Study 31 currently requires more tablets and is more expensive to import ($6.08) and purchase ($233). The TB program can substantially decrease import costs ($2.26–14) and drug costs ($391–2308) per multidrug-resistant (MDR)-TB regimen when using new 6-month or shorter drug regimens from the Nix-TB, NExT, TB PRACTECAL, ZeNix, or BEAT TB trials instead of 9–20-month regimens with import costs of $9.96–507 and drug costs of $354–15 028. For a commonly used 20-month all-oral, bedaquiline-containing MDR-TB regimen, we estimated costs of $41 for drug import and $1773 for drug purchase. Conclusions The implementation of a new and shorter DS-TB regimen may increase the costs for drug purchase and import. The implementation of new and shorter MDR-TB regimens may decrease the costs for drug purchase and/or drug import. [ABSTRACT FROM AUTHOR]

Objectives Procalcitonin testing is recommended to discriminate febrile young infants at risk of serious bacterial infections (SBI). However, this test is not available in many clinical settings, limited largely by cost. This study sought to evaluate contemporary real-world costs associated with the usual care of febrile young infants, and estimate impact on clinical trajectory and costs when incorporating procalcitonin testing. Methods We assessed hospital-level door-to-discharge costs of all well-appearing febrile infants aged ≤60 days, evaluated at a tertiary paediatric hospital between April/2016 and March/2019. Emergency Department and inpatient expense data for usual care were obtained from the institutional general ledger, validated by the provincial Ministry of Health. These costs were then incorporated into a probabilistic model of risk stratification for an equivalent simulated cohort, with the addition of procalcitonin. Results During the 3-year study period, 1168 index visits were included for analysis. Real-world median costs-per-infant were the following: $3266 (IQR $2468 to $4317, n=93) for hospitalized infants with SBIs; $2476 (IQR $1974 to $3236, n=530) for hospitalized infants without SBIs; $323 (IQR $286 to $393, n=538) for discharged infants without SBIs; and, $3879 (IQR $3263 to $5297, n=7) for discharged infants subsequently hospitalized for missed SBIs. Overall median cost-per-infant of usual care was $1555 (IQR $1244 to $2025), compared to a modelled cost of $1389 (IQR $1118 to $1797) with the addition of procalcitonin (10.7% overall cost savings; $1,816,733 versus $1,622,483). Under pessimistic and optimistic model assumptions, savings were 5.9% and 14.9%, respectively. Conclusions Usual care of febrile young infants is variable and resource intensive. Increased access to procalcitonin testing could improve risk stratification at lower overall costs. [ABSTRACT FROM AUTHOR]

The Occupational Health and Safety Act 1993 and its attending Regulations in South Africa, require employers to conduct cost analysis studies to inform decision-making related to exposure control for occupational health hazard such as noise. Cost analysis, as per South African National Standard/ISO 31000 risk assessment guideline, is an important input for the decision-making process of the risk management process. The costs of administrating a hearing conservation programme intended to minimise noise-induced hearing loss is an example of a cost analysis. This study enrolled four companies from the South African manufacturing and utilities sectors with the aim of establishing whether cost analysis is included during the noise risk assessment process; and determining administration costs of HCP administration. A HCP cost questionnaire was completed by each company's occupational hygiene professionals and risk officers. None of the companies in the study included cost analysis in their respective risk assessment processes. The overall costs, derived from the HCP cost item questionnaire, was much greater for Company A (4 290 014 Rands) than all of the other companies combined (970 685 Rands). Hearing protection device expenditures across the four companies were the greatest expense, while audiometry was the smallest expense owing to service internalisation. The HCP expenditures are incurred on periodic basis, yearly or biennial, and are internalised in companies as direct costs. Cost analysis can enhance the noise risk assessment process by providing additional input to support the decision-making process related to noise control. This challenges the occupational hygiene profession to pursue new frontiers and decision-making models in the scope of noise risk management, beyond noise measurements and hearing protection device use recommendation. [ABSTRACT FROM AUTHOR]

With an increase in the ageing population, there is a rise in the burden of cardiovascular disease. Age and Ageing have compiled collections of their key cardiovascular themed papers. The first Age and Ageing Cardiovascular Collection focussed on blood pressure, coronary heart disease and heart failure. In this second collection, publications since 2011 were selected with emphasis on atrial fibrillation, transient ischaemic attack (TIA) and stroke. The prevalence of TIA and stroke increases as people get older. In this commentary we summarise studies published in Age and Ageing that bring to the fore the need for a multidisciplinary, person-centred approach to care, conscientious identification of risk factors and their management and prevention strategies, which will inform policy ultimately reducing the burden of cost placed by stroke care on healthcare financing. Read the latest Cardiovascular Collection here. [ABSTRACT FROM AUTHOR]

Estimating the current cost of cancer care is important to health policy makers. An indispensable step in cost projection is to estimate cost trajectories from an incident cohort of cancer patients using longitudinal medical cost data, accounting for terminal events such as death, and right censoring due to loss of follow-up. Since the cost of cancer care and survival are correlated, a scientifically meaningful quantity for inference in this context is the mean cost trajectory conditional on survival. We propose a two-stage semiparametric approach to estimate the longitudinal cost trajectories from a joint model of longitudinal medical costs and survival. The longitudinal cost trajectories corresponding to various survival times form a bivariate surface in a triangular area. The cost trajectories are estimated using the tensor products of discretized measurement time and survival, as well as effective ridge penalties for data in 2D arrays. The proposed approach balances the practical considerations of model flexibility, statistical efficiency, and computational tractability. We used the proposed method to estimate the cost trajectories of renal cell cancer patients using the Surveillance, Epidemiology, and End Results-Medicare linked database. [ABSTRACT FROM AUTHOR]

Purpose Manual restocking and tracking of noncontrolled medications in anesthesia workstations (AWSs) is complicated and time intensive, provides several opportunities for error, and lacks perpetual inventory transparency regarding expiration and lot number. This pre-post study assessed the impact of radio-frequency identification (RFID) technology on restocking of noncontrolled medications in AWSs in relation to workflow, improved patient safety due to reduced restocking errors, and restocking accuracy and efficiency, as well as the estimated costs of on-site medication RFID tagging versus purchase of pretagged products. Summary Pre- and postimplementation process steps were mapped. Randomized AWS tray audits were conducted to assess patient safety, and AWS tray restocking efficiency was measured through stopwatch studies. Time and costs associated with purchase of manufacturer RFID tagged medications versus manually tagging medications on-site were estimated. Pre-post comparisons were completed using descriptive statistics. Prior to implementation, manual AWS restocking took a mean (SD) of 37.9 (24.7) seconds (range, 4.6-135.9 seconds), compared to 145.9 (50.6) seconds (range, 43.4-314.3 seconds) after implementation. The automated workflow took technicians an average of 108 seconds (1.8 minutes) longer than the baseline time. However, restocking errors were reduced by 64.7% and outdated and missing medications eliminated. Manually applying tags to packages containing 25 vials took a mean (SD) of 174.8 (19.8) seconds (range, 131-218 seconds) for smaller vials, compared to 128.1 (21.6) seconds (range, 102-166 seconds) for larger vials. Manual tag application was also more expensive than purchasing of pretagged vials. Conclusion Automated RFID technology for AWS restocking decreased restocking errors but increased the length of time to complete the restocking process. [ABSTRACT FROM AUTHOR]

Aims Systematic use of patient-reported outcomes (PROs) have the potential to improve quality of care and reduce costs of health care services. We aimed to describe whether PROs in patients diagnosed with heart disease are directly associated with health care costs. Methods and results A national cross-sectional survey including PROs at discharge from a heart centre with 1-year follow-up using data from national registers. We included patients with either ischaemic heart disease (IHD), arrhythmia, heart failure (HF), or valvular heart disease (VHD). The Hospital Anxiety and Depression Scale, the heart-specific quality of life, the EuroQol five-dimensional questionnaire, and the Edmonton Symptom Assessment Scale were used. The economic analysis was based on direct costs including primary, secondary health care, and medical treatment. Patient-reported outcomes were available from 13 463 eligible patients out of 25.241 [IHD (n = 7179), arrhythmia (n = 4322), HF (n = 987), or VHD (n = 975)]. Mean annual total direct costs in all patients were €23 228 (patients with IHD: €19 479, patients with arrhythmia: €21 076, patients with HF: €34 747, patients with VDH: €48 677). Hospitalizations contributed overall to the highest part of direct costs. For patients discharged with IHD or arrhythmia, symptoms of anxiety or depression, worst heart-specific quality of life or health status, and the highest symptom burden were associated with increased economic expenditure. We found no associations in patients with HF or VHD. Conclusion Patient-reported outcomes at discharge from a heart centre were associated with direct health care costs in patients with IHD and arrhythmia. Registration ClinicalTrials.gov: NCT01926145. [ABSTRACT FROM AUTHOR]

Background Bacterial infections such as osteomyelitis and endocarditis routinely require several weeks of treatment with intravenous (IV) antimicrobials. Outpatient parenteral antimicrobial therapy (OPAT) programs allow patients to receive IV antimicrobials in an outpatient clinic or at home. The outcomes and costs of such treatments remain uncertain. Methods We conducted a retrospective observational cohort study over a 5-year study interval (1 June 2012 to 31 March 2018) using population-based linked administrative data from British Columbia, Canada. Patients receiving OPAT following a hospitalization for bacterial infection were matched based on infection type and implied duration of IV antimicrobials to patients receiving inpatient parenteral antimicrobial therapy (IPAT). Cumulative adverse events and direct healthcare costs were estimated over a 90-day outcome interval. Results In a matched cohort of 1842 patients, adverse events occurred in 35.6% of OPAT patients and 39.0% of IPAT patients (adjusted odds ratio, 1.04 [95% confidence interval {CI},.83–1.30; P =.61). Relative to IPAT patients, OPAT patients were significantly more likely to experience hospital readmission (30.5% vs 23.0%) but significantly less likely to experience Clostridioides difficile diarrhea (1.2% vs 3.1%) or death (2.0% vs 8.8%). Estimated mean direct healthcare costs were $30 166 for OPAT patients and $50 038 for IPAT patients (cost ratio, 0.60; average cost savings with OPAT, $17 579 [95% CI, $14 131–$21 027]; P <.001). Conclusions Outpatient IV antimicrobial therapy is associated with a similar overall prevalence of adverse events and with substantial cost savings relative to patients remaining in hospital to complete IV antimicrobials. These findings should inform efforts to expand OPAT use. [ABSTRACT FROM AUTHOR]

Latino day laborers (LDL) are a vulnerable population of workers facing considerable risk for occupational injury. Under the guidance of our Community Advisory Board, we developed and tested the feasibility, acceptability and preliminary effects of Vales+Tú (You Are Worth More), a workplace injury risk-reduction program implemented by promotores on street-corners where LDL seek employment. The program was informed by theoretical perspectives emphasizing individual and group agency and self-determination. A pilot three-arm cluster-randomized community trial was conducted among 75 LDL. The intervention arms consisted of an individualized Brief Motivational Interview, a Group Problem Solving activity and a standard of care control (OSHA safety cards). We met our study goal of 25 LDL per intervention arm, and contacted 88% of participants post intervention. Participants evaluated the interventions favorably. At post-test, the Brief Motivational Interview group reported significant reductions in exposure to workplace hazards and increases in risk-reduction practices. The Group Problem Solving participants showed significant reductions in exposure to hazards (t -test −4.16, p < 0.001). Both intervention groups increased their reliance on corner peers, a measure of social support. Standard of care participants increased in self-efficacy to work safely. Overall, the only significant different between the three study conditions was in self-efficacy. These findings provide evidence of the feasibility and acceptability of Vales+Tú and show preliminary program efficacy. A large-scale replication trial will permit a more formal modeling of the study findings. Clinical Trial Registration (ClinicalTrials.gov): NCT04378348. [ABSTRACT FROM AUTHOR]

Direct-to-consumer telemedicine platforms have expanded their reach to include services for the evaluation and treatment of testosterone deficiency. We aim to (i) evaluate the treatment practices and costs associated with receiving testosterone therapy through direct-to-consumer telemedicine platforms; (ii) compare these practices to the American Urological Association guidelines; and (iii) compare the cost of receiving similar care at a tertiary center. Google was queried to identify telemedicine platforms offing testosterone therapy. Websites were analyzed for information regarding the initial consultation, initial laboratory evaluation, follow up, treatment monitoring regimen, and associated costs of receiving testosterone therapy. The costs for similar services at a tertiary care center were estimated using a single institution's online cost estimator for a patient with no insurance, private insurance, or Medicare. Evaluation and treatment practices of each platform were compared to the American Urological Association guidelines, and a cost analysis was completed for the cost of (i) undergoing an initial evaluation, and (ii) receiving 12 months of treatment through each platform and at a tertiary center. Three online platforms met inclusion criteria: Hone, Regenex Health, and TRT Nation. The initial evaluation and follow up of patients on TTh were similar between the online platforms and practice guidelines. The costs of the initial consultation were lowest for the patient with Medicare at a tertiary center and via the telemedicine platforms. Conversely, the cost of 12 months of intramuscular testosterone treatment was highest via the telemedicine platforms, ranging from $1,586 to $4,200, as compared to the tertiary center, which ranged from $134.01 to $1,333.04 with varying insurance models. Costs of ongoing treatment with transdermal testosterone are similarly higher via DTC platforms. Patients with private insurance or Medicare should be counseled that ongoing treatment through telemedicine platforms will likely incur a greater cost than receiving such care at a tertiary center that can utilize insurance coverage. Practice and cost comparisons include accurate, up-to-date information based on each platform's website. Limitations include the analysis of only three telemedicine platforms, and the ability to describe only the information provided on each website. In addition, cost estimates for the tertiary center only include a single type of private and public insurance, limiting generalizability. This observational study indicates that direct-to-consumer telemedicine platforms are largely following practice guidelines in the evaluation and treatment of testosterone, however, there is a high cost associated with ongoing treatment. Jesse E, Sellke N, Rivero M-J, et al. Practice Comparison and Cost Analysis of Direct-to-Consumer Telemedicine Platforms Offering Testosterone Therapy. J Sex Med 2022;19:1608–1615. [ABSTRACT FROM AUTHOR]

Mexico has a population of 129 million and is considered one of the most unequal countries in the world, suffering from widespread health disparities. There is a pressing need to strengthen epidemiologic capacity in Mexico, to help solve the complex health problems the country faces and to reduce health inequities. However, the representation of Mexican epidemiologists in the largest epidemiologic society in North America is low, despite the short distance to the United States. In this commentary, we discuss the barriers to higher representation of Mexican epidemiologists within the Society for Epidemiologic Research (SER), including language barriers, costs, and regional necessities. We also discuss opportunities to expand Mexican SER representation and collaboration. Overall, we hope that this is a call towards expanding SER global participation and starting a conversation on a common agenda for epidemiologic research. [ABSTRACT FROM AUTHOR]