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We study how internal trade costs affect the Chinese economy. Combining regional and industry data with a multiregional multisector general equilibrium model, we quantify the magnitude of total trade costs and institutional trade costs, and the impact of their changes on aggregate, regional, and sectoral total factor productivity, gross domestic product, and welfare. Using unique data, we estimate the sectoral trade elasticity of internal trade in 16 tradable sectors. We use our calibrated model to perform a variety of counterfactual exercises. We find that the welfare gains are negative for a 5% reduction in total trade costs and for the elimination of institutional trade costs, which can be attributed to inherent inefficiencies in the economy. However, as total trade costs decrease further, the positive welfare effect significantly exceeds the impact of inefficiency. The regional and sectoral effects of changes in trade costs show that the spatial structure of the economy, input‐output linkages, and local factors together determine the heterogeneity of sectoral and regional consequences. Finally, we infer the relative changes in China's internal trade costs from 2012 to 2017, and calculate their economic effects. [ABSTRACT FROM AUTHOR]

Background: Economic evaluations are being conducted with increasing frequency in the maternity care setting, with more randomized controlled trials containing a health economic component. Key emerging criticisms of economic evaluation in maternity care are lack of robust data collection and measurement, inconsistencies in methodology, and lack of adherence to reporting guidelines. Methods: This article provides a guide to the design of economic evaluations alongside clinical trials in maternal health. We include economic concepts and considerations for the maternity setting and provide examples from the UK and Australia. Results: There are many important considerations for the design of economic evaluations alongside clinical trials. To be effective, researchers must select types of economic evaluation, which align with their study objectives; choose an appropriate evaluation perspective, time horizon, and discount rate; and identify accurate ways to measure and evaluate health outcomes and costs. Discussion: This guide is written for noneconomists and can be used for designing economic evaluations to be conducted as a part of clinical trials. We seek to improve the quality, consistency, and transparency of economic evaluations in maternal health. [ABSTRACT FROM AUTHOR]

Objective: To compare the amounts of water and plastic used in surgical hand washing with medicated soaps and with alcohol‐based products and to compare costs and consumption in a year, based on scheduled surgical activity. Method: This retrospective study was carried out at Udine's Gynecology Operating Block from October to November 2022. We estimated the average amount of water with a graduated cylinder and the total cost of water usage based on euros/m3 indicated by the supplier; for each antiseptic agent we collected the data relevant to wash time, amount of water and product used per scrub, number of handscrubs made with every 500 mL bottle and cost of a single bottle. We put data into two hypothetical contexts, namely WHO guidelines and manufacturers' recommendations. Data were subjected to statistical analysis. Results: The daily amount of water using povidone‐iodine, chlorhexidine‐gluconate and alcohol‐based antiseptic agents was 187.6, 140.7 and 0 L/day (P value = 0.001), respectively; A total of 69 000 L/year of water would be saved if alcohol‐based products were routinely used. A single unit of an alcohol‐based product allows three times as many handscrubs as any other product (P value = 0.001) with consequent reduction in plastic packaging. Conclusion: Despite the cost saving being negligible, choosing alcohol‐based handrub over medicated soap handrub – on equal antiseptic efficacy grounds ‐ could lead to a significant saving of water and plastic, thus making our operating theaters more environmentally friendly. Synopsis: If routinely used for surgical handrub, alcohol‐based antiseptic agents lead to a significant saving of water and reduction in plastic waste in operating theaters. [ABSTRACT FROM AUTHOR]

Background and aims: The use and manufacture of methamphetamine has increased in Afghanistan in recent years. Recent research and reports have pointed to the ephedra plant, which grows wildly, as a key source of ephedrine used in the manufacture of methamphetamine. This paper aimed to estimate the relative efficiencies and scale of inputs required to manufacture methamphetamine in Afghanistan. Methods: Monte Carlo simulations model of the amount of ephedra or cold medications needed to render a pure kilogram of methamphetamine in Afghanistan, accounting for uncertainty in ranges of key parameters informed from the literature and elsewhere. Final estimates were extrapolated to recent seizure totals. Results: For dried ephedra, the median estimate is 196.8 kg (25th–75th percentiles 119.3–346.6 kg) needed to produce 1 kg of methamphetamine compared with 27.9 kg (25th–75th percentiles 21.9–36.8 kg) for cold medications. Nearly 2.7 t of methamphetamine were seized in Afghanistan in 2021. Assuming a purity range of 50%–90%, some 266–478 t of dried ephedra or 38–68 t of cold medication would need to have been processed. Conclusion: Simulated estimates show that considerable amounts of either ephedra or cold medication are needed to produce 1 kg of methamphetamine in Afghanistan. This raises questions about the plausibility of ephedra as the dominant source of Afghanistan's methamphetamine. [ABSTRACT FROM AUTHOR]

Aim: This paper aims to highlight the vital importance of investing in advanced practice nursing (APN) for enhancing emergency care throughout Africa. Background: APN's role is increasingly recognized as pivotal in optimizing healthcare, particularly in emergency settings in Africa. It offers improved patient care quality and strengthens the healthcare workforce. Sources of evidence: Evidence is drawn from successful implementations of APN in various healthcare environments. This includes the development of APN‐specific curricula and training, mentorship initiatives, clinical supervision, and defining advanced nursing roles within healthcare organizations. Investing in APNs in emergency care in Africa can lead to improved quality and access to care, cost‐effectiveness, enhanced patient outcomes and satisfaction, and opportunities for professional development and career advancement in the healthcare workforce. Discussion: Despite facing barriers in implementation, APN in emergency care presents innovative solutions. Investing in APN can help healthcare entities and policymakers surmount these challenges, providing specialized patient care and improving health outcomes. The discussion emphasizes the benefits such as enhanced access to care, reduced healthcare costs, and improved patient outcomes, alongside bolstering the healthcare workforce. Conclusion: The necessity and benefits of investing in APN for emergency care in Africa are clear. It is crucial for improving healthcare delivery and outcomes. Implications for nursing practice: APN investment leads to a more competent and efficient nursing workforce, capable of addressing complex emergencies and improving patient care. Implications for nursing policy and health/social policy: The paper advocates for policies that support APN development and integration into the healthcare system, emphasizing the need for research to assess APN's long‐term impact and establish best practices for its implementation in emergency care across Africa. [ABSTRACT FROM AUTHOR]

This study revealed determinants that influence motive inference toward helpers who engage in lifesaving. The costly signalling theory contends that higher costs associated with helping behaviour will promote one's inference of altruistic motives toward a helper. We examined how costs affect third parties' motive inference when controlling for benefits to recipients. In addition, in terms of projection theory, we predicted that the stronger the third parties' praise‐seeking need, the more likely it is they will infer self‐presentational motives toward a helper. We also examined if the praise‐seeking need would moderate the effect of cost on motive inference. Two vignette studies using hypothetical scenarios were conducted. In Study 1 (N = 140) and Study 2 (N = 100), the main effect of costs was found to be significant, indicating that the larger the cost, the more likely it is that a third party inferred altruistic motives toward a helper. Moreover, the main effect (but not the moderation effect) of the praise‐seeking need was also significant, as predicted above. This study provides stronger support for the costly signalling theory and reveals an individual‐difference factor that determines motive inference toward a helper. [ABSTRACT FROM AUTHOR]

Summary: Telemonitoring of obstructive sleep apnea patients is increasingly being adopted though its cost‐effectiveness evidence base is scanty. This study investigated whether telemonitoring is a cost‐effective strategy compared with the standard follow‐up in patients with obstructive sleep apnea who are starting continuous positive airway pressure treatment. In total, 167 obstructive sleep apnea patients were randomised into telemonitoring (n = 79) or standard follow‐up (n = 88), initiated continuous positive airway pressure treatment, and were followed up for 6 months. The frequencies of healthcare contacts, related costs (in USD 2021 prices), treatment effect and compliance were compared between the follow‐up approaches using generalised linear models. The cost effectiveness analysis was conducted from a healthcare perspective and the results presented as cost per avoided extra clinic visit. Additionally, patient satisfaction between the two approaches was explored. The analysis showed no baseline differences. At follow‐up, there was no significant difference in treatment compliance, and the mean residual apnea–hypoapnea index. There was no difference in total visits, adjusted incidence rate ratio 0.87 (0.72–1.06). Participants in the telemonitoring arm made eight times more telephone visits, 8.10 (5.04–13.84), and about 73% fewer physical healthcare visits 0.27 (0.20–0.36). This translated into significantly lower total costs for the telemonitoring approach compared with standard follow‐up, −192 USD (−346 to −41). The form of follow‐up seemed to have no impact on the extent of patient satisfaction. These results demonstrate the telemonitoring of patients with obstructive sleep apnea initiating continuous positive airway pressure treatment as a cost saving strategy and can be argued as a potential worthy investment. [ABSTRACT FROM AUTHOR]

Introduction: In 2018, the Mozambique Ministry of Health launched guidelines for implementing differentiated service delivery models (DSDMs) to optimize HIV service delivery, improve retention in care, and ultimately reduce HIV‐associated mortality. The models were fast‐track, 3‐month antiretrovirals dispensing, community antiretroviral therapy groups, adherence clubs, family approach and three one‐stop shop models: adolescent‐friendly health services, maternal and child health, and tuberculosis. We conducted a cost‐effectiveness analysis and budget impact analysis to compare these models to conventional services. Methods: We constructed a decision tree model based on the percentage of enrolment in each model and the probability of the outcome (12‐month retention in treatment) for each year of the study period—three for the cost‐effectiveness analysis (2019–2021) and three for the budget impact analysis (2022–2024). Costs for these analyses were primarily estimated per client‐year from the health system perspective. A secondary cost‐effectiveness analysis was conducted from the societal perspective. Budget impact analysis costs included antiretrovirals, laboratory tests and service provision interactions. Cost‐effectiveness analysis additionally included start‐up, training and clients' opportunity costs. Effectiveness was estimated using an uncontrolled interrupted time series analysis comparing the outcome before and after the implementation of the differentiated models. A one‐way sensitivity analysis was conducted to identify drivers of uncertainty. Results: After implementation of the DSDMs, there was a mean increase of 14.9 percentage points (95% CI: 12.2, 17.8) in 12‐month retention, from 47.6% (95% CI, 44.9–50.2) to 62.5% (95% CI, 60.9–64.1). The mean cost difference comparing DSDMs and conventional care was US$ –6 million (173,391,277 vs. 179,461,668) and –32.5 million (394,705,618 vs. 433,232,289) from the health system and the societal perspective, respectively. Therefore, DSDMs dominated conventional care. Results were most sensitive to conventional care interaction costs in the one‐way sensitivity analysis. For a population of 1.5 million, the base‐case 3‐year financial costs associated with the DSDMs was US$550 million, compared with US$564 million for conventional care. Conclusions: DSDMs were less expensive and more effective in retaining clients 12 months after antiretroviral therapy initiation and were estimated to save approximately US$14 million for the health system from 2022 to 2024. [ABSTRACT FROM AUTHOR]

Background: This analysis assessed the cost‐effectiveness of insulin glargine 300 units/mL (Gla‐300) versus insulin glargine 100 units/mL (Gla‐100) in insulin‐naïve adults with type 2 diabetes (T2D) inadequately controlled with oral antidiabetic drugs (OADs). Methods: Costs and outcomes for Gla‐300 versus Gla‐100 from a US healthcare payer perspective were assessed using the BRAVO diabetes model. Baseline clinical data were derived from EDITION‐3, a 12‐month randomized controlled trial comparing Gla‐300 with Gla‐100 in insulin‐naïve adults with inadequately controlled T2D on OADs. Treatment costs were calculated based on doses observed in EDITION‐3 and 2020 US net prices, while costs for complications were based on published literature. Lifetime costs ($US) and quality‐adjusted life‐years (QALYs) were predicted and used to calculate incremental cost‐effectiveness ratio (ICER) estimates; extensive scenario and sensitivity analyses were conducted. Results: Lifetime medical costs were estimated to be $353,441 and $352,858 for individuals receiving Gla‐300 and Gla‐100 respectively; insulin costs were $52,613 and $50,818. Gla‐300 was associated with a gain of 8.97 QALYs and 21.12 life‐years, while Gla‐100 was associated with a gain of 8.89 QALYs and 21.07 life‐years. This resulted in an ICER of $7522/QALY gained for Gla‐300 versus Gla‐100. Thus, Gla‐300 was cost‐effective versus Gla‐100 based on a willingness‐to‐pay threshold of $50,000/QALY. Compared with Gla‐100, Gla‐300 provided a net monetary benefit of $3290. Scenario and sensitivity analyses confirmed the robustness of the base case. Conclusion: Gla‐300 may be a cost‐effective treatment option versus Gla‐100 over a lifetime horizon for insulin‐naïve people in the United States with T2D inadequately controlled on OADs. [ABSTRACT FROM AUTHOR]

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

Introduction Methods Result Conclusion While digital breast tomosynthesis (DBT) has proven to enhance cancer detection and reduce recall rates (RR), its integration into BreastScreen Australia for screening has been limited, in part due to perceived cost implications. This study aims to assess the cost effectiveness of digital mammography (DM) compared with synthesized mammography and DBT (SM + DBT) in a first round screening context for short‐term outcomes.Clients recalled for nonspecific density (NSD) as a single lesion by both readers at the Northern Sydney Central Coast BreastScreen service in 2019 were included. Prior images were excluded to simulate first‐round screening. Eleven radiologists read DM and synthesized mammography with DBT (SM + DBT) images 4 weeks apart. Recall rates (RR), reading time, and diagnostic parameters were measured, and costs for screen reading and assessment were calculated.Among 65 clients studied, 13 were diagnosed with cancer, with concordant cancer recalls. SM + DBT reduced recall rates (RR), increased reading time, maintained cancer detection sensitivity, and significantly improved other diagnostic parameters, particularly false positive rates. Benign biopsy recalls remained equivalent. While SM + DBT screen reading cost was significantly higher than DM (DM AU$890 ± 186 vs SM + DBT AU$1279 ± 265; P < 0.001), the assessment cost (DM AU$29,504 ± 9427 vs SM + DBT AU$18,021 ± 5606; P < 0.001), and combined screen reading and assessment costs were significantly lower (DM AU$30,394 ± 9508 vs SM + DBT AU$19,300 ± 5721; P = 0.001). SM + DBT screen reading and assessment of 65 patients resulted in noteworthy cost savings (AU$11,094), equivalent to assessing 12 additional clients.In first round screening, DBT yields significant cost savings by effectively reducing unnecessary recalls to assessment while maintaining diagnostic efficacy. [ABSTRACT FROM AUTHOR]

Objectives: To provide insight into the health and social care costs during the disease trajectory in persons with dementia and the impact of institutionalization and death on healthcare costs compared with matched persons without dementia. Methods: Electronic health record data from family physicians were linked with national administrative databases to estimate costs of primary care, medication, secondary care, mental care, home care and institutional care for people with dementia and matched persons from the year before the recorded dementia diagnosis until death or a maximum of 4 years after the diagnosis. Results: Total mean health and social care costs among persons with dementia increased substantially during the disease trajectory, mainly due to institutional care costs. For people who remained living in the community, mean health and social care costs are higher for people with dementia than for those without dementia, while for those who are admitted to a long‐term care facility, mean health and social care costs are higher for people without dementia than for those with dementia. Conclusions: The steep rise in health and social care costs across the dementia care trajectory is mainly due to increasing costs for institutional care. For those remaining in the community, home care costs and hospital care costs were the main cost drivers. Future research should adopt a societal perspective to investigate the influence of including social costs. Key points: Health and social care costs among persons with dementia increase substantially during the disease trajectory.This steep rise in costs during the disease trajectory is mainly due to institutional care costs.For people who remained living in the community, mean health and social care costs are higher for people with dementia than for those without dementia.For people who are admitted to a long‐term care facility, mean health and social care costs are higher for people without dementia than for those with dementia. [ABSTRACT FROM AUTHOR]

Background: Prediabetes management is a priority for policymakers globally, to avoid/delay type 2 diabetes (T2D) and reduce severe, costly health consequences. Countries moving from low to middle income are most at risk from the T2D "epidemic" and may find implementing preventative measures challenging; yet prevention has largely been evaluated in developed countries. Methods: Markov cohort simulations explored costs and benefits of various prediabetes management approaches, expressed as "savings" to the public health care system, for three countries with high prediabetes prevalence and contrasting economic status (Poland, Saudi Arabia, Vietnam). Two scenarios were compared up to 15 y: "inaction" (no prediabetes intervention) and "intervention" with metformin extended release (ER), intensive lifestyle change (ILC), ILC with metformin (ER), or ILC with metformin (ER) "titration." Results: T2D was the highest‐cost health state at all time horizons due to resource use, and inaction produced the highest T2D costs, ranging from 9% to 34% of total health care resource costs. All interventions reduced T2D versus inaction, the most effective being ILC + metformin (ER) "titration" (39% reduction at 5 y). Metformin (ER) was the only strategy that produced net saving across the time horizon; however, relative total health care system costs of other interventions vs inaction declined over time up to 15 y. Viet Nam was most sensitive to cost and parameter changes via a one‐way sensitivity analysis. Conclusions: Metformin (ER) and lifestyle interventions for prediabetes offer promise for reducing T2D incidence. Metformin (ER) could reduce T2D patient numbers and health care costs, given concerns regarding adherence in the context of funding/reimbursement challenges for lifestyle interventions. [ABSTRACT FROM AUTHOR]

Background and Objectives Materials and Methods Results Conclusions Obstetric haemorrhage is the leading cause of maternal morbidity and mortality worldwide. We aimed to estimate the economic cost of Major Obstetric Haemorrhage (MOH) and the cost of therapeutic blood components used in the management of MOH in Ireland.We performed a nationwide cross‐sectional study utilising top‐down and bottom‐up costing methods on women who experienced MOH during the years 2011–2013. Women with MOH were allocated to Diagnostic Related Groups (DRGs) based on the approach to MOH management (MOH group). The total number of blood components used for MOH treatment and the corresponding costs were recorded. A control group representative of a MOH‐free maternity population was designed with predicted costs. All costs were expressed in Euro (€) using 2022 prices and the incremental cost of MOH to maternity costs was calculated. Cost contributions are expressed as percentages from the estimated total cost.A total of 447 MOH cases were suitable for sorting into DRGs. The estimated total cost of managing women who experienced MOH is approximately €3.2 million. The incremental cost of MOH is estimated as €1.87 million. The estimated total cost of blood components used in MOH management was €1.08 million and was based on an estimated total of 3997 products transfused. Red blood cell transfusions accounted for the highest contribution (20.22%) to MOH total cost estimates compared to other blood components.The total cost of caring for women with MOH in Ireland was approximately €3.2 million with blood component transfusions accounting for between one third and one half of the cost. [ABSTRACT FROM AUTHOR]

Introduction: Dementia is now responsible for the greatest burden of disease of any chronic illness in older Australians. Rural and remote communities bear the impacts of this disproportionately. Additional training and education for healthcare staff to support people living with dementia is needed. Objective: The objective of this scoping review was to map and synthesise the evidence related to barriers and enablers of accessing dementia training for Australian healthcare workers located in rural and remote areas. Design: This scoping review systematically searched multiple databases in January 2023 for peer‐reviewed literature on the topic. Reviewers used Covidence to screen titles and abstracts of located sources, and to screen full‐text articles. Findings: From 187 articles screened, seven peer‐reviewed journal articles were included in the final data analysis; all were from Australia or Canada. The most common barrier described was low staffing, precluding release of staff for dementia training. Enablers to participation in dementia training were availability of online training programs, as well as training providers collaborating with end users to ensure the training met their learning needs. Discussion: This review provides evidence of barriers and enablers specific to rural and remote healthcare workers accessing dementia training. It also explores other approaches to training that have been trialled successfully in different settings. Conclusion: Addressing the identified barriers and enablers may assist in developing training approaches appropriate for existing staff, and in meeting training needs for the future workforce. [ABSTRACT FROM AUTHOR]

Precision‐dosing models forecast infliximab doses to achieve targeted trough concentrations in patients with inflammatory bowel disease (IBD). These models have shown to reduce nonresponse and improve patient outcomes. We compared infliximab doses determined by iDOSE precision dosing with standard dosing, and the associated drug costs, in patients with IBD. In this retrospective study, patients with IBD treated with infliximab every 8 weeks at 5 mg/kg were included. An infliximab dose was named dose X if 3 previous infliximab doses, laboratory values including trough infliximab concentrations, and the patient's weight were recorded. The actual dose X was compared to an iDOSE‐predicted dose X. Net drug use and costs were evaluated. A total of 174 patients—56% men; median age, 36 (interquartile range, 29‐47) years; 135 with Crohn disease; and 31 with ulcerative colitis—were included, with 417 dose X recordings. Median prior infliximab therapy was 2 (0‐4) years. Comparing actual dose X with predicted dose X, 52% and 32% of doses were subtherapeutic when aiming for trough concentrations of 5‐10 and 3‐7 μg/mL, respectively. Treatment costs increased by 102% and 29% for the 2 trough ranges, respectively. On multivariate regression analysis, subtherapeutic infliximab concentrations were associated with ulcerative colitis compared with Crohn disease (odds ratio, 9.81; 95% confidence interval, 1.28‐75.40; P =.028) and predose X infliximab trough concentration [odds ratio, 0.07; 95% confidence interval, 0.03‐0.15; P <.001]. Over half of maintenance infliximab drug doses were too low to achieve infliximab blood concentrations of 5 μg/mL or greater. While applying precision dosing may improve patient outcomes, drug costs could be considerably greater. [ABSTRACT FROM AUTHOR]

Background: Single‐cell sequencing (SCS) marks the advent of a transformative period in biomedical studies, enabling unprecedented insight into the cellular intricacies of health and disease. Methods: By dissecting the genetic, epigenetic and proteomic landscapes at the single‐cell level, SCS transcends traditional bulk sequencing methodologies, illuminating the heterogeneity and dynamics of individual cells. Results: This analytical leap facilitates a deeper understanding of disease mechanisms, offers novel diagnostic and therapeutic targets and underpins the development of precision medicine across diverse fields such as neurology, oncology and immunology. Conclusions: Despite its profound potential, SCS encounters challenges, including complex sample preparation, sophisticated data analysis and cost considerations. Nevertheless, ongoing advancements promise to overcome these barriers, integrating SCS with other omics data and leveraging machine learning to enhance biological understanding and clinical application. With the advancement of SCS technologies, personalised healthcare might be fundamentally altered, facilitating tailored and efficacious treatment strategies. [ABSTRACT FROM AUTHOR]

Most new medicines entering the market are high‐cost speciality drugs. These drugs can cost tens to hundreds of thousands of dollars per course of treatment and in some cases millions of dollars per dose. Approximately half of all spending on medicines is projected to target only 2–3% of patients, raising important questions about resource allocation. While there is no doubt that breakthrough innovations have transformed clinical care in some disciplines, it is also true that cost is becoming one of the primary barriers to treatment access and that many new medicines do not provide value commensurate with their prices. This article examines pricing trends, the reasons for high prices and their implications for access and clinical practice. [ABSTRACT FROM AUTHOR]

Aim: Obesity has a significant impact on all‐cause mortality rate and overall health care resource use (HCRU). These outcomes are also strongly linked to age, sex and local deprivation of the population. We aimed to establish the lifetime costs of obesity by demographic group/geographic area using published mortality rates and HCRU use for integrated care boards (ICB) in England in the context of costs of therapeutic intervention. Methods: Population and expected mortality rates by age, sex and deprivation were obtained from national data. Obesity class prevalence was taken from the health of the nation study. The published impact of obesity by age, group, sex and deprivation on mortality and HCRU were applied to estimate life years lost and lifetime HCRU [by sex, age band and body mass index (BMI) class for each ICB]. The year 2019 was chosen as the study basis data to avoid influences of COVID‐19 pandemic on obesity rates with application of 2022/23 HCRU values. Outcomes including prevalence, deaths, life years lost, HCRU and lifetime HCRU were compared by age and sex groups across four BMI classes normal/underweight (BMI <25 kg/m2), overweight (25‐29.9 kg/m2), obese class I and II (30‐39.9 kg/m2), and obese class III (≥40), with benchmarking being set against all population being BMI <25 kg/m2 overall and by each of the 42 ICBs. We also associated future life with deaths to provide an estimate of 'future life years lost' occurring each year. Results: Total population aged >16 years was 45.4 million (51% female). Prevalence: 13.7 million (28% of the total adult population) had a BMI ≥30 mg/m2 and BMI ≥40 kg/m2 were 1.50 million (12%) of these 1.0 million (68%) were female and of these 0.6 million 40% were women aged 16‐49 years. In addition, 35% of those with a BMI ≥40 kg/m2 were in the top deprivation quintile (i.e. overall 20%). Mortality was based on expected deaths of 518K/year, and modelling suggested that if a BMI <25 kg/m2 was achieved in all individuals, the death rate would fall by 63K to 455K/year for the English population (12% reduction). For those with a BMI ≥40 kg/m2 the predicted reduction was 12K deaths (54% lower); while in those aged 16‐49 years with a BMI ≥40 kg/m2 72% of deaths were linked to obesity. For future life years lost, we estimated 2.5 years were lost in people with BMI 30‐39.9 kg/m2 6.7 years when BMI ≥40 kg/m2. However, for those aged 16‐49 years with a BMI ≥40 kg/m2, 8.3 years were lost. HCRU, for weight reduction, the annual HCRU decrease from BMI ≥40 kg/m2 to BMI 30‐39.9 kg/m2 was £342 per person and from BMI 30‐39.9 to 25‐29.9 kg/m2 the reduction was £316/person. However, lifetime costs were similar because of reduced life expectancy for obese individuals. In quality adjusted life years (QALY), overall, 791 689 future life years were lost (13.1% of all) in people with BMI ≥25 kg/m2 and were related to excess weight. When the NICE £30 000 per QALY value was applied to the estimated total 791 689 future life years lost then the potential QALY value reduction lost was equivalent to £24 billion/year or £522/person in the obese population. For morbidly obese men and women the potential QALY value lost was £2864/person/year. Regarding geography, across the 42 ICBs, we observed significant variation in the prevalence of BMI ≥40 (1.8%‐4.3%), excess mortality (11.6%‐15.4%) and HCRU linked to higher BMI (7.2%‐8.8%). The areas with the greatest impact on HCRU were in the north‐west, north‐east and Midlands of England, while the south shows less impact. Conclusion: The expected increases in annual HCRU because of obesity, when considered over a lifetime, are being mitigated by the increased mortality of obese individuals. Our data suggest that simple short‐term HCRU reduction brought about through BMI reduction will be insufficient to fund additional specialist weight reduction interventions. The HRCUs associated with BMI are not in most cases related to short‐term health conditions. They are a cumulative result over a number of years, so for age 16‐49 years reducing BMI from ≥40 to 30‐39.9 kg/m2 might show an annual decrease in HCRU/person by £325/year for women and £80/year for men but this might not have immediately occurred within that year. For those aged >70 years reducing BMI from ≥40 to 30‐39.9 kg/m2 might show an annual decrease in HCRU/person by £777/year for women and £796/year for men but also may not be manifest within that year. However, for the morbidly obese men and women, the potential QALY value lost was £2864 per person per year with the potential for these funds to be applied to intensive weight management programmes, including pharmacotherapy. [ABSTRACT FROM AUTHOR]

Highlights Polymer adhesives have considerable mechanical and environmental privileges; however, their high price makes them uncommercial for common uses. This study investigates the incorporation of recycled or byproduct fillers in epoxy resin‐based composites to assess their mechanical properties, environmental impacts, and cost efficiency. The fillers examined include fly ash, glass powder, slag, silica powder, and limestone powder. Tensile, compressive, and fracture tests were conducted on composites with various filler proportions (0%–80% by weight). From microstructure observations, round (fly ash, glass powder) and rough (slag, silica, and limestone powder) morphologies are seen. Also, it is seen that all the fillers are well distributed in the matrix; with the increase of filler content, the air voids increase. The tensile and compressive results indicate that adding fillers improves the composite's strengths, with up to a 20% increase compared to neat epoxy resin. However, when filler contents exceed 40%, the strengths decrease. Fracture toughness values also decrease with increasing filler content. Comparing the results with those of other studies indicates the similarity of trends. Cost‐strength and CO2eq‐strength curves were evaluated to assess the financial and environmental aspects. The composites show potential for cost efficiency but may have some environmental drawbacks compared to traditional construction materials like cement concrete. The incorporation of recycled or byproduct fillers in epoxy resin composites. Examined fillers include fly ash, glass, slag, silica, and limestone powder. Tensile, compressive, flexural, and fracture tests were conducted. SEM and failure patterns were analyzed, and similar studies were compared. Cost‐strength and CO2eq‐strength data evaluated. [ABSTRACT FROM AUTHOR]

Close-kin mark-recapture (CKMR) is a method analogous to traditional mark-recapture but without requiring recapture of individuals. Instead, multilocus genotypes (genetic marks) are used to identify related individuals in one or more sampling occasions, which enables the opportunistic use of samples from harvested wildlife. To apply the method accurately, it is important to build appropriate CKMR models that do not violate assumptions linked to the species' and population's biology and sampling methods. In this study, we evaluated the implications of fitting overly simplistic CKMR models to populations with complex reproductive success dynamics or selective sampling. We used forward-in-time, individual-based simulations to evaluate the accuracy and precision of CKMR abundance and survival estimates in species with different longevities, mating systems, and sampling strategies. Simulated populations approximated a range of life histories among game species of North America with lethal sampling to evaluate the potential of using harvested samples to estimate population size. Our simulations show that CKMR can yield nontrivial biases in both survival and abundance estimates, unless influential life history traits and selective sampling are explicitly accounted for in the modeling framework. The number of kin pairs observed in the sample, in combination with the type of kinship used in the model (parent-offspring pairs and/or half-sibling pairs), can affect the precision and/or accuracy of the estimates. CKMR is a promising method that will likely see an increasing number of applications in the field as costs of genetic analysis continue to decline. Our work highlights the importance of applying population-specific CKMR models that consider relevant demographic parameters, individual covariates, and the protocol through which individuals were sampled. [ABSTRACT FROM AUTHOR]

Introduction: Alcohol is a harmful, toxic and addictive substance that causes many diseases and injuries. Alcohol use also incurs a financial cost to the health care system and wider economy. This project aimed to undertake a cost impact analysis of alcohol‐related harms at the local level in New South Wales (NSW). The alcohol‐related harms costing model is an interactive tool designed for use by local health districts, stakeholders such as Liquor and Gaming NSW, NSW Independent Liquor and Gaming Authority and community stakeholders. Methods: Costs included in the analysis were alcohol‐related hospitalisations, deaths, crimes, emergency department attendances, outpatient presentations and their impacts on productivity. Two local government areas (LGA) were used as case studies to demonstrate local impacts. Results: In 2019–2020, the total cost of alcohol‐related harms for NSW was estimated at $9 billion, at a rate of $120.3 million per 100,000 population. The total costs were comprised of alcohol‐attributable premature mortality ($8.3 billion), non‐fatal health care costs ($275 million) and crime costs ($457 million). A comparative analysis of two case study LGAs estimated that alcohol‐related harms cost $195 million for the Northern Beaches LGA and $351 million for the Central Coast LGA. Discussion and Conclusions: This research has developed a 'proof‐of‐concept' model to estimate the cost of alcohol‐related harms at the local level in Australia, empowering health agencies and local community stakeholders to use economic evidence in their submissions in response to new liquor licence applications and other policies that impact their local community. This economic evidence can be used to improve the quality of decisions on alcohol regulation and policies. There are a number of future research opportunities that would enhance the economic evidence available to liquor licensing decision‐makers. [ABSTRACT FROM AUTHOR]

The article addresses the issue of underpowered trials in evaluating new care models, particularly in randomized controlled trials (RCTs). It highlights challenges like implementation issues and incomplete engagement, leading to ambiguous results. It suggests strategies for improving trial power, including cautious estimation of effect sizes, anticipating uptake challenges, using preparatory studies and others.

Aim: This study aimed to characterize the periodontal breakdown during supportive periodontal care (SPC) and to quantify the corresponding cost‐effectiveness of periodontal therapy. Materials and Methods: Data were obtained from charts of patients who received active periodontal therapy (APT) with a minimum follow‐up of ≥10 years. Analysis was done to identify factors associated with the incidence of additional sub‐gingival instrumentation (SGI) and/or surgery (SUR) during SPC and mean cumulative cost of recurrence was calculated. All relevant data were collected. Results: In all, 442 patients were included. Over the follow‐up period, 62% of Stage I and II patients and 72% of Stage III and IV patients required further treatment following the APT; 56.5% of SGI patients and 78.6% of SUR patients received a second intervention. SUR patients received more SUR during the follow‐up period (p =.035). Stage III and IV patients received more SUR during SPC than Stage I and II patients (p =.001). Grade C patients received more SUR during the follow‐up period (p <.05). During the 5‐year period preceding retreatment, the mean SPC visits were lower for patients who did not require retreatment (p <.001). Risk factors such as regularity of maintenance, smoking and diabetes were related to a higher chance of receiving SUR during the follow‐up period (p <.05). The mean cumulative costs indicated less recurrence cost for compliers in Stage III and IV or Grade B and C but not for those in Stage I and II or Grade A. Conclusions: The risk of relapse in the maintenance population may be correlated with higher stage and grade, patient compliance, modifiable risk factors and the nature of the treatment provided during APT. The total cost of treatment of recurrences was lower for compliers in Stage III/IV and Grade B/C compared with erratic compliers with the same severity and risk. [ABSTRACT FROM AUTHOR]

Introduction: The LINC‐II randomized controlled trial in St. Petersburg, Russia for HIV‐positive adults who inject drugs found that a multi‐component intervention including initiation of antiretroviral therapy (ART) during admission to an addiction hospital, strengths‐based case management and naltrexone significantly increased 12‐month HIV viral suppression and ART retention. We conducted a comparative cost analysis to determine if the 12‐month cost of the intervention is affordable within the current Russian health system. Methods: We used LINC‐II trial records and questionnaire responses to calculate the resources utilized by each participant in the study, including inpatient days, medications, laboratory tests, outpatient consultations, case manager interactions and opioid medication treatment. Quantities of resources utilized were multiplied by unit costs for each resource estimated from the service fee or price lists used by the study facilities for each specific service delivered. We report the average cost/study primary (viral suppression at 12 months) or secondary (retention in care at 12 months) outcome/participant in 2021 USD and compare costs between study arms. Results: The trial enrolled 225 participants (111 intervention, 114 control) between September 2018 and December 2020. Viral suppression, non‐suppression and missing suppression results were 28% and 14%, 49% and 37%, and 31% and 41% for the control and intervention arms, respectively. Retention results were 35% and 51% for the control and intervention arms, respectively. The average cost per study participant was $2714 in the control arm and $4342 in the intervention arm. The average cost per participant virally suppressed at 12 months was $3662 (control) and $6355 (intervention). The average cost per participant retained at 12 months was $4050 (control) and $5448 (intervention). For those retained, the cost difference between the arms was comprised of opioid treatment (35%), case management (31%), outpatient visits (18%) and additional days of ART (12%). Conclusions: The LINC‐II intervention increased the cost of care for HIV‐positive people who inject drugs in Russia significantly, but some components of the intervention, particularly earlier initiation of ART and case management, may be justifiable due to their success in reaching a challenging subgroup of the population in need. Clinical Trial Number: NCT03290391 [ABSTRACT FROM AUTHOR]

Background: Hospital admission and discharge are at high risk of drug‐related problems (DRPs) in older patients with cancer. This study aimed to assess the clinical and economic impact of a comprehensive pharmaceutical care intervention (RECAP) to optimize drug therapy in patients with cancer ≥75 years admitted to oncology or geriatric wards. Method: RECAP intervention was defined as follows: at admission and discharge, hospital pharmacists conducted comprehensive medication reconciliation and review, identified relevant DRPs and provided optimization recommendations to prescribers; at discharge, pharmacists also provided patient education and shared information with primary care providers. The impact of the intervention was assessed by the rate of implementation of recommendations by the prescribers and the evolution of polypharmacy rate; a peer review of the clinical significance of DRPs was performed by an expert panel of geriatric oncologists and pharmacists. A cost saving analysis compared cost avoided through resolution of DRPs to cost of pharmacist's time. Results: From January 2019 and August 2020, 201 patients were included (median age 80 [75–97] years), 68.7% with solid tumors. DRPs requiring optimization were identified in 70.9% of patients at admission (mean 1.7 DRP/patient) and 47.7% at discharge (0.9 DRP/patient). Most pharmacist recommendations (70.8%) were followed by prescribers, allowing the correction of 1.2 DRP/patient at admission and 0.7 DRP/patient at discharge. Half of resolved DRPs were rated as clinically significant. However, polypharmacy rate was not reduced at discharge. Cost comparison showed $7.2 avoided for $1 invested, with an estimated total net benefit of $354,822 (mean $1766 per patient). Conclusions: The RECAP model significantly reduces DRPs in hospitalized older patients with cancer. The model was cost saving, confirming the value of implementing it in routine practice. [ABSTRACT FROM AUTHOR]

Aqueous photoelectrochemical (PEC) cells have long been considered a promising technology to convert solar energy into hydrogen. However, the solar‐to‐H2 (STH) efficiency and cost‐effectiveness of PEC water splitting are significantly limited by sluggish oxygen evolution reaction (OER) kinetics and the low economic value of the produced O2, hindering the practical commercialization of PEC cells. Recently, organic upgrading PEC reactions, especially for alternative OERs, have received tremendous attention, which improves not only the STH efficiency but also the economic effectiveness of the overall reaction. In this review, PEC reaction fundamentals and reactant‐product cost analysis of organic upgrading reactions are briefly reviewed, recent advances made in organic upgrading reactions, which are categorized by their reactant substrates, such as methanol, ethanol, glycol, glycerol, and complex hydrocarbons, are then summarized and discussed. Finally, the current status, further outlooks, and challenges toward industrial applications are discussed. [ABSTRACT FROM AUTHOR]

Background: Changes to prescribing policies in England have restricted or stopped access to gluten‐free food on prescription for people with coeliac disease in some geographical areas. The present study aimed to explore the impact of these changes on the affordability and obtainability of gluten‐free foods for adults with coeliac disease. Methods: Semi‐structured qualitative interviews (n = 24) were conducted with people with coeliac disease living in areas where prescriptions for gluten‐free foods were no longer available, were restricted or followed national guidelines. Interviews explored the impact of gluten‐free prescribing changes on the affordability and obtainability of gluten‐free food, as well as dietary adherence. Results: All participants considered gluten‐free substitute foods to be expensive. Participants felt the availability of gluten‐free foods has improved over time, also acknowledging some challenges remain, such as limited local availability. For most, the withdrawal of prescriptions had minimal impact requiring small adjustments such as reducing the quantity of foods obtained. However, greater challenges were faced by those less mobile, permanently sick or disabled and/or on lower incomes. Conclusions: The majority of participants affected by the withdrawal of prescriptions were able to adapt to cope with these changes. However, participants with mobility issues, who are permanently sick or disabled and/or on lower incomes were struggling to afford and obtain gluten‐free substitute foods from elsewhere. The withdrawal of prescriptions may further widen health inequalities. Further research should focus on the long‐term impacts of prescription withdrawal for the vulnerable groups identified. Key points: Prescriptions for gluten‐free substitute foods have been restricted or withdrawn in some areas of England, but the impact of these changes on people with coeliac disease is unknown.The present study found that the majority of people with coeliac disease were able to adapt to cope with prescribing changes, but certain groups (people with mobility issues, who are permanently sick or disabled and/or on lower incomes) were struggling to afford and obtain gluten‐free foods.Future research should focus on the longer‐term impacts of no access or restricted access to gluten‐free substitute foods on prescription, with specific focus on the groups identified above. [ABSTRACT FROM AUTHOR]

Objectives: The STrAtegies for RelaTives (START) intervention is effective and cost‐effective in supporting family carers of people with dementia. It is currently not available to all eligible carers in England. What would be the impacts on service costs and carer health‐related quality of life if START was provided to all eligible carers in England, currently and in future? Methods: Effectiveness and cost‐effectiveness data from a previously conducted randomised controlled trial were combined with current and future projections of numbers of people with newly diagnosed dementia to estimate overall and component costs and health‐related quality of life outcomes between 2015 (base year for projections) and 2040. Results: Scaling‐up START requires investments increasing annually but would lead to significant savings in health and social care costs. Family carers of people with dementia would experience improvements in mental health and quality of life, with clinical effects lasting at least 6 years. Scaling up the START intervention to eligible carers was estimated to cost £9.4 million in 2020, but these costs would lead to annual savings of £68 million, and total annual quality‐adjusted life year (QALY) gains of 1247. Although the costs of START would increase to £19.8 million in 2040, savings would rise to £142.7 million and Quality adjusted life years gained to 1883. Conclusions: Scaling‐up START for family carers of people with dementia in England would improve the lives of family carers and reduce public sector costs. Family carers play a vital part in dementia care; evidence‐based interventions that help them to maintain this role, such as START, should be available across the country. Key points: Family carers are the mainstay of dementia support across the world.The STrAtegies for RelaTives (START) intervention has previously been shown to be clinically and cost‐effective.Making START available to all eligible family carers in England, both currently and projected to 2040, would lead to significant savings in health and social care service costs, amounting to £143 million in 2040.Improvements in the mental health and quality of life of carers would also be substantial. [ABSTRACT FROM AUTHOR]

Complementary feeding among children aged 6–23 months is a key determinant of micronutrient deficiencies and childhood stunting, the burdens of which remain high in Kenya. This study examines the affordability of complementary foods to increase young children's nutrient consumption across eight provinces in Kenya. We combined data from household surveys, food composition tables and published sources to estimate the cost of portion sizes that could meet half of the children's daily iron, vitamin A, calcium, zinc, folate, vitamin B12 and protein requirements from complementary feeding. These costs were compared to current household food expenditures. The selection of foods and price and expenditure data were stratified by province. Our analysis indicates that vitamin A, vitamin B12 and folate are affordable to most households in Kenya via liver, beans and in some provinces, orange‐fleshed fruits and vegetables, avocado and small dried fish. Calcium, animal‐ source protein, zinc and iron were less affordable and there was more provincial variation. In some provinces, small dried fish were an affordable source of calcium, protein and zinc. In others (North Eastern, Central, Eastern, parts of Rift Valley and Coast), small dried fish were not commonly consumed and other foods were less affordable. Future research should consider interventions aimed at reducing prices, increasing availability and changing behaviours related to these foods. Solutions such as supplementation and fortification may be needed for iron and zinc in some locations. Food affordability presented the greatest barriers in North Eastern province, which had lower dietary diversity and may require additional targeted interventions. [ABSTRACT FROM AUTHOR]

The costs for hydrogen refueling of fleets were calculated by a two‐step approach. Firstly, different hydrogen refueling station (HRS) system configurations were simulated and optimized for various HRS sizes and 350 bar pressure, with the Fraunhofer ISE's toolkit H2ProSim, showing that large‐scale and pipeline‐supplied HRS can reduce the hydrogen refueling costs. Secondly, as customer travel costs to the HRS play an important role, especially in the hydrogen market activation phase, the placement and dimensioning of the HRS network was optimized in a case study for the Upper Rhine region. The analysis shows possible network structure and cost distributions for a set of specific customers. Hydrogen supply costs are highly dependent on the hydrogen demand and spatial distribution of the customers and can drop to values of around € 0.60 kg−1 for depot refueling stations for high‐volume customers. However, some customers cannot be supplied at a reasonable cost. [ABSTRACT FROM AUTHOR]

Advantaged group allies can incur costs or rewards as a result of their allyship. The present work investigates whether such costs and rewards affect how marginalised group members perceive these allies. Across four experiments that collectively examine marginalised group members' perceptions of individual and corporate allies in the context of allyship for women's rights, Black Lives Matter and the LGBTQI+ community, we find that allies are perceived differently as a function of the costs and rewards associated with their allyship. Allies who face costs are perceived more positively in terms of tenacity and genuine motivations, and are generally evaluated more favourably compared to allies who do not face costs and those who, instead, garner rewards for their allyship. These findings demonstrate that marginalised group members are cognisant of the costs and rewards allies may reap, and that this information can shape their judgements of allies' investment in the cause. [ABSTRACT FROM AUTHOR]

Introduction: Currently, Indonesia still has one of the highest rates of new HIV/AIDS infections among countries in Asia and the Pacific region. The WHO has recommended pre‐exposure prophylaxis (PrEP) as an additional HIV epidemic prevention step, which has been applied globally and related to the reduction in the number of HIV cases. However, information on the cost of implementing PrEP is rarely available in developing countries, especially in Southeast Asia. Designing a cost‐effective approach to scale up PrEP and to estimate the potential budget impact requires information on the cost of implementing PrEP. This study aims to estimate the cost of implementing PrEP at community‐based clinics in Indonesia. Methods: We collected healthcare and non‐healthcare/client costs from nine community‐based clinics in various cities/districts in Indonesia. The healthcare costs included data on resource utilisation and costs to deliver PrEP, divided into recurrent and capital costs using a discount rate of 3%. Non‐healthcare costs included out‐of‐pocket costs (e.g., transportation, meals) and productivity loss by clients and accompanying person(s) in accessing PrEP. On average, we interviewed 27 clients/clinic. Results: The annual cost of providing PrEP per client is US $365.03, 39% lower than the yearly cost of antiretroviral treatment (ART) per person (approximately US $600). Drugs and non‐healthcare costs contribute approximately 67% of the cost. The cost of PrEP amounts to US $292,756.45/year, covering 802 clients. The non‐healthcare cost per visit at all sites never reaches more than 10% of the average monthly household expenditure. Conclusions: The cost of providing PrEP per person is approximately US $365 and is 39% lower than the annual cost of ART per person. Lowering the cost of PrEP ARV drugs would reduce the cost. Scaling up PrEP should recognise this cost structure and strive to reach economies of scale as the intervention gains more clients while simultaneously controlling new HIV infections. [ABSTRACT FROM AUTHOR]

Introduction: Considering Japan's aging society, the number of older individuals who die at home is expected to increase. In Japan, there are challenges in utilizing and promoting home‐visit nursing services at the end of life for community‐dwelling older adults. We examined the use of home‐visit nursing services at the end of patients' lives and the recommended use patterns of this service (utilization, timing of initiation, and continuity) that contribute to reducing the medical care and long‐term care costs (total costs) in the last 3 months of life. Design: This was a retrospective cohort study. Methods: We examined 33 municipalities in Japan, including depopulated areas. The analysis included 22,927 people aged 75 or older who died between September 2016 and September 2018. We used monthly medical care and long‐term care insurance claims data. Participants were classified into five groups based on their history of home‐visit nursing service use: (1) early initiation/continuous use, (2) early initiation/discontinued or fragment use, (3) not‐early initiation/continuous use, (4) not‐early initiation/fragment use, and (5) no use. Univariate and multivariate linear regression analyses were performed to examine the association between total costs in the last 3 months of life and patterns of home‐visit nursing service use. Results: Overall, the median age was 85, and 12,217 participants were men (53.3%). In the last half year before death, 5424 (23.7%) older adults used home‐visit nursing services. Multivariable linear regression analysis of the log10‐transformed value of total costs revealed that compared with the no use group, the early initiation/continuous use group was estimated to have 0.88 times (95% confidence interval: 0.84, 0.93) the total costs in the last 3 months of life (p < 0.001). Conclusion: Early initiation use of home‐visit nursing services may contribute to reducing total costs in the last 3 months of life for Japanese people aged 75 years or older living at home as they approach the end of life. Clinical relevance: When approaching the end of life, many older adults require daily life care and palliative care. Policymakers are strengthening end‐of‐life care for community‐dwelling older adults in Japan. Although the current results do not demonstrate the effectiveness of home‐visit nursing services, they provide a perspective from which to assess the use of home‐visit nursing services and its impact on older adults. The findings can be helpful in considering how to provide nursing care in home‐care settings for older adults who prefer to spend their final days at home. [ABSTRACT FROM AUTHOR]

The article presents the discussion on navigating low-value care in regional, rural and remote Australia. Topics include identified that approximately a third of urine cultures, coagulation studies, blood cultures and cranial CT scans conducted within the TUH-ED setting; and accept the patient until testing and imaging have been done, citing the need for efficiency.

Aims and Objectives: Studies in adult medicine have shown that physicians base testing decisions on the patient's clinical condition but also consider other factors, including local practice or patient expectations. In pediatrics, physicians and parents jointly decide on behalf of a (young) child. This might demand more explicit and more complex deliberations, with sometimes conflicting interests. We explored pediatricians' considerations in diagnostic test ordering and the factors that influence their deliberation. Method: We performed in‐depth, semistructured interviews with a purposively selected heterogeneous sample of 20 Dutch pediatricians. We analyzed transcribed interviews inductively using a constant comparative approach, and clustered data across interviews to derive common themes. Results: Pediatricians perceived test‐related burden in children higher compared with adults, and reported that avoiding an unjustified burden causes them to be more restrictive and deliberate in test ordering. They felt conflicted when parents desired testing or when guidelines recommended diagnostic tests pediatricians perceived as unnecessary. When parents demanded testing, they would explore parental concern, educate parents about harms and alternative explanations of symptoms, and advocate watchful waiting. Yet they reported sometimes performing tests to appease parents or to comply with guidelines, because of feared personal consequences in the case of adverse outcomes. Conclusion: We obtained an overview of the considerations that are weighed in pediatric test decisions. The comparatively strong focus on prevention of harm motivates pediatricians to critically appraise the added value of testing and drivers of low‐value testing. Pediatricians' relatively restrictive approach to testing could provide an example for other disciplines. Improved guidelines and physician and patient education could help to withstand the perceived pressure to test. [ABSTRACT FROM AUTHOR]

Introduction: Intra‐disciplinary practice is rarely discussed in occupational therapy and the broader health‐care literature. Community‐based occupational therapists often work autonomously in clients' homes and consequently have limited access to routine intra‐disciplinary practices. Additionally, the community‐based role covers a large scope of practice requiring comprehensive expertise. This study aimed to describe occupational therapists' perspectives on intra‐disciplinary practice within community health settings. Methods: This study utilised an online cross‐sectional survey design, collecting quantitative and qualitative data to explore perspectives of occupational therapists working within Australian community health services. Quantitative data were analysed using descriptive statistics. Qualitative data were analysed using thematic analysis. Both forms of data were compared and contrasted. Results/Findings: Eighty occupational therapists completed the survey. Seventy‐eight participants (97%) previously used or currently use intra‐disciplinary practice in their workplace. Participants predominantly consult their peers when client needs are perceived as complex. Participants indicated that intra‐disciplinary practice can benefit the client, therapist, and workplace. Enablers and barriers to the use of intra‐disciplinary practice had overlapping themes, including access to therapists, attitudes towards intra‐disciplinary practice, management support, and funding influences. Most participants expressed a desire to utilise intra‐disciplinary practices (n = 70, 87%) and were also likely or extremely likely to incorporate it into their clinical work (n = 73, 91%). Participants who did not want to utilise intra‐disciplinary practices or who were unsure provided reasons related to cost, practice inefficiencies, and being uncertain of the benefit. Conclusions: Occupational therapists perceive intra‐disciplinary practice as beneficial for problem‐solving and an opportunity for knowledge sharing that supports therapist confidence with clinical reasoning. Conversely, some therapists believe its use may lead to client confusion, a greater need for communication and coordination among therapists, and that power differentials between therapists may discourage equal collaboration. Greater understanding of intra‐disciplinary practice will help guide how it is used and supported in community health settings. [ABSTRACT FROM AUTHOR]

This cost analysis, from a societal perspective, compared the cost difference of a networked teletrial model (NTTM) with four regional hubs versus conventional trial operation at a single metropolitan specialist centre. The Australian phase 3 cancer interventional randomised controlled trial included 152 of 328 regional participants (patient enrolment 2018–2021; 6‐month primary end point). The NTTM significantly reduced (AU$2155 per patient) patient travel cost and time and lost productivity. [ABSTRACT FROM AUTHOR]

There is a paucity of public discussion of costs spent on drug trials during coronavirus disease 2019 (COVID‐19) and their value, and of large public outlay on research funding for vaccine and drug development that did not deliver medicines nor vaccines for Australians. This oversight left us at the behest of global supply chains, politics and commercial cost‐plus pricing for vaccines. It is possible that these outcomes were the result of some major cognitive biases and the failure of a clinical pharmacologist's voice in the leadership teams. Biases included unawareness of the complexities of taking interesting chemicals in vitro to development into therapeutic use that can be tolerated, show efficacy and have appropriate disposition in humans; lack of a systems approach to therapeutic development; and an understanding of the relevance and translatability of pharmacology, physiology and clinical drug development. We believe that reflecting on and addressing these biases will help Australia reposition itself better with a therapeutics and clinical trial strategy for future pandemics, built into the strategy of a Centre for Disease Control. [ABSTRACT FROM AUTHOR]

Cracking performance of control and RAPed hot mix asphalt (HMA) mixtures was studied under low and medium temperatures. The effects of recycled asphalt pavement (RAP) content (0 and 50%), compaction method, and temperature (−20, 0 and +20°C) on KIf and KIIf were investigated. Cracking resistances of both modes showed similar trends. The fracture toughness of RAPed mixture at +20°C was higher than the control mixture. However, at −20°C, KIf and KIIf obtained from the RAPed mixture were about 22% lower than control mixture. A cost analysis was performed to compare the manufacturing costs of both mixtures. Accordingly, the cost of HMA mixture containing 50% RAP was 26% less than the control mixture. The proposed life‐cost index in the RAPed mixture was 10, 25, and 100% greater than the control mixture at −20, 0, and +20°C, respectively. Temperature and RAP content had the most important impacts on fracture toughness and cost, respectively. Highlights: A life‐cost index was defined and proposed for comparing the performance of asphalt mixtures.Crack resistance of control and RAPed mixtures under both modes I and II were considered as life index.Mixture made of 50% RAP can be used for paving and repair purposes especially at moderate regions.The manufacturing cost of RAPed mixture was approximately 26% less than the control mixture. [ABSTRACT FROM AUTHOR]

Aims: The provision of Home Enteral Nutrition (HEN) is a well‐established support for patients, however, significant inconsistencies in funding result in financial burden for some healthcare services across Australia. Recent government‐initiated funding changes prompted the development of a new HEN service for eligible patients with a disability, moving from a universal to more individualised approach to care. Methods: This retrospective observational study included patients enrolled on a newly established disability‐specific HEN service at a paediatric tertiary hospital between July 2020 and February 2022 inclusive. Components of service development were explored including service model, clinical resources, information related to patient enrolments and costings for annual HEN requirements provided by dietitians. Retrospective quantitative data was collected from the Electronic Medical Record system and analysed using descriptive statistics. Results: A total of 362 patient enrolments occurred over a 21‐month period, with an average of 17 new patients having accessed the service each month. Annual HEN supports were quoted at a median cost of $13487.94 AUD (2364.97–44170.92), mostly attributable to consumable requirements. Most eligible participants chose to receive care through the new HEN service. Supports were quoted >330% higher than previous fixed price allocations, highlighting the true cost associated with HEN care. Large variation in costings may be attributed to the diversity and complexity of patients. Conclusion: Funding changes presented a unique opportunity to meet pre‐existing resource deficits and enabled individualised access to HEN supports for paediatric patients with a disability. [ABSTRACT FROM AUTHOR]

Accessing the pericardial space safely and efficiently is an important skill for interventional cardiac electrophysiologist. With the increased recognition of the complexity of the 3‐dimensional arrhythmogenic substrate due to advances in imaging and mapping technologies there has been an expansion of epicardial procedures in recent years. Equally, minimally invasive implantation of epicardial pacing, cardiac resynchronization, or defibrillation leads is expanding in specific patients where transvenous systems are contraindicated or their long term sequelae should be ideally avoided. Selective delivery of intrapericardial pharmacological antiarrhythmic therapy is yet another potential indication, albeit still investigational. The expanding indications for percutaneous epicardial procedures is contrasted by the still substantial risk and challenges associated with accessing the pericardial space. Myocardial perforation, coronary artery laceration, and damage to the surrounding organs are all recognized and feared complications. A number of innovative epicardial access techniques have been proposed to overcome the difficulties and risks of traditional dry subxiphoid punctures and may allow for more widespread use of epicardial access in the future. We review 10 different established and novel subxiphoidal epicardial access techniques describing procedural success rates, safety profile and overall experience. The technical aspects as well as access times and costs for extra equipment will be reviewed. Finally, an outlook of reported preclinical techniques awaiting in‐human feasibility studies is provided. [ABSTRACT FROM AUTHOR]

Background: Female healthcare workers have a high prevalence of low back pain (LBP)‐related sickness absence. Here, we report findings of a 24‐month follow‐up of a previously published 6‐month randomized controlled trial (RCT). Methods: By adopting an RCT with 6 months of intervention and follow‐up at 6, 12, and 24 months, we assessed the maintenance of changes in the effectiveness (LBP and fear of pain) of the interventions (neuromuscular exercise [NME], back‐care counseling, both combined) using a generalized linear mixed model adjusted for baseline covariates. The incremental cost‐effectiveness ratio was calculated in terms of quality‐adjusted life years (QALY). A bootstrap technique was used to estimate the uncertainty around a cost‐effectiveness acceptability curve. Results: Of the 219 females, 71% had data at 24 months. Between 6 and 24 months, LBP intensity (primary outcome) remained low in all intervention arms (−20% to −48%) compared to the control (−10% to −16%). Pain interfering with work remained low in the combined and exercise arms for up to 24 months. At 24 months, the total costs were lowest in the combined arm (€484 vs. €613–948, p < 0.001), as were the number of back‐related sickness absence days (0.16 vs. 1.14–3.26, p = 0.003). The analysis indicated a 95% probability of the combined arm to be cost‐effective per QALY gained at €1120. Conclusions: Six months of weekly NME combined with four counseling sessions was cost‐effective for treating LBP and the effect was maintained over 24 months. Trial registration: ClinicalTrials.gov, NCT01465698, 7/11/2011, prospective. [ABSTRACT FROM AUTHOR]

Background: Real‐world evidence examining the incremental health care resource use (HCRU) and cost burden of incident dementia among patients with Parkinson's disease psychosis (PDP) are needed within the United States (US). Objectives: To compare HCRU and cost burden between PDP patients with incident dementia (PDP + D) versus without incident dementia (PDP). Methods: A retrospective analysis of inpatient (Part A), outpatient (Part B), and prescription drug (Part D) claims from the 100% Medicare sample was conducted to compare PDP + D patients versus PDP patients between 01/01/14‐12/31/18. Patients with a diagnosis of dementia, psychosis, secondary parkinsonism, or other psychotic disorders, during 12‐month pre‐index were excluded. Patients in both groups were matched using 1:1 propensity score matching (PSM) methodology using 31 variables (age, sex, race, region and 27 Elixhauser comorbidity characteristics). Differences in 12‐month post‐index HCRU rates and mean per patient per year (PPPY) costs for all‐cause inpatient (IP) hospitalizations, and by type of IP stay (i.e., short‐term [ST‐stay], skilled nursing facility [SNF‐stay] and long‐term [LT‐stay]) were analyzed via logistic and gamma log‐link regression models. Results: Of the 12,484 patients who met our study criteria, 1855 PSM‐matched cohorts were identified. Mean age, gender, and comorbidities were similar in PSM groups. Approximately, 50.3% with PDP + D reported ≥1 all‐cause IP hospitalizations versus 36.0% with PDP (p < 0.05) during 12‐month follow‐up. Specifically, all‐cause ST‐stay, SNF‐stay, and LT‐stay among PDP + D versus PDP patients were: 45.2% versus 35.7%, 28.3% versus 15.7%, and 8.5% versus 6.0% (p < 0.05), respectively. Psychiatric‐related ST‐stay, SNF‐stay, and LT‐stay among PDP + D versus PDP patients were: 12.3% versus 9.0%, 7.5% versus 3.4%, and 2.4% versus 1.2% (p < 0.05), respectively. Mean PPPY all‐cause IP hospitalization costs for PDP + D patients versus PDP patients was $17,891 (±29,882) versus $11,599 (±$25,247) (p < 0.05). Conclusions: Patients with PDP + D experience significantly higher all‐cause and psychiatric‐related IP hospitalizations, including ST‐stays, LT stays, and SNF stays. They also had 54% greater mean PPPY IP hospitalization costs versus PDP patients. Key points: The results of this retrospective analysis of Medicare beneficiaries with Parkinson's disease psychosis (PDP) show that nearly 4 in 5 patients with PDP have incident concurrent dementia (PDP + D).PDP + D patients had significantly higher rates of hospitalizations for both all‐cause and psychiatric‐related reasons. Particularly they had more frequent short‐term stays, long‐term stays, and skilled nursing facility stays.PDP + D patients also had incurred 54% higher costs for inpatient hospitalization compared to PDP patients without dementia.These findings highlight the additional burden imposed by dementia on PDP patients and the potential need to manage dementia symptoms as well. [ABSTRACT FROM AUTHOR]

Aim: The colonoscopic‐assisted laparoscopic wedge resection (CAL‐WR) is proven to be an effective and safe alternative to a segmental colon resection (SCR) for large or complex benign colonic polyps that are not eligible for endoscopic removal. This analysis aimed to evaluate the costs of CAL‐WR and compare them to the costs of an SCR. Method: A single‐centre 90‐day 'in‐hospital' comparative cost analysis was performed on patients undergoing CAL‐WR or SCR for complex benign polyps between 2016 and 2020. The CAL‐WR group consisted of 44 patients who participated in a prospective multicentre study (LIMERIC study). Inclusion criteria were (1) endoscopically unresectable benign polyps; (2) residual or recurrence after previous polypectomy; or (3) irradically resected low risk pT1 colon carcinoma. The comparison group, which was retrospectively identified, included 32 patients who underwent an elective SCR in the same period. Results: Colonoscopic‐assisted laparoscopic wedge resection was associated with significantly fewer complications (7% in the CAL‐WR group vs. 45% in the SCR group, P < 0.001), shorter operation time (50 min in the CAL‐WR group vs. 119 min in the SCR group, P < 0.001), shorter length of hospital stay (median length of stay 2 days in the CAL‐WR group vs. 4 days in the SCR group, P < 0.001) and less use of surgical resources (reduction in costs of 32% per patient), resulting in a cost savings of €2372 (£2099 GBP) per patient (P < 0.001). Conclusion: Given the clinical and financial benefits, CAL‐WR should be recommended for complex benign polyps that are not eligible for endoscopic resection before major surgery is considered. [ABSTRACT FROM AUTHOR]

Medical cost data often consist of zero values as well as extremely right‐skewed positive values. A two‐part model is a popular choice for analyzing medical cost data, where the first part models the probability of a positive cost using logistic regression and the second part models the positive cost using a lognormal or Gamma distribution. To address the unmeasured confounding in studies on cost outcome under two‐part models, two instrumental variable (IV) methods, two‐stage residual inclusion (2SRI) and two‐stage prediction substitution (2SPS) are widely applied. However, previous literature demonstrated that both the 2SRI and the 2SPS could fail to consistently estimate the causal effect among compliers under standard IV assumptions for binary and survival outcomes. Our simulation studies confirmed that it continued to be the case for a two‐part model, which is another nonlinear model. In this article, we develop a model‐based IV approach, Instrumental Variable with Two‐Part model (IV2P), to obtain a consistent estimate of the causal effect among compliers for cost outcome under standard IV assumptions. In addition, we develop sensitivity analysis approaches to allow the evaluation of the sensitivity of the causal conclusions to potential quantified violations of the exclusion restriction assumption and the randomization of IV assumption. We apply our method to a randomized cash incentive study to evaluate the effect of a primary care visit on medical cost among low‐income adults newly covered by a primary care program. [ABSTRACT FROM AUTHOR]

Objective: To describe the pharmacoepidemiology and costs associated with medications dispensed during pregnancy. Design: Pharmacoepidemiological study and cost analysis. Setting: Queensland, Australia. Population: All women who gave birth in Queensland between January 2013 and June 2018. Methods: We used a whole‐of‐population linked administrative dataset, Maternity1000, to describe medications approved for public subsidy that were dispensed to 255 408 pregnant women. We describe the volume of medications dispensed and their associated costs from a Government and patient perspective. Main outcome measures: Prevalence of medication use; proportion of total dispensings; total medication costs in AUD 2020/21 ($1AUD = $0.67USD/£0.55GBP in December 2022). Results: During pregnancy, 61% (95% CI 60.96–61.29%) of women were dispensed at least one medication approved for public subsidy. The mean number of items dispensed per pregnancy increased from 2.14 (95% CI 2.11–2.17) in 2013 to 2.47 (95% CI 2.44–2.51) in 2017; an increase of 15%. Furthermore, mean Government cost per dispensing increased by 41% from $21.60 (95% CI $20.99–$22.20) in 2013 to $30.44 (95% CI $29.38–$31.49) in 2017. These factors influenced the 53% increase in total Government expenditure observed for medication use during pregnancy between 2013 and 2017 ($2,834,227 versus $4,324,377); a disproportionate rise compared with the 17% rise in women's total out‐of‐pocket expenses observed over the same timeframe ($1,880,961 versus $2,204,415). Conclusions: Prevalence of medication use in pregnancy is rising and is associated with disproportionate and rapidly escalating cost implications for the Government. [ABSTRACT FROM AUTHOR]

This paper aims to propose an equivalent trapezoidal traction–separation law (ET‐TSL) of the cohesive zone model applicable to a wide range of ductile and brittle adhesives using equivalent and fictitious material concepts. The ET‐TSL can reduce the analysis time and cost of complex problems without degrading the prediction accuracy. To experimentally validate the proposed ET‐TSL, double‐cantilever beam (DCB) samples were fabricated with glass fiber‐reinforced polymer substrates and a highly ductile adhesive and then tested. The fracture behavior of the specimens was modeled using the proposed ET‐TSL. Moreover, the accuracy and comprehensiveness of the proposed model were verified by employing the proposed ET‐TSL for different adhesive joints made of different adhesives ranging from brittle to ductile adhesives and different substrates found in the literature. It was found that the proposed ET‐TSL can provide reasonable accuracy in simulating the fracture response of different types of adhesive joints with brittle and ductile adhesives. Highlights: An equivalent traction–separation law (TSL) of the cohesive zone model (CZM) was proposed for modeling fracture in adhesive joints.The proposed model can be employed for a wide range of brittle and ductile adhesives.The proposed model was validated via the experimental results of the double‐cantilever beam test.The comprehensiveness of the proposed model was verified for various adhesives. [ABSTRACT FROM AUTHOR]

Background: Diagnosis of gestational diabetes mellitus (GDM) in a pregnancy has a significant impact on health service resources and represents a substantial financial and time impost on women. Aim: To describe a cost‐minimisation analysis conducted following the demonstration of clinically equivalent care of women using a novel, digital model for GDM management, compared with conventional care. Materials and Methods: A pre‐implementation model of care was compared with the post‐implementation model of care which included systematic development and delivery of education videos, use of the Commonwealth Scientific and Industrial Research Organisation 'M♡THer' smart phone app/portal and a dramatically reduced schedule of visits. The Mater Mothers' Hospital Brisbane cares for approximately 1200 women with GDM per annum, on which the cost estimates were based. Service costs were estimated using the resource method, where resource volumes and costs were gathered from experts within the health service. Patient costs were estimated using results from a short survey completed by a cohort of the study population. Results: Health service costs showed a modest saving of AU$17 441.78 (US$12 158.92) in the intervention group over a 12‐month period. Cost savings for the woman were estimated at $566.56 (US$394.96) per patient after accounting for lost wages, childcare expenses, and travel expenses avoided. This reduction led to an overall saving of $679 872 (US$473 948.82) for the cohort of 1200 women, primarily due to the reduction in face‐to‐face visits. Conclusion: Re‐imagining GDM patient care by introducing a novel, digital‐based GDM model of care has substantial positive cost implications for patients. [ABSTRACT FROM AUTHOR]