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Operating under both supply-side and demand-side uncertainties, a mobile-promotion platform conducts advertising campaigns for individual advertisers. Campaigns arrive dynamically over time, which is divided into seasons; each campaign requires the platform to deliver a target number of mobile impressions from a desired set of locations over a desired time interval. The platform fulfills these campaigns by procuring impressions from publishers, who supply advertising space on apps via real-time bidding on ad exchanges. Each location is characterized by its win curve, that is, the relationship between the bid price and the probability of winning an impression at that bid. The win curves at the various locations of interest are initially unknown to the platform, and it learns them on the fly based on the bids it places to win impressions and the realized outcomes. Each acquired impression is allocated to one of the ongoing campaigns. The platform’s objective is to minimize its total cost (the amount spent in procuring impressions and the penalty incurred due to unmet targets of the campaigns) over the time horizon of interest. Our main result is a bidding and allocation policy for this problem. We show that our policy is the best possible (asymptotically tight) for the problem using the notion of regret under a policy, namely the difference between the expected total cost under that policy and the optimal cost for the clairvoyant problem (i.e., one in which the platform has full information about the win curves at all the locations in advance): The lower bound on the regret under any policy is of the order of the square root of the number of seasons, and the regret under our policy matches this lower bound. We demonstrate the performance of our policy through numerical experiments on a test bed of instances whose input parameters are based on our observations at a real-world mobile-promotion platform. This paper was accepted by Baris Ata, stochastic models and simulation. Supplemental Material: The online appendices are available at https://doi.org/10.1287/mnsc.2022.4441 .

With the prosperity of global trade and maritime transportation, dry port is playing a significant role in freight transport industry through relieving seaport congestion and facilitating improved logistics solutions. This article studies the rail shuttle service pricing and scheduling problem in a dry port system with one dry port and multiple shippers. Bilevel models are developed to address the interaction between the dry port and shippers, with the dry port as the leader and individual shippers as followers. The optimal properties of the proposed bilevel model are analyzed, and a solution procedure is proposed to obtain the global optimal solution. Numerical studies are carried out to investigate the sensitivity of optimal decisions, and performance of both parties with respect to various system parameters. This study shows that offering a higher storage price could not always bring higher profit for the dry port. An extremely high storage price will reduce shippers’ total costs, especially for shippers with high production rates. If the seaports’ cutoff time is short, shippers with low production rates would have to bear high expenses. It is also found that low setup costs at shippers will bring not only cost savings for shippers, but also profit improvement for the dry port.

Problem Definition: Problem Definition: We develop a framework to plan capacity for ambulatory surgery centers (ASCs) typically consisting of three stages. The problem is to determine the capacity in each stage that efficiently covers possible daily patient demand and to coordinate the three stages of patient visits. The objective is to minimize the total cost incurred in satisfying the daily patient demand, where the total cost is defined as the sum of overtime cost and amortized construction cost for the three stages. Academic/Practical Relevance: Timely capacity adjustment is important for ASC practitioners, but related research is limited. We explicitly consider three sequential stages that are typical in ASCs: the pre-operative at holding room (HR), intra-operative at operating room (OR), and post-operative at post-anesthesia care unit (PACU). Such ASCs can be modeled as a hybrid flow shop (HFS) in the scheduling literature. The interdependence of activities and uncertainties in patient-mix as well as their durations pose a significant challenge to manage the capacity of each activity and achieving a smooth patient flow. Methodology: In contrast to the traditional top-down approach to capacity planning, our approach contributes by proposing a bottom-up strategy based on optimization methods combined with analytics that are informed by operational-level archival patient data. Specifically, we use analytics tools to classify patients into groups, which reduces the complexity of the capacity planning problem and improves the model's practicality. Later, we develop several mathematical formulations and heuristics based on scheduling theory to derive the most cost-efficient capacity solution. Results: Given the trade-off between overtime cost and amortized capacity construction cost, this study relaxes the fixed capacity assumption of traditional HFS problems. Because of the computational complexity of the exact HFS model, we develop a heuristic that is straightforward and easy to implement to find cost-efficient capacities for the three stages. Our computational study examines how uncertain business parameters, e.g., patient-mix, service durations, overnight-stay probabilities, affect the capacity planning decision. Managerial implications: This study highlights the benefit of considering multiple stages together in capacity planning, rather than focusing solely on the operating rooms exclusively. We expect our approach to guide the more than 5,000 ASCs in the U.S., performing 23 million surgeries annually, to make appropriate investments that will improve ASC operations via capacity adjustment and patient scheduling.

Following state-level legal changes that increase labor dismissal costs, firms increase their innovation in new processes that facilitate the adoption of cost-saving production methods, especially in industries with a large share of labor costs in total costs. Firms with high innovation ability exhibit larger increases in process innovation and capital-labor ratios - an effect driven by both increases in capital investment and decreases in employment. By facilitating the adjustment of the input mix when conditions in input markets change, innovation ability allows firms to mitigate value losses and is a key driver of their performance.

In this paper, we first propose a multi-objective task-scheduling optimization problem that minimizes both the makespans and total costs in a fog-cloud environment. Then, we suggest an optimization model based on a Discrete Non-dominated Sorting Genetic Algorithm II (DNSGA-II) to deal with the discrete multi-objective task-scheduling problem and to automatically allocate tasks that should be executed either on fog or cloud nodes. The NSGA-II algorithm is adapted to discretize crossover and mutation evolutionary operators, rather than using continuous operators that require high computational resources and not able to allocate proper computing nodes. In our model, the communications between the fog and cloud tiers are formulated as a multi-objective function to optimize the execution of tasks. The proposed model allocates computing resources that would effectively run on either the fog or cloud nodes. Moreover, it efficiently organizes the distribution of workloads through various computing resources at the fog. Several experiments are conducted to determine the performance of the proposed model compared with a continuous NSGA-II (CNSGA-II) algorithm and four peer mechanisms. The outcomes demonstrate that the model is capable of achieving dynamic task scheduling with minimizing the total execution times (i.e. makespans) and costs in fog-cloud environments

In this paper, we address the Multi-Component Application Placement Problem (MCAPP) in Mobile Edge Computing (MEC) systems. We formulate this problem as a Mixed Integer Non-Linear Program (MINLP) with the objective of minimizing the total cost of running the applications. In our formulation, we take into account two important and challenging characteristics of MEC systems, the mobility of users and the network capabilities. We analyze the complexity of MCAPP and prove that it is NP-hard, that is, finding the optimal solution in reasonable amount of time is infeasible. We design two algorithms, one based on matching and local search and one based on a greedy approach, and evaluate their performance by conducting an extensive experimental analysis driven by two types of user mobility models, real-life mobility traces and random-walk. The results show that the proposed algorithms obtain near-optimal solutions and require small execution times for reasonably large problem instances.

Motivated by the remanufacturing systems at Daimler AG and other automobile, aerospace and heavy machinery parts dealers/manufacturers, we develop a hybrid manufacturing/remanufactu-ring system with controlled two-way substitution between new and remanufactured products. We develop Markov decision processes for management on product-level as well as on component-level. We show that the optimal policy on product-level has the switching-curve structure under the assumption that the lost sales costs for new and remanufactured products are identical. Based on this structural result, we develop an efficient, close-to-optimal heuristic for the general product-level model and for the component-level model. Our numerical experiments indicate that two-way substitution on component level significantly reduces total cost. We also extend our model to strategic cost that includes environmental aspects in the objective function. For this model, we find that substitution appears to be a phenomenon primarily beneficial for profit-oriented firms. Sustainability-oriented firms require significantly less frequent product substitution.

Inventory is the company's assets that have an important role in business operations, inventory shortages could result in the cessation of the production process and if you are inventory too large (over stock) can result in very high costs to store and preserve the material during storage thus company needs to make proactive inventory management, meaning that the company should he able to minimize the total cost to be incurred related to the supply of raw materialsIn PT Gunawan Dianjaya Steel Corporation, can be seen on the inventory management policies in terms of fees and maintenance costs of raw materials, PT Gunawan Dianjaya Steel Tbk alone can not determine when to hold back ordering or commonly called the reorder point, so the company made a purchase raw materials as much as I Ox within a period of I year during 2010 with a quantity of 286 464 748 kgKeywords: Inventory, Economic Order Quantity (EOQ) and Reorder Point

Structural balance in signed social networks has become a research hotspot for the task of finding the optimal network structure, which is able to make social systems reach a relatively stable and harmonious state. Usually, such a structural balance problem can be modeled as an optimization problem. The typical way of existing optimization methods for structural balance is to only minimize the total cost of changing the unbalanced edges in the whole network, but it neglects the load balance of changing edges between different nodes in signed social network, which may not fit the nature of the social systems. In this paper, we propose a novel structural balance model, which incorporates the total cost information of the changed edges in the whole network and the balance information of the changed edges of each single node. To optimize the novel structural balance model, we propose a Judgment-Rule-based Evolutionary Algorithm, called JREA, based on two significant essential features of the structural balance problem, i.e., the determination of node attribute depending on node’s degree and the attributes of its neighbour nodes. Extensive experiments are conducted on the four generated signed social networks and the three real signed social networks. Experimental results demonstrate the effectiveness and efficiency of the algorithm.

In this paper, we study an inventory model for an omnichannel retailer, that is, a retailer that sells items both via brick-and-mortar stores and online. Online items are delivered from a warehouse, which also replenishes the stores. When the inventory in a store drops below a certain level, the retailer offers customers a discount for purchasing online. In this way, the retailer can save items for customers who need the item immediately and thus avoid lost sales. For this model, we propose an approximation method for calculating the average inventory costs for one store and one warehouse and an optimization procedure for the case of more stores. Using extensive numerical experiments, we show that the approximations are very close to the performance measured via simulation. Finally, we show that by adopting the discounts policy proposed in this paper, the retailer can reduce its total cost, on average, by 8.5% compared to the no-discounts policy.

In the multi-access edge computing environment, app vendors deploy their services and applications at the network edges, and edge users offload their computation tasks to edge servers. We study the user-perceived delay-aware service placement and user-allocation problem in edge environment. We model the MEC-enabled network, where the user-perceived delay consists of computing delay and transmission delay. The total cost in the offloading system is defined as the sum of service placement, edge server usage and energy consumption cost, and we need to minimize the total cost by determining the overall service-placing decision and user-allocation decision, while guaranteeing that the user-perceived delay requirement of each user is fulfilled. Our considered problem is formulated as a Mixed Integer Linear Programming problem, and we prove its NP-hardness. Due to the intractability of the considered problem, we propose a LOCal-search based algorithm for USer-perceived delay-aware service placement and user-allocation in edge environment, named LOCUS, which starts with a feasible solution and then repeatedly reduces the total cost by performing local-search steps. After that, we analyze the time complexity of LOCUS and prove that it achieves provable guaranteed performance. Finally, we compare LOCUS with other existing methods and show its good performance through experiments.

Introduction Intensive care unit (ICU) admission is required for approximately 25% of patients affected with coronavirus disease-19 (COVID-19) and imposes a high economic burden on patients in resource-limited settings. Method We conducted a retrospective direct medical care cost analysis of COVID-19 patients requiring ICU admission after obtaining the Institutional Ethics Committee approval. Data were obtained from the records of patients admitted to the COVID-19 ICU of a tertiary care trust teaching hospital from June 2020 to December 2020. Direct costs were analyzed and correlated with various demographic variables and clinical outcomes. Results A total of 176 patients were included (males—76%). The median direct medical cost for a median stay of 13 days was INR 202248.5 ($ 2742.91). Hospital drugs and disposables accounted for 20% of the total cost followed by bed charges (19%), equipment charges (17%), biosafety protective gear (15.5%), pathological and radiological tests (15%), clinical management (7.6%), and biomedical waste management (1.6%). Government schemes accounted for 79% of medical claims followed by directly paying patients (12.5%) and private insurance (8.5%). The cost was significantly higher in patients with diabetes mellitus and sepsis and in those requiring mechanical ventilation (MV) (p

CONTEXT: Patients with underlying chronic illness requiring mechanical ventilation for acute respiratory failure are at risk for poor outcomes and high costs. OBJECTIVES: Identify characteristics at time of intensive care unit (ICU) admission that identify patients at highest risk for high-intensity, costly care. METHODS: Retrospective cohort study using electronic health and financial records (2011–2017) for patients requiring ≥48 hours of mechanical ventilation with ≥1 underlying chronic condition at an academic healthcare system. Main outcome was total cost of index hospitalization. Exposures of interest included number and type of chronic conditions. We used finite mixture models to identify the highest-cost group. RESULTS: 4,892 patients met study criteria. Median cost for index hospitalization was $135,238 (range, $9,748-$3,176,065). Finite mixture modelling identified three classes with mean costs of $89,980, $150,603, and $277,712. Patients more likely to be in the high-cost class were: 1) < 72 years old (OR: 2.03; 95% CI:1.63, 2.52); 2) with dementia (OR: 1.55; 95% CI:1.17, 2.06) or chronic renal failure (OR: 1.27; 95% CI:1.08, 1.48); 3) weight loss ≥ 5% in year prior to hospital admission (OR: 1.25; 95% CI:1.05, 1.48); and 4) hospitalized during prior year (OR: 1.92; 95% CI:1.58, 2.35). CONCLUSION: Among patients with underlying chronic illness and acute respiratory failure, we identified characteristics associated with the highest costs of care. Identifying these patients may be of interest to healthcare systems and hospitals and serve as one indication to invest resources in palliative and supportive care programs that ensure this care is consistent with patients’ goals.

Background: One goal of the End tuberculosis (TB) Strategy is to see no TB-affected households experiencing catastrophic costs. Therefore, it is crucial for TB-elimination programs to identify catastrophic costs and their main drivers in order to establish appropriate health and social measures. This study aimed to measure the percent of catastrophic costs experienced by Egyptian TB patients and to identify its determinants.Methods: We conducted a prospective cohort study with 151 Egyptian TB patients recruited from two chest dispensaries from the Cairo governate from May 2019 to May 2020. We used a validated World Health Organization TB patient-cost tool to collect data on patients’ demographic information, household income, and direct and indirect expense of seeking TB treatment. We considered catastrophic TB costs to be total costs exceeding 20% of the household’s annual income.Results: Of the patients, 33% experienced catastrophic costs. The highest proportion of the total came in the pretreatment stage. Being the main breadwinner, experiencing job loss, selling property, and the occurrence of early coronavirus disease 2019 lockdown were independent determinants of the incidence of catastrophic costs. Borrowing money and selling property were the most-often reported coping strategies adopted.Conclusion: Despite the availability of free TB care under the Egyptian National TB Program, nearly a third of the TB patients incurred catastrophic costs. Job loss and being the main breadwinner were among the significant predictors of catastrophic costs. Social protection mechanisms, including cash assistance and insurance coverage, are necessary to achieve the goal of the End TB Strategy.

Objective To investigate whether interview travel cost and time differed for urology residency applicants from medical schools with higher versus lower proportions of students from groups underrepresented in medicine (URiMs). Methods We identified 22 medical schools, 11 with 20% URiM students, and 17 “highly ranked” urology residency programs. We contacted the residency programs and requested interview dates, preferred lodging options, and institution-based cost-savings. We constructed interview itineraries for 22 hypothetical students (one from each school), and compared the total cost and time for travel to all 17 interviews. Total travel time and interview costs for the students at schools with 20% URiM were compared, with findings considered statistically significant at p Results Each student was able to attend all 17 interviews. The median total cost was similar for applicants from schools >20% URiM ($8074.80; range: $7027.60-$13,702.59) and 20% URiM was 176.4 (range: 93.7-246.2) hours and for applicants from schools Conclusions Financial and temporal costs were similar for applicants from medical schools with 20% URiM students. Thus, absolute cost considerations are unlikely to account for differences in URiM representation in urology. However, the relative impact of interview costs may be different for URiM students. Effective and durable engagement of URiM students in urology requires an introspective assessment of objective versus anecdotal barriers to recruiting and retaining URiM medical students.

Objectives To examine the budget impact of emicizumab as prophylactic therapy in reducing the frequency of bleeding episodes in patients with hemophilia A with inhibitors in Malaysia. Methods A budget impact model was built to assess the cost implication of introducing emicizumab for routine prophylaxis of bleeding episodes in people with hemophilia A with inhibitors. It was based on the public healthcare system in Malaysia over a 5-year duration. The primary analysis computed healthcare costs for emicizumab compared with no prophylactic regimen to calculate the budget needed to treat all patients with hemophilia A with inhibitors. Results The introduction of emicizumab resulted in a total incremental budget of Malaysian Ringgit (RM) 20 356 897 ($4 917 125) during the first year. The total cost for the current situation (no prophylaxis) was RM13 425 941 ($3 242 981), whereas the total cost for the new situation (prophylaxis with emicizumab) was RM33 782 838 ($8 160 106). The 5-year cumulative incremental budget impact from 2021 to 2025 was RM97 205 459 ($23 479 579) with an uncertainty range from −RM4 869 886 (−$1 176 301) to RM138 035 597 ($33 341 932) and a total of 72 patients treated with emicizumab. In a sensitivity analysis, the use of emicizumab was cost saving if the annual bleeding rate was greater than 16 instead of 6 times per year. Conclusion The 5-year budget impact might be considered reasonable and possibly cost saving. The model and approach used in this study to obtain relevant parameters where scarce data exist may help other jurisdictions with future adaptation.

Objectives Nebulized 3% hypertonic solution (HS) is associated with lower total cost and higher quality-adjusted life-years. Nevertheless, the expected budget impact of this drug had not been explicitly estimated. The aim of this study was to evaluate the budget impact of 3% HS in the treatment of acute bronchiolitis in Colombia. Methods A budget impact analysis was performed to evaluate the potential financial impact of the use of 3% HS. The analysis considered a 4-year time horizon and a Colombian national health system perspective. The incremental budget impact was calculated by subtracting the cost of the new treatment, in which 3 % HS (added to humidified oxygen) was reimbursed, from the cost of the conventional treatment without 3 % HS (only humidified oxygen or adrenaline nebulization). Univariate 1-way sensitivity analyses were performed. Results In the base-case analysis, the 4-year costs associated with HS and non-3% HS were estimated to be 47 792 230 US dollars and 53 312 832 US dollars, respectively, indicating savings for Colombian national health system equal to 5 520 602 US dollars if HS is adopted for the routine management of patients with acute bronchiolitis. This result was robust in univariate 1-way sensitivity analysis. Conclusion HS was cost saving in emergency settings for treating infants with acute bronchiolitis. This evidence can be used by decision makers in Colombia to improve clinical practice guidelines and should be replicated to validate their results in other middle-income countries.

We consider a variant of the vehicle routing problem (VRP) where each customer has a unit demand and the goal is to minimize the total cost of routing a fleet of capacitated vehicles from one or multiple depots to visit all customers. We propose two parallel algorithms to efficiently solve the column-generation-based linear-programming relaxation for this VRP. Specifically, we focus on algorithms for the “pricing problem,” which corresponds to the resource-constrained elementary shortest path problem. The first algorithm extends the pulse algorithm for which we derive a new bounding scheme on the maximum load of any route. The second algorithm is based on random coloring from parameterized complexity which can be also combined with other techniques in the literature for improving VRPs, including cutting planes and column enumeration. We conduct numerical studies using VRP benchmarks (with 50–957 nodes) and instances of a medical home care delivery problem using census data in Wayne County, Michigan. Using parallel computing, both pulse and random coloring can significantly improve column generation for solving the linear programming relaxations and we can obtain heuristic integer solutions with small optimality gaps. Combining random coloring with column enumeration, we can obtain improved integer solutions having less than 2% optimality gaps for most VRP benchmark instances and less than 1% optimality gaps for the medical home care delivery instances, both under a 30-minute computational time limit. The use of cutting planes (e.g., robust cuts) can further reduce optimality gaps on some hard instances, without much increase in the run time. Summary of Contribution: The vehicle routing problem (VRP) is a fundamental combinatorial problem, and its variants have been studied extensively in the literature of operations research and computer science. In this paper, we consider general-purpose algorithms for solving VRPs, including the column-generation approach for the linear programming relaxations of the integer programs of VRPs and the column-enumeration approach for seeking improved integer solutions. We revise the pulse algorithm and also propose a random-coloring algorithm that can be used for solving the elementary shortest path problem that formulates the pricing problem in the column-generation approach. We show that the parallel implementation of both algorithms can significantly improve the performance of column generation and the random coloring algorithm can improve the solution time and quality of the VRP integer solutions produced by the column-enumeration approach. We focus on algorithmic design for VRPs and conduct extensive computational tests to demonstrate the performance of various approaches.

Background Gynecological cancers (GCs) are an important cause of morbidity and mortality among women worldwide. The incidence of cancer is increasing in Iran, and according to statistics, it has become the most important cause of mortality. This study aimed to assess the economic burden of GCs, including cervical, ovarian, and endometrial cancers, in Iran in 2014. Methods We used a prevalence-based cost of illness methodology to investigate the annual healthcare cost of GCs and to determine the productivity loss. The productivity loss was estimated, using the human capital approach. We obtained our data from a referral hospital for the year 2014; we also used expert opinion and occupational and statistical data. To estimate direct medical cost, we used bottom-up approach and we estimated the average cost of each procedure, multiplied by the number of patients receiving the procedure. Results The total cost of GCs in Iran was estimated at $51 million in 2014. The direct costs were $32 million, and indirect costs were $19 million of the total annual cost. The total cost of ovarian cancer was the highest among 3 cancers. Conclusions Knowing that the cost of GCs has a significant impact on the burden of disease and imposes an economic burden on the country could force policy makers to allocate their resource in the prevention programs and new approach in patient's management. This could lead to diagnose more GCs in the early stages, reduce mortality, and increase the quality of life.

At present, city logistics mostly adopts a two-echelon dispatching model which combines distribution centers located in suburbs and fixed satellites located in urban areas for distribution. However, both expensive rental fees and daily changes of customer demand in metropolitan areas make dispatching route generated by fixed satellites inefficient. Moreover, the existing mobile depot model needs a large investment for facilities. In this paper, we propose a two-echelon city dispatching model with mobile satellites (2ECD-MS) which locations of mobile satellites change according to demands of customers to ensure the efficiency of delivery routes in every day. A cluster-based variable neighborhood search scheduling algorithm is proposed to determine locations of mobile satellites and dispatching routes of trucks and tricycles. Then, the 2ECD-MS is extended to 2ECD-MS-TDD to allow trucks dispatching directly (TDD) for further cost reduction. Experimental results show that the 2ECD-MS significantly reduces the total cost against the model using fixed satellites mode by 3.5% while the 2ECD-MS-TDD further reduces the total cost against the 2ECD-MS significantly by 3.25% in 54 cases with different customer scales, geographical scopes, and distribution types. These show the superiority of the proposed methods in cost reduction for city logistics in comparison to the traditional fixed model.

This paper proposes a reliable hypercube queuing problem where servers (e.g., vehicles) can be dispatched either individually or jointly as cooperative units, and these servers are subjected to probabilistic disruptions. The probability of a server disruption depends on the amount of resources (e.g., firefighter staffing number) allocated to this server. If any server in a cooperation unit is disrupted, a less preferred (e.g., based on capabilities and source station) but functioning and available unit will be dispatched instead. This paper derives formulas for steady-state system performance metrics for this new hypercube queuing system. The queuing model is embedded into a mixed-integer non-linear program to optimize the allocation of resources so as to minimize the total costs under server disruptions. An empirical case study is used to compare the system performance measures under a range of implementation scenarios, and sensitivity analyses are conducted to reveal insights.

Absorption chillers are one of the most used equipment in industrial, commercial, and domestic applications. For the places where high cooling is required, they are utilized in a network to perform the cooling demand. The main objective of the current study was to find the optimum operating conditions of a network of steam absorption chillers according to energy and economic viewpoints. Firstly, energy and economic analysis and modeling of the absorption chiller network were carried out to have a deep understanding of the network and investigate the effects of operating conditions. Finally, the particle swarm optimization search algorithm was employed to find an optimum levelized total costs of the plant. The absorption chiller network plant of the Marun Petrochemical Complex in Iran was selected as a case study. To verify the simulation results, the outputs of energy modeling were compared with the measured values. The comparison with experimental results indicated that the developed model could predict the working condition of the absorption chiller network with high accuracy. The economic analysis results revealed that the levelized total costs of the plant is 1730 $/kW and the payback period is three years. The optimization findings indicated that working at optimal conditions reduces the levelized total costs of the plant by 8.5%, compared to the design condition.

Aim: To describe the treatment landscape and associated economic burden for myelodysplastic syndrome in Japan. Methods: We studied nationwide retrospective claims data from 2008 to 2019. The study cohort was categorized into patients receiving transfusion, erythropoiesis-stimulating agent, erythropoiesis-stimulating agent + transfusion, azacitidine, azacitidine + transfusion and others. Results: Our study found that the azacitidine + transfusion group had the highest medical cost and severity of disease compared with the other groups. In those patients, healthcare resource utilization and the costs of transfusions, including iron chelation therapy, increased medical costs. Conclusion: Our retrospective analysis provides a current snapshot of real-world treatment patterns and associated incremental economic costs of iron chelation therapy with the presence of transfusions that drive an increase in total costs.

Background Better insights into the natural course of cystic fibrosis (CF) have led to treatment approaches that have improved pulmonary health and increased the life expectancy of affected individuals. This study evaluated how the combination of modified demographics and changes in CF management impacted resource consumption and the cost of care. Methods Medical records of CF patients from 2006 to 2016 in the French CF Registry were linked to their corresponding claims data (SNDS). Medications, medical visits, procedures, hospitalisations, and indirect costs were annualized by calendar year from 2006 to 2017. Results Of the 7,671 patients included in the French CF Registry, 6,187 patients (80.7%) were linked to the SNDS (51.9% male, mean age = 24.7 years). The average cost per patient was €14,174 in 2006, €21,920 in 2011 and €44,585 in 2017. Costs associated with hospital stays increased from €3,843 per patient in 2006 to €6,741 in 2017. In 2017, the mean cost per CF patient was allocated as follows: 72% for medications (of which 51% for modulator therapies), 15% for hospital stays, 7% for medical visits, 3% for indirect costs, 2% for medical devices, 1% for outpatient medical procedures. Conclusion There was a strong increase in the mean annual cost per CF patient between 2006 and 2017, mostly due to the cost of therapy after the introduction of cystic fibrosis transmembrane conductance regulator (CFTR) modulators. The combination of an increase in the number of CF patients – particularly adult patients – and an increase in the annual cost per patient led to a substantial increase in the total cost of CF disease care for the health systems.

Background Home spirometry with regular symptom assessment is one strategy to track lung health to intervene early in episodes of pulmonary exacerbations (PE). In a multi-center randomized controlled trial home spirometry and symptom tracking demonstrated no significant differences regarding the primary clinical endpoint, FEV1, compared to usual care, but did identify differences in healthcare utilization. We used data from the Early Intervention in Cystic Fibrosis Exacerbation (eICE) study to evaluate whether home monitoring of PE is a cost-minimizing intervention in the context of this randomized trial. Methods We reviewed healthcare resource utilization of all 267 eICE participants, including outpatient visits, antibiotics and hospitalizations. Prices were identified in the IBM/Watson MarketScanⓇ Commercial Claims and Encounters Databases and averaged over the 2014-2017 period. Using total healthcare utilization costs, we generated summary statistics by intervention and protocol arm (total cost, mean cost, standard deviation). We performed Welch Two Sample t-tests to determine if total costs and cost by type of utilization differed significantly between groups. Results Outpatient visit costs were significantly higher by 13% in the Early Intervention (EI) than in the usual care (UC) arm ($3,345 vs. $2,966). We found no significant differences in outpatient antibiotic, hospitalization, or total health care costs between the arms. Conclusions Within the context of the eICE trial, outpatient visits were significantly higher in those with experimental home spirometry care, but that did not translate into statistically significant differences of overall health care costs between the two arms.

Introduction Patients with heart failure (HF) are likely to have multiple diseases with complex therapy regimens. Pharmacist intervention in HF treatment can reduce all-cause mortality and hospitalization, but the economic outcome is not known. Objective This study aimed to assess the cost-effectiveness of pharmacist contribution in HF setting compared with usual care. Methods A decision analytical model was developed to estimate the cost and outcome from a health care system perspective in Thailand. Clinical inputs were obtained from literature review. Pharmacist costs, hospitalization cost for HF, risk of hospitalization death, risk of nonhospitalization death, and readmission rate were based on data from Thailand. The cost and outcome were discounted at 3% annually. Outcome measures The incremental cost-effectiveness ratio (ICER) was calculated and presented for the year 2020. A series of sensitivity analysis was also performed. Results Pharmacist intervention incurred higher total costs than usual care, because total cost of pharmacists was 186,040 THB (5936 USD) whereas usual care cost was 151,654 THB (4839 USD). It also provided more quality-adjusted life years (QALYs) than usual care, from 2.4 to 2.8. In addition, patient life years (LY) were increasing from 3.3-3.8. This yielded an ICER of 77,398 THB/LY (2467 USD/LY) or 103,037 THB/QALYs (3,288 USD/QALYs). This ICER is considered to be cost-effective at the willingness-to-pay level of 160,000 THB/QALY (5191.87 USD). Conclusion At this current situation in Thailand, pharmacists may represent good value for the nation’s limited health care resources. The information should be used in national policies to plan for pharmacist work force implementation and production line in the near future.

Recently, the closed-loop supply chain (CLSC) and its application to various fields have been an area of great interest. Despite the importance of CLSC, there remains a paucity of evidence on agriculture in this area. In this work, a CLSC network for the avocado industry is firstly designed by developing a bi-objective model considering the costs of the avocado industry and the social factor of job employment opportunities. The two objectives are the total costs minimization and job employment maximization in various opened locations. To validate the proposed model, a real case study in Puebla, Mexico, is addressed. The GAMS software and its CPLEX solver are utilized to find the best optimum solutions and determine the best locations to open different centers. The applicability of the proposed network is verified by conducting several sensitivity analyses on the important parameters of the problem. According to the obtained results, demand has the most effect on this network in which that a 25 percent decrease in demand can increase the total cost (the first objective) up to 40 percent and improve employment efficiency (the second objective) up to around 30 percent, simultaneously.

Outpatient technologies are important for maintaining health and overall quality of life, yet the degree of access and coverage of these technologies remains variable within and across jurisdictions. In Canada, assistive technologies are not included in universal health coverage, and are not subject to the Canada Health Act's criteria and conditions that provinces and territories must fulfill to receive the full federal cash contribution under the Canada Health Transfer. As such, the thirteen Canadian provincial and territorial governments make separate decisions on programs and coverage. Drawing on the WHO Universal Coverage Cube we compare who gets access, the types of technologies that can be accessed, and the level of coverage (total costs covered) in Canada. Overall, each Canadian jurisdiction had at least one publicly supported program. All relied on a 'health assessment' of an individual's need to determine eligibility. Income and eligibility for social assistance was used as eligibility criteria in 6 of the 13 jurisdictions. Mobility aids as well as audio, visual, and communication aids were included in all jurisdictions. While some programs offered full financial support for some technologies, forms of cost sharing were common. The results are discussed in the context of international experiences, demographic changes, and health system trends to highlight areas for policy learning.

Relevance. Health management has not escaped the pressure of the current epidemiological situation. In a complex scenario, characterized by the COVID-19 pandemic, the daily dynamics become more complex and greater agility is required for decision-making. Much of the success of those decisions is determined by access to timely information, especially in crisis conditions and limited resources. For this reason, health organizations are interested in knowing the costs of pathologies that frequently constitute causes of hospitalization. In this sense, community - acquired bacterial bronchopneumonia stands out, which is a disease that frequently causes hospitalization of pediatric patients. Objective. This article aims to carry out a partial retrospective financial evaluation in order to determine the costs associated with the treatment of community-acquired bacterial bronchopneumonia in pediatric patients. Materials and methods. The study was developed from the perspective of the health institution General Hospital Guillermo Luis Fernndez Hernndez - Baquero in the city of Moa. For this, the analysis - synthesis and comparative methods were used, as well as the methodology to calculate and analyze disease costs. Results. The research focused on the January-March quarters of the years 2017 and 2018 and provided valuable accounting information regarding the direct and indirect costs of the treatment of the pathology in question, which serves as a tool for the correct management of the hospital institution. Conclusion . The direct costs exceeded the indirect costs and the items that most affected the total cost were the salaries of the workers, food, and medicines used to treat the disease. The need to develop digital health was evidenced, with special emphasis on digital medical records to facilitate access to them and thus avoid the loss of information due to its deterioration. The study provides useful information to the management of the health institution, which serves as support for budget analysis and future projections.

BACKGROUND: Three novel acute treatments for migraine-lasmiditan, ubrogepant, and rimegepant-were approved by the FDA in 2019 and 2020 for adults with migraine with and without aura. American Headache Society guidance recommends that these novel acute treatments be considered for patients who are contraindicated to or fail to respond or tolerate oral triptans, the current standard of acute care. OBJECTIVE: To estimate, from a US commercial plan perspective, the budget impact of adding lasmiditan as an option to a formulary that already includes ubrogepant and rimegepant. METHODS: Epidemiologic data were drawn from US Census data, the American Migraine Prevalence and Preventive study, and the first wave of the OVERCOME US survey, a web-based survey that included 21,000 patients with migraine. A model with a 3-year time horizon was built assuming that demand for the novel acute treatments would not vary based on whether lasmiditan is included in the formulary. The model examined a variety of populations, in particular beneficiaries with previous use of 1 or more oral triptans or contraindicated to triptans and beneficiaries with previous use of 2 or more oral triptans or contraindicated to triptans. Primary outcomes were the incremental differences in total cost and average cost per member per month (PMPM) between scenarios with and without lasmiditan. One-way sensitivity analyses with model parameters that were varied by plus or minus 15% were conducted to assess the effect of key parameters on the incremental total cost over 3 years. RESULTS: The addition of lasmiditan to a formulary that already includes ubrogepant and rimegepant resulted in a total savings of -$927,657 (-1.5% compared with the scenario without lasmiditan) over a 3-year time horizon in the population with previous history of using 1 or more oral triptans or contraindicated to a triptan. In the population with previous history of using 2 or more oral triptans or contraindicated, the addition of lasmiditan resulted in a total budget impact of -$466,518 (-1.3%) over a 3-year time horizon. Most of the cost savings was attributable to reductions in drug acquisition cost. Savings in total costs resulted in average incremental cost per PMPM of -0.03 and -$0.01, respectively. CONCLUSIONS: The addition of lasmiditan to the formulary as a novel acute treatment option for migraine alongside ubrogepant and rimegepant resulted in lower budget impact on a 3-year time horizon from a US commercial payer's perspective. This result is important to US commercial payers as they seek to incorporate the emerging novel acute treatments for migraine into their benefit designs. DISCLOSURES: This work was funded by Eli Lilly and Company. Milev and Sun are employed by Evidera, which received funding from Eli Lilly and Company for work on this project. Pohl, Mason, Njuguna, and Loo are employees and stockholders of Eli Lilly and Company.

Introduction Invasive meningococcal disease (IMD) is a severe infectious disease, mainly affecting children under 5 years, associated with long-term physical, neurological and psychological sequelae. In Spain, most IMD cases are caused by meningococcal serogroup B (MenB). This study estimates its economic burden from a societal perspective in Spain. Methods A previously published bottom-up, model-based incidence costing approach by Scholz et al. (2019) to estimate the economic burden of MenB in Germany was adapted to the Spanish setting. Diagnosis and age-related costs for a hypothetical Spanish cohort were calculated over a lifetime horizon. Official Spanish databases, literature and expert opinion were used as data sources. The costs were updated to 2019 prices, and a 3% discount rate was applied. Direct costs related to the acute IMD phase, long-term sequelae, rehabilitation and public health response were considered. Indirect costs included productivity losses and premature mortality and were calculated using the human-capital approach (HCA) and friction-cost approach (FCA). Deterministic and probabilistic sensitivity analyses were also performed. Result At base-case, the total cost for a cohort of 142 patients (2017–2018 period) was €4.74 million (€33,484/case) using the FCA and €13.14 million (€92,768/case) using the HCA. Direct costs amounted to €4.65 million (€32,765/case). Sequelae costs represented 62.46% of the total cost using the FCA and 77.63% using the HCA. Deterministic sensitivity analysis showed that variation of ± 20% in the input parameter values (population, epidemiology, productivity, costs) had the greatest influence on the base-case results, and the probabilistic sensitivity analysis showed the probability of fitting base-case estimates was > 99%, both for FCA and HCA. Discussion MenB IMD is an uncommon but severe disease, with a high economic burden for Spanish society. The elevated costs per IMD case reflect its severity in each patient suffering this disease, especially due to the development of sequelae.

Recent research on deterministic methods for circulating cooling water systems optimization has been well developed. However, the actual operating conditions of the system are mostly variable, so the system obtained under deterministic conditions may not be stable and economical. This paper studies the optimization of circulating cooling water systems under uncertain circumstance. To improve the reliability of the system and reduce the water and energy consumption, the influence of different uncertain parameters is taken into consideration. The chance constrained programming method is used to build a model under uncertain conditions, where the confidence level indicates the degree of constraint violation. Probability distribution functions are used to describe the form of uncertain parameters. The objective is to minimize the total cost and obtain the optimal cooling network configuration simultaneously. An algorithm based on Monte Carlo method is proposed, and GAMS software is used to solve the mixed integer nonlinear programming model. A case is optimized to verify the validity of the model. Compared with the deterministic optimization method, the results show that when considering the different types of uncertain parameters, a system with better economy and reliability can be obtained (total cost can be reduced at least 2%).

Innovative, patient-centered, and pragmatic dialysis technologies are urgently needed to accommodate the growing national interest in home dialysis use. To help achieve this goal, the US Centers for Medicare & Medicaid Services (CMS) are expanding reimbursement for eligible home dialysis machines through an existing payment mechanism, the transitional add-on payment for new and innovative equipment and supplies (TPNIES). This mechanism incentivizes the early adoption of innovative equipment into practice by reimbursing dialysis providers up to 26% of the total cost of approved home dialysis machines. Machines are evaluated for TPNIES eligibility using prespecified substantial clinical improvement (SCI) criteria that are derived from the Inpatient Prospective Payment System (for non-nephrology technologies). Although the SCI criteria may be suitable for some non-nephrology technologies, they have not been adapted to consider the unique and complex care inherent in home dialysis. Thus, many of the SCI criteria appear unsuitable for home dialysis machines. To better incentivize innovation, CMS should develop nephrology-specific transparent and pragmatic criteria for TPNIES. In this perspective, we provide an overview of the TPNIES payment mechanism, highlight areas of concern within the policy, and offer solutions for improving TPNIES that could better promote the adoption of new home dialysis machines.

Objective The aim of this study was to estimate the direct cost per episode and the annual cost for upper respiratory tract infection (URTI) in children in Ambulatory Health Centers of the Ministry of Public Health (MSP) of Ecuador. Methods A cost of illness study with a provider perspective was carried out through a micro-costing of health resources and valuated in international dollars. Medical visits, laboratory tests, imaging examinations, and other procedures were valued using the tariff framework of services for the National Health System, and for prescribed medication a reported cost registry of pharmacy purchases made in the year of study was used. Results We included 380 electronic health records of children. We found a re-consultation rate of 22.89%, a medicine prescription rate of 95.52%, and an antibiotic prescription rate of 45.26%. The first medical consultation accounted for 71.9% of the total cost of URTI, the following visits accounted for 11.82%, and medication accounted for 14.68%. Antibiotics accounted for 58.92% of the total cost of medication. Conclusion The direct medical cost to the MSP of Ecuador of 1 episode of URTI in children in primary care was around I$37.28 (2017 dollars) (95% CI: I$35.81-I$38.75). The total cost of URTI cases in children to the MSP in 2017 was at least I$50.478 million (2017 dollars) (95% CI I$48.527m-I$52.523m). Re-consultation and the prescription of medication represent an important component of the direct cost of medical care of URTI.

An algorithm for optimum design of nonlinear viscous dampers with the goal of achieving minimum total cost is presented. An appropriate cost model is developed to determine the initial cost of equipping structures with viscous dampers, and the expected costs of the studied structures related to the possible earthquakes over their life time are estimated using life cycle cost analysis (LCCA). The results of this analysis are used in a multi-objective optimization algorithm with the aim of achieving minimum initial and life cycle cost. To evaluate the seismic behavior of structures, the Endurance Time (ET) method is used as a dynamic response-history analysis method which requires much less computational effort in comparison with conventional time history methods. To this end, the optimum arrangement of nonlinear viscous dampers along with their damping exponent (Alpha) for two weak steel moment frames with 4 and 8 stories are acquired using multi-objective genetic algorithm. Results from the proposed method are compared with two classic methods; uniform and stiffness proportional damping methods. With the aim of proposing an optimal Alpha value, a detailed discussion is provided on its effects on the overall performance of studied structures in terms of life cycle cost.

The fast-growing prevalence of Parkinson's disease (PD) creates a heavy burden for society and the health care system. Although different ways to mitigate the economic burden of PD have been discussed in the literature, including several effective treatments, few studies have paid attention to the effect of care rehabilitation (CR) on PD costs over a long-term care period. This study tracked medical expenses, care costs, and total costs of elderly individuals with PD for 3 years based on medical claims data merged with long-term care insurance (LTCI) claims data, and determined whether CR reduced PD costs. Using a retrospective, longitudinal cohort design, 3950 elderly individuals with PD who received LTCI services from April 2014 to March 2017 in Fukuoka Prefecture, Japan were followed. PD costs were compared between the CR group and the non-CR group, and a hierarchical linear model was used to examine whether CR was associated with medical expenses, care costs, and total costs. The mean value of total costs in fiscal years 2014, 2015, and 2016 were ¥3,124,944 (US$29,504), ¥3,328,398 (US$31,425), and ¥3,615,892 (US$34,140), respectively. In a hierarchical linear model, CR alone was not associated with medical expenses and care costs; additionally, CR had a positive association with higher total costs. However, the interaction term between CR and baseline care needs level significantly reduced care costs and total costs. That indicates that if older PD patients with higher care needs level receive CR, their care costs and total costs will be reduced. Further research is needed to clarify how CR reduces these patients' costs.

In the recent past, cricket production has attracted a myriad of interests in the Global Food Sector. However, low production, limited input resources and rearing systems constrain the utilization of crickets. Scanty information exists on sundry input resources for upscaling of cricket production and how such inputs can be efficiently managed. This study sought to determine economic efficiency of improvised cricket rearing system using a generalized additive stochastic frontier approach (GAM-SFA) to assess the efficiency in cricket production under the new technology. Twenty-day old Acheta domesticus and Gryllus bimaculatus were separately reared in improvised cage system comprising bamboo hideouts, scrap blankets, cut bamboo stems and the plywood-based cages. GAM-SFA was used to estimate efficiency scores. Results revealed that the production was efficient. Feed, labor and water were positive and significant at 5% suggesting their importance and positive influence on cricket output. Similarly, the cost of feed, labor, water and scrap blanket were positive and significant suggesting that increase in these costs of inputs would increase the total cost. The mean TE, AE and EE were 85, 92 and 79%, respectively implying that there still exist potential to increase output using present technology and costs of production. Assessing key determinants of economic efficiency in cricket production under the system is necessary. Key words: Economic efficiency, crickets, GAM-SFA, improvised system.

Cost-saving strategies are important, especially in a resource-constrained environment. One such strategy well supported in the literature is the reuse of temporary monolateral external fixator components, a strategy we utilize at our institution. The aim of the study was to determine the safety and cost saving associated with the reuse of definitive circular external fixator components in a resource-constrained environment. We performed a retrospective review of all adult patients who were treated with either new or reused circular external fixators from a single manufacturer between January and December 2017. Reused circular external fixator components, excluding half pins and wires, were subjected to an in-house reprocessing protocol. Cost savings were calculated as the difference between the price of a completely new frame and the amount invoiced for new components only in a reused frame. Thirty-three patients were included in the study with an average age of 31.9 years. The mean duration of treatment with a circular external fixator was 5.8 months. No mechanical failure events were recorded during the study period. Our institution saved approximately 52% (R717 503.89) and 63% (R136 568.19) of expected total cost for hexapod and Ilizarov frames, respectively. The strategy of reusing circular external fixator components is unconventional, and this study was conducted to evaluate the safety and potential savings in a resource-constrained environment. We demonstrated this practice to be reasonably safe and to result in significant cost savings which might be relevant in low-and-middle-income countries.

Introduction Baricitinib–remdesivir (BARI-REM) combination is superior to remdesivir (REM) in reducing recovery time and accelerating clinical improvement among hospitalized patients with coronavirus disease 2019 (COVID-19), specifically those receiving high-flow oxygen/noninvasive ventilation. Here we assessed the cost-effectiveness of BARI-REM versus REM in hospitalized patients with COVID-19 in the USA. Methods A three-state model was developed addressing costs and patient utility associated with COVID-19 hospitalization, immediate post hospital care, and subsequent lifetime medical care. Analysis was performed from the perspective of a payer and a hospital. Both perspectives evaluated two subgroups: all patients and patients who required oxygen. The primary measures of benefit in the model were patient quality-adjusted life years (QALYs) accrued during and after hospitalization, cost per life years gained, cost per death avoided, and cost per use of mechanical ventilation avoided. Results In the base-case payer perspective with a lifetime horizon, treatment with BARI-REM versus REM resulted in an incremental total cost of $7962, a gain of 0.446 life years and gain of 0.3565 QALYs over REM. The incremental cost-effectiveness ratios of using BARI-REM were estimated as $22,334 per QALY and $17,858 per life year. The base-case and sensitivity analyses showed that the total incremental cost per QALY falls within the reduced willingness-to-pay threshold of $50,000/QALY applied under health emergencies. In all hospitalized patients, treatment with BARI-REM versus REM reduced total hospital expenditures per patient by $1778 and total reimbursement payments by $1526, resulting in a $252 reduction in net costs per patient; it also resulted in a net gain of 0.0018 QALYs and increased survival of COVID-19 hospitalizations by 2.7%. Conclusion Our study showed that BARI-REM is cost-effective compared to using REM for hospitalized patients with COVID-19. The base-case results of this cost-effectiveness model were most sensitive to average annual medical costs for recovered patients. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-021-01982-6.

Tempe is a typical Indonesian food made fermented soybeans. Tempe is a good source of nutrition because it contains protein, carbodydrates, fat, vitamins and minerals needed by the body. Soybean used to make tempe must be of good quality. Pliken Village is a tempe production center, because it has the highest number of tempe craftsmen in Banyumas Regency. With the increase in soybean prices which have continued to increase lately, the tempe business has decreased due to lack of capital to continue the business. The purpose of this research are to: 1). Knowing the amount of costs, revenues and income before and after increase in soybean prices in the tempe production business in Pliken Village. 2). Knowing the factors that affect the increase in tempe production costs. The researh was carried out in Pliken Village from May 2021 to July 2021. The target of this research is the tempe craftsmen of Pliken Village who produce for one month. The sampling method uses simple random sampling technique and obtained by respondents as many as 81 craftsmen using the slovin formula. The analytical method used is the analysisno costs and revenues, and multiple linear regression analysis. Based on the results of the analysis of costs, revenues and income shows the total cost incurred by the craftsmen before the increase in soybean prices and after the increase in soybean prices is Rp. 11,883,809 per month. Based on the classical assumption test there are factors that affect the increase in production costs such as soybean prices, family labor wages, wages for non-family workers, gasoline prices, and banana leaf prices. While the factors that do not affect the increase in production costs are the price of yeast, the price of plastic and the price of used paper.

Background: Human cadaveric allograft (HCA) and costal cartilage autograft (CCA) have been described for reconstruction during rhinoplasty. Neither are ideal due to infection, resorption, and donor site morbidity. The clear superiority of 1 graft over the other has not yet been demonstrated. This study assesses comparative costs associated with current grafting materials to better explore the cost ceiling for a theoretical tissue engineered implant. Materials and methods: A cost utility analysis was performed. Initial procedure costs include physician fees (CPT 30420), hospital outpatient prospective payments, ambulatory surgical center payments, and fees for the following: rib graft (CPT 20910), hospital observation, and DRG (155) for inpatient admission. Additional costs for revision procedure, included the following fees: physician (CPT 30345), rib graft, hospital outpatient prospective payment, and ambulatory surgical center payments. Total costs under each scenario were calculated with and without the revision procedure. Comparison of total costs for each potential outcome to the estimated health utility value allowed for comparison across rhinoplasty subgroups. Results: The mean cost of primary outpatient rhinoplasty using HCA and CCA were $8075 and $8342 respectively. Revision outpatient rhinoplasty averaged $7447 and increased to $8228 if costal cartilage harvest was required. Hospital admission increased the cost of primary rhinoplasty with CCA to $8609 for observational admission and to $13653 for 1 day inpatient admission. Revision CCA rhinoplasty with an inpatient admission complicated by pneumothorax increased costs to $21 099. Conclusion: Cost of rhinoplasty without hospitalization was similar between HCA and CCA and this cost represents the lower limit of a practical cost for an engineered graft. Considering complications such as need for revision or for admission after CCA due to surgical morbidity, the upper limit of cost for an engineered implant would approximately double.

Since its first launched in 2014, many hospitals claimed to have financial loss due to inequality between hospital real tariff and BPJS payment. It is important to identify the characteristics and trends of caesarean deliveries in hospitals prior to measuring the efficiency level under INA-CBGs system. However, until now there is yet to be a descriptive study to understand this issue comprehensively. To fill this research gap, this study aimed to compare caesarean section incidents and costs between private and public hospitals in West Sumatra, Indonesia. This study is expected to describe real situation related to caesarean cases and explore the preference of patients in the province for caesarean deliveries. This study was retrospective and cross-sectional design of caesarean section in all West Sumatran hospitals under INA-CBGs system. The data used was taken from BPJS region West Sumatra-Riau-Jambi for period 2016 to 2018. During that period, almost 59 thousand caesarean section were performed, of which 64% in private hospitals and 36% in public hospitals. Within three years, caesarean cases in private hospitals were almost doubled while public hospitals showed a decreasing trend. In 2018, three quarter of caesarean costs was paid by BPJS to private hospitals while public hospitals only received a quarter of total costs.

The present study aimed to assess the effect of implementing Rapid Prototyping (RP) in the product development phase on the sustainability of a conventional supply chain. The sustainability indicators of RP utilization were identified through a critical literature review and consulting two experienced RP practitioners to determine the key variables regarding the potential impact of RP on the supply chain components, with an emphasis on sustainability pillars. A generic system dynamics modeling was provided to simulate the RP-adapted supply chain and measure its sustainability performance. The simulation results indicated that RP utilization in the design phase could decrease the number of the assembly parts and material consumption in conventional manufacturing, while indirectly affecting the reduction of waste generation, logistics, CO2 emissions, processes, and the total costs which are related to environmental and economic aspects of the sustainable supply chain. Findings indicated that significant increase in operational skills and knowledge as the main indicators of the social dimension could remarkably reduce the failure rates and increase the quality of the products. This indicator plays a pivotal role in operational success and could be enhanced through training programs. Social sustainability indirectly affects environmental and economic sustainability. This was the first model-based research to examine the potential effects of RP on the sustainability of a conventional manufacturing. The proposed generic model encompassed the variables that could be applicable in every scenario to help decision-makers change values or add more variables within specific industry settings and choose the applicable ones, which in turn, accelerating the RP adoption in supply chains and providing insights for operational decisions regarding product design stage.

Актуальность. Здоровье – найвысшая ценность не просто в контексте восприятия конкретным лицом, но и общества и государства в целом. Согласно содержания международных документов, утвержденных Генеральной Ассамблеей ООН, ВОЗ, Всемирной медицинской ассоциацией правительства несут ответственность за здоровье населения, обеспечивют реализацию права человека на жизнь и здоровье. Однако, для формирования мощной и действенной системы здравоохранения в Украине для фармацевтического обеспечения льготных категорий граждан полезным является опыт организации обеспечения здравоохранения в экономически развитых странах. Цель работы заключалась в изучении опыта Великобритании по организации организации системы здравоохранения для фармацевтического обеспечения лекарственными средствами льготных категорий населения. Материалы и методы. Для достижения поставленной цели были использованы общепринятые методы нормативно-правового, документального, ретроспективного и сравнительного анализа. Результаты. Система финансирования здравоохранения Великобритании предусматривает поступление преобладающей части средств из государственного бюджета, при этом распределение осуществляется по управленческой вертикали от высшего звена к низшему. Именно галоги, которые составляют около 90% бюджета здравоохранения, являются финансовым основанием национальной системы здравоохранения Великобритании. Для сравнения, только 7,5% средств поступают от работодателей. Поэтому можно утверждать, что система здравоохранения Великобритании фактически полностью обеспечивается за счет финансовых платежей со стороны плательщиков налогов и собственно государственного обеспечения. В мировой практике принято выделять три основные модели финансирования сферы здравоохранения: частная, бюджетная (модель Бевериджа), смешанная (модель Бисмарка). Частная модель финансирования существует за счет создания устойчивой конкуренции между заведениями здравоохранения. Частное страхование составляет около 40% от общих затрат, а остаток стоимости фармацевтического обеспечения покрывает сам пациент. Частная модель финансирования характерна для таких развитых стран как США и Япония. Бюджетная модель финансирования или модель Бевериджа предусматривает покрытие значительной части затрат на фармацевтическое обеспечение государственными учреждениями. Такая модель характерна и для Великобритании. Смешанная модель финансирования или модель Бисмарка базируется на «трех китах»: государство, предприятия и личные средства гражданина. Данная система финансирования на страховой основе характерна для Германии, Австрии и Франции. Частная медицина Великобритании — одна из наиболее передовых и наиболее дорогих в мире. В этой стране около 300 негосударственных госпиталей, каждый из которых получает лицензию в местном подразделении Национальной системы здравохранения и проходит проверку дважды в год. Здесь отсутствуют очереди, а медицинскую помошь предоставляют в полном и необходимом объеме. Платные услуги врачей и кабинетов оплачивают или страховые компании, или пациенты самостоятельно. В крупных компаниях Великобритании распространено медицинское страхование как дополнительный бонус к зарплате. Выводы. Опыт Великобритании по обязательному мединскому страхованию распространен в странах с преимущественным государственным финансированием. Модель Бевериджа распространена во многих странах, в которых государство обеспечивает компенсацию 80% и более затрат на здравоохранение (Канада, Австралия, Греция, Швеция, Испания). Значительные подвижки в системе здравоохранения Великобритании, возможность выбрать вид страхования и воспользоваться льготами на получение лекарственных средств позволила искусственно повысить конкуренцию между учреждениями здравоохранения, а соответственно – улучшить качество и скорость фармацевтического обеспечения пациентов. Таким образом, бюджетная медицина Великобритании – приоритет для многих стран мира и залог государственного финансирования фармацевтического обеспечения льготных категорий населения, независимо от уровня доходов и социального статуса.

Objective The provision of medicines through state public hospitals is comparatively restrictive compared with the federally funded Pharmaceutical Benefits Scheme (PBS). Individual states are progressively moving towards statewide medicines formularies. Although a statewide formulary has existed in Queensland for some time. The effects of hospital formularies on medicines utilisation and policy in Australia has not been quantified. Thus, the aim of the present study was to quantify the effects of the Queensland Health List of Approved Medicines (LAM) on medicines utilisation in Queensland at a state and PBS-purchasing level and describe the implications for medicines policy. Methods This study used a quasi-experimental design with an interrupted time series (with control for PBS) examining utilisation effects of medicines within the therapeutic classes of proton pump inhibitors and non-vitamin K oral anticoagulants with LAM listing or delisting. Results The LAM was demonstrated to be highly effective at controlling utilisation within Queensland Health purchasing. Effects on PBS utilisation were evident, resulting in increases in generic utilisation (where available) and associated reduced total costs both within Queensland Health and to the PBS. The full benefit is likely underestimated due to limitations in the PBS datasets. Conclusion The LAM is a highly effective state medicines policy tool with demonstrable effects on PBS utilisation. With increased use of statewide medicines formularies, this will be an increasingly relevant aspect of Australia’s overall medicines policy. What is known about the topic? State medicines policy is comparatively restrictive compared with the federal PBS. Most Australian states have, or are developing, statewide medicines formularies. What does this paper add? By examining several classes of medicines, a substantial quantitative effect of the Queensland state formulary on both state and PBS medicines utilisation can be demonstrated. Increased use of generic medicines and reduced costs are seen. What are the implications for practitioners? With increased use of state medicines formularies, state medicines formularies will become increasingly relevant to medicines policy makers and advocates at both the state and federal level.

Stream processing is a new memory computing paradigm that deals with dynamic data streams efficiently. Storm is one of the stream processing frameworks, but the default stream processing scheduler of storm also has some problems. For example, it does not consider reducing the cost in the cloud environment while ensuring the performance requirements. In this paper, a cost-efficient scheduling algorithm for Storm framework (CE-Storm) is proposed to reduce cost while satisfying deadline constrain. First, a new cost-efficient model (including resources usage cost, energy cost and communication cost) based on Storm framework is built. Then, based on the cost model, a cost-efficient scheduling algorithm which integrated resource monitoring module and communication detection module is designed. The nodes in the cluster are prioritized according to the cost-efficient information, and the nodes with higher priority are assigned tasks first to minimize the total cost of the cluster. Furthermore, this algorithm also reduces the communication cost between nodes and improves the cost effectiveness of the Storm cluster. We have performed extensive experiments on Storm clusters using Hibench’s workloads in cloud environment. The result shows that the cost consumption of Storm clusters in cloud environment is reduced by 19.25% on average compared with the traditional scheduling algorithm. In others words, the proposed algorithms effectively improve the cost efficiency of Storm cluster in the cloud environment while satisfying the performance constrains.

The initial data for calculating the basic salary are: the labour intensity of carrying out maintenance and repair of machinery and equipment in animal husbandry, as well as hourly tariff rates for workers in workshops and areas for the repair of agricultural machinery and tools, which are accepted directly in farms and repair and maintenance organizations independently, but not lower than the tariff rate has been established for budget organizations. The purpose of the work was to calculate the basic salary of personnel according to the tariff categories used in the Republic of Belarus, and to consider the key provisions of the methodology for determining the total costs of technical service of machinery and equipment in animal husbandry. The most important provisions of the methodology for calculating the basic salary of personnel of repair and maintenance departments and organizations operating in the livestock subcomplex of the Agro-industrial complex of the Republic of Belarus have been presented. The main points of the methodology for calculating the total costs of maintenance and repair for machines and equipment of livestock farms and complexes have been given in relation to the conditions and their own features of accounting and planning of repair and maintenance work in domestic animal husbandry. An example of practical calculation of costs for carrying out various types of maintenance and repair of a widely used domestic milking machine has been considered.

Retribution Tariff of Public Health Center (Puskesmas) in Cimahi City is regulated according to Regulation of Retribution Tariff according to Regulation No. 8 Year 2011. Based on the tariff value from 2011 until now still valid with same tariff. Based on the above, it is necessary to evaluate the tariff compared with the increase of the price of health equipment and the operational cost of other puskesmas supporting the puskesmas service, which increases annually.. The purpose of this research is to analyze the tariff of puskesmas. This research method is qualitative descriptive research. Result of research indicate that tariff of puskesmas service there are several alternatives along with the increase of tools, drugs and raw materials, this becomes the base of tariff policy consideration, with consideration of price increase of puskesmas tariff or addition of health budget subsidy in Cimahi City. Conclusion: Based on the unit cost of indirect cost calculation tariff of public health service Rp 26,973, -. Based on the total cost (total cost) of public health services Rp 62,529, - Based on the comparison of other city tariffs from the mayor regulation of 2011-2012 is Rp 2000, - to Rp 4000, -. Based on the proposals from the Disccusion Focus Group (FGD), several public health centers in Cimahi City, on average, were Rp 8,500. Based on the academic proposal, the average inflation rate (Rp 11,000), ability to pay (Rp 9,475, -) cost (Rp 11,507), generic drug cost (Rp 6,556, -), average proposals of puskesmas (Rp 8,500, -), namely: Rp 11,567, - rounded Rp 11.000, -. Keywords: Analysis, Retribution Tariff of Puskesmas

In recent years, harvesting solar energy as a renewable and sustainable energy source has been studied extensively across engineering fields. Having reviewed more than 50 large-scale projects of Hydronic Asphalt Pavement (HAP), this paper offers a series of findings: the range of construction cost of asphalt collector varies between 25 and 151 €/m2 and 1.760–3.000 €/m2 for the heat exchanger and the total cost. The energy harvest capacity of asphalt solar collector systems (0,6–0,8 GJ/m2/year) and the required amount of heat for snow melting projects (100–900 W/m2) vary significantly in different projects. Using grid supports for easier pipe placement and protection of pipes against heavy loads during and after construction is recommended. Pavement solar collector systems reduced carbon dioxide emissions by 8–100% in different projects by changing their source of energy from fossil fuels to renewable and sustainable sources. Moreover, in order to further evaluate the sustainability of the HAP systems, a detailed life cycle assessment is required, including all available data related to the energy performance, pavement service life, material end-of-life recycling, etc. Finally, the paper identifies the knowledge gaps requiring further research especially in the area of energy output of the HAP systems, pavement service life and life cycle assessment.