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Recent meta‐analyses of randomized controlled trials (RCTs) have demonstrated significant reduction in cancer mortality by vitamin D supplementation. We estimated costs and savings for preventing cancer deaths by vitamin D supplementation of the population aged 50+ years in Germany. Our analysis is based on national data on cancer mortality in 2016. The number of preventable cancer deaths was estimated by multiplying cancer deaths above age 50 with the estimated proportionate reduction in cancer mortality derived by vitamin D supplementation according to meta‐analyses of RCTs (13%). Saved costs were estimated by multiplying this number by estimated end‐of‐life cancer care costs (€40 000). Annual costs of vitamin D supplementation were estimated at 25€ per person above age 50. Comprehensive sensitivity analyses were conducted. In the main analysis, vitamin D supplementation was estimated to prevent almost 30 000 cancer deaths per year at approximate costs of €900 million and savings of €1.154 billion, suggesting net savings of €254 million. Our results support promotion of supplementation of vitamin D among older adults as a cost‐saving approach to substantially reduce cancer mortality., Vitamin D supplementation to Germany's population aged 50 years and above was estimated to prevent almost 30 000 cancer deaths per year at approximate costs of €900 million and savings of €1.154 billion. Thus, supplementation of vitamin D among older adults appears to be a cost‐saving approach for reducing cancer mortality.

SETTING: Early diagnosis of latent tuberculous infection (LTBI) should be pursued in healthcare workers (HCWs). While HCWs in hospitals are screened for LTBI, HCWs in outpatient settings are usually not. In 2017, in Italy, a tuberculosis (TB) infected paediatrician working in an outpatient vaccination service infected 15 adults and nine children. The investigation involved 2490 children and 151 adults. Among children, nine were tuberculin skin test-positive, and four developed active TB. Among 123 adult contacts with longer exposure, seven were interferon-gamma release assay (IGRA) positive and none had active TB. Among 28 close contacts, eight had a positive IGRA, and three had pulmonary TB. The total outbreak cost €1 017 903.OBJECTIVE: To compare the outbreak cost with those of potential screening programme strategies.RESULTS: Regular screening of paediatric outpatient HCWs would have cost between €2592 and €11 373. Extending the screening to all outpatient HCWs (caring for adults and children) would have cost between €66 384 and €155 043. Investigating only close contacts would have cost €42 857.CONCLUSION: Each of these screening strategies would have been cost-effective compared with the outbreak investigation occurring in real life with a cut-off of 474 for the maximum number of tested outpatient HCWs needed for the screening strategy to be cost-saving.

Background Identification and treatment of malnutrition across the care continuum can help prevent illness onset or relapse and maximize the effectiveness of other medical treatments. This study aimed to evaluate the effect of a nutrition‐focused quality improvement program (QIP) conducted in a home health agency (HHA) on hospitalization rates and healthcare costs incurred over 90 days. Methods This was a multisite, pre‐post QIP implemented at 2 branches of an Illinois‐based HHA. The QIP included 1546 patients who were (1) at‐risk or malnourished hospitalized patients discharged to the HHA, (2) referred by a physician during an outpatient visit, or (3) enrolled in the HHA through a skilled nursing facility. A historic (n = 7413 patients) and concurrent group (n = 5235) of patients were used for comparisons. Propensity score matching was used to account for imbalances in patient characteristics. Results The QIP led to reduced relative risk of hospitalization post‐enrollment to the QIP by 24.3%, 22.8%, and 18.3% at 30, 60, and 90 days, respectively, when compared with the historic group, and by 18.2%, 16.2%, and 12.1% when compared with the concurrent group. Total cost savings from reduced 90‐day healthcare resource utilization was $2,318,894, or $1500 per patient treated. Conclusions Rates of hospitalization and healthcare resources can be significantly reduced through the implementation of a nutrition‐focused QIP delivering oral nutritional supplements in home health settings for adults at‐risk/malnourished. These results highlight the importance of nutrition as a strategy for HHAs and other post‐acute care institutions to improve patients' health outcomes and generate cost savings.

Development of paper industry has been restricted by resources, energy and environment deeply, further reducing energy consumption becomes an urgent problem to be solved. In this paper, the calculating model of steam consumption in bleaching process is established under the premise of ensuring product quality and controlling bleaching cost. Then, an optimization model for minimizing steam consumption is constructed. Compared with before optimization, the steam consumption of the optimized bleaching system reduced by 19.48% (0.5014 t/adt) at a loss of 0.11% brightness (0.1 ISO%) and 5.17% viscosity (33 mL/g). The amount of chemicals should be increased to ensure the quality of the pulp while decreasing the bleaching temperature to reduce steam consumption, the cost of bleaching pulp has decreased by 1.62% (3.19 USD/adt) after optimization. The verification experiments showed all the pulp quality indices can meet the requirements of bleached pulp.

Background Given that China has encouraged EHR usage in hospitals for more than a decade, patients’ access to their own EHR data is still not as widely utilized as expected. Methods We cultivated a survey with four categories and field interviews of measures to identify whether hospitals have already released EHR data to patients, inpatients or outpatients, the top EHR release contents and the most popular release software. Results Of the 1344 responding hospitals from 30 provinces nationwide, 41.37% of hospitals have already released their EHR data to patients, of which 97.12% are through smart apps. More than 91% of hospitals use WeChat, and 32.37% of hospitals developed their own standalone apps or use vendors’ apps. A total of 54.63% were released to both outpatients and inpatients, and the top release contents were all objective. A rough estimation is made that releasing EHR data to patients via smart apps may save the hospital 15.9 million RMB per year and patients 9.4 million RMB altogether. Conclusions EHR data release is believed to bring both patient and hospital cost savings and efficiency gains but is still considered spontaneous and requires legal support and government regulation.

[ES] Uno de los mayores retos para el mercado de bombas de calor geotérmicas es el alto coste asociado a la perforación de los intercambiadores de calor geotérmicos. Conseguir unos intercambiadores de calor geotérmicos más eficientes reduciría dicho coste, ya que sería necesaria una menor longitud de intercambiador para obtener las mismas temperaturas de trabajo en él (misma eficiencia de la bomba de calor). La eficiencia térmica de un intercambiador de calor geotérmico está caracterizada por su resistencia térmica. Dicha resistencia térmica depende de una serie de elementos entre los que se encuentran: propiedades y caudal del fluido que recorre el intercambiador de calor, diámetro de la perforación geotérmica, geometría y materiales de la tubería del intercambiador de calor y las propiedades del material de relleno de la perforación (grouting). Cuanto mayor sea la resistencia térmica del intercambiador de calor, menor será el calor transferido entre el fluido caloportador y el terreno, traduciéndose en una necesidad mayor de longitud de intercambiador enterrado. Por lo tanto, es necesario una reducción de este parámetro al mínimo posible. En consecuencia, el objetivo principal de esta tesis doctoral consiste en, a partir de un modelo analítico comprensivo de cuantificación del impacto de los parámetros anteriores, realizar un estudio detallado para analizar su influencia combinada en la resistencia térmica del intercambiador geotérmico, pero también examinando dicho efecto en otros planos, como costes económicos de ejecución del intercambiador y de explotación (consumo eléctrico de la bomba de calor y costes de bombeo asociados)., [CA] Un dels majors reptes per al mercat de bombes de calor geotèrmiques és l'alt cost associat a la perforació dels bescanviadors de calor geotèrmics. Aconseguir uns bescanviadors de calor geotèrmics més eficients reduiria aquest cost, ja que seria necessària una menor longitud de bescanviador per a obtenir les mateixes temperatures de treball en ell (mateixa eficiència de la bomba de calor). L'eficiència tèrmica d'un bescanviador de calor geotèrmic està caracteritzada per la seva resistència tèrmica. Aquesta resistència tèrmica depèn d'una sèrie d'elements entre els quals es troben: propietats i cabal del fluid que recorre el bescanviador de calor, diàmetre de la perforació geotèrmica, geometria i materials de la canonada del bescanviador de calor i les propietats del material de farciment de la perforació (grouting). Com més gran sigui la resistència tèrmica del bescanviador de calor, menor serà la calor transferida entre el fluid termòfor i el terreny, traduint-se en una necessitat major de longitud de bescanviador enterrat. Per tant, és necessari una reducció d'aquest paràmetre al mínim possible. En conseqüència, l'objectiu principal d'aquesta Tesi Doctoral consisteix en, a partir d'un model analític comprensiu de quantificació de l'impacte dels paràmetres anteriors, realitzar un estudi detallat per a analitzar la seva influència combinada en la resistència tèrmica del bescanviador geotèrmic, però també examinant aquest efecte en altres plans, com a costos econòmics d'execució del bescanviador i d'explotació (consum elèctric de la bomba de calor i costos de bombament)., [EN] One of the biggest challenges for the ground source heat pump market is the high cost associated with drilling geothermal borehole heat exchangers. Achieving more efficient geothermal heat exchangers would reduce this cost, since a shorter exchanger length would be required to obtain the same working temperatures in it (same efficiency of the heat pump). The thermal efficiency of a geothermal heat exchanger is characterized by its borehole thermal resistance. This borehole thermal resistance depends on a number of parameters, mainly: properties and flow rate of the working fluid that flows through the borehole heat exchanger, diameter of the geothermal borehole, geometry and materials of the heat exchanger pipe and the properties of the borehole grouting material. The higher thermal resistance of the heat exchanger, the less heat is transferred between the heat carrier fluid and the ground, resulting in an increased requirement for the length of the buried heat exchanger. Consequently, it is essential to reduce this parameter to the minimum possible. Therefore, the main objective of this Ph. Doctoral Thesis is to carry out, based on a comprehensive analytical model of quantification of the impact of the above mentioned parameters, a detailed study to analyze their combined influence on the thermal resistance of the geothermal borehole, but also exploring this effect in other less researched areas, such as economic costs of running the exchanger and operating it (electricity consumption of the heat pump and associated pumping costs)., This research has received funding from the European Union’s Horizon 2020 Research and Innovation program under grant agreement No [657982], [727583] and [792355].

Background: Emergency interhospital transfer of patients with stroke with large vessel occlusion to a comprehensive stroke center for mechanical thrombectomy is resource-intensive and can be logistically challenging. Imaging markers may identify patients in whom intravenous thrombolysis (IVT) alone is likely to result in thrombus resolution, potentially rendering interhospital transfers unnecessary. Here, we investigate how predicted probabilities to achieve IVT-mediated recanalization affect cost-effectiveness estimates of interhospital transfer. Methods: We performed a health economic analysis comparing emergency interhospital transfer of patients with acute large vessel occlusion stroke after administration of IVT with a scenario in which patients also receive IVT but remain at the primary hospital. Results were stratified by clinical parameters, treatment delays, and the predicted probability to achieve IVT-mediated recanalization. Estimated 3-month outcomes were combined with a long-term probabilistic model to yield quality-adjusted life years (QALYs) and costs. Uncertainty was quantified in probabilistic sensitivity analyses. Results: Depending on input parameters, marginal costs of interhospital transfer ranged from USD −61 366 (cost saving) to USD +20 443 and additional QALYs gained from 0.1 to 3.0, yielding incremental cost-effectiveness ratios of Conclusions: Predicted probabilities to achieve IVT-mediated recanalization significantly affect the cost-effectiveness of interhospital transfer for MT, in particular in elderly patients with moderate or severe stroke symptoms. However, high predicted recanalization rates alone do not generally imply that patients should not be considered for transfer.

Soybean rust (SBR), caused by Phakopsora pachyrhizi (Sydow &amp, Sydow), has become a serious issue in Brazil. As Brazil is one of the largest soybean-producing and exporting countries in the world, a considerable decrease in soybean production due to SBR would have a significant impact on the global soybean market. SBR-resistant cultivars have been developed to prevent a decrease in soybean production. This study was conducted to evaluate the effect of SBR-resistant cultivars on soybean production and the soybean market in Brazil using a supply and demand model. This model consists of functions of yield, cultivated area, exports, and stock changes of soybean and soybean products, demand for soybean products, and price linkages. Five scenarios were simulated to evaluate the economic impact of adopting SBR-resistant cultivars as follows: One without SBR infection, two with serious production losses due to SBR in the south and southeast regions and all the states of Brazil, and two with the adoption of SBR-resistant cultivars in the south and south-east regions and all the states of Brazil. Our simulations suggest that adopting SBR-resistant cultivars reduces the cost of controlling SBR by approximately half and is essential for sustainable soybean production and a stable global soybean market.

Digitalization transforms companies, businesses, and ecosystems in several ways. However, digital solutions have still often a supplementary role in company´s operations and the arising monetary benefits are typically hard to define. At the same time as digital technologies get more and more complex, so do the monetization models to create business value from these technologies. This paper focuses on establishing a framework to define the customer value generated by digital solutions and on examining the value creation potential of digital solutions. Firstly, the aim is in increasing understanding of phenomena of a customer value. Secondly, the customer value is researched empirically in case studies in maritime and in forest industry. The case studies focus on analyzing the technology providers’ digital solutions as risk mitigation investments where the cost-effectiveness is of central concern and where the benefits arise largely from the avoidance or reduction of negative consequences in the operation and maintenance phases of the asset life cycle. In the developed value assessment framework, the inherent uncertainty is taken into account by a what-if-analysis i.e. by re-calculating the results if initial parameter values are changed. The framework contributes to refining of the value of the digital solution, and to demonstrating and communicating the costs and risks as well as the benefits achieved by a potential customer.

Background and aims To evaluate the economic impact of using 2nd generation basal insulin analogs, Glargine 300 Units/ml (Gla-300) vs Degludec 100 Units/ml (IDeg-100), in patients with type 2 diabetes (T2D). Methods and results An economic analysis was conducted using findings from the BRIGHT study (the first controlled, head-to-head study comparing Gla-300 vs IDeg-100), and costs for the Italian National Healthcare Service (NHS). A cost-minimization analysis (CMA) and a budget impact analysis (BIA) were conducted. Only pharmacological costs were included in the analysis. The CMA estimated patient treatment costs at 24 weeks and 1 year; the BIA assessed the economic impact of treating the overall Italian population of T2D insulin-naive patients, who initiated insulin treatment during the period September 2017–August 2018 (N = 55 318). In the BIA, four different scenarios were compared: i) all patients receive IDeg-100 (Scenario A); ii) 61% of patients receive Gla-300, 39% IDeg-100 (Scenario B); iii) 80% of patients receive Gla-300, 20% IDeg-100 (Scenario C); iv) all patients treated with Gla-300 (Scenario D). The average treatment costs per patient were lower with Gla-300 vs IDeg-100 (at 24 weeks: €129 vs €161; at 1 year: €324 vs €409, respectively). Results of the BIA showed that comparing Scenario D vs Scenario A, total savings would amount to €1.76 million at 24 weeks, €4.73 million at 1 year, €5.53 million at 2 years. Conclusion A larger use of Gla-300 vs IDeg-100 for the treatment of T2D patients would lead to a relevant reduction of therapy costs in Italy.

BACKGROUND: Gelatin-thrombin hemostatic matrix (FloSeal®) use is associated with shorter surgical times and less blood loss, parameters that are highly valued in neurosurgical procedures. We aimed to assess the effectiveness of gelatin-thrombin in neurosurgical procedures and estimate its economic value. METHODS: In a 6-month retrospective evaluation at 2 hospitals, intraoperative and postoperative information were collected from patients undergoing neurosurgical procedures where bleeding was controlled with gelatin-thrombin matrix or according to local bleeding control guidelines (control group). Study endpoints were: length of surgery, estimated blood loss, hospitalization duration, blood units utilized, intensive care unit days, postoperative complications, and time to recovery. Statistical methods compared endpoints between the gelatin-thrombin and control groups and resource utilization costs were estimated. RESULTS: Seventy-eight patients (38 gelatin-thrombin; 40 control) were included. Gelatin-thrombin was associated with a shorter surgery duration than control (166±40 versus 185±55 minutes, P=0.0839); a lower estimated blood loss (185±80 versus 250±95 mL; P=0.0017); a shorter hospital stay (10±3 versus 13±3 days; P

Phase Change Materials (PCMs) can absorb and release a high amount of energy, and therefore, can be used for shifting electricity demand in some household appliances. Indeed, the use of PCMs in a cabinet refrigerator leads to increase its OFF time and flexibility and moves the energy consumption to other periods for a reduction of the peak energy demand. The higher flexibility of the refrigerator with PCM can be exploited to reduce its running cost considering that many countries adopted Time-of-Use (TOU) tariffs, in which the electricity cost is based on the time of energy use over a day and a week. Hence, this work proposes an algorithm based on Simulated Annealing (SA) method to identify the optimal working scheduling of a refrigerator with PCM to reduce its running costs. Experimental results have been used as inputs for the algorithm, and nine 2-TOU and three 3-TOU electricity tariffs from different European countries have been selected to test the methodology. The possibility to achieve running cost savings for various case studies has been proven. Furthermore, higher is the difference between the peak and off-peak electricity cost; more significant is the economic benefits reached by the proposed method.

Lockdown and self-isolation are to date the only solution to limit the spread of recent outbreak of coronavirus disease (CoViD-19), highlighting the great advantage of home dialysis in a patient otherwise forced to travel from / to the dialysis center to receive this "life-saving" treatment. Indeed, to prevent spreading of CoViD-19 infection among extremely fragile dialysis patients, as well as among dialysis workers, hemodialysis (HD) centers are adopting specific procedures ("dedicated" dialysis facilities, portable osmosis, etc.) with a great economic and organizational commitment. Peritoneal dialysis (PD) represents a type of home dialysis therapy not yet adequately implemented to date, in spite of safe and simple practice, as well as similar dialytic efficiency vs in-center hemodialysis. Remote patient monitoring (RPM) systems have been developed in automated PD (APD) cyclers in order to improve the acceptance of this dialysis method, to increase the compliance to the prescribed therapy and to control treatment adequacy. In this review we assess the potential advantages of RPM in APD, that are the chance for patients to acquire greater independence and safety in the home treatment, to allow better access to care for residents in remote areas, faster resolution of problems, reduction in hospitalizations and mortality rates, as well as time and cost saving for both the patient and the staff. The use of medical devices (sphygmomanometer, glucometer, balance, etc.), connected by wireless to the clinician's portal, might also allow a wider diffusion of incremental dialysis, an integrated therapy that combines conservative management of ESKD patients with a soft dialysis based on the residual kidney function and symptomatology, with potential prognosis and economic benefits. Although the majority of the studies are small and observational, a wider use of RPM systems is desirable to broaden the spread of home dialysis, as we learnt from Coronavirus pandemic.

Purpose. The research aims at the analysis of the possibility of using in the development of one-group train formation plan the criterion, which allows to consider the costs associated with the movement of cars and locomotives. Methodology. The existing methods for development of train formation plan and current directions of its optimization are analyzed. The formulas for calculating the cost-saving criterion for running cars and locomotives in through-trains have been developed. Findings. The dependence between the service speed and the category of train was analyzed on the examples of railway sections of the Belarusian Railways. The obtained results allowed to conclude that, in general, the service speed of through-trains is higher than that of local trains. At the same time, the traffic intensity and section capacity affect the difference between the service speeds of trains belonging to the different categories. The one-group train formation plan was developed using the traditional methods and the proposed criterion on the example of the railway direction, where four marshalling yards are located. The use of the proposed methodology for the development of train formation plan can provide significant savings in operating costs due to the acceleration of the passing of the car through the railway sections. Originality. The use of the additional parameter in the development of train formation plan – «the criterion of cost saving when running of rolling stock in through-trains» – is proposed. It is shown that the application of this criterion makes it possible to substantiate the creation of separate assignments of some car-streams, while these car-streams would be considered as unprofitable, when using traditional methods of the calculation of train formation plan. The authors analyzed the influence of such factors as the train composition, the length of the railway section and the car traffic volume on the cost savings by using the proposed criterion. Practical value. The obtained results can be used in the development of the train formation plan, which will save the operating costs connected with the movement of cars and locomotives.

Bangladesh has an agrarian economy in which paddy is the dominant crop. A significant amount of field losses of paddy occurs every year due to natural calamities and a shortage of time during the harvesting period. During this study, a modification was done on locally developed BAU self-propelled reaper and its performance was compared with manual harvesting system of paddy. Several experiments were conducted in Boro paddy (April–May 2017) and Aman paddy harvesting (November–December 2017) at BAU farm of Bangladesh Agricultural University after necessary modification works in the workshop. An experiment was also conducted on Aman paddy in 2017 at BAU farm for determining manual harvesting cost. The technical and economic performances of the modified BAU self-propelled reaper were determined based on the field experiments. Results reveal that average fuel consumption, effective field capacity and field efficiency were 2.71 L/ha, 0.255 ha/h and 77.27%, respectively for the modified BAU self-propelled reaper and 2.88 L/ha, 0.25 ha/h and 75.76%, respectively for the existing BAU self-propelled reaper. These results indicated that field performances of modified BAU self-propelled reaper were better than that of the existing BAU reaper. Paddy harvesting cost was found 916 Tk/ha for modified BAU self-propelled reaper and 9200 Tk/ha for manual harvesting system. The benefit-cost ratio of the modified BAU self-propelled reaper was 2.18. Considering the technical and economic performances, modified BAU self-propelled reaper was found suitable than the existing BAU reaper. So, the modified BAU self-propelled reaper may be introduced in Bangladesh in the commercial basis.J. Bangladesh Agril. Univ. 16(2): 171-177, August 2018

Labour-only procurement system is gaining fast popularity among construction clients who want to make savings by procuring materials themselves, leaving the contractor to provide only the labour needed. This study, therefore, appraised this procurement system by assess­ing its cost performance, its suitability, construction par­ticipant’s willingness to use it for subsequent projects and its merits and demerits. Using a survey design approach through the use of questionnaire and a pro forma, data were gathered from a total of 98 construction profes­sionals and contractors who have been involved in the use of this procurement system. Analyses of data were done using percentage, mean item score, Mann-Whitney U test and paired samples t-test. The study revealed that this procurement system is best for procuring residential buildings and minor alteration works. Construction participants who have used this system before are willing to still use it for subsequent works, as it delivers projects within budget and discourages short-changing of specifi­cations and standard by contractors. However, the need for the time commitment and reduction in contractor’s profit are its major disadvantages. For its cost perfor­mance, an overall cost saving of about 2% was discovered for the assessed 32 projects. The findings of this study will be beneficial to various interest groups such as clients and estate developers in selecting the right procurement option to use.

Background Given the high costs associated with the care of those with Alzheimer’s disease (AD) dementia, we examined the likely impact of a reduction in the rate of cognitive decline upon cost outcomes associated with this disease. Methods Using the group of patients with mild AD dementia from the GERAS study, generalised linear modelling (GLM) was used to explore the relationship between change in cognition as measured using the Mini-Mental State Examination (MMSE) and UK overall costs (health care and social care costs, and total societal costs) associated with AD dementia. Results A total of 200 patients with mild AD dementia were identified. Least squares mean (LSM) ± standard error (SE) reduction in MMSE score was 3.6 ± 0.4 points over 18 months. Using GLM it was possible to calculate that this worsening in cognition was associated with an 8.7% increase in total societal costs, equating to an increase of approximately £2200 per patient over an 18-month period. If the rate of decline in cognition was reduced by 30% or 50%, the associated savings in total societal costs over 18 months would be approximately £670 and £1100, respectively, of which only £110 and £180, respectively, could be attributed to a saving of health care costs. Conclusion This study demonstrates that there are potential savings to be made in the care of patients with AD dementia through reducing the rate of cognitive decline. A reduction in wider societal costs is likely to be the main contributor to these potential savings, and need to be further evaluated when intervention costs and cost offsets can be measured.

This article evaluates the potential of dimming road lighting in order to save energy and lower costs while avoiding any adverse effects on the visibility of drivers. An experimental study under varying road surface conditions was conducted to examine the combined effect of car headlights and different road lighting intensities on the visibility level. The luminance levels of the road surface, contrast and visibility level of the objects were measured from a stationary car under three road surface conditions: a) dry, b) wet, and c) snowy conditions. The results support the feasibility of reducing road lighting intensity when car headlights are available. When within the range of car headlights, road lighting did not improve the visibility level. In the presence of car headlights, the average luminance providing a sufficient visibility level was found to be 0.19, 0.63 and 0.75 cd/m2 under dry, wet and snow conditions, respectively. This would allow an energy savings of 317kWh/year/luminaire, representing savings of 80% luminaire/year for LED luminaires.

Objectives As a cancer treatment option, chemotherapy costs make up a large part of the budgets of social insurance foundations and related expenditures are increasing continuously annually. Cost saving and waste minimizing strategies are required to reduce the expenditures in the field of oncology. The study aimed to reduce the amount of wasted antineoplastic drugs and medical supply consumption. Materials and methods The study explains why vials with a larger size and drugs in liquid form should be preferred over various smaller sizes and powder forms of antineoplastic preparations. Results Amounts of drug wastage, vial adaptor, and transfer set consumption data were recorded regularly for a period of seven months. The average vial adaptor consumption per patient in the last three months decreased from 5 to 3.3. The preference of liquid forms as much as possible instead of powder forms, which has a shorter stability time after dilution, and the choice of larger package sizes of frequently used drugs decreased vial adaptor consumption. Potential savings were calculated as around 31.660 USD annually. Costs of total wasted doses were 8.699.87 USD, and the whole antineoplastic drug consumption was 515.500 USD during the study. A decrease of 0.58 USD was observed per capita when the first and last three-month periods were compared in terms of waste costs. Conclusion These values indicate that the reduction of wasted drugs have potential annual savings of 3.375 USD. It is shown that total potential savings of 35.000 USD could be made per year. By implementing the same principles in all hospitals in Turkey, approximately 2.8 million USD could be made annually. The pharmaceutical industry and hospital pharmacists have important responsibilities in this issue.

Introduction: Glaucoma, a chronic eye disease requires regular monitoring and treatment to prevent vision-loss. In Australia, most public ophthalmology departments are overburdened. Community Eye Care is a ‘collaborative’ care model, involving community-based optometrist assessment and ‘virtual review’ by ophthalmologists to manage low-risk patients. C-EYE-C was implemented at one Australian hospital. This study aims to determine whether C-EYE-C improves access to care and better utilises resources, compared to hospital-based care. Methods: A clinical and financial audit was conducted to compare access to care and health system costs for hospital care and C-EYE-C. Attendance, wait-time, patient outcomes, and the average cost per encounter were calculated. A weighted kappa assessed agreement between the optometrist and ophthalmologist decisions. Results: There were 503 low-risk referrals, hospital (n = 182) and C-EYE-C (n = 321). C-EYE-C had higher attendance (81.6% vs 68.7%, p = 0.001); and shorter appointment wait-time (89 vs 386 days, p < 0.001). Following C-EYE-C, 57% of patients avoided hospital; with 39% requiring glaucoma management. C-EYE-C costs were 22% less than hospital care. There was substantial agreement between optometrists and ophthalmologist for diagnosis (k = 0.69, CI 0.61–0.76) and management (k = 0.66, CI 0.57–0.74). Discussion: C-EYE-C showed higher attendance, and reduced wait-times and health system costs. Conclusions: Upscale of the C-EYE-C model should be considered to further improve capacity of public eye services in Australia.

Introducao Ha 8 anos, A.C, um simpatico italiano, recebeu stents coronarios. Ha mais ou menos 3 meses passou a ter dificuldade respiratoria progressiva com sensacao de aperto no peito; perda de apetite e emagreceu 4 kg, mas continuou trabalhando com boa disposicao. Estivera em duas consultas hospitalares previas, nas quais foi informado de que o pulmao estava normal, com base na radiografia. Nao haviam chegado a diagnostico definitivo, e por isso veio ao consultorio. Sua aparencia geral era normal; nada [...]

This paper reviews performance of combined pile-raft foundations (CPRF). The goal of the study is obtaining the ability to design solid, reliable and cost-effective foundations allowing for minimum settlements. The task is to develop methods for calculating CPRF for optimum choice of the foundation raft size, dimensions and number of piles. To achieve these results, an analytical method was used, curves of the ratio of CPRF settlement to raft foundation settlement vs. total load N on the piles were plotted. The scientific significance of the study is in the method of engineering calculation of CPRF, which is better correlated to the experimental data and allows optimal distribution of loads between the raft and piles, ensuring reliability and operational integrity of buildings, reduction of settlements and the number of piles, which would lead to cost savings and reduced consumption of materials for foundations. A new coefficient showing the residual stress has been introduced, and a method for its calculation has been proposed. A new equation for determination of the share of total load N on the piles has been obtained. This equation is more general in comparison with the previously generated equations. It allows excluding the assumption that the stresses arising under the raft completely dissipate at the level of the pile end. Application of the developed methods will increase reliability and reduce settlements and the number of piles, which ultimately will lead to cost savings and reduced consumption of materials for foundations. © 2019 Published under licence by IOP Publishing Ltd.

Virtual reality (VR) systems can offer benefits of improved ergonomics, but their resolution may currently be limited for the detection of small features. For detection of lung nodules, we compared the performance of VR versus standard picture archiving and communication system (PACS) monitor. Four radiologists and 1 novice radiologist reviewed axial computed tomography (CTs) of the thorax using standard PACS monitors (SM) and a VR system (HTC Vive, HTC). In this study, 3 radiologists evaluated axial lung-window CT images of a Lungman phantom. One radiologist and the novice radiologist reviewed axial lung-window patient CT thoracic images (32 patients). This HIPAA-compliant study was approved by the institutional review board. Detection of 227 lung nodules on patient CTs did not result in different sensitivity with SM compared with VR. Detection of 23 simulated Lungman phantom lung nodules on CT with SM resulted in statistically greater sensitivity (78.3%) than with VR (52.2%, P = 0.041) for 1 of 3 radiologists. The trend was similar but not significant for the other radiologists. There was no significant difference in the time spent by readers reviewing CT images with VR versus SM. These findings indicate that performance of a commercially available VR system for detection of lung nodules may be similar to traditional radiology monitors for assessment of small lung nodules on CTs of the thorax for most radiologists. These results, along with the potential of improving ergonomics for radiologists, are promising for the future development of VR in diagnostic radiology.

The evolution of resistant pathogens is a worldwide health crisis and adherence to European Association of Urology (EAU) guidelines on antibiotic prophylaxis may be an important way to improve antibiotic stewardship and reduce patient harm and costs.To evaluate the prevalence of antibiotic-resistant bacterial strains and health care costs during a period of adherence to EAU guidelines in a tertiary referral urologic institution.A protocol for adherence to EAU guidelines for antibiotic prophylaxis for all urologic procedures was introduced in January 2011. Data for 3529 urologic procedures performed between January 2011 and December 2013 after protocol introduction were compared with data for 2619 procedures performed between January 2008 and December 2010 before protocol implementation. The prevalence of bacterial resistance and health care costs were compared between the two periods.The outcome measures were the proportion of resistant uropathogens and costs related to antibiotic consumption and symptomatic postoperative infection. We used χ2 and Fisher's exact tests to test the significance of differences.The proportion of patients with symptomatic postoperative infection did not differ (180/3529 [5.1%] vs. 117/2619 [4.5%]; p=0.27). A total of 342 isolates from all patients with symptomatic postoperative infections were analysed. The rate of resistance of Escherichia coli to piperacillin/tazobactam (9.1% vs. 5.4%; p=0.03), gentamicin (18.3% vs. 11.2%; p=0.02), and ciprofloxacin (32.3% vs. 19.1%; p=0.03) decreased significantly after protocol introduction. The defined daily dose (DDD) use of ciprofloxacin fell from 4.2 to 0.2 DDD per 100 patient-days after implementation (p0.001). Antibiotic drug costs (€76,980 vs. €36,700) and costs related to postoperative infections (€45,870 vs. €29,560) decreased following introduction of the protocol (p0.001).Adherence to EAU guidelines on antibiotic prophylaxis reduced antibiotic usage without increasing post-operative infection rate and lowered the prevalence of resistant uropathogens.We analysed the impact of adherence to European Association of Urology guidelines on antibiotic prophylaxis for all surgical urologic procedures on the prevalence of infections and resistant bacterial strains and on costs. We found that adherence to the guidelines reduced the rate of bacterial resistance, in particular against piperacillin/tazobactam, gentamicin, and ciprofloxacin, and reduced costs without increasing the risk of postoperative infection after urologic procedures. We recommend adherence to the guidelines as an important part of antibiotic stewardship programmes.

PurposeTo compare post-operative recovery of prosthetic hip surgery patients with or without the implementation of iron supplementation with a new highly absorbable oral iron formulation.MethodsObservational retrospective quality improvement assessment conducted on patients who had undergone elective prosthetic hip surgery (first implant) with ferritin 100mcg/dl but C-reactive protein (CRP) >3mg/l and transferrin saturation (TSAT) 100mcg/l to two groups of patients with iron deficiency, of which only one received iron supplementation. Measurements included haemoglobin levels, length of hospital stay, and number of transfused patients/blood units.ResultsPatients with iron deficiency supplemented with Sideral (R) Forte compared to non-supplemented patients showed a smaller decline in post-operative Hb (9.71.24g/dl vs 8.4 +/- 0.6g/dl), required shorter hospital stay (4 vs 6.5days) and less blood transfusions (0 in the iron-supplemented group vs 7units in the non-iron-supplemented group), yielding an overall savings of 1763.25 Euro/patient.Conclusions p id=Par4 Pre-operative sucrosomial iron supplementation at least 4weeks prior to elective surgery in non-anaemic patients limits the drop in post-operative Hb levels, determining higher post-operative haemoglobin, quicker post-surgical recovery, shorter hospitalisation, and decreased surgery-related costs.

BackgroundMinimising prescription costs while maintaining quality is a core element of delivering high-value healthcare. There are various strategies to achieve savings, but almost no research to date on determining the most effective approach. We describe a new method of identifying potential savings due to large national variations in drug cost, including variation in generic drug cost, and compare these with potential savings from an established method (generic prescribing).MethodsWe used English National Health Service (NHS) Digital prescribing data, from October 2015 to September 2016. Potential cost savings were calculated by determining the price per unit (eg, pill, millilitre) for each drug and dose within each general practice. This was compared against the same cost for the practice at the lowest cost decile to determine achievable savings. We compared these price-per-unit savings to the savings possible from generic switching and determined the chemicals with the highest savings nationally. A senior pharmacist manually assessed whether a random sample of savings were practically achievable.ResultsWe identified a theoretical maximum of £410 million of savings over 12 months. £273 million of these savings were for individual prescribing changes worth over £50 per practice per month (mean annual saving £33 433 per practice); this compares favourably with generic switching, where only £35 million of achievable savings were identified. The biggest savings nationally were on glucose blood testing reagents (£12 million), fluticasone propionate (£9 million) and venlafaxine (£8 million). Approximately half of all savings were deemed practically achievable.DiscussionWe have developed a new method to identify and enable large potential cost savings within NHS community prescribing. Given the current pressures on the NHS, it is vital that these potential savings are realised. Our tool enabling doctors to achieve these savings is now launched in pilot form at OpenPrescribing.net. However, savings could potentially be achieved more simply through national policy change.

Purpose The purpose of this paper is to enhance the understanding of motives behind corporate giving and at finding out whether and when operational efficiency plays a major role in the case of surplus food donations by food supply chain companies. Design/methodology/approach A multiple case study methodology has been applied considering a sample of 16 food sector companies operating in Italy. Three cases have been analyzed in-depth to highlight the contextual factors that make cost savings possible and donations sizeable and regular. Findings The results show that the willingness of companies to reduce operational costs plays a relevant role in managerial decisions concerning the recovery and donation of unsold food, although to different degrees across the supply chain stages. Originality/value The paper shows that not only strategic and moral motives, but also economic efficiency concern plays an important role in the managerial decision-making process pertaining to surplus food donations.

Chuanwei Xin,1 Zhu Dong,2 Mengmeng Lin,1 Gong-Hua Li1 1Department of Pharmacy, Zhejiang Academy of Traditional Chinese Medicine, Tongde Hospital of Zhejiang Province, 2Department of Pharmacy, the Fifth People’s Hospital of Yuhang District, Hangzhou, China Background: The prescriptions of proton pump inhibitors (PPIs) have raised concern due to both huge increase in medical expenditure and the possible long-term adverse events caused by them; therefore, an approach to taper off the irrational use of PPIs by patients is clinically warranted. The aim of this study was to evaluate the impact of pharmaceutical interventions on the rational use of PPIs.Patients and methods: A single-center, pre- to post-intervention study (pharmaceutical interventions group and control group) was performed in a Chinese hospital. Pharmaceutical interventions were performed in the post-intervention group, including educative group activities, real-time monitoring of clinical records and making recommendations to doctors on PPI prescriptions based on the criteria set at the beginning of the study. The number of patients with rational indication, the accuracy rate of administration route, the duration of therapy and the changes in total PPI costs, mean PPI costs, mean total drug costs and mean hospitalization costs were the main outcome measures.Results: A total of 285 patients were included in the study. After 6 months of interventions, significant improvements in the number of patients with rational indication were found (96.5% in the pharmaceutical interventions group vs 71.8% in the control group, P

INTRODUCTION: Biosimilar products play an important role in improving the access to biological medicines for an increased number of patients and enhancing the financial sustainability of the health systems. AIM: To assess the cost saving potential associated with the introduction of two biosimilars (Benepali ® and Flixabi ® ) vs. their respective reference biological products on the European and Italian markets. METHODS: A budget impact model was developed to estimate the cost saving of the hypothetical introduction of Benepali ® and Flixabi ® vs. Enbrel ® and Remicade ® , respectively, in three European countries. The analysis was conducted from the payer perspective, over a 3-year period. In addition, the same model was used to assess the impact of Benepali ® vs. Enbrel ® in three Italian regions over a 2-year period. The model compares the costs associated with the current treatment patterns, used to manage patients with all the conditions which Benepali ® and Flixabi ® are authorized for, with that of a hypothetical treatment pattern in which biosimilar products have been introduced. Only direct costs associated with the drug acquisition were considered. The model was constructed using published country- or region-specific data, where available. Annual drug acquisition costs were calculated using the dosing information from SPCs and country-/region-specific price lists. RESULTS: The introduction of Benepali ® and Flixabi ® in the biologic therapeutic setting of three European countries resulted in substantial cost savings across the entire scenario, with different penetration over a 3-year period. Similarly, over a 2-year horizon, the introduction of Benepali ® in the biologic therapeutic setting of three Italian regions resulted in significant cost savings. In all cases, the greater savings were observed in the scenario where the biosimilars’ penetration was higher. CONCLUSIONS: The introduction of Benepali ® and Flixabi ® has a substantial cost saving potential for the Italian and European health systems, and the budget impact is sensitive to the uptake rates of the biosimilars market.

Financial toxicity of cancer treatment is now a well-recognised problem in cancer medicine leading to patient bankruptcy and even poor survival, including in high-income countries and countries with public health care systems. Many oncologists, despite acknowledging the severity of financial toxicity as a problem, resign the responsibility of reducing the costs of cancer treatment to the government, industry, and oncology societies. However, an oncologist can play an important role in reducing the costs of cancer treatment because all cancer treatment decisions are made between the oncologist and the patient. In this article, I point out a few examples of low value practices from various oncology disciplines that we oncologists can easily replace or abandon in our practice and contribute to lessening the financial toxicities to patients and society. As these examples suggest, reducing cost does not necessarily mean compromising efficacy. We should continuously keep looking for other similar cost-saving strategies in our practice.

Today, many hospitals have a running enterprise picture archiving and communication system (PACS) and their administrators should have the tools to measure the system activity and, in particular, how much it is used. The information would be valuable for decision-makers to address asset management and the development of policies for its correct utilization and eventually start training initiatives to get the best in resource utilization and operators’ satisfaction. On the economic side, a quantitative method to measure the usage of the workstations would be desirable to better redistribute existing resources and plan the purchase of new ones. The paper exploits in an unconventional way the potential of the IHE Audit Trail and Node Authentication (ATNA) profile: it uses the data generated in order to safeguard the security of patient data and to retrieve information about the workload of each PACS workstation. The method uses the traces recorded, according to the profile, for each access to image data and to calculate how much each station is used. The results, constituted by measures of the frequency of PACS station usage suitably classified and presented according to a convenient format for decision-makers, are encouraging. In the time of the spending review, the careful management of available resources is the top priority for a healthcare organization. Thanks to our work, a common medium such as the ATNA profile appears a very useful resource for purposes other than those for which it was born. This avoids additional investments in management tools and allows optimization of resources at no cost. © 2016 Society for Imaging Informatics in Medicine.

Background : The use of pharmacokinetics is associated with cost savings in anti-tumor necrosis factor (anti-TNF) therapy, but the long-term cost savings in a large cohort of Crohn’s disease (CD) patients are unknown. Aim : The goal of this study was to compare the cost of anti-TNF therapy in two cohorts of CD patients losing response to infliximab, one using a test-based strategy and one an empirical dose escalation. Methods : We used a selected mathematical model to describe the trajectories of CD patients based on a discrete event system. This design allowed us to track over a given period a double cohort of patients who moved randomly and asynchronously from one state to another, while keeping all the information on their entire trajectory. Both cohorts were modeled using state diagram parameters where transition probabilities from one state to another are derived from literature data. Costs were estimated based on the French health care system. Results : Cost savings among the 10,000 CD patients using a test-based strategy were €131,300,293 at 5 years. At 5 years the mean cost saving was €13,130 per patient. The direct cost of the test had no impact on the results until the cost per test reached €2,000. Conclusions : A test-based strategy leads to major cost savings related to anti-TNF therapy in CD. Keywords: infliximab; pharmacokinetics; adalimumab; Crohn’s disease; cost saving (Published: 30 October 2015) Citation: Journal of Market Access & Health Policy 2015, 3 : 29229 - http://dx.doi.org/10.3402/jmahp.v3.29229

The research focuses on the impact of the shipping strategy to decrease the commercial speed of container vessels, in order to reduce the bunker costs, on current service patterns. In this regard, the study also hypothesizes potential development trends in the near future. The reduction of the commercial speed, commonly referred to as “slow steaming,” has been introduced to mitigate the negative effects of the recent economic crisis by cutting navigation costs and reducing the capacity supplied in order to assure a more efficient fleet deployment. Nowadays, this practice provokes a strong impact on maritime services and inter-port competition, as it leads to differentiate the offer of shipping services, combining fast and direct services among main hubs and cheaper and slower services also calling on small ports.The paper addresses the impact of slow steaming in the major shipping services and discusses the effects on service patterns between Asia and Europe, bringing practical insights for ocean carriers...

Making use of an original firm level dataset, we explore the causal impact of innovation on the manufacturing firm export activity in Turkey. We model process and product innovation as separately - through cost savings and product quality improvements, respectively - affecting the firm profitability and, consequently, the firm export propensity. This modeling choice highlights heterogeneous effects across high and low income destination markets. In a Multiple Propensity Score Matching framework, we, then, test the impact of each innovation activity and of their joint adoption. We find that only the latter fosters the first time entry into exporting, when the destination market is high income. Nevertheless, innovation positively affects the firmexport propensity. New product introduction is more rewarding than process innovation, especially for exporting to lowincome economies. Process innovation, though, strengthens the positive role of product innovation for exporting to more advanced markets.