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BACKGROUND: Monoclonal antibodies are widely used anticancer therapies. Increasing demand for ambulatory care necessitates exploration of efficiency measures. OBJECTIVES: The primary objective was to evaluate the impacts on chair time and associated cost of priming IV administration sets with a bolus of the prescribed monoclonal antibody drugs. A secondary objective was to assess the associated incidence of hypersensitivity reactions. METHODS: A large tertiary hospital in Brisbane, Australia, conducted a randomized controlled trial (N = 128) with a two-arm design. Included monoclonal antibodies were daratumumab, obinutuzumab, pembrolizumab, and nivolumab. FINDINGS: There was a statistically significant reduction in chair time for obinutuzumab, pembrolizumab, and nivolumab compared with the control. Findings suggest that this priming intervention reduces chair time and cost for some monoclonal antibody drugs. Future research could assess this practice in other oncology therapies. [ABSTRACT FROM AUTHOR]

This study evaluates the cost‐effectiveness of the geko device a neuromuscular electro‐stimulator technology with standard of care (SoC) versus SoC alone for venous leg ulcer (VLU) treatment, from the UK National Health Service (NHS) perspective over 12 months. Research was conducted across NHS UK facilities, primarily within community services and outpatient leg ulcer clinics, encompassing a total of 51 patients. A partitioned survival model, based on a two‐arm randomised controlled trial, assessed wound healing rates using Kaplan–Meier curves and parametric extrapolations over a 12‐month time horizon. Costs were derived from UK reference costs the British National Formulary, and the Personal Social Services Research Unit (2021/22). The primary outcome measured was the incremental cost per quality‐adjusted life‐year gained. The geko device provides additional benefits by stimulating the lateral popliteal nerve, augmenting venous, arterial, and microvascular flow. The addition of the geko device to SoC significantly enhanced outcomes, increasing healing probability by 68% compared to SoC. This integration would result in a cost saving of £774.14 per patient when compared to the SoC alone across the NHS. Economic analyses indicate that integrating the geko device into SoC protocols would reduce the overall NHS expenditure on VLU wound management by as much as 15%. The approach also positively impacted health‐related quality of life. The geko™ device when used adjunctively with SoC would be a cost‐effective method for managing chronic VLUs within the NHS, improving healing rates and offering economic benefits. [ABSTRACT FROM AUTHOR]

The study determined the effect of quadruple bottom line reporting (proxies by economic, social, environmental, and governance disclosures) on cost saving among listed manufacturing firms in Nigeria. Ex-post facto research design was adopted using a population size of 21 listed consumer goods manufacturing firms from which a sample of fifteen was purposively selected. The data collected for the study spanned a period of 10 years from 2013 to 2022. Random effect model was estimated at 5% significance level which revealed that economic, social, environmental, and governance disclosures significantly enhance cost saving among listed manufacturing firms in Nigeria. In conclusion, the adoption of quadruple bottom line reporting can offer manufacturing firms a strategic advantage. It aligns with global trends in sustainable business practices and can position these firms to enjoy cost-saving opportunities. To maximize the benefits of quadruple bottom line reporting, manufacturing firms should make a concerted effort to integrate economic, social, environmental, and governance disclosures into their business practices in order to enhance transparency and accountability, leading to improved cost-saving opportunities. [ABSTRACT FROM AUTHOR]

Background: The aim of this study is to assess the cost savings from medication reviews conducted for individuals living in nursing homes in Estonia. Medication reviews performed as part of the automated dose dispensing (ADD) service by community pharmacies might help identify suboptimal medicine regimens. Methods: We use a case study approach to identify suboptimal use of medication in treatment plans and estimate the potential cost saving from medication reviews. To achieve this, we assess 101 treatment plans submitted for medication review by nursing homes in Estonia between 2021 and 2023. Additionally, we run OLS regressions to identify the most important determinants of medication cost savings. Results: We estimate an average direct cost saving of €43.62 per patient per year, which corresponds to 8.27% of the average annual medication costs. If medication reviews were conducted for all elderly individuals over 75 years old who use six or more prescription medicines, nearly 2% of Estonia's pharmaceutical budget could be saved. Regression analysis indicates that the most significant contributors to these cost savings are suboptimal use of generics, incorrect dosages (too high), and the elimination of incorrect medications. Conclusions: Our study suggests that annual medication reviews conducted as part of the ADD service might help reduce medication expenditure when offered to a wider public. [ABSTRACT FROM AUTHOR]

Background: Operating rooms contribute to over 40% of hospital expenses, with a portion attributed to waste from single-use, sterile surgical supplies (SUSSS). This research aimed to determine the amount of cost wastage due to not using SUSSS during laparotomy procedures. Methods: A descriptive-analytical investigation was conducted in two prominent teaching hospitals in Mashhad, Iran 2018. Seventy-seven laparotomy surgeries were scrutinized, documenting both used and unused disposable devices, with their respective costs being assessed. Data analysis was performed using SPSS version 16 software. Results: The study revealed that during surgery in the operating rooms, waste of SUSSS averaged 5.9%. Betadine solution and sterile Gauze types were the top two contributors to resource wastage. Sterile Gauze types incurred the highest cost loss. The study found a significant correlation between cost wastage and surgeon experience (r = 0.296, P < 0.001) as well as surgery duration (r = 0.439, P < 0.001). Conclusion: Inadequate management of available and commonly used disposable supplies leads to increased hospital expenses. Enhancing the surgical team's knowledge of sterile surgical supplies usage and making thoughtful selections can play a vital role in curbing health costs by minimizing waste of SUSSS in the operating rooms. [ABSTRACT FROM AUTHOR]

The study determined the effect of quadruple bottom line reporting (proxies by economic, social, environmental, and governance disclosures) on cost saving among listed manufacturing firms in Nigeria. ­Ex-post facto research design was adopted using a population size of 21 listed consumer goods manufacturing firms from which a sample of fifteen was purposively selected. The data collected for the study spanned a period of 10 years from 2013 to 2022. Random effect model was estimated at 5% significance level which revealed that economic, social, environmental, and governance disclosures significantly enhance cost saving among listed manufacturing firms in Nigeria. In conclusion, the adoption of quadruple bottom line reporting can offer manufacturing firms a strategic advantage. It aligns with global trends in sustainable business practices and can position these firms to enjoy cost-saving opportunities. To maximize the benefits of quadruple bottom line reporting, manufacturing firms should make a concerted effort to integrate economic, social, environmental, and governance disclosures into their business practices in order to enhance transparency and accountability, leading to improved cost-saving opportunities.

Abstract Background The aim of this study is to assess the cost savings from medication reviews conducted for individuals living in nursing homes in Estonia. Medication reviews performed as part of the automated dose dispensing (ADD) service by community pharmacies might help identify suboptimal medicine regimens. Methods We use a case study approach to identify suboptimal use of medication in treatment plans and estimate the potential cost saving from medication reviews. To achieve this, we assess 101 treatment plans submitted for medication review by nursing homes in Estonia between 2021 and 2023. Additionally, we run OLS regressions to identify the most important determinants of medication cost savings. Results We estimate an average direct cost saving of €43.62 per patient per year, which corresponds to 8.27% of the average annual medication costs. If medication reviews were conducted for all elderly individuals over 75 years old who use six or more prescription medicines, nearly 2% of Estonia’s pharmaceutical budget could be saved. Regression analysis indicates that the most significant contributors to these cost savings are suboptimal use of generics, incorrect dosages (too high), and the elimination of incorrect medications. Conclusions Our study suggests that annual medication reviews conducted as part of the ADD service might help reduce medication expenditure when offered to a wider public.

Abstract Background Operating rooms contribute to over 40% of hospital expenses, with a portion attributed to waste from single-use, sterile surgical supplies (SUSSS). This research aimed to determine the amount of cost wastage due to not using SUSSS during laparotomy procedures. Methods A descriptive-analytical investigation was conducted in two prominent teaching hospitals in Mashhad, Iran 2018. Seventy-seven laparotomy surgeries were scrutinized, documenting both used and unused disposable devices, with their respective costs being assessed. Data analysis was performed using SPSS version 16 software. Results The study revealed that during surgery in the operating rooms, waste of SUSSS averaged 5.9%. Betadine solution and sterile Gauze types were the top two contributors to resource wastage. Sterile Gauze types incurred the highest cost loss. The study found a significant correlation between cost wastage and surgeon experience (r = 0.296, P

Despite growing public, academic, and government awareness of the energy consumption issue, there is still little research on the scales and patterns of Household Electricity Consumption (HEC), particularly in developing countries such as Malaysia. Therefore, the present study examines the status of HEC using electricity consumption breakdowns, key performance indicators (KPIs) for electricity consumption and Material Flow Analysis (MFA) by showing potential electricity savings, cost savings, and emission reductions using 5-star energy efficiency appliances. This study used a face-to-face survey of 400 participants in Seremban, the capital city of Negeri Sembilan. The study found that the majority of respondents (49%) consumed about 300-600 kWh/month of electricity with an estimated cost of MYR231.80 per month. Additionally, the study found that households in flats recorded lower average electricity consumption (460.16 kWh/unit) than bungalow households (885.92 kWh/unit) due to respondents’ socio-economic status, the physical size of the houses and the number of appliances owned. The study also revealed that the average energy consumption was higher for refrigerators (9.6 kWh/day) and air conditioners (4.5 kWh/day) due to the use of large amounts of energy to maintain a steady temperature. The material flow analysis shows that energy savings were approximately 22.53%, potential cost savings were MYR12,676.15 per month, and the potential reduction emissions were about 100,759.92 kgCO2e for one month with using EEA compared to non-EEA. The present study empirically discussed the significance of HEC quantification and the opportunity for energy efficiency is critical as a solution for sustainable urban metabolism in a developing country.

Abstract Lessons learned from past experiences push for an alternate way of crop production. In India, adopting high density planting system (HDPS) to boost cotton yield is becoming a growing trend. HDPS has recently been considered a replacement for the current Indian production system. It is also suitable for mechanical harvesting, which reducing labour costs, increasing input use efficiency, timely harvesting timely, maintaining cotton quality, and offering the potential to increase productivity and profitability. This technology has become widespread in globally cotton growing regions. Water management is critical for the success of high density cotton planting. Due to the problem of freshwater availability, more crops should be produced per drop of water. In the high-density planting system, optimum water application is essential to control excessive vegetative growth and improve the translocation of photoassimilates to reproductive organs. Deficit irrigation is a tool to save water without compromising yield. At the same time, it consumes less water than the normal evapotranspiration of crops. This review comprehensively documents the importance of growing cotton under a high-density planting system with deficit irrigation. Based on the current research and combined with cotton production reality, this review discusses the application and future development of deficit irrigation, which may provide theoretical guidance for the sustainable advancement of cotton planting systems.

Aim Methods Results Conclusion This study estimated the healthcare cost savings for the government due to the prevention of gastroenteritis (GE) infections and lower respiratory tract infections (LRTI) in the first year of life, attributed to an increase in the exclusive breastfeeding rate at 4 months in Hong Kong.The model used the best available data inputs, with uncertainty considered using probabilistic sensitivity analysis. We additionally assessed the impact of neonatal jaundice (NNJ) on the economic benefits of increasing exclusive breastfeeding rates.During 2010–2019, five admissions for GE and three admissions for LRTI per 1000 births would have been prevented in the first year of life if the exclusive breastfeeding rate at 4 months increased from the actual levels (~15–30%) to 50%, resulting in annual healthcare cost savings of USD1.05 (95% CI 1.03–1.07) million/year. The cost saving would reach USD1.89 (95% CI 1.86–1.92) million/year if the exclusive breastfeeding rate at 4 months increase to 70%. However, if higher NNJ admissions during 7–90 days related to more exclusive breastfeeding are considered, the cost saving would reduce by 60%.Our findings can guide policymakers in allocating budget and resources for breastfeeding promotion in Hong Kong. The prevention of unnecessary NNJ admissions would maximise the economic benefits of exclusive breastfeeding at 4 months. [ABSTRACT FROM AUTHOR]

Lessons learned from past experiences push for an alternate way of crop production. In India, adopting high density planting system (HDPS) to boost cotton yield is becoming a growing trend. HDPS has recently been considered a replacement for the current Indian production system. It is also suitable for mechanical harvesting, which reducing labour costs, increasing input use efficiency, timely harvesting timely, maintaining cotton quality, and offering the potential to increase productivity and profitability. This technology has become widespread in globally cotton growing regions. Water management is critical for the success of high density cotton planting. Due to the problem of freshwater availability, more crops should be produced per drop of water. In the high-density planting system, optimum water application is essential to control excessive vegetative growth and improve the translocation of photoassimilates to reproductive organs. Deficit irrigation is a tool to save water without compromising yield. At the same time, it consumes less water than the normal evapotranspiration of crops. This review comprehensively documents the importance of growing cotton under a high-density planting system with deficit irrigation. Based on the current research and combined with cotton production reality, this review discusses the application and future development of deficit irrigation, which may provide theoretical guidance for the sustainable advancement of cotton planting systems. [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusion The aim of this study was to assess the usefulness of routine hemoglobin testing following elective and urgent cesarean section (CS) in patients without primary postpartum hemorrhage (PPH).This retrospective cohort study included women who underwent vaginal delivery (VD), elective CS, and urgent CS at Carmel Medical Center from 2015 to 2020. Data were extracted from the obstetric database, excluding deliveries with PPH. Demographic and obstetric variables were recorded. Primary outcomes were the need for packed red blood cell transfusion.A total of 19 446 women were included, with five (0.3%) requiring a blood transfusion in the elective CS group, 27 (0.17%) in the VD group, and eight (0.4%) in the urgent CS group. Urgent CS was associated with a higher risk of blood transfusion, but there was no significant difference between elective CS and VD. Elective CS showed the lowest rates of post‐delivery hemoglobin below 7 g/dL 1 (0.1%) compared to VD 16 (0.6%) and urgent CS 13 (0.7%).Routine postoperative hemoglobin testing following elective CS in asymptomatic patients without PPH appears unnecessary. This study supports reconsidering routine hemoglobin testing following elective CS, aligning with the goal of optimizing resource utilization while maintaining patient quality. [ABSTRACT FROM AUTHOR]

Iodine-125 (I-125) seeds, commonly used in low-dose rate brachytherapy for ocular malignancies, are often discarded after a single use. This study examines the potential cost savings at an institution with high ocular melanoma referrals, by re-using I-125 seeds for eye-plaque brachytherapy. In this single-institutional retrospective analysis, data was collected from I-125 seed orders from 8/2019 through 10/2022. Information including number of seeds ordered per lot, number of plaques built per lot, and number of seeds used per lot were collected. Cost per lot of seed was assumed to be the current cost from the most recent lot of 35 seeds. During the study, 72 I-125 seed lots were ordered bi-weekly, with a median of 35 seeds per lot (Range: 15–35). Each seed was used on average 2.26 times prior to being discarded. The average duration of each seed lot used was 62.2 days (Range: 21–126). Each seed lot contributed to the construction of an average of 8.4 eye plaques (Range: 2–20). With seed recycling, 2,475 seeds were used to construct 608 eye-plaques. Without re-using practice this would require 5,694 seeds. This resulted in a percentage cost savings of 56.5%, with a total seed cost reduction of $344,884, or $559 per eye-plaque on average. This is the first study to evaluate cost savings relative to re-using I-125 seeds for eye plaques. The data demonstrates how an institution can decrease costs associated with I-125 radiation seeds used for eye-plaque brachytherapy by re-using them. [ABSTRACT FROM AUTHOR]

Heart failure (HF) is increasing globally and turning out to be a serious worldwide public health problem with significant morbidity and mortality. This study aims to systemically review the budget impact analysis of heart failure treatments on health care expenditure worldwide. Scientific databases such as PubMed, Web of Science, Scopus, and Google Scholar were searched for budget impact analysis and heart failure treatments, over January 2001 to August 2023. The quality assessment of the selected studies was evaluated through ISPOR practice guideline. Nineteen studies were included in this systematic review. Based on ISPOR recommendations, most studies were performed on a 1-year time horizon and used a government (public health) or health system perspective. Data for selected studies was mainly collected from randomized clinical trials, published literature, pharmaceutical companies, and registry data. Only direct costs were reported in the studies. Sensitivity analyses were stated in almost all studies. However, studies conducted in high-income countries reported sensitivity analyses more elaborately than those performed in low- and middle-income countries. In many published articles related to the budget impact analyses of heart failure treatment, addition of new treatments to the health system's formularies can lead to a reduction in cardiovascular hospitalization rates, re-hospitalization rates, cardiac-associated mortality rates, and an improvement in heart failure class, which can decrease the costs of hospitalizations, specified care visits, primary care visits, and other related treatments. [ABSTRACT FROM AUTHOR]

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

Delays in construction are a widespread global problem, leading to potential cost overruns and legal disputes. Additionally, delays can result in a decline in construction quality and loss of public trust. The aim of this study is to examine the effects of project delays in various regions and the preventive role of optimizing concrete works. Literature review and bibliometric analysis are carried out to determine global research trends. Findings show that optimizing concrete works can provide benefits such as cost savings, time savings, improved quality and safety, and environmental benefits. Optimization of concrete material composition is one of the most examined topics in this field. Based on the findings, construction firms have the potential to attain cost efficiencies while concurrently mitigating carbon emissions. [ABSTRACT FROM AUTHOR]

Introduction: In alignment with China's national directive for improved drug management in anesthesiology, the Affiliated Hospital of Qingdao University initiated a quality improvement project, aiming to tackle the prevailing challenges of inefficiencies in drug administration, escalating drug costs, and the notable communication gap between pharmacists and anesthesiologists. Methods: We employed a Plan-Do-Study-Act methodology to establish a pharmacy team and execute a multidimensional pharmaceutical intervention. The interventions included the formulation of standard procedures, guidelines and regulations, assistance from an information system (including automatic dispensing cabinets and prospective prescription review system), communication feedback (via WeChat groups), and education for anesthesiology staff. The intervention spanned from April to September 2023, focusing on optimizing medication management, achieving cost savings, and enhancing the satisfaction of anesthesia team members, with an additional observation from October to December 2023. Results: Following the interventions, improvements were observed in drug management practices. These enhancements included increased compliance with accounting procedures, more rigorous registration of controlled substances, and more effective disposal of liquid residues. There was no adverse events related to high-alert medications or look-alike drug usage errors. The introduction of automatic dispensing cabinets and a prospective prescription review system markedly improved work efficiency. The utilization of a WeChat group facilitated effective communication about unreasonable prescriptions and drug-related issues. Among the 29,061 patients who underwent surgery both before and after the interventions, significant reductions were observed both in the drug proportion and the per capita drug costs (P = 0.03, P = 0.014, respectively). The per capita drug cost decreased by 20.82%, from ¥723.43 to ¥572.78, consistently remaining below ¥600 throughout the 9-month observation period. The per capita cost of monitoring drugs including dezocine, butorphanol, haemocoagulase agkistrodon, penehyclidine, and ulinastatin experienced a significant reduction (P < 0.05). Additionally, in the satisfaction questionnaires returned, a remarkable 94.44% of anesthesiology staff expressed high satisfaction with the comprehensive pharmaceutical interventions. Conclusion: The quality improvement project has yielded remarkable positive outcomes, serving as a model worthy of reference and replication in similar healthcare settings. [ABSTRACT FROM AUTHOR]

Clinical pharmacy services are the specialized practices of pharmacists to provide pharmaceutical care. All these activities are documented as pharmacist interventions to avoid medication errors which occur during prescribing, dispensing, and administration. The purpose of this study is to conduct an economic analysis of the pharmacist interventions using integrated health system. A retrospective study was conducted in a tertiary care hospital. Pharmacist interventions were analyzed by an independent pharmacist. Cost-saving and cost avoidance analyses were carried out for drug-related interventions. Economic analysis was performed and tabulated both in PKR and USD. Out of 1330 interventions, 1250 (95%) interventions were accepted and changed the prescription upon the physician-pharmacist consultation while 71 (5%) were not accepted. Interventions related to prescribing and duplication errors were the highest of all (30 and 29% respectively). Pharmacist interventions were recorded with a 95% acceptance rate. Cost analysis showed that pharmacist interventions saved around 105,115.88 US dollars. Clinical pharmacy services provided by integrated health system are a cost saving program. The cost saved per intervention for our study is around USD 37 which is more than another similar study which quoted USD 30.35 per intervention. [ABSTRACT FROM AUTHOR]

Despite strong evidence of benefits and increasing consumer demand for homebirth, Australia has failed to effectively upscale it. To promote the adoption and expansion of homebirth in the public health care system, policymakers require quantifiable results to evaluate its economic value. To date, there has been limited evaluation of the financial impact of birth settings for women at low risk of pregnancy complications. This study aimed to examine the difference in inpatient costs around birth between offering homebirth in the public maternity system versus not offering public homebirth to selected women who meet low-risk pregnancy criteria. We used a whole-of-population linked administrative dataset containing all women who gave birth in Queensland (one Australian State) between 01/07/2012 and 30/06/2018 where publicly funded homebirth is not currently offered. We created a static microsimulation model to compare the inpatient cost difference for mother and baby around birth based on the women who gave birth between 01/07/2017 and 30/06/2018 (n = 36,314). The model comprised of a base model – representing standard public hospital care, and a counterfactual model – representing a hypothetical scenario where 5 % of women who gave birth in public hospitals planned to give birth at home prior to the onset of labour (n = 1816). Costs were reported in 2021/22 AUD. In our hypothetical scenario, after considering the effect of assumptive place and mode of birth for these planned homebirths, the estimated State-level inpatient cost saving around birth (summed for mother and babies) per pregnancy were: AU$303.13 (to Queensland public hospitals) and AU$186.94 (to Queensland public hospital funders). This calculates to a total cost saving per annum of AU$11 million (to Queensland public hospitals) and AU$6.8 million (to Queensland public hospital funders). A considerable amount of inpatient health care costs around birth could be saved if 5 % of women booked at their local public hospitals, planned to give birth at home through a public-funded homebirth program. This finding supports the establishment and expansion of the homebirth option in the public health care system. [ABSTRACT FROM AUTHOR]

Propofol and fentanyl have broadly used alone or in combination to induce sedation or anesthesia. The current study aims to assess the additive impact and economic benefit of using combination of propofol and fentanyl in elective curettage cases in Iraq. A total of 75 women were recruited to perform clinical trial between 1st January and 10th March 2023 at the department of gynecology and obstetrics in the Baghdad teaching hospital, Iraq. The sample was subdivided equally into three groups and received different doses of propofol alone (GI), Fentanyl alone (GII), and combination of propofol and fentanyl (GIII) respectively. The dose required for propofol to induce general anesthesia declined to 1.4 mg/kg -1.5 mg/kg instead of 2.5mg/kg, and 2 µg/kg instead of 8 µg/kg for fentanyl in the combination. Out of 25 cases, 19 (76%) patients being unconscious in a time of two minutes as a result of additive effect. Moreover, the cost evaluation showed a cost saving of USD 0.09/minute for every operated curettage weighing 65kg and average surgical time of 21.57+11.06 minutes. The combination of propofol and fentanyl is effective for sedation and anesthesia and cost saving. [ABSTRACT FROM AUTHOR]

Introduction: New bone cement products have been developed attempting to shorten their setting time and thus cut down time in the operating room. This study determines whether faster-setting bone cement shortens time in the operating room, and whether the quantity used compromises postoperative TKA outcomes. Additionally, this study looks at cost analyses of the quantity of bone cement used in TKA procedures. Materials and methods: One-hundred and sixty patients at a single institution with primary TKA surgeries between January 2019 and December 2021, and a clinic follow-up of at least one year, were identified. Five cement products used in this time period were identified and categorized by fast- or slow-setting products if their set times were marketed below or above six minutes, respectively. Results: Estimated blood loss was higher in patients receiving fast-setting cements (160.0 vs 126.4 mL; p = 0.0009); however, operative time showed no difference between the cohorts (88.2 vs 89.2 min; p = 0.99). Fewer bags of cement were used for the fast cohort (1.3 vs 1.8 bags; p < 0.0001). The fast group was significantly cheaper on average per patient only when comparing between antibiotic bone cements (p = 0.007). No differences were found in postoperative outcomes between the two groups. Conclusions: No differences were found in operative times between the fast and slow cemented groups. Fewer bags of faster-setting cement only proved cost saving relative to other antibiotic bone cements studied. Nonetheless, decreased usage of fast cement did not result in any different postoperative outcomes compared to slow cements. Level of evidence: III. [ABSTRACT FROM AUTHOR]

Medication error (ME) can occur throughout the patient care process. Medication reconciliation (MR) is widely accepted as a tool to prevent the occurrence of ME by 63–66%. Currently, a computer-based process has been used for MR, making it convenient and quick to operate more than usual recording. In 2019, it was used for the 1st time in Ta Phraya Hospital but it has not been evaluated. Therefore, the researcher is interested in analyzing net-benefit in inpatients with chronic non-communicable diseases by comparing patients receiving and not receiving MR and study MEs. This retrospective study collected data in the admission and discharge process by dividing patients into two groups of 563 patients in each group. MR group consisted of patients receiving MR process, collected data from October 1, 2019, to September 30, 2020, and No MR group consisted of patients not receiving MR process, collected data from October 1, 2018, to September 30, 2019. The costs and the cost savings were collected and analyzed using STATA Version 14.0. One-way sensitivity analysis was conducted in this study. The result found that most of the patients in both groups were ≥60 years old, female, and eligible for universal health insurance. General data showed no significant difference between groups. All 120 MEs in this study, included 67 (6.0%) and 53 (4.7%) MEs in MR and No MR groups, respectively. The most common ME in both groups was omission error. Net benefit and benefit-to-cost ratio (B/C ratio) were 325.7 and 5.9, respectively. One-way sensitivity analysis showed a positive net benefit and B/C ratio. This study suggests that implementing MR in inpatient care can be a cost savings strategy compared with usual care. [ABSTRACT FROM AUTHOR]

With rising healthcare expenditures in the United States, patients and providers are searching to maintain quality while reducing costs. The aim of this study was to investigate patient willingness to pay for anterior cervical discectomy and fusion (ACDF), degenerative lumbar spinal fusions (LF), and adult spine deformity (ASD) surgery. A survey was developed and distributed to anonymous respondents through Amazon Mechanical Turk (MTurk). The survey introduced 3 procedures: ACDF, LF, and ASD surgery. Respondents were asked sequentially if they would pay at each increasing price option. Respondents were then presented with various cost-saving methods and asked to select the options that made them most uncomfortable, even if those would save them out-of-pocket costs. In total, 979 of 1,172 total responses (84%) were retained for analysis. The average age was 36.2 years and 44% of participants reported a household income of $50,000 to 100,000. A total of 63% used Medicare and 13% used Medicaid. A total of 40% stated they had high levels of financial stress. A total of 30.1% of participants were willing to undergo an ACDF, 30.3% were willing to undergo a LF, and 29.6% were willing to undergo ASD surgery for the cost of $3,000 (p=.98). Regression demonstrated that for ACDF surgery, a $100 increase in price resulted in a 2.1% decrease in willingness to pay. This is comparable to degenerative LF surgery (1.8% decrease), and ASD surgery (2%). When asked which cost-saving measures participants were least comfortable with for ACDF surgery, 60% stated "Use of the older generation implants/devices" (LF: 51%, ASD: 60%,), 61% stated "Having the surgery performed at a community hospital instead of at a major academic center" (LF: 49%, ASD: 56%), and 55% stated "Administration of anesthesia by a nurse anesthetist" (LF: 48.01%, ASD: 55%). Conversely, 36% of ACDF patients were uncomfortable with a "Video/telephone postoperative visit" to cut costs (LF: 51%, ASD: 39%). Patients are unwilling to contribute larger copays for adult spinal deformity correction than for ACDF and degenerative lumbar spine surgery, despite significantly higher procedural costs and case complexity/invasiveness. Patients were most uncomfortable forfeiting newer generation implants, receiving the operation at a community rather than an academic center, and receiving care by physician extenders. Conversely, patients were more willing to convert postoperative visits to telehealth and forgo neuromonitoring, indicating a potentially poor understanding of which cost-saving measures may be implemented without increasing the risk of complications. [ABSTRACT FROM AUTHOR]

Use of drones in plant inspection, in particular inspection involving tall stacks, to reduce safety risks has picked up considerably in the recent past. However, there are essential plant inspections that involve detailed contact-based inspection, which cannot be achieved using drones. Such cases include close-up inspections like ultrasonic inspection for corrosion studies and inspections that require customized tools. In these scenarios, use of robotic crawlers is the superior option. Leaks or accidental release of chemicals in process plants can have severe consequences, not only for workers and neighboring populace but also for the reputation and financial stability of organizations. Thus safety risk management becomes a crucial component in any work undertaken in every industry. Ultrasonic inspections involve nondestructive testing of wall thickness of tanks and piping to assess the risk of failure. Such inspections require elaborate access arrangements to preclude the possibility of fall from height accidents. The optimal way to prevent accidents to eliminate the hazard as far as reasonably practical. When work-related specific hazards are eliminated, the probability of accidents in that work becomes zero. The paper presents two practical case studies implemented in two different industries, where safetyrelated risk was completely eliminated using robotics, with collateral benefits in the form of reduction in outage times and a significant 60-90% overall costs savings. [ABSTRACT FROM AUTHOR]

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

IntroductionPooled testing is a potentially efficient alternative strategy for COVID-19 testing in congregate settings. We evaluated the utility and cost-savings of pooled testing based on imperfect test performance and potential dilution effect due to pooling and created a practical calculator for online use.MethodsWe developed a 2-stage pooled testing model accounting for dilution. The model was applied to hypothetical scenarios of 100 specimens collected during a one-week time-horizon cycle for varying levels of COVID-19 prevalence and test sensitivity and specificity, and to 338 skilled nursing facilities (SNFs) in Los Angeles County (Los Angeles) (data collected and analyzed in 2020).ResultsOptimal pool sizes ranged from 1 to 12 in instances where there is a least one case in the batch of specimens. 40% of Los Angeles SNFs had more than one case triggering a response-testing strategy. The median number (minimum; maximum) of tests performed per facility were 56 (14; 356) for a pool size of 4, 64 (13; 429) for a pool size of 10, and 52 (11; 352) for an optimal pool size strategy among response-testing facilities. The median costs of tests in response-testing facilities were $8250 ($1100; $46,100), $6000 ($1340; $37,700), $6820 ($1260; $43,540), and $5960 ($1100; $37,380) when adopting individual testing, a pooled testing strategy using pool sizes of 4, 10, and optimal pool size, respectively.ConclusionsPooled testing is an efficient strategy for congregate settings with a low prevalence of COVID-19. Dilution as a result of pooling can lead to erroneous false-negative results.

The Libyan Government decided to build 1,500 schools in the reconstruction plan. Libyan Construction Industry (LCI) suffers from projects’ poor value. So, effective management of resources is crucial. LCI should adopt cost-optimizing tools. This study applied value engineering (VE) to School Model 15 at Al-Khums City to maximize the utilization of the available budget. The saving of the significant items ranged between 20% and 30% leading to cost reduction in the overall project. The study concluded that Educational Facilities Authority (EFA) could save about 30% of the assigned funds. This result encourages the EFA to create a VE department in its organization.

Background: The treatment of acute bacterial skin and skin structure infections (ABSSSI) usually involves intravenous (i.v.) antibiotics requiring hospitalisation and increasing hospital costs. Since 2014, dalbavancin is approved for ABSSSIs treatment. However, evidence of its health economic impact on the German healthcare system is still limited. Methods: Diagnosis-related groups (DRG) based cost analysis was used to evaluate real-world data (RWD) from a German tertiary care center. All patients treated with i.v. antibiotics in the Department of Dermatology and Venereology at the University Hospital of Cologne were included to detect potential cost savings from a payer perspective. Thus, for the inpatient care German diagnosis-related groups (G-DRG) tariffs, length of stay (LOS), main- and secondary DRG-diagnoses and for the outpatient setting ‘Einheitlicher Bewertungsmaßstab’ (EBM) codes were evaluated. Results: This retrospective study identified 480 inpatient cases treated for ABSSSI between January 2016 until December 2020. Complete cost data were available for 433 cases and the detection of long-hospital-stay patients based on surcharges for exceeding the upper limit LOS led to 125 cases (29%) including 67 females (54%) and 58 males (46%) with an overall mean age of 63.6 years; all treated for International Classification of Diseases (ICD −10th revision) code A46 ‘erysipelas’. A sub-analysis focussed on DRG J64B with a total of 92 cases exceeding the upper limit LOS by a median of 3 days resulted in a median surcharge of €636 (mean value €749; SD €589; IQR €459-€785) per case. In comparison, we calculated outpatient treatment costs of approximately €55 per case. Thus, further treatment of these patients in an outpatient setting before exceeding the upper limit LOS might result in a cost-saving potential of approximately €581 per case. Conclusion: Dalbavancin appears a cost-efficient option to reduce inpatient treatment costs by transitioning to an outpatient setting of patients with ABSSSI potentially exceeding the upper limit LOS.

This paper develops and explains step by step how a company used lean accounting tools to identify cost savings and how these savings are integrated into a project investment evaluation. Little is known about the use of lean accounting tools in small and medium-sized companies operating in regional economies of Latin America, and this study is designed to continue expanding our knowledge of the subject. The tool used is value stream mapping and it is shown how it allows to identify cost savings, which is the first stage to calculate the recurring cash flows that is a critical building block of traditional project evaluation tools. This study is based on a real case that links aspects of production method and improvements applying lean manufacturing and financial indicators of the project. The development of the investment project allowed the company under study to improve delivery times, operation safety, production stability, process automation and increase the overall processing capacity of the plant. It also made visible sources of inefficiency in the current process that impacted parts handling, operating costs, rework, and direct labor. [ABSTRACT FROM AUTHOR]

Objectives Treatment-related problems (TRPs) are events associated with patients' managements adversely affecting the patients' optimum outcomes. Asthma is a common chronic condition characterised by acute episodes of exacerbation. In Jordan, data regarding TRPs in asthma exacerbations are lacking. This study aimed to identify/classify TRPs among patients hospitalised with asthma exacerbation in Jordan and to estimate their costs. Methods A retrospective observational cohort study (Jan 2017–Jul 2021) was conducted in a tertiary centre in Jordan. TRPs were identified during hospitalisation and at discharge using a standardised classification tool and assessed for their severity. Potential cost savings (the extra cost of medication/procedure associated with TRPs) and potential cost avoidance (the cost avoidable by preventing TRPs and their associated adverse drug events) were investigated. Key findings A total of 494 cases were included in the study. A total of 3933 TRPs (2931 during hospitalisation; 1002 at discharge) were identified with a mean of 4.7 ± 2.2 and 2.0 ± 1.2 TRPs during hospitalisation and at discharge, respectively. 'Unnecessary drug therapy' (40.8%) and 'ineffective/incomplete drug therapy' (44.1%) were the most common TRPs during hospitalisation and at discharge, respectively. In 82% of the cases, systemic corticosteroids were administered for a longer period than recommended. Most of the TRPs were of moderate severity. Potential cost savings and cost avoidance were estimated to be USD 30 919.3 and USD 734 179.9 respectively, with a total cost of USD 766 046.8. Conclusions The prevalence and cost of TRPs among asthma exacerbations are relatively high. Interventions to reduce such problems are necessary to avoid the negative clinical outcomes of TRPs and their economic burden on patients and healthcare systems. [ABSTRACT FROM AUTHOR]

The Libyan Government decided to build 1,500 schools in the reconstruction plan. Libyan Construction Industry (LCI) suffers from projects' poor value. So, effective management of resources is crucial. LCI should adopt cost-optimizing tools. This study applied value engineering (VE) to School Model 15 at Al-Khums City to maximize the utilization of the available budget. The saving of the significant items ranged between 20% and 30% leading to cost reduction in the overall project. The study concluded that Educational Facilities Authority (EFA) could save about 30% of the assigned funds. This result encourages the EFA to create a VE department in its organization. [ABSTRACT FROM AUTHOR]

Blockchain network and technology is a peer-to-peer distributed system that operates in a decentralized manner. The two concepts enable to create a secure environment and allow users to exchange transactions, contracts and data thereby establishing trust amongst the users. The current study aims to investigate the issues faced in the financial sector by means of applying blockchain technology. For this, the current study provides an overview of blockchain technology and analyze the major issues and challenges faced in financial sector due to the application of the blockchain technology. It is believed that traditional system tends to be cumbersome, error-prone and slow and unsafe, in contrast, users find the blockchain as cheaper, transparent and more effective. Particularly blockchain technology provides the banking sector, security, performance, and cost reduction in many of their processes and provides quality of services to their users. [ABSTRACT FROM AUTHOR]

Purpose: The main challenges in revision total hip arthroplasty (rTHA) are the treatment of the bone loss and the pre-operative planning. 3D-printed models may enhance pre-operative planning. The aim of the study is to compare the intra- and peri-operative results and costs for Paprosky type 3 rTHAs planned with 3D-printed models to ones accomplished with the conventional imaging techniques (X-rays and CT scan). Methods: Seventy-two patients with Paprosky type 3 defect underwent rTHA between 2014 and 2021. Fifty-two patients were treated with standard planning and 20 were planned on 3D-printed models. Surgical time, intra-operative blood loss, number of transfused blood units, number of post-operative days of hospitalization, and use of acetabular rings were compared between the two groups. A costs comparison was also performed. Results: The 3D-printed group showed reduced operative time (101.8 min (SD 27.7) vs. 146.1 min (SD 49.5), p < 0.001) and total days of hospitalization (9.3 days (SD 3.01) vs. 12.3 days (SD 6.01), p = 0.009). The cost of the procedures was significantly lower than the control group, with an adjusted difference of 4183 euros (p = 0.004). No significant differences were found for the number of total transfused blood units and blood loss and the number of acetabular rings. Conclusion: The use of 3D-printed models led to a meaningful cost saving. The 3D-printed pre-operative planning for complex rTHAs seems to be effective in reducing operating time, hospital stay and overall costs. [ABSTRACT FROM AUTHOR]

Electric arc furnace dust, due to steel fabrication by-products, some of that material has been contaminated with radioactive materials from orphan sources. After calculating the concentration of radionuclide activity, it is known that the material meets the criteria for clearance of application and can be used for other purposes according to the appropriate characteristics. By determining the clearance, EAF dust will be processed through a stabilization/solidification method to be used as a material for making paving blocks. Through elemental analysis of EAF dust using the Micro-XRF method, it is known that sample 1 has a Ca content of 3.9%, CaO is 5.51%, Si is 0.64%, and SiO2 is 1.36%, while sample 2 has Ca content. 4.8%, CaO 6.74% Si 0.63% and SiO2 1.34%. The compressive strength test results based on Indonesian National Standard (SNI) 03-0691-1996 give the results of paving blocks included in quality D with a value of 9.2 MPa which can be used for parks or other purposes. In the calculation of cost savings analysis, determining the clearance for EAF dust can provide cost savings of Rp. 205,562,000 compared to if it had to be managed as radioactive waste. The production cost for one paving block using a mixture of EAF dust is Rp. 2,213.77 or Rp. 97,405.88 for units per m². [ABSTRACT FROM AUTHOR]

The treatment of acute bacterial skin and skin structure infections (ABSSSI) usually involves intravenous (i.v.) antibiotics requiring hospitalisation and increasing hospital costs. Since 2014, dalbavancin is approved for ABSSSIs treatment. However, evidence of its health economic impact on the German healthcare system is still limited. Diagnosis-related groups (DRG) based cost analysis was used to evaluate real-world data (RWD) from a German tertiary care center. All patients treated with i.v. antibiotics in the Department of Dermatology and Venereology at the University Hospital of Cologne were included to detect potential cost savings from a payer perspective. Thus, for the inpatient care German diagnosis-related groups (G-DRG) tariffs, length of stay (LOS), main- and secondary DRG-diagnoses and for the outpatient setting 'Einheitlicher Bewertungsmaßstab' (EBM) codes were evaluated. This retrospective study identified 480 inpatient cases treated for ABSSSI between January 2016 until December 2020. Complete cost data were available for 433 cases and the detection of long-hospital-stay patients based on surcharges for exceeding the upper limit LOS led to 125 cases (29%) including 67 females (54%) and 58 males (46%) with an overall mean age of 63.6 years; all treated for International Classification of Diseases (ICD −10th revision) code A46 'erysipelas'. A sub-analysis focussed on DRG J64B with a total of 92 cases exceeding the upper limit LOS by a median of 3 days resulted in a median surcharge of €636 (mean value €749; SD €589; IQR €459-€785) per case. In comparison, we calculated outpatient treatment costs of approximately €55 per case. Thus, further treatment of these patients in an outpatient setting before exceeding the upper limit LOS might result in a cost-saving potential of approximately €581 per case. Dalbavancin appears a cost-efficient option to reduce inpatient treatment costs by transitioning to an outpatient setting of patients with ABSSSI potentially exceeding the upper limit LOS. [ABSTRACT FROM AUTHOR]

Disposable instrument use during video-assisted thoracoscopic lobectomy is a significant driver of cost. The purpose of the study was to measure the effect of increasing surgeon cost awareness via successive "value improvement initiatives" on instrument costs. We prospectively collected disposable instrument use data for all video-assisted thoracoscopic lobectomies performed by 5 Board-certified thoracic surgeons over 4 successive time periods: Period 1: control group of consecutive video-assisted thoracoscopic lobectomies before interventions; Period 2: video-assisted thoracoscopic lobectomies after displaying disposables price list in operating room; Period 3: video-assisted thoracoscopic lobectomies after educational presentation outlining disposable instrument price differences; Period 4: video-assisted thoracoscopic lobectomies after surgeon self-assessment with peer comparison of cost data from Period 3 and positive deviance seminar identifying the lowest-cost surgeon to lead discussion of optimal cost-reduction strategies. Instrument use and costs were compared among the 4 groups using the Kruskal–Wallis test. A total of 373 lobectomy cases were analyzed. Compared with Period 1, median stapler-related and total disposable costs for video-assisted thoracoscopic lobectomy cases decreased after successive value improvement initiatives, with lowest costs in Period 4 (P <.0001). Multiple linear regression analysis demonstrated per lobectomy disposables cost reduction of $397.53 in Period 4, after controlling for surgeon and lobe (P <.0001). Operating room time was reduced after successive value improvement initiatives (P <.0001). Cost awareness and surgeon engagement activities were associated with sustained cost reduction for video-assisted thoracoscopic lobectomies. Surgeon self-assessment, peer comparison, and positive deviance seminar were associated with the largest cost reduction. Significant hospital cost-savings may be realized with surgeon-led value improvement initiatives. [Display omitted] [Display omitted] [ABSTRACT FROM AUTHOR]

Human serum albumin (HSA) is a commonly used product with high impact on healthcare expenditure. Little is known regarding the appropriateness of HSA use in healthcare system. This study aimed to assess prescriber's compliance to the approved HSA criteria. Potential cost saving was also estimated. A cross-sectional study was performed in a tertiary care, university hospital in Bangkok in 2019. Prescriptions for HSA for all adult patients along with corresponding medical records were reviewed and assessed against the approved HSA criteria. Deviation from the criteria was used to estimate the potential cost saving. A total of 688 prescriptions were reviewed, 200 prescriptions met the inclusion criteria and were included in the analysis. Among six indications in the approved criteria for HSA, the rates of criteria compliance ranged from 48 to 90%. Hypoalbuminemia was found to be the main reason for inappropriate use. The estimated cost saving from inappropriate HSA use was €3,543 (€59 per prescription). Significant deviation from the approved criteria of HSA use was seen in a Thai hospital and significant cost saving can be made by increasing the compliance to the criteria. A practice improvement initiative to promote rational use of HSA is warranted. [ABSTRACT FROM AUTHOR]