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The difficulty of determining how many observations to collect is a source of inefficiency in consumer behavior research. Group sequential designs, which allow researchers to perform interim analyses while data collection is ongoing, could offer a remedy. However, they are scarcely used in consumer behavior research, probably owing to low awareness, perceived complexity, or concerns about the validity of this approach. This article offers a tutorial on group sequential designs and introduces Pre-Registered Interim Analysis Designs (PRIADs): A practical five-step procedure to facilitate the adoption of these designs in marketing. We show that group sequential designs can be easily adopted by marketing researchers, and introduce a companion app to help researchers implement them. We demonstrate multiple benefits of PRIADs for researchers engaged in confirmatory hypothesis testing: They facilitate sample size decisions, allow researchers to achieve a desired level of statistical power with a smaller number of observations, and help conduct more efficient pilot studies. We validate this cost-saving potential through a comprehensive re-analysis of 212 studies published in the Journal of Consumer Research , which shows that using PRIADs would have reduced participant costs by 20–29%. We conclude with a discussion of limitations and possible alternatives to PRIADs. [ABSTRACT FROM AUTHOR]

In service systems with delay-sensitive customers, customer decisions to join the queue or balk influence demand, impacting service provider profits. Studies show that customers can be risk-seeking for short waits and risk-averse when waits exceed expectations. Prior research on this mixed-risk attitude is limited, focussing on optimal pricing policies from a social welfare perspective. This study fills this gap by investigating the impact of this behaviour on customer joining strategies and the provider's pricing and capacity policies. We analyse a profit-maximising firm managing an unobservable queue where customers display mixed-risk behaviour towards delay parameterised by a risk-switching point and a degree of risk propensity. Customers join or balk based on expected utility, while the firm determines the service price and rate to maximise expected profit. We derive optimal strategies for both customers and the firm under scenarios with concave or convex capacity costs. Computational experiments show that optimal pricing, capacity, and profit peak at intermediate risk-switching points. For smaller points, optimal price and capacity rise with the customers' degree of risk propensity, while larger points have minimal impact. Numerical exploration emphasises the significance of capacity cost and the effectiveness of leveraging price over controlling capacity for maximising firm profitability. [ABSTRACT FROM AUTHOR]

In public libraries, especially those in rural settings, it is important that every dime of library funding is leveraged effectively into serving the community. As part of a year-long project beginning in January 2023, we are evaluating item-level cost-effectiveness for each circulating item housed at the public library in Lakeville, Indiana. Through the use of big(ish) data, some custom Python scripting, and machine learning algorithms we hope to answer: How much money is saved by library patrons through their use of the public library's physical collection? How much money is saved by the community through the operation of a public library based on the use of the circulating collection? And are there any non-obvious traits which make an item or title a more or less cost-effective circulating asset? In this column, I will describe the scripts, share initial findings, discuss challenges, and investigate next steps. [ABSTRACT FROM AUTHOR]

Visual-inertial SLAM (VINS) has garnered substantial interest in the field of mobile robotics due to its robustness and cost-effectiveness. The incorporation of both point and line features in visual SLAM has shown significant performance improvements compared to relying solely on point features. Furthermore, learning-based features consistently outperform traditional hand-crafted features across a diverse range of tasks. Leveraging all these observations, we propose a novel deep learning technique, termed learning-based point and line visual-inertial odometry (LPL-VIO), which is aimed to enhance robustness and performance of traditional systems. LPL-VIO takes a 2-stage approach, including a deep learning front-end and a traditional nonlinear optimization back-end. In the first stage (front-end), we employ proposed networks for points and lines to extract and track deep learning-based point and line features in visual images, while implementing IMU preintegration. In the second stage (back-end), we adopt a sliding window strategy to tightly couple point and line re-projection errors with IMU preintegration residuals. These residuals are optimized using bundle adjustment for precise global pose estimation. Extensive experiments are conducted on both public EuRoC datasets and our own real-world dataset collected in challenging outdoor environments. Qualitative and quantitative results show that our method exhibits strong competitiveness compared with the existing point–line techniques, and outperforms the popular VINS-Mono. [ABSTRACT FROM AUTHOR]

Wire- and arc-based additive manufacturing (WA-AM) technology is a prominent solution to produce components having large-scale dimensions in terms of elevated deposition rates, high material utilization efficiency, and cost effectiveness. Although many research works have explored the WA-AM process of 316L stainless steel, the selection of optimal input parameters for enhancing geometrical characteristics of the WA-AMed 316L stainless steel has not been addressed. In this paper, the variables—voltage (U), current (I), and traveling speed (V), were optimized to obtain the expected attributes of weld beads (WB) in the WA-AM of 316L SS. The empirical models of the width (BW), height (BH), and contact angle (CA) of WBs were developed using a BRFFNN (Bayesian regularized feed forward neural networks) model. To determine the best optimality, the non-dominated-sorting-genetic algorithm based on a grid partition (NSGA-GP) and TOPSIS (technique for order of preference by similarity-to-ideal solution) were adopted. The outcomes indicate that the developed BRFFNN models are adequate to predict the objectives (BW, BH, and CA). The optimized value of I, U, and V is 130 A, 22.0 V, and 0.30 m/min, respectively, which enable BW, BH, and CA to be improved by 22.97%, 11.24%, and 5.61%, respectively. The optimal parameters were used to successfully build a component without major defects, indicating their suitability for producing 316L SS components used in industrial applications. The outcomes have demonstrated the efficiency of the proposed optimization approach, which can also be used to predict optimal parameters of other AM and conventional manufacturing processes. [ABSTRACT FROM AUTHOR]

Objective: To determine the budget impact of implementing multidisciplinary complex pain clinics (MCPCs) for Veterans Health Administration (VA) patients living with complex chronic pain and substance use disorder comorbidities who are on risky opioid regimens. Data Sources and Study Setting: We measured implementation costs for three MCPCs over 2 years using micro‐costing methods. Intervention and downstream costs were obtained from the VA Managerial Cost Accounting System from 2 years prior to 2 years after opening of MCPCs. Study Design: Staff at the three VA sites implementing MCPCs were supported by Implementation Facilitation. The intervention cohort was patients at MCPC sites who received treatment based on their history of chronic pain and risky opioid use. Intervention costs and downstream costs were estimated with a quasi‐experimental study design using a propensity score‐weighted difference‐in‐difference approach. The healthcare utilization costs of treated patients were compared with a control group having clinically similar characteristics and undergoing the standard route of care at neighboring VA medical centers. Cancer and hospice patients were excluded. Data Collection/Extraction Methods: Activity‐based costing data acquired from MCPC sites were used to estimate implementation costs. Intervention and downstream costs were extracted from VA administrative data. Principal Findings: Average Implementation Facilitation costs ranged from $380 to $640 per month for each site. Upon opening of three MCPCs, average intervention costs per patient were significantly higher than the control group at two intervention sites. Downstream costs were significantly higher at only one of three intervention sites. Site‐level differences were due to variation in inpatient costs, with some confounding likely due to the COVID‐19 pandemic. This evidence suggests that necessary start‐up investments are required to initiate MCPCs, with allocations of funds needed for implementation, intervention, and downstream costs. Conclusions: Incorporating implementation, intervention, and downstream costs in this evaluation provides a thorough budget impact analysis, which decision‐makers may use when considering whether to expand effective programming. [ABSTRACT FROM AUTHOR]

Background: Madagascar has made significant progress in the fight against malaria. However, the number of malaria cases yearly increased since 2012. ITNs and IRS are key interventions for reducing malaria in Madagascar. Given the increasing number of cases and limited resources, understanding the cost-effectiveness of these strategies is essential for policy development and resource allocation. Methods: Using a societal perspective, this study aims to estimate the cost of the National Malaria Control Program (NMCP) through the first national malaria strategic plan (implemented over the period 2009–2013) and to assess the cost-effectiveness of two individually implemented malaria control interventions (ITNs and IRS) in two districts, Ankazobe and Brickaville. The cost-effectiveness ratio (CER) of ITN intervention was then compared to the CER of IRS intervention to identify the most cost-effective intervention. The cost of the NMCP and the costs incurred in the implementation of each intervention at the district level were initially estimated. On the basis of two results, the CERs of ITN or IRS correspond to the total cost of ITN or IRS divided by the number of people protected or the number of disability-adjusted life years (DALYs) averted. A deterministic univariate sensitivity analysis was conducted to assess the robustness of the results with a discount rate of 2.5% (0–5%) (costs and DALYs) and a 95% CI (person protected). Results: From 2009 to 2013, the NMCP cost USD 45.4 million (USD 43.5–47.5, r = 0–5%) per year, equivalent to USD 2.0 per capita per year. IRS implementation costs were four times higher than those of ITNs. The CER of IRS per case protected (USD 295.1 [285.1-306.1], r = 0–5%) was higher than the CER of ITNs (USD 48.6 [USD 46.0-51.5, r = 0–5%] in Ankazobe and USD 26.5 [USD 24.8–28.4, r = 0–5%] in Brickaville). The CERs per DALY averted of IRS was USD 427.6 [USD 413.0-546.3, r = 0–5%] in Ankazobe and, for ITNs, it was USD 85.4 [USD 80.8–90.5, r = 0–5%] in Ankazobe and USD 45.3 [USD 42.2–48.4, r = 0–5%] in Brickaville. Compared to the country GDP per capita (USD PPP 1494.6 in 2013), ITN intervention was "highly cost-effective" while the CER for IRS interventions was sensitive to parameter variation (CI, 95% of persons protected), which ranges from highly cost-effective to only cost-effective (USD 291.5–2004, r = 2.5%). Conclusion: In the Malagasy context, IRS intervention cost more and was less effective than ITN intervention. Willingness to pay for IRS is questioned. A relevant budget impact analysis should be conducted before a potential extension of this intervention. [ABSTRACT FROM AUTHOR]

Single-beam echo sounders have gained popularity for various applications due to their compact dimensions, ease of use, and cost-effectiveness. The question that often arises among the users is whether these devices can fulfill the necessary accuracy requirements. This paper concentrates on assessing the accuracy that can be achieved using a single-beam echo sounder. An accuracy assessment was performed by comparing the depths derived from the 3D model created from the single-beam echo sounder data to those obtained through more accurate and independent method (tacheometric surveying) in the test area. Accurate depth determination was achieved through trigonometric leveling, employing a specific methodology that allows for precise depth measurements up to 4.5 meters. The assessment results were compared to the vertical accuracy requirements for surveying and mapping in shallow waters, recommended by the International Hydrographic Organization. The results indicate that, with a 95% probability, the depths determined by the single-beam echo sounder meet the total vertical uncertainty (TVU) requirements specified by the S-44 standard for Order 1a survey. [ABSTRACT FROM AUTHOR]

Electronic monitoring (EM) systems incorporating cameras and other devices can collect a broad range of data to support fisheries management. We reviewed the data collection capabilities of EM and considered approaches to increasing efficiency, including cost effectiveness, of EM review. EM can provide information on catch, effort, catch handling, bycatch mitigation, fishing gear and operational data, which are relevant for fisheries management including by Regional Fisheries Management Organisations (RFMOs). Methods to increase efficiency and decrease costs of EM review apply from the programme design phase, through data collection and review. At review, costs may be reduced by sampling imagery optimally to meet monitoring objectives. Considering RFMOs as users of EM-collected information, we applied EMoptim, an open-source simulation model developed in R that estimates the amount of EM review necessary to meet one or more user-specified monitoring objectives. EMoptim uses stratification to increase review efficiency and incorporates a function to explore review costs against the monitoring objectives set. We evaluated the amount of EM review needed to estimate catch with specified precision, using fishery data available from the Western and Central Pacific Fisheries Commission. Model outputs show that EM review requirements increase as catch frequency decreases, dispersion of catch events increases, and when more precise catch estimates are required. Geographical stratification reduced the amount of review required for more commonly caught species and when catch events were focused in a limited area. Optimising review rates across multiple monitoring objectives was most effective for more commonly caught species. We highlight opportunities for future use and development of this prototype modelling package. [ABSTRACT FROM AUTHOR]

Objective: To examine the test-retest reliability of the Functional Assessment of Cancer Therapy − 8 Dimension (FACT-8D) for the first time, and to conduct a head-to-head comparison of the distribution properties and validity between the FACT-8D and EQ-5D-5L in Colorectal Cancer (CRC) Patients. Methods: We conducted a longitudinal study on Chinese CRC patients, employing Functional Assessment of Cancer Therapy-General (FACT-G) and EQ-5D-5L at baseline, and FACT-G during follow-up (2–7 days from baseline). Utility scores for FACT-8D were derived from all available value sets (Australia, Canada and USA), while EQ-5D-5L scores were obtained from corresponding value sets for various countries. We assessed convergent validity using pairwise polychoric correlations between the FACT-8D and EQ-5D-5L; known-groups validity by discriminating participants' clinical characteristics, and effect size (ES) was tested; test-retest reliability for FACT-8D using kappa and weighted Kappa for choice consistency, and intraclass correlation coefficient (ICC) and Bland-Altman method for utility consistency. Results: Among the 287 patients with CRC at baseline, 131 were included in the retest analysis. The utility scores of FACT-8D were highly positively correlated with EQ-5D-5L across various country value sets (r = 0.65–0.77), and most of the dimensions of FACT-8D and EQ-5D-5L were positively correlated. EQ-5D-5L failed to discriminate known-groups in cancer stage across all value sets, whereas both were significant in FACT-8D (ES = 0.35–0.48, ES = 0.38–0.52). FACT-8D showed good test–retest reliability (Cohen's weighted Kappa = 0.494–0.722, ICC = 0.748–0.786). Conclusion: The FACT-8D can be used as a valid and reliable instrument for clinical evaluation of patients with CRC, outperforming EQ-5D-5L in differentiating clinical subgroups and showing promise for cancer practice and research. Plain summary: Recently, the Multi-Attribute Utility in Cancer Consortium developed the Functional Assessment of Cancer Therapy − 8 Dimension (FACT-8D), a new cancer-specific multi-attribute utility instrument based on the Functional Assessment of Cancer Therapy - General (FACT-G). This addresses the FACT-G's limitation in directly generating utility values, which has broad application prospects in cost-utility analysis within the field of oncology. To our knowledge, this is the first study to examine the test-retest reliability of FACT-8D and to conduct a head-to-head comparison of its distribution properties and validity against the EQ-5D-5L in colorectal cancer (CRC) patients. The results indicate that FACT-8D is a valid and reliable instrument for clinical evaluation of CRC patients, demonstrating superior performance in differentiating between known clinical groups compared to the generic MAUI EQ-5D-5L, and is a promising instrument for use in cancer practice and research. [ABSTRACT FROM AUTHOR]

Rationale: Reimbursement process of oncology drugs in Europe occurs within a complex decision‐making process that varies between Member States. Distinctions between the States trigger societal debates since it is necessary to balance access to medicines and health systems sustainability. Aims and Objectives: We aimed to review the evidence concerning factors associated with the reimbursement decision or Health Technology Agency recommendation of oncology drugs in Europe. Methods: A systematic literature search was performed in two databases from inception to august 2023. Screening and data extraction were performed by pairs. Results: Thirteen articles were included and encompassed data from 11 nations. Seven articles showed that cost‐effective (C‐E) drugs and lower Incremental Cost‐Effectiveness Ratios (ICERs) had higher likelihood of reimbursement. Disease severity might influence the reimbursement decision with financial agreements. Improvement in clinical outcomes, substantial clinical benefit (p < 0.01) or overall survival gains (p < 0.05) were positively associated. Orphan drug designation impact varies between countries but positive decisions are usually achieved under specific conditions. Clinical and C‐E uncertainty frequently led to reimbursement with financial agreements or outcomes‐based conditions. Sociodemographic factors as: social health insurance system, higher Gross Domestic Product and larger elderly population were positively associated with reimbursement (p < 0.01). Conclusion: There is a need for further research into key determinants of reimbursement decisions in Europe and the development of drug access models that can effectively address and overcome costs and effectiveness uncertainties. [ABSTRACT FROM AUTHOR]

Background: To compare the effectiveness, cost, and safety of four regimens recommended by the World Health Organization (WHO) for rifampicin resistance/multidrug-resistance tuberculosis (RR/MDR-TB) Treatment in Eastern China. Methods: We performed a cohort study among patients with RR/MDR between 2020 and 2022 in Jiangsu Province. The treatment success rate, cost, and drug adverse reaction rate were compared. Results: Between 2020 and 2022, 253 RR/MDR-TB patients were enrolled in the study. 37 (14.62%), 76 (30.04%), 74 (29.25%), and 66 (26.09%) patients had the short-term regimens, the new long-term oral regimens, the new long-term injectable regimens, and the traditional long-term regimens, respectively. The treatment success rate was the highest among patients treated with the short-term regimen (75.68%) and was the lowest among patients treated with the traditional long-term regimens (60.61%). The estimated mean cost per favorable outcome was 142.61 thousand Chinese Yuan (CNY), and the short-term regimens showed the lowest cost in the four regimes (88.51 thousand CNY vs. 174.24 thousand CNY, 144.00 thousand CNY, and 134.98 thousand CNY). Incremental cost-effectiveness ratios of the short-term regimens, the new long-term oral regimen, and the new long-term injectable regimens were -3083.04, 6040.09, and 819.68 CNY compared to the traditional long-term regimens. Conclusions: For RR/MDR-TB patients in China who meet the criteria for short-term regimens, the short-term regimens were proven to be the most cost-effective of the four regimens recommended by WHO. For RR/MDR-TB patients in China who don't meet the criteria for short-term regimens, the new long-term injectable regimens are more cost-effective than the remaining two regimens. [ABSTRACT FROM AUTHOR]

Objectives: Low back pain was the sixth most common reason for an ED visit in 2022–2023 in Australia, one‐third of these patients were subsequently admitted to hospital. Therefore, we have assessed whether some patients could be diverted to alternate clinical pathways, via admission to a virtual hospital (rpavirtual), and be cared for remotely in their own homes. Methods: Ethics approval was granted for protocols X21‐0278 & 2021/ETH10967 and X21‐0094 & 2021/ETH00591. We conducted a mixed‐method process evaluation, using the RE‐AIM framework (reach, effectiveness, adoption, implementation and maintenance) to answer key questions regarding the Back@Home model of care. Results: This preliminary evaluation describes a cohort of the first 50 patients who received care between 13 February and 31 July 2023. The service had high levels of reach and adoption, very low levels of ED representation, and no AEs. Virtual care cost a median of AU$2215 (interquartile range = AU$1724–AU$2855) per admission. Patients admitted virtually had the same high satisfaction with care as traditionally admitted patients and reported less pain and better physical function. Conclusions: Preliminary findings suggest that this model of care is a safe, acceptable, and feasible alternative to hospitalisation for non‐serious low back pain, in a select cohort of patients meeting inclusion criteria. Further data collection will inform whether Back@Home has had an impact on length of stay or traditional admission rates. [ABSTRACT FROM AUTHOR]

Weakly supervised point cloud segmentation has garnered considerable interest recently, primarily due to its ability to diminish labor-intensive manual labeling costs. The effectiveness of such methods hinges on their ability to augment the supervision signals available for training implicitly. However, we found that most approaches tend to be implemented through complex modeling, which is not conducive to deployment and implementation in resource-poor scenarios. Our study introduces a novel scene consistency modeling approach that significantly enhances weakly supervised point cloud segmentation in this context. By synergistically modeling both complete and incomplete scenes, our method can improve the quality of the supervision signal and save more resources and ease of deployment in practical applications. To achieve this, we first generate the corresponding incomplete scene for the whole scene using windowing techniques. Next, we input the complete and incomplete scenes into a network encoder and obtain prediction results for each scene through two decoders. We enforce semantic consistency between the labeled and unlabeled data in the two scenes by employing cross-entropy and KL loss. This consistent modeling method enables the network to focus more on the same areas in both scenes, capturing local details and effectively increasing the supervision signals. One of the advantages of the proposed method is its simplicity and cost-effectiveness. Because we rely solely on variance and KL loss to model scene consistency, resulting in straightforward computations. Our experimental evaluations on S3DIS, ScanNet, and Semantic3D datasets provide further evidence that our method can effectively leverage sparsely labeled data and abundant unlabeled data to enhance supervision signals and improve the overall model performance. [ABSTRACT FROM AUTHOR]

Targeting actionable fusions has emerged as a promising approach to cancer treatment. Next-generation sequencing (NGS)–based techniques have unveiled the landscape of actionable fusions in cancer. However, these approaches remain insufficient to provide optimal treatment options for patients with cancer. This article provides a comprehensive overview of the actionability and clinical development of targeted agents aimed at driver fusions. It also highlights the challenges associated with fusion testing, including the evaluation of patients with cancer who could potentially benefit from testing and devising an effective strategy. The implementation of DNA NGS for all tumor types, combined with RNA sequencing, has the potential to maximize detection while considering cost effectiveness. Herein, we also present a fusion testing strategy aimed at improving outcomes in patients with cancer. [ABSTRACT FROM AUTHOR]

Minimally invasive parathyroidectomy is the treatment of choice in patients with primary hyperparathyroidism (PHP), but it needs a reliable preoperative localization method to detect hyperfunctioning parathyroid tissue. Higher sensitivity and lower radiation exposure was demonstrated for [18F]fluorocholine PET/CT (FCh-PET/CT) in comparison to [99mTc]sestamibi (MIBI) scintigraphy. However, data of its efficiency in resource use and patient outcomes is lacking. The aim of our study was to determine the resource efficiency and patient outcomes of FCh-PET/CT in comparison to conventional MIBI scintigraphy. A group of 234 patients who underwent surgery after MIBI scintigraphy was compared to a group of 163 patients who underwent surgery after FCh-PET/CT. The whole working process from the implementation of imaging to the completion of surgical treatment was analyzed. The economic burden was expressed in the time needed for the required procedures. The time needed to perform imaging was reduced by 83% after FCh-PET/CT in comparison to MIBI scintigraphy. The time needed to perform surgery was reduced by 41% when intraoperative parathyroid hormone monitoring was not used. There was no significant difference in the time of surgery between FCh-PET/CT and MIBI scintigraphy. FCh-PET/CT reduces the time of imaging, the time of surgery and potentially reduces the number of reoperations for persistent disease. [ABSTRACT FROM AUTHOR]

Background: Access to essential medications remains a challenge, especially among socioeconomically disadvantaged populations. In 2021, 18 million U.S. adults struggled to afford prescribed medications, a problem exacerbated by the prevalence of chronic conditions like diabetes, hypertension, and mental health disorders. The 340B Drug Pricing Program has enabled eligible healthcare organizations to purchase drugs at reduced prices, thus enhancing medication accessibility for financially constrained patients. This study explores the impact of the Retail Pharmacy Prescription Assistance Program within a 340B-eligible health system in addressing this issue. Objective: To evaluate the effectiveness of a Retail Pharmacy Prescription Assistance Program in increasing access to essential medications and reducing financial burden for eligible outpatients within a 340B-eligible health system. Methods: This exploratory study was conducted at a 340B-eligible academic medical center and focused on the implementation of the Retail Pharmacy Prescription Assistance Program (RPPA Program). Eligible patients, already enrolled in the health system's financial assistance program, were identified, and assessed for additional eligibility for the RPPA Program, ensuring prescriptions were written by internal providers and that patients did not have access to other financial assistance resources. Data collected included patient demographics, medication history, dispensed prescriptions, out-of-pocket patient savings, and pharmacist interventions. Results: During the study, 156 patients were enrolled. About half (51%; n = 79) did not utilize its services due to reasons such as the absence of active prescriptions, prescriptions from external providers, or existing coverage by the patients' insurance. Of the 563 prescriptions clinically evaluated, 72% (n = 407) were dispensed free of charge to 77 patients, resulting in $13,945 in out-of-pocket patient savings. Of the total prescriptions assessed, 28% (n = 156) were not included on the RPPA Program formulary and were not changed to a RPPA formulary alternative for various reasons, such as a formulary alternative was not available, or the patient opted not to switch to formulary alternatives. Conclusions: The RPPA Program proved effective in reducing financial barriers to accessing essential outpatient medications. While it yielded positive outcomes, the program's benefit was constrained to a limited patient demographic, underscoring the imperative to expand identification and engagement strategies to include a broader patient population. [ABSTRACT FROM AUTHOR]

Objectives: We perform a cost-effectiveness analysis (CEA) and budget impact analysis (BIA) of baloxavir marboxil compared to current care in the Netherlands for patients at risk of influenza-related complications, including patients with comorbidities and the elderly. Methods: In the CEA, a decision tree model was developed to assess the cost-effectiveness of baloxavir marboxil for a cohort of 52-year-olds from a societal perspective. A lifetime horizon was taken by incorporating the quality-adjusted life expectancy. The BIA included different epidemiological scenarios, estimating different plausible epidemiological scenarios for seasonal influenza considering the whole Dutch population with an increased risk of influenza complications. Results: The base-case ICER was estimated to be €8,300 per QALY. At the willingness-to-pay threshold of €20,000 per QALY, the probability of being cost effective was 58%. The base-case expected budget impact was €5.7 million on average per year, ranging from €1.5 million to €10.5 million based on the severity of the influenza epidemic and vaccine effectiveness. Conclusion: In the Netherlands, baloxavir is a cost-effective treatment option for seasonal influenza, with a base-case ICER of €8,300 per QALY for the population aged 60 years and over and patients at high risk of influenza-related complications. For a large part, this ICER is driven by the reduction of the illness duration of influenza and productivity gains in the working population. [ABSTRACT FROM AUTHOR]

Background: Cost-utility analysis typically relies on preference-based measures (PBMs). While generic PBMs are widely used, disease-specific PBMs can capture aspects relevant for certain patient populations. Here the EORTC QLU-C10D, a cancer-specific PBM based on the QLQ-C30, is validated using Dutch trial data with the EQ-5D-3L as a generic comparator measure. Methods: We retrospectively analysed data from four Dutch randomised controlled trials (RCTs) comprising the EORTC QLQ-C30 and the EQ-5D-3L. Respective Dutch value sets were applied. Correlations between the instruments were calculated for domains and index scores. Bland–Altman plots and intra-class correlations (ICC) displayed agreement between the measures. Independent and paired t-tests, effect sizes and relative validity indices were used to determine the instruments' performance in detecting clinically known-group differences and health changes over time. Results: We analysed data from 602 cancer patients from four different trials. In overall, the EORTC QLU-C10D showed good relative validity with the EQ-5D-3L as a comparator (correlations of index scores r = 0.53–0.75, ICCs 0.686–0.808, conceptually similar domains showed higher correlations than dissimilar domains). Most importantly, it detected 63% of expected clinical group differences and 50% of changes over time in patients undergoing treatment. Both instruments showed poor performance in survivors. Detection rate and measurement efficiency were clearly higher for the QLU-C10D than for the EQ-5D-3L. Conclusions: The Dutch EORTC QLU-C10D showed good comparative validity in patients undergoing treatment. Our results underline the benefit that can be achieved by using a cancer-specific PBM for generating health utilities for cancer patients from a measurement perspective. [ABSTRACT FROM AUTHOR]

Background: Well Parent Japan (WPJ) is a new hybrid group parent training programme combining sessions to improve mothers' psychological well‐being with a culturally adapted version of the New Forest Parenting Programme (NFPP). This study investigates the effectiveness and cost‐effectiveness of WPJ against treatment as usual (TAU) within Japanese child mental health services. Methods: TRANSFORM was a pragmatic multi‐site randomised controlled trial (RCT) with two parallel arms. Altogether 124 mothers of 6–12‐year‐old children with DSM‐5 ADHD were randomised to WPJ (n = 65) or TAU (n = 59). Participants were assessed at baseline, post‐treatment and three‐month follow‐up. The primary outcome was parent‐domain stress following intervention. Secondary outcomes included maternal reports of child‐domain stress, parenting practices, parenting efficacy, mood, family strain, child behaviour and impairment. Objective measures of the parent–child relationship were collected at baseline and post‐treatment. Data analysis was intention to treat (ITT) with treatment effects quantified through analysis of covariance (ANCOVA) via multilevel modelling. An incremental cost‐effectiveness ratio (ICER) assessed WPJ's cost‐effectiveness. Results: WPJ was superior to TAU in reducing parent‐domain stress post‐treatment (adjusted mean difference = 5.05, 95% CI 0.33 to 9.81, p =.036) and at follow‐up (adjusted mean difference 4.82, 95% CI 0.09 to 9.55, p =.046). Significant WPJ intervention effects were also observed for parenting practices, parenting efficacy and family strain. WPJ and TAU were not significantly different post‐intervention or at follow‐up for the other secondary outcomes. The incremental cost of WPJ was 34,202 JPY (315.81 USD). The probability that WPJ is cost‐effective is 74% at 10,000 JPY (USD 108.30) per one‐point improvement in parenting stress, 92% at 20,000 JPY (216.60 USD). The programme was delivered with high fidelity and excellent retention. Conclusions: WPJ can be delivered in routine clinical care at modest cost with positive effects on self‐reported well‐being of the mothers, parenting practices and family coping. WPJ is a promising addition to psychosocial interventions for ADHD in Japan. [ABSTRACT FROM AUTHOR]

Earthquake catastrophes continue to cause substantial damage and casualties in many parts of the world. Despite design codes and standards having succeeded in reducing life losses during earthquakes, the level of damage in buildings after severe earthquakes still cannot be precisely predicted. Code provisions focus on the safety of buildings with no consideration of the amount of damage expected after an event. Current U.S. guidelines designate three performance levels related to the inelastic rotational demands of RC shear walls––immediate occupancy, life safety, and collapse prevention. The damage corresponding to these performance levels is minor, moderate, and severe, respectively. In the current study, these performance limits were implemented, along with other recognized standards, in order to design four RC ductile shear wall buildings with different heights located in a high seismic hazard zone. Each building was designed based on Canadian building codes to reach the three designated performance levels. For each case, the quantities of the constitutive materials of the RC shear walls were estimated and compared. The impact of the targeted performance level on the building's gravity-load-resisting system was also investigated. The cost effectiveness of using moderately ductile shear walls in high seismic hazard zones was also examined. [ABSTRACT FROM AUTHOR]

Background: Ethical principles behind prioritization in healthcare are continuously relevant. However, applying ethical principles during times of increased need, such as during the COVID-19 pandemic, is challenging. Also, little is known about nursing home nurses' prioritizations in their work to achieve well-being and health for nursing home residents. Aim: The aim of this study was to explore nursing home nurses' priority-setting for older nursing home residents in Sweden during the COVID-19 pandemic. Research design, participants, and research context: We conducted a qualitative interview study. Data were collected through in-depth interviews (retrospective self-reports) between February and May 2021 with 21 nursing home nurses. To help respondents to recall their memories, we used the critical incident technique (CIT). We analyzed data within the theoretical framework and the methodological orientation of content analysis. Ethical considerations: Written and verbal consent was obtained before the interviews, and information was given to participants informing them that participation was entirely voluntary. The Swedish Ethical Review Agency gave an advisory opinion stating that there were no ethical objections to the research project (Dnr. 2020-05649). Findings: We identified an overarching theme—nursing home nurses struggling on multiple fronts, "just do it"—and seven categories: striving for survival and caring about a dignified death; responding sensitively to relatives' expectations; ranking the urgency of needed care; responding to input from different actors; combating the spread of infection in unconventional ways; taking the lead and doing what is required; and following the ideals of person-centered nursing. Conclusions: Nurses' priority-setting for older nursing homes residents during the COVID-19 pandemic meant strain and struggle. In some cases, nurses had taken responsibility for priorities falling outside their statutory powers. Different demands and interests affected nurses' priorities. Nursing home nurses need organizational and managerial support to prioritize. [ABSTRACT FROM AUTHOR]

The article discusses the implementation of national quality improvement programs for emergency surgery patients in the UK, focusing on hip fracture and emergency laparotomy cases. These programs, such as the UK National Hip Fracture Database (NHFD) and the UK National Emergency Laparotomy Audit (NELA), have led to improved outcomes and reduced mortality rates for patients. However, there are concerns about unintended consequences, resource allocation, and potential impacts on other patient groups. The need for a nuanced systems understanding of the effects of standardized care pathways is emphasized, highlighting the importance of balancing quality improvement efforts with broader healthcare considerations. [Extracted from the article]

Background: Almost 2 million people in the UK live with sight loss, and this number is predicted to double by 2050. There is increasing recognition of the need to provide counselling services to people living with sight loss. Aim: The aim of this research was to assess whether there is an unmet need for counselling services for people living with sight loss in North Wales and to estimate the social value and budget impact of the potential roll‐out of counselling services to this population. Method: Between December 2020 and May 2021, a telephone survey was completed by 192 people living with sight loss in North Wales, UK. The survey instrument was a 19‐item questionnaire, which included the Short Warwick–Edinburgh Mental Well‐being Scale (SWEMWBS). Using data from the SWEMWBS and published statistics, a social return on investment (SROI) and budget impact analysis were conducted. Results: Most respondents (84%, n = 161) had never been offered counselling in relation to sight loss. Thirty‐nine per cent (n = 74) stated that they would use a new counselling service if it were available. Fifty‐one per cent (n = 97) indicated that counselling could be especially beneficial for people who have recently been registered or diagnosed with sight loss (the timely window). Of those who completed the SWEMWBS, approximately 25% reported low mental well‐being or probable depression. Social return on investment analysis estimated that providing counselling services for people with sight loss in North Wales could generate a social value of £3.42 for every £1 invested. Conclusion: Timely counselling may improve an individual's ability to cope with sight loss and improve their quality of life over time. [ABSTRACT FROM AUTHOR]

Breast and gynecologic cancers are common across the world and are associated with substantial societal and economic burden. Pembrolizumab was among the first immune checkpoint inhibitors targeting programmed cell death protein 1 to be approved for the treatment of patients with triple-negative breast cancer, cervical cancer, and endometrial cancer. Recent clinical trials have established pembrolizumab regimens as a standard of care treatment for these tumor types. Clinical data are further supported by patient-reported outcome, cost-effectiveness, and real-world evidence. Pembrolizumab monotherapy and combination regimens do not negatively influence health-related quality of life and are cost-effective relative to comparators. Ongoing phase 3 studies with pembrolizumab will expand the current understanding of its use in breast and gynecologic cancers. Several of these studies are in patients with early-stage disease with the hope of curing patients. The main objective of this review is to summarize the clinical, humanistic, and economic value of pembrolizumab in these settings and to describe the future challenges for patients, caregivers, clinicians, and payers. [ABSTRACT FROM AUTHOR]

Objective: Chimeric antigen-receptor T-cell therapy (CAR-T) is characterised by early phase data at the time of registration, high upfront cost and a complex manufacturing and administration process compared with standard therapies. Our objective was to compare the performance of different models to assess the cost effectiveness of CAR-T using a state-transition model (STM), partitioned survival model (PSM) and discrete event simulation (DES). Methods: Individual data for tisagenlecleucel for the treatment of young patients with acute lymphoblastic leukaemia (ALL) were used to populate the models. Costs and benefits were measured over a lifetime to generate a cost per quality-adjusted life-year (QALY). Model performance was compared quantitatively on the outcomes generated and a checklist developed summarising the components captured by each model type relevant to assessing cost effectiveness of CAR-T. Results: Models generated similar results with base-case analyses ranging from an incremental cost per QALY of $96,074–$99,625. DES was the only model to specifically capture CAR-T wait time, demonstrating a substantial loss of benefit of CAR-T with increased wait time. Conclusion: Although model type did not meaningfully impact base-case results, the ability to incorporate an outcome-based payment arrangement (OBA) and wait time are important elements to consider when selecting a model for CAR-T. DES provided greater flexibility compared with STM and PSM approaches to deal with the complex manufacturing and administration process that can lead to extended wait times and substantially reduce the benefit of CAR-T. This is an important consideration when selecting a model type for CAR-T, so major drivers of uncertainty are considered in funding decisions. [ABSTRACT FROM AUTHOR]

Background: Psoriatic arthritis (PsA) is an inflammatory disease characterised by a variety of clinical manifestations. Considering the economic burden posed by PsA and the increasing number of treatment options, economic evaluations are required to better allocate available resources. This work aims to update a previous published literature review on PsA cost-of-illness and cost-effectiveness analysis. Methods: A search was performed of English-language literature between January 2017 and March 20, 2024 in Medline/PubMed, Embase and Cochrane library using the terms 'psoriatic arthritis', 'cost of illness' and 'cost effectiveness'. Data on decision model, time horizon, population, treatment options, perspective, type of costs, relevant results and authors' conclusion were extracted from the reviewed articles. Finally, the quality of the included studies was evaluated. Results: Twenty-seven studies met the inclusion criteria: 16 cost-of-illness and 11 cost-effectiveness/cost-utility analyses. PsA is characterised by high direct and indirect costs. Drug costs as well as hospitalisation and absenteeism were the major drivers of the observed costs. The cost-effectiveness analyses reported the dominance or the cost effectiveness of biologic therapies compared with non-biologic PsA treatment. Biological options like bimekizumab and ixekizumab have demonstrated a better cost-effectiveness profile in PsA patients compared with other treatments (i.e., other biological treatments). Conclusions: There was an increased number of economic evaluations compared with the previous review. PsA is still associated with significant economic burden worldwide. The main cost was represented by therapies, specifically biological therapies. Amongst the biological therapies, bimekizumab and ixekizumab appear to provide the most economic benefit. Finally, new economic studies are needed to enrich knowledge on the economic burden of subgroups of PsA patients as well as early treatment of PsA with new therapies. [ABSTRACT FROM AUTHOR]

Background and Objective: Accurately extrapolating survival beyond trial follow-up is essential in a health technology assessment where model choice often substantially impacts estimates of clinical and cost effectiveness. Evidence suggests standard parametric models often provide poor fits to long-term data from immuno-oncology trials. Palmer et al. developed an algorithm to aid the selection of more flexible survival models for these interventions. We assess the usability of the algorithm, identify areas for improvement and evaluate whether it effectively identifies models capable of accurate extrapolation. Methods: We applied the Palmer algorithm to the CheckMate-649 trial, which investigated nivolumab plus chemotherapy versus chemotherapy alone in patients with gastroesophageal adenocarcinoma. We evaluated the algorithm's performance by comparing survival estimates from identified models using the 12-month data cut to survival observed in the 48-month data cut. Results: The Palmer algorithm offers a systematic procedure for model selection, encouraging detailed analyses and ensuring that crucial stages in the selection process are not overlooked. In our study, a range of models were identified as potentially appropriate for extrapolating survival, but only flexible parametric non-mixture cure models provided extrapolations that were plausible and accurately predicted subsequently observed survival. The algorithm could be improved with minor additions around the specification of hazard plots and setting out plausibility criteria. Conclusions: The Palmer algorithm provides a systematic framework for identifying suitable survival models, and for defining plausibility criteria for extrapolation validity. Using the algorithm ensures that model selection is based on explicit justification and evidence, which could reduce discordance in health technology appraisals. [ABSTRACT FROM AUTHOR]

Background: Although selpercatinib has shown clinical benefits for rearranged during transfection (RET) fusion–positive non-small cell lung cancer (NSCLC), its cost-effectiveness requires further evaluation. Aim: This study aimed to evaluate the cost-effectiveness of selpercatinib versus chemotherapy and pembrolizumab in the first-line treatment of RET fusion–positive NSCLC from the perspective of the United States (US) payer. Method: A partitioned survival model was developed based on data from the LIBRETTO-431 trial. Cost and utility values for the health state were obtained from database data or published literature. The measured outcomes included quality-adjusted life-years (QALYs) and the incremental cost-effectiveness ratio (ICER). One-way sensitivity analysis and probabilistic sensitivity analyses (PSA) were conducted to assess the uncertainty of the model. Results: Selpercatinib increased QALYs in patients with RET fusion–positive NSCLC by 0.90 compared to chemotherapy plus pembrolizumab, with an additional cost of $542,517.45, resulting in an ICER of $603,286.49/QALY, which exceeded the willingness-to-pay (WTP) threshold ($150,000) in the US. One-way sensitivity analysis suggested that the utility of progressed disease, the utility of progression-free survival, the price of selpercatinib, the discount, the price of pemetrexed, and the price of pembrolizumab had the greatest influence on the cost- effectiveness analysis process. In the PSA, 99.9% of the scatter points were distributed above the US WTP threshold of $150,000. Conclusion: From the perspective of the US payer, selpercatinib is not cost-effective compared to chemotherapy and pembrolizumab for first-line treatment in patients with RET fusion-positive NSCLC. [ABSTRACT FROM AUTHOR]

Objectives: This study compares the demographics, diagnoses, re-admission rates, sick leaves, and prescribed medications of patients accessing digital general practitioner (GP) visits with those of patients opting for traditional face-to-face appointments in a primary health care setting. Design: The study adopted a retrospective analysis of patient record data collected in 2019, comparing visits to a digital primary health center with traditional health center visits. Setting: Primary health care. Participants: The data encompassed patients who utilized the digital clinic and those who visited public health centers for primary health care services. Main Outcome Measures: The study assessed demographics, health diagnoses, prescribed medications, sick leave recommendations, re-admission rates, and differences in costs between digital clinic and face-to-face visits. Secondary outcomes included a comparative analysis of medication categories, resolution rates for health problems, and potential impacts on health care utilization. Results: Digital clinic users were typically younger, more educated, and predominantly female compared with health centre users. Digital visits were well-suited for uncomplicated infections, while health centre appointments were associated with a higher prevalence of chronic conditions. Medication patterns differed between the two modalities, with digital clinic users receiving generic over-the-counter drugs and antibiotics, whereas health centre visits commonly involved cardiac and antihypertensive medications. Sick leave recommendations were slightly higher in the digital clinic, but the difference was not significant. Approximately 70% of health problems addressed in the digital clinic were successfully resolved, and the cost of digital visits was about 50,3% of face-to-face appointments. Conclusion: Digital health care services offer a cost-efficient alternative for specific health problems, appealing to younger, educated individuals, when compared to the users of public health center, and may enable improvement of cost-effectiveness combined with acceptable demand management and patient segmentation practices. The results highlight the potential benefits of digital clinics, particularly for uncomplicated cases, while also emphasizing the importance of suitable referral mechanisms for in-person consultations. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to review studies exploring the experiences and perceptions of healthcare students and providers regarding their personal choices for elective female fertility preservation and their recommendations of the same to patients. Design/Methods: Employing Pluye and Hong's convergent qualitative synthesis approach, a mixed‐studies review was conducted. The appraisal of studies was performed using the Mixed Methods Appraisal Tool and data analysis utilised Thomas and Harden's thematic synthesis approach. Data Sources: Six electronic databases (PubMed, Embase, CINAHL, PsycINFO, Scopus and Web of Science) were searched from their inception till November 2023. Results: About 24 studies were reviewed, uncovering four major themes: varied personal perspectives, knowledge gaps and role ambiguities, perceived temporal and financial constraints and apprehensions related to fear and stigma. Conclusion/Implication: This review underscored the challenges faced by healthcare professionals and students in their personal pursuit of elective fertility preservation. Addressing these challenges demands the implementation of fertility navigators, culturally and religiously sensitive public health campaigns and staff training. Moreover, standardised guidelines, transparent cost and process reporting, evidence‐based education, counselling on risks and success rates and governmental support in the form of subsidies can mitigate barriers, enhance cost‐effectiveness and promote equitable access to care. Collaboration among stakeholders is imperative to ensure equitable access and maintain quality care in elective female fertility preservation. Reporting Method: This mixed studies review followed the reporting guidelines in the Preferred Reporting Items for Systematic Review and Meta‐Analyses (PRISMA) statement. Patient or Public Contribution: No Patient or Public Contribution. Trial Registration: This review has been registered on the Prospective Register of Systematic Reviews (PROSPERO) database (CRD42023395406) [ABSTRACT FROM AUTHOR]

Background: Sleep is a fundamental prerequisite for physical and mental health. Poor quality of sleep is common among post‐cardiac surgery patients and leads to serious health conditions. Objective: To conduct a systematic review that investigates the effectiveness of eye masks, earplugs and deep‐breathing exercise on sleep quality among post‐cardiac surgery patients. Design: A systematic review of interventional studies was established to meet the PRISMA guidelines. Methods: PRISMA guidelines were used to assess the findings of 11 selected studies that met the inclusion criteria, published between 2007 and 2023 across four databases: CINAHL, JDNR, MEDLINE and PubMed. The search was conducted on 23 November 2023. Results: The 11 most eligible studies were analysed. All of them were interventional, encompassing a total of 787 participants. Randomised controlled trials were the most common design. Interventions included eye masks, earplugs and deep‐breathing exercises. The Richards‐Campbell Sleep Questionnaire was the most used assessment scale. Most of the reviewed studies found that the use of non‐pharmacological interventions (eye masks, earplugs and deep‐breathing exercise) significantly improves the quality of sleep. These interventions were also found to have potentially positive effects on reducing pain and delirium experienced by patients after undergoing cardiac surgery. Conclusions: Non‐pharmacological interventions (eye masks, earplugs and deep‐breathing exercise) were found to be cost‐effective interventions that could be easily applied in the clinical setting and are effective in improving the quality of sleep among patients after cardiac surgery. [ABSTRACT FROM AUTHOR]

Summary: Sequential romosozumab-to-alendronate or sequential teriparatide-to-alendronate can be a cost-effective treatment option for postmenopausal women at very high risk of fracture. Purpose: To estimate the 10-year probability of a major osteoporotic fracture (MOF) at which sequential treatment with romosozumab or teriparatide followed by alendronate, compared with alendronate alone, becomes cost-effective in a UK setting. Methods: A microsimulation model with a Markov structure was used to simulate fractures, costs, and quality-adjusted life years (QALYs), in women receiving sequential treatment with either romosozumab or teriparatide followed by alendronate, compared with alendronate alone. Patients aged 50 to 90 years with a recent MOF, hip or spine fracture were followed from the start of a 5-year treatment until the age of 100 years or death. The analysis had a healthcare perspective. Efficacy of romosozumab, teriparatide and alendronate was derived from phase III randomised controlled trials. Resource use and unit costs were derived from the literature. Cost-effectiveness intervention threshold (CEIT), defined as the 10-year probability of a major osteoporotic fracture at which treatment becomes cost-effective, was compared with clinically appropriate intervention thresholds for bone-forming treatment in women with very high fracture risk as recommended by the UK National Osteoporosis Guideline Group (NOGG). Results: The base case analysis showed that sequential romosozumab-to-alendronate treatment was cost-effective from a 10-year MOF probability of 18–35% and above depending on age and site of sentinel fracture at a willingness to pay (WTP) of £30,000. For teriparatide-to-alendronate, treatment was cost-effective at a 10-year MOF probability of 27–57%. The results were sensitive to pricing of the drugs but relatively insensitive to treatment duration, romosozumab persistence assumptions, and site of sentinel fracture. The CEITs for romosozumab-to-alendronate treatment were lower than the clinical thresholds from the age of 70 years meaning that treatment could be considered both cost-effective and aligned with the NOGG treatment guidelines. By contrast, for teriparatide-to-alendronate the CEITs were higher than the clinical thresholds irrespective of age. However, cost-effective scenarios were found in the presence of strong clinical risk factors in addition to a recent sentinel fracture. Conclusion: The results of this study indicate that sequential romosozumab-to-alendronate or teriparatide-to-alendronate treatment can be a cost-effective treatment option for postmenopausal women at very high risk of fracture. [ABSTRACT FROM AUTHOR]

Background: The higher cost of balanced fluids has historically contributed to preferential normal saline (NS) use. Recent clinical trials demonstrated that balanced fluids reduced the incidence of major adverse kidney events among hospitalized patients and also reduced mortality among critically ill patients. This study sought to conduct an economic evaluation of a recently published quality improvement (QI) intervention to increase preferential balanced fluid prescribing, which significantly increased the relative proportion of balanced fluid orders. Methods: Using clinical trial data and real-world data from our prior QI intervention in conjunction with local and regional cost data, we constructed a decision tree to examine the economic cost and clinical consequences of using NS, lactated ringers (LR), and plasma-lyte for 30,000 hypothetical adult patients and 1,290 hypothetical critically ill adult patients with sepsis admitted to our institution over one year. Clinical outcomes (hospitalization to day 30) included development of acute kidney injury (AKI), new requirement for renal replacement therapy (RRT), and in-hospital mortality. The primary economic outcome was the difference in cost between the pre- and post-QI intervention periods. Sensitivity analyses and breakeven analyses were performed. Evaluation was conducted from South Carolina hospitals’ perspective. Results: For the overall cohort, simulation predicted that 53 AKIs, 2 instances of RRT, and 62 deaths were avoided in the post-intervention year with a net cost savings of $704,507. For the critically ill patients with sepsis, simulation predicted that 32 AKIs, 4 instances of RRT, and 12 deaths were avoided with a net cost savings of $474,676. Sensitivity analyses using outcome data from additional clinical trials also estimated annual cost savings ($77,677-$414,872). Conclusions: The QI intervention was predicted to improve patient outcomes while yielding significant cost-savings. The marginally increased cost of balanced fluids should not discourage implementation of interventions aimed at increasing evidence-supported balanced fluid prescribing. [ABSTRACT FROM AUTHOR]

Background: Assessment of the cost-related burden of chronic diseases is important for making informed decisions. An effective and efficient methodology for examining medical expenditures is one of the most significant challenges for stakeholders. The objective of this study was to examine the role of the variables of diagnosis-related group (DRG) in determining the direct expense of chronic diseases in lower southern Thailand and suggest the determinants having high explainability. Methods: The records of 6,147 patients admitted to Satun Hospital from 2014 to 2018 and diagnosed with chronic conditions were analyzed in this study. Descriptive analysis was used to summarize the main characteristics. Correlation was used to analyze the strength of the relationship. A log-linear regression model was used to evaluate the adjusted mean cost using determinants of DRG. Results: The overall average medical expense for chronic disease was Thailand Baht (THB) 17,985. Chronic kidney and chronic obstructive pulmonary diseases were the most expensive chronic diseases with an average expense of about THB 20,000 and 25,000. All the determinants were significantly contributing to overall expense of chronic disease with a p-value < 0.001. However, the length of stay, number of diagnoses, and number of procedures had high explainability in the expense model. Conclusions: The expense assessment model plays a significant role in controlling and preventing the medical costs associated with chronic diseases. Healthcare administrators, stakeholders, and researchers need to make strategies by considering the results of this study to improve the DRGs-based hospital cost model. [ABSTRACT FROM AUTHOR]

Introduction/Objectives: The cost of medical services is a major barrier to healthcare accessibility for underserved populations in the United States. Community charity medical clinics help address this disparity by providing free or reduced-cost care for the medically underinsured; however, their economic and public health contributions are unknown. The objective of this study was to evaluate the scope of services and monetary impact of 4 community charity medical clinics in North Texas, with one of the largest medically underinsured populations in the United States. Methods: A cross-sectional study was conducted using electronic health records from 4 clinics serving adults and children in North Texas. Encounters from June 1 to December 31, 2018 completed by with sufficient documentation to assign a level of service were reviewed. There were 3942 encounters identified and 2148 (54.5%) audited. Centers for Medicare and Medicaid Services Evaluation and Management Standards were used to identify level of service provided for each encounter, and their subsequent value was determined based on CMS fee-for-service schedules at the time service was provided. Common conditions managed during these encounters were identified using ICD-10 codes documented with each encounter. Results: The most prevalent diagnoses encountered were hypertension, diabetes, hyperlipidemia, and major depressive disorder. We estimate the total value of services and medications provided for 1 year is between $840 278.30 to $845 737.41. Conclusions: The charity clinics in North Texas provide a significant economic impact through a high level of charity care and a broad scope of services for a vulnerable patient population. The results may be used in the development and implementation of future services to meet the needs of the medically underinsured. [ABSTRACT FROM AUTHOR]

Background: Cost-effectiveness analyses of health technologies have become a part of the decision-making process in healthcare policies. Nevertheless, economic results are not always presented in comprehensible formats for non-technical audiences, such as the general population, healthcare professionals or decision-makers. The purpose of this study was to observe which formats best convey the key message of an economic evaluation, and which are best received by two different audiences. Methods: The summary of a hypothetical cost-effectiveness analysis was edited in different formats: infographic, plain language text and video-abstract for the general population; executive summary and policy brief for a specialized population, i.e. clinicians, clinical and non-clinical managers, or methodologists in health-technology assessment. Participants were randomly shown one of the formats, and data on objective and subjective comprehension, and perceived usefulness/acceptability were gathered by means of online questionnaires. Statistical differences between formats within each audience were analysed. Results: In the general population (N = 324), objective comprehension was statistically significantly better for infographic than for video-abstract (p = 0.005), and for plain text than for video-abstract (p = 0.024). There were no differences in subjective comprehension, but video-abstract was considered statistically significantly more useful to understand the information than plain text (p = 0.011). In the specialized population (N = 100), no statistically significant differences were observed for objective and subjective comprehension, although policy brief was perceived as statistically significantly more useful than executive summary (p = 0.005). Conclusions: A balance between effectivity of conveying the message and attractivity of the format needs to be sought, to facilitate non-technical audiences' understanding of economic data and, consequently, perceive decision-making processes as more transparent and legitimate. The infographic and policy brief could be robust ways to present economic data to the general public and specialized audience, respectively. [ABSTRACT FROM AUTHOR]

Objective: To estimate the efficiency of a nurse‐led telephone program for nonadherent to treatment Type 2 diabetics with comorbid depression (TELE‐DD program). Design: Secondary analysis of cost‐consequence and budget impact, utilizing data from a randomized clinical trial conducted in the primary healthcare setting. The target population consisted of Type 2 diabetic patients with comorbid depression who were nonadherent to their pharmacological treatment. Method: The average cost per controlled patient (glycated hemoglobin < 7%) and the incremental cost‐effectiveness ratio were calculated. Similarly, the budgetary impact over 1 year of implementing this program in the region of reference of the randomized clinical trial was assessed. Results: The number of controlled patients is higher in the TELE‐DD group at 6, 12, and 18 months. The average cost per controlled patient was higher in the TELE‐DD group than in the control group at 6 months (€160.31 vs. €49.79), but lower at 12 (€150.09 vs. €179.59) and 18 months (€209.22 vs. €376.88). The incremental cost‐effectiveness ratio at 6, 12, and 18 months was €254.47, €143.65, and €177.46, respectively. The budget impact analysis revealed that implementing the TELE‐DD program would result in a reduction of €721,940.68 in expenditure for the funder in the first year of application. Conclusions: A nurse‐led telephone program for nonadherent Type 2 diabetics with comorbid depression is an efficient option in the management of healthcare resources. These results highlight the role of nursing in chronic patient management and the efficient use of healthcare resources. Trial Registration: ClinicalTrials.gov Identifier: NCT04097483. [ABSTRACT FROM AUTHOR]

Background: Management of benign vocal fold lesions (BVFLs) is variable with individuals receiving surgery, voice therapy, or a combination of these approaches. Some evidence suggests that the best outcomes may be achieved when patients are offered pre- and post-operative voice therapy in addition to phonosurgery, but what constitutes pre- and post-operative voice therapy is poorly described. The pre- and post-operative voice therapy (PAPOV) intervention has been developed and described according to the TIDieR checklist and Rehabilitation Treatment Specification System (RTSS) for voice. The PAPOV intervention is delivered by specialist speech and language therapists trained in the intervention and comprises 7 essential and 4 additional components, delivered in voice therapy sessions with patients who are having surgery on their vocal folds for removal of BVFLs. Study design: Non-randomised, multicentre feasibility trial with embedded process evaluation. Method: Forty patients from two sites who are due to undergo phonosurgery will be recruited to receive the PAPOV intervention. Measures of feasibility, including recruitment, retention, and adherence, will be assessed. The feasibility of gathering clinical and cost effectiveness data will be measured pre-treatment, then at 3 and 6 months post-operatively. An embedded process evaluation will be undertaken to explain feasibility findings. Discussion: This study will assess the feasibility of delivering a described voice therapy intervention protocol to patients who are undergoing surgery for removal of BVFLs. Findings will be used to inform the development and implementation of a subsequent effectiveness trial, should this be feasible. Trial registration: This trial has been prospectively registered on ISRCTN (date 4th January 2023), registration number 17438192, and can be viewed here: https://www.isrctn.com/ISRCTN17438192. [ABSTRACT FROM AUTHOR]

A thorough and comprehensive knowledge of the evolutionary pattern in the thermal-hydraulic-mechanical-chemical (THMC) behavior of cement-stabilized clay is essential for a more reasonable design of improved clay in practical engineering. Sensitive marine clays with low strength, reinforced by various cement contents (0%, 6%, and 12%), were produced as samples to study the evolutionary pattern of the THMC behavior of reinforced clays. Samples with designed curing times (1, 3, 7, 28, and 90 days) will be trimmed to the appropriate size and utilized in a series of mechanical tests. Furthermore, the other portion of the samples, which is pre-installed with sensors, is used to monitor the development in internal temperature, volumetric water content, suction, and electrical conductivity for 90 days. The results showed that the content of cement and curing time have a significant influence on the THMC behavior of reinforced clay. Meanwhile, the results indicate a strong coupling of the THMC behavior of clays reinforced by cement. The results will be of critical assistance in gaining advanced knowledge into the evolutionary pattern in the THMC behavior of reinforced clays as well as making a contribution to optimizing the stability, cost-effectiveness, and durability of the design of reinforced clays. [ABSTRACT FROM AUTHOR]

Conventional power systems are almost at the verge of their existence and are quickly being replaced by modern, especially smarter alternatives. Rapid and wide deployment of Load side management, which is a smarter and modern way to ensure efficient and economical use of power, is a classic example. However, there are several challenges which need to be addressed before it can be realized as a commercially viable solution. Suitable communication method, called "Home Area Networks", is a mandatory requirement which should be cost effective, robust and with ability to simultaneously handle large number of devices. Due to various inherent issues, communication protocols commonly used now-a-days, are not fully capable to address the requirements of HANs. Power Line Carrier Communications (PLCC) can be a suitable and efficient alternative of quick realization of HANs. In this paper, various aspects of PLCC have been analyzed for use in HANs. Modulation methods, materials, physical parameters and effect of noise have been analyzed. The paper evaluates performance and effectiveness of FSK modulation with aluminum transmission medium for PLC within a residential environment, focusing on the tradeoffs between distance, transmission medium diameter, and type of transmission medium, and cable gauge, which can degrade the performance of PLCC. A novel simulation model has been presented incorporating RLCG (Resistance, Inductance, Capacitance, and Conductance) tools and additive white Gaussian noise (AWGN). Performance parameter have been comprehensively analyzed of implementation using aluminum as a communication medium. This paper discusses cost effectiveness of PLCC by replacing copper by aluminum as the transmission medium. The study reveals that aluminum cables must be twice the size of copper cable in order to achieve same communication distances. Higher carrier frequencies in FSK modulation increase noise susceptibility, consequently reducing achievable communication distances. Cables with smaller diameters results in lower transmission ranges. These results highlight the trade-offs involved in implementing FSK for in-home PLCC (iPLCC). The study highlights how crucial it is to take these trade-offs into account while developing and refining FSK-based iPLCC systems for use in smart homes. [ABSTRACT FROM AUTHOR]

Online cognitive tasks are gaining traction as scalable and cost-effective alternatives to traditional supervised assessments. However, variability in peoples' home devices, visual and motor abilities, and speed-accuracy biases confound the specificity with which online tasks can measure cognitive abilities. To address these limitations, we developed IDoCT (Iterative Decomposition of Cognitive Tasks), a method for estimating domain-specific cognitive abilities and trial-difficulty scales from task performance timecourses in a data-driven manner while accounting for device and visuomotor latencies, unspecific cognitive processes and speed-accuracy trade-offs. IDoCT can operate with any computerised task where cognitive difficulty varies across trials. Using data from 388,757 adults, we show that IDoCT successfully dissociates cognitive abilities from these confounding factors. The resultant cognitive scores exhibit stronger dissociation of psychometric factors, improved cross-participants distributions, and meaningful demographic's associations. We propose that IDoCT can enhance the precision of online cognitive assessments, especially in large scale clinical and research applications. [ABSTRACT FROM AUTHOR]

Background: This study investigated the cost-effectiveness of using fenofibrate to treat type 2 diabetes in Australia. The financial burden of type 2 diabetes mellitus is estimated to surpass AUD10 billion, mainly due to the cost of diabetic complications from diabetic neuropathy. Clinical evidence from the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study demonstrated that fenofibrate can reduce the risk of amputation and other diabetes-related complications. Methods: This study used a calibrated UKPDS model with an Australian diabetes cohort to simulate complications and deaths over a 20-year time horizon. The effectiveness of fenofibrate was assessed using the FIELD study. Total cost was calculated over the 20-year time horizon. Input data was obtained from the Australian Refined-Disease Related Groups and the Australian Pharmaceutical Benefits Scheme. Results: The model estimated that fenofibrate is associated with lower complication costs, which save over AUD 4.6 million per 1,000 patients. The most significant savings were observed in amputations. The incremental cost-effectiveness ratio for fenofibrate treatment was estimated to be AUD 739/LY gained and AUD 1189/QALY gained. Conclusion: The use of fenofibrate in Type 2 diabetes patients is estimated to result in cost savings in an Australian setting due to fewer diabetes complications. [ABSTRACT FROM AUTHOR]

IOUT (Internet of Underwater Things) relies on underwater acoustic sensors, which have limited resources such as battery power and bandwidth. The exchange of data among these sensors faces challenges like propagation delay, node displacement, and environmental errors, making network maintenance difficult. The objective of this study is to address the energy efficiency and performance issues in IOUT networks by proposing and evaluating an energy-efficient routing protocol called Efficient Cost Wakeup Routing Protocol (ECWRP). To achieve the objective, the study focuses on two key parameters: Cost and Duty Cycle. The Duty Cycle parameter helps in reducing undesirable impacts during underwater communications, improving the performance of the routing protocol. The Cost parameter is utilized to select the most efficient path for data transmission, considering factors such as transmitting power levels. The protocol is applied to a multi-hop mesh-based network. The proposed ECWRP routing protocol is assessed through simulations, demonstrating its superior efficiency compared to the Ride algorithm. By eliminating unnecessary handshaking and optimizing route selection, ECWRP significantly enhances energy efficiency and overall performance within the IoUT network. The study's findings on the enhanced energy efficiency and performance improvements achieved by the ECWRP protocol hold promising implications for the design and optimization of IoUT networks, paving the way for more sustainable and effective communication systems in underwater environments. In conclusion, the study demonstrates the effectiveness of the Efficient Cost Wakeup Routing Protocol (ECWRP) in enhancing energy efficiency and performance in multi-hop mesh-based IoUT networks. The protocol's utilization of the Duty Cycle parameter reduces undesirable impacts, while the Cost parameter enables the selection of the most efficient path for data transmission. The results confirm the superiority of the ECWRP protocol compared to the Ride algorithm, highlighting its potential for optimizing network performance and improving resource utilization in IoUT environments. [ABSTRACT FROM AUTHOR]

Regulated mobile health applications are called digital health applications ("DiGA") in Germany. To qualify for reimbursement by statutory health insurance companies, DiGA have to prove positive care effects in scientific studies. Since the empirical exploration of DiGA cost-effectiveness remains largely uncharted, this study pioneers the methodology of cohort-based state-transition Markov models to evaluate DiGA for depression. As health states, we define mild, moderate, severe depression, remission and death. Comparing a future scenario where 50% of patients receive supplementary DiGA access with the current standard of care reveals a gain of 0.02 quality-adjusted life years (QALYs) per patient, which comes at additional direct costs of ~1536 EUR per patient over a five-year timeframe. Influencing factors determining DiGA cost-effectiveness are the DiGA cost structure and individual DiGA effectiveness. Under Germany's existing cost structure, DiGA for depression are yet to demonstrate the ability to generate overall savings in healthcare expenditures. [ABSTRACT FROM AUTHOR]

Background: Clinical guidelines are widely used to support clinical decision making, so they could also provide economic information about medical interventions to promote cost-conscious health care. We developed a new way to integrate economic information into the Finnish Current Care Guidelines. Methods: Our development team consisted of clinical guideline specialists and health economists. We first looked at integration of economic information in clinical guidelines of other countries. Our key principle was that economic information should be integrated only to mutually exclusive medical interventions where the extensive choice of one the options will yield a significant cost differences on the national level. For the comparative effectiveness information of the interventions, we primarily looked for network meta-analyses. We then combined the effectiveness information presented as number needed to treat with prices or costs for the interventions and present the result as a cost per responder, which reflects both effectiveness and price or costs. Results: We introduce a process to integrate and present the economic information of the selected interventions in tables in the Current Care Guidelines. Conclusions: Our novel way to integrate economic information into the Current Care Guidelines is an effort to support cost-conscious clinical decision making to promote cost-effective health care in Finland. This process is general and could be used in clinical guidelines in other countries as well. [ABSTRACT FROM AUTHOR]

Polyethylene terephthalate (PET) is widely used in bottle production by stretch blow molding processes (SBM processes) due to its cost-effectiveness and low environmental impact. The presented literature review focuses on microcavitation and solid-state post-condensation effects that occur during the deformation of PET in the SBM process. The literature review describes cavitation and microcavitation effects in PET material and solid-state post-condensation of PET on the basis of a three-phase model of the PET microstructure. A three-phase model of PET microstructure (representing the amorphous phase in two ways, depending on the ratio of the trans-to-gauche conformation of the PET macromolecule and the amount of free volume) with a nucleation process, a crystallization process, and the use of positron annihilation lifetime spectroscopy (PALS) to analyze PET microstructure are discussed in detail. The conceptual model developed based on the literature combines solid-state post-condensation with microcavitation via the diffusion of the post-condensation product. This review identifies the shortcomings of the developed conceptual model and presents them with five hypotheses, which will be the basis for further research. [ABSTRACT FROM AUTHOR]

Background/Objectives: Unmet oral health needs of residents in residential aged care facilities (RACFs) arise due to the unique challenges of assessing oral health statuses and maintaining oral healthcare in RACFs. This pilot study assessed the feasibility of using real-time teledentistry under the guidance of a dentist to train RACF staff to undertake an oral health assessment. Methods: An oral health assessment of residents was first conducted by RACF staff at two Queensland, Australia RACFs using the Oral Health Assessment Tool, with an intra-oral camera connected to a laptop, through videoconferencing, under the guidance of a dentist. A survey recorded the views of RACF staff on the acceptability of the teledentistry method. The quality of the images obtained through the camera was assessed by the dentist. Finally, cost-effectiveness was calculated between teledentistry and traditional face-to-face assessments. Results: Sixteen residents (mean age 79.3 ± 8.68 years) and eight staff (mean age 33.3 ± 6.16 years) participated in this study. Both RACF staff and residents found that the real-time teledentistry set-up was user-friendly, while the dentist rated the quality of the images as acceptable for diagnostic purposes. Real-time teledentistry was more cost-effective than bringing a dentist on-site, while taking the RACF residents to an off-site dental office for examination was the most expensive approach. Conclusions: Real-time teledentistry is feasible and cost-effective, and it is an acceptable alternative to a face-to-face clinical exam for oral health assessment in RACFs. This approach could be used in RACFs where wireless internet connectivity is available. [ABSTRACT FROM AUTHOR]

This research investigates the adaptation of conventional injection-molding techniques for producing thick-walled polycarbonate optical components, specifically targeting their application in automotive light guides. With the automotive industry's growing demand for reliable yet cost-efficient optical products, the study examines how traditional injection-molding processes can be refined to enhance dimensional accuracy and reduce defects. Simulations and experimental trials were conducted to evaluate the impact of critical process parameters, such as melt temperature, mold temperature, injection pressure, and gate design, on the overall quality of the final components. The results show that by carefully optimizing these parameters, it is possible to significantly reduce common defects like warpage, surface imperfections, and dimensional instability. This research highlights the potential of existing molding techniques to meet high industry standards while maintaining cost-effectiveness, offering valuable guidance for manufacturers aiming to produce high-quality optical components for demanding applications like automotive lighting. [ABSTRACT FROM AUTHOR]