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Abstract Introduction Invasive meningococcal disease (IMD) caused by Neisseria meningitidis is a rapidly progressing, rare disease that often presents as meningitis or sepsis. It mostly affects infants and adolescents, with high fatality rates or long-term sequelae. In the Netherlands, serogroup B (MenB) is most prevalent. We aimed to estimate the economic burden of MenB-related IMD between 2015 and 2019, including direct and indirect medical costs from short- and long-term sequelae, from a societal perspective. Methods IMD incidence was based on laboratory-based case numbers from the Netherlands Reference Laboratory for Bacterial Meningitis (Amsterdam UMC, Amsterdam, the Netherlands); there were 74 MenB cases on average per year in the study period 2015–2019. Case-fatality rate (3.8%) and percentage of patients discharged with sequelae (46%) were derived from literature. Direct costs included treatment costs of the acute phase, long-term sequelae, and public health response. Indirect costs were calculated using the human capital (HCA) and friction costs (FCA) approaches, in which productivity losses were estimated for patients and parents during the acute and sequelae phases. Costs were discounted by 4% yearly. Results Estimated costs due to MenB IMD in an annual cohort were €3,094,199 with FCA and €9,480,764 with HCA. Direct costs amounted to €2,974,996, of which 75.2% were related to sequelae. Indirect costs related to sequelae were €52,532 with FCA and €5,220,398 with HCA. Conclusion Our analysis reflects the high economic burden of MenB-related IMD in the Netherlands. Sequelae costs represent a high proportion of the total costs. Societal costs were dependent on the applied approach (FCA or HCA). Graphical Plain Language Summary

Introduction: Invasive meningococcal disease (IMD) caused by Neisseria meningitidis is a rapidly progressing, rare disease that often presents as meningitis or sepsis. It mostly affects infants and adolescents, with high fatality rates or long-term sequelae. In the Netherlands, serogroup B (MenB) is most prevalent. We aimed to estimate the economic burden of MenB-related IMD between 2015 and 2019, including direct and indirect medical costs from short- and long-term sequelae, from a societal perspective. Methods: IMD incidence was based on laboratory-based case numbers from the Netherlands Reference Laboratory for Bacterial Meningitis (Amsterdam UMC, Amsterdam, the Netherlands); there were 74 MenB cases on average per year in the study period 2015–2019. Case-fatality rate (3.8%) and percentage of patients discharged with sequelae (46%) were derived from literature. Direct costs included treatment costs of the acute phase, long-term sequelae, and public health response. Indirect costs were calculated using the human capital (HCA) and friction costs (FCA) approaches, in which productivity losses were estimated for patients and parents during the acute and sequelae phases. Costs were discounted by 4% yearly. Results: Estimated costs due to MenB IMD in an annual cohort were €3,094,199 with FCA and €9,480,764 with HCA. Direct costs amounted to €2,974,996, of which 75.2% were related to sequelae. Indirect costs related to sequelae were €52,532 with FCA and €5,220,398 with HCA. Conclusion: Our analysis reflects the high economic burden of MenB-related IMD in the Netherlands. Sequelae costs represent a high proportion of the total costs. Societal costs were dependent on the applied approach (FCA or HCA). Graphical Plain Language Summary: [ABSTRACT FROM AUTHOR]

The paper discusses the Russian features of management accounting of production costs in medium and small enterprises, which being properly organized and functioning, provide an opportunity to use information the performance improving of the organization. Its multi-variance, enshrined in domestic accounting standards, involves the use of various approaches to the formation of costs, in particular, the normative method, which is the subject of this study. Based on the results of the work, as an optimization measure for material-intensive industries, the authors propose to use material costs as a basis for distributing indirect costs and ones for auxiliary production instead of the major employees’ wages. The methodology is based on a systematic and dialectical approach, observation, systematization, analysis, grouping, classification and generalization of data; as well as on such accounting tools as costing and double entry. The specific experience in management cost accounting using the example of an enterprise producing paving tiles will give an opportunity to develop a practical base of works out in determining the stages of costing and the features of the costs specifications of the main and auxiliary production based on the facts of economic life.

The calculation of aircraft cost is stated necessary to assess the economic feasibility of their operation, as well as in agriculture, the possibility of acquiring new ones, and to justify air transportation tariffs. (Research purpose) The research purpose is to substantiate the methodology and calculate the prime cost of using BAS-137 VIM unmanned aerial system for the application of pesticides, fertilizers and other agrochemicals. (Materials and methods) When developing the methodology for calculating the prime cost of using an unmanned aerial system for applying pesticides and fertilizers, the Guidelines for determining the cost of domestic and international flights for Russian airlines were used. (Results and discussion) We have obtained the main dependences of the prime cost of using BAS-137 VIM for the introduction of working fluids: on the application rate, the field rut length, the distance of approach to the refueling place, and the operating flight speed. (Conclusions) The authors developed a methodology for calculating the prime cost of using an unmanned aerial system for applying pesticides and fertilizers, including direct and indirect operating costs. It was found out that at the working fluid application rates of 5-100 liters per hectare, the changes in the cost of using BAS-137 VIM are within the range from 280.9 to 1315.5 rubles per hectare. At an application rate of 10 liters per hectare within the rut length of 0.3-2.0 kilometers, the application prime cost is 307.1-529.5 rubles per hectare. It was obtained that at the application rates of 5-20 liters per hectare and the rut length of 0.6-1.0 kilometers, the prime cost will be the lowest, within the range of 264-369 rubles per hectare at an operating flight speed of 60 kilometers per hour and within the range of 482-587 rubles per hectare at a flying speed of 30 kilometers per hour. It was shown that with a twofold increase in BAS-137 VIM operating speed, the prime cost decreases by 1.2-1.5 times.

A common rule in many countries for mitigating the damage caused by African swine fever (ASF) is to eradicate the virus at the outbreak in order to prevent its dispersal and the associated social costs of depopulating infected domestic pigs. The economic performance of this practice, as measured by five different evaluation criteria (net present value, benefit-cost ratio, rate of return, internal rate of return, and payback time), depends on the type of control cost and the spatial and dynamic allocation of benefits, i.e. avoided losses from infected domestic pig farms. The present paper calculates the direct and indirect costs of immediate control measures during an ASF outbreak in wild boars in Mid Sweden. The direct costs include expenses incurred for surveillance, laboratory tests, depopulation of wild boar etc., while the indirect costs are borne by firms and people in the area in relation to movement restrictions. The calculations showed that the total cost of control measures amounted to 28 million euros, with indirect costs making up 40 % of this figure. The benefits were greatly dependent on the speed of ASF dispersal and assumptions about pig farmers' investment responses, which implied large variations in each of the five evaluation criteria. [ABSTRACT FROM AUTHOR]

The method of costs allocation for equipment maintenance and operation has been analyzed. It is especially important to properly allocate costs by type of product at those industrial enterprises, where a complex range of products is produced as a result of a single production process. The main method for calculating the product cost unit in industry is calculating the product cost and expense budget. Differentiated methods should be used in allocating indirect costs between particular products or types of products, depending on the nature of a cost, its economic nature, and its connection with the process of forming production cost. In calculating production cost, costs for production maintenance and management are identified, having a very diverse composition. A big group of expenses connected with equipment operation (depreciation on operating equipment and vehicles; maintenance repair of the equipment and shop-floor travelers; wear of low-value tools; the wages of workers engaged in equipment maintenance; maintenance materials) is singled out in a special spending pattern. It is established that quite accurate results are also used in a number of industries. For example, the method of allocation of indirect costs allows the maintenance costs and equipment operation costs to be reasonably allocated, thus making it possible to more accurately calculate the production cost and make management decisions on this basis. It should be noted that, since indirect costs include a large number of various production costs, which differ in many economic respects, allocation of all indirect costs should not be carried out on a single basis.

Teamir Abadi,1 Anagaw Derseh Mebratie2 1Health Bureau Health Care Financing Reform Case Team, Tigray Regional Health Bureau, Mekelle, Ethiopia; 2School of Public Health, Addis Ababa University, Addis Ababa, EthiopiaCorrespondence: Teamir AbadiTigray Regional Health Bureau, Mekelle, EthiopiaTel +251914423809Fax +251344408830Email teamirabadi2@gmail.comBackground: The government of Ethiopia introduced an exemption policy that guarantees free maternal healthcare services from public providers. This policy aims to ensure financial protection and enhance utilization of services especially for low-income people. However, patients in most cases incur health expenditure when seeking health care. This paper aims to assess direct and indirect medical costs of treating maternal complications and associated factors at a public hospital in Northern Ethiopia.Methods: An institution-based cross-sectional study design was carried on 267 mothers with complications. A multivariate linear regression model at 5% level of significance was used to analyze factors driving the outcome.Results: The median cost was more than seven times the monthly minimum wage, and this may cause severe financial consequences for the poor. Direct medical costs accounted for the major share (68%) of total cost, and this was mainly driven by lack of diagnostic services at public facilities and paying for private providers. Expenditure for treatment of maternal complications is positively associated with income, absence from work, travel time to the facility and being diagnosed at a private facility.Conclusion: The overall evidence in this study poses a concern about the context in which fee exemption reforms are being implemented.Keywords: maternal complications, treatment, direct and indirect costs, Mekelle, Ethiopia

Background: Multiple sclerosis (MS) places a considerable financial burden on the society. However, data quantifying the contemporary cost burden in France are lacking. Objective: This cost-of-illness study aimed to estimate the direct and indirect costs associated with MS in France. Methods: Between October 2020-November 2020, 208 French adults with a confirmed diagnosis of MS were recruited via MSCopilot® (a new MS self-assessment digital solution) and several MS patient networks. Indirect costs were estimated using a combination of top-down and bottom-up approaches. Direct costs were retrieved from Assurance Maladie (i.e. national system of health insurance) publications. Out-of-pocket expenses (OOPEs) incurred by MS patients were also reported. All costs were expressed in €2020. Data from the survey were extrapolated to the overall French MS population. Results: MS exerted an annual cost burden of €2.7 billion on the French society (indirect costs: €1.3 billion; direct costs: €1.4 billion). Mean annual costs were €27,164.7 per-patient, with indirect and direct costs accounting for 48.1% and 51.9% of the total annual costs, respectively. OOPEs contributed over €90 million to the total annual costs. Conclusions: MS imposes a substantial cost burden on the French society, with approximately half of the total annual costs driven by indirect costs. [ABSTRACT FROM AUTHOR]

Daniel Asrat Kassa,1 Solomon Mekonnen,2 Adane Kebede,1 Tsegaye Gebremedhin Haile1 1Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia; 2Department of Human Nutrition, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, EthiopiaCorrespondence: Tsegaye Gebremedhin HaileDepartment of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, PO Box 196, Gondar, EthiopiaTel +251-921279362Email tsegishg27@gmail.comPurpose: Hemodialysis is a renal replacement therapy for end-stage renal disease (ESRD) patients who consume substantial healthcare resources, which increases the economic burden. Plenty of factors affects the cost of hemodialysis treatment, particularly in resource-limited settings. Moreover, the demand for hemodialysis may decrease as the cost increases, but there is limited evidence in Ethiopia. Thus, this study aimed to estimate the cost of hemodialysis treatment among ESRD patients in the tertiary hospitals of Addis Ababa City and Amhara region, Ethiopia.Patients and Methods: An institutional-based cross-sectional study was conducted among 172 ESRD patients undergoing hemodialysis treatment. A structured questionnaire and patients’ medical chart were used to estimate the costs, and the human capital approach was applied to calculate the indirect costs. A generalized linear model (GLM) was fitted after the modified park test to identify the associated factors. In the final GLM, a p-value of < 0.05 and a 95% CI were used to declare the significant variables.Results: The mean annual cost of hemodialysis treatment was 121,089.27ETB ($4466.59) ± 33,244.99 ($1226.29). The direct and indirect costs covered 77.0% and 23.0% of the total costs, respectively. Age (ex(b): 1.01, p-value < 0.001), highest wealth status (ex(b): 1.09, p-value: 0.008), eight (ex(b): 1.27, p-value < 0.001) and 12 visits/month (ex(b): 1.34, p-value < 0.001), anemia (ex(b): 1.13, p-value < 0.001), and comorbidity (ex(b): 1.09, p-value: 0.039) were the factors associated with the costs of hemodialysis treatment.Conclusion: The annual cost of hemodialysis treatment among ESRD patients was high compared to the national per capita health expenditure, and two-thirds covered by the direct medical costs. Old age, high wealth status, more visits, anemia, and comorbidity were factors associated with the costs of hemodialysis. Therefore, the healthcare system must make a great effort for cost reduction and reduce the patients with kidney disease before they reach end-stages.Keywords: burden of ESRD, direct costs, indirect costs, GLM, hemodialysis, Ethiopia

The definition of relationships between damage and losses is a crucial aspect for the prediction of seismic effects and the development of reliable models to define risk maps, loss scenarios and mitigation strategies. The paper focuses on the analysis of post-earthquake empirical data to define relationships between buildings' damage expressed as usability rating or as global damage state and the associated costs for repair (i.e. direct costs) or for population assistance (i.e. a part of total indirect costs). The analysis refers to the data collected on residential buildings damaged by 2009 L'Aquila earthquake. For different usability rating or damage states, the paper presents the costs expressed in terms of percentage with respect to the reference unit cost of a new building (%Cr and %Ca for repair and population assistance costs, respectively). In particular, the costs analysis refers to undamaged, lightly or severely damaged buildings classified according to usability rating (i.e. A, B-C or E according to Italian classification) or to five different global Damage States (DSs). DSs comply with European Macroseismic Scale (EMS-98) and derive from literature available matrices properly defined to convert empirical damage to structural and non-structural components into building global damage. The %Cr probability density functions and relevant statistics derive from the analysis of actual data of post-earthquake reconstruction process, while, to determine those related to %Ca, a deep analysis of population assistance types, person/month assistance cost for each assistance form, and a methodology to associate such costs to each building are herein presented and discussed. Finally, the paper presents a relationship calibrated on empirical data to directly correlate repair costs on a building with assistance costs to their occupants. The relationships between empirical damage and direct and indirect costs herein presented are of paramount importance because they allow reliable loss scenarios to be defined by simply using literature fragility curves (defined according to empirical or mechanical approaches) aimed at evaluating the probability of exceeding different usability rating or damage states of existing buildings. [ABSTRACT FROM AUTHOR]

Occupational health and safety (OHS), as a fundamental human right, forms the basis of the obligation of employers to employees, requiring employers to do what is right. Responsible management practices encompass cognisance of sustainability, responsibility as well as legal, financial and moral aspects related to OHS compliance. As point of departure, an overview of core OHS criteria for small businesses is provided, with reference to awareness of these criteria in the G20 countries. This article utilises quantitative and qualitative data analysis to examine the reasons why small business owners/managers comply with occupational health and safety directives, such as the Occupational Health and Safety Act (OHS Act) and the Compensation for Occupational Injuries and Diseases Act (COIDA) in South Africa, determine if such reasons for compliance culminate in actual compliance, and determine the perceived effect of direct and indirect costs of OHS incidents. A total of 350 small business owners/managers took part in this study. The findings indicate that whilst small business owners/ managers realise the rationale behind OHS compliance in terms of moral, legal and financial components, moral aspects related to OHS compliance are deemed most important. Small business owners/managers thus seem to realise the importance of OHS compliance. However, when it comes to adhering to their responsibility in terms of general safety regulations of the OHS Act and registration with the Compensation Fund as specified in the COIDA (as examples of actual compliance), small business owners/managers’ compliance does not reflect such realisation. A model to enhance OHS standards in small businesses, encompassing legal, moral and financial rationales, is proposed. [ABSTRACT FROM AUTHOR]

Concerns related to production costs in general, their analysis and, implicitly, the methods used for this purpose derive from the need of economic agents to produce high quality products, while seeking to incur costs as low as possible. It can be said that this issue must be given the necessary attention because only through a continuous analysis of production costs companies may survive and develop in an increasingly unfavorable, unstable economic environment, marked by fierce competition in all areas of activity and a continuous increase in the prices of used resources. Cost analysis represents an important area in the efficient operation of the enterprise in terms of limited resources, its task being to provide the necessary information to managers in order to develop strategic decisions. [ABSTRACT FROM AUTHOR]

Background: Third leading cause of mortality in the world is cancer, with more than 12 million new cases and nearly 7.6 million deaths in 2007. The time estimation of healthcare costs of patients with cancer is an important component in developing national programs and policies of cancer. The present study aimed to investigate the epidemiology and costs of hospitalization of patients with cancer who were admitted to a regional referral center of the eastern Iran. Methods: The present research was descriptive and had a cross-sectional and population-based design. It was conducted on all patients with cancer in a regional referral center in eastern Iran in 2018. The files of hospitalized cancer patients with disease codes of C0 to D48/9 and all patients who were admitted to the center for the treatment of cancer in 2018 and those who were discharged, were extracted and classified based on international codes of ICD10. Costs of the present study consisted of four categories including direct costs of cancer patients, direct costs of admission due to the cancer, direct outpatient costs, and indirect costs. Statistical data analysis was done by using criteria such as frequency, mean, and standard deviation through STATA Version 11. Results: During the study, 1467 cancer patients were referred to Omid Hospital of Mashhad. Among them, 49.9% were males and 50.1% were females. 183 patients were in age range of 56-60 years. The highest prevalence and hospitalization were related to cancer of gastrointestinal organs (36%), and the highest hospital cost belonged to cancers involving bone, cartilage and joints (51.855 USD). The total cost of treating cancer patients was 1074990 USD and the average cost of cancer patients was 73278 USD per patient. Hoteling with a portion of 28% comprised the highest cost. The patients’ share of out of pocket payment for treatment cost was 7% and the governmental share was 6%. The highest cost of treatment for cancer patients was paid by insurance companies (87%). Discussion: The research results indicated that cancer patients bore high direct and indirect costs during their treatment; hence, new policies for reducing costs in these cases are needed. The increasing number of cancer patients and their treatment costs requires the active participation of all responsible organizations along with continuing financial support by financial institutions such as banks or charities and the development of appropriate government policies on supporting these patients.

Aim: to assess the socio-economic burden of smoking in the Russian Federation for 2017.Materials and methods. The socio-economic burden was calculated and extrapolated to the entire population of smokers in Russia and then compared with equal sized populations of quitters and non-smokers.Results. In 2017, the burden of tobacco smoking (including the direct costs of medical care and payment for temporary disability, as well as indirect costs - the under-received gross domestic product (GDP) due to temporary disability) was 510.6 billion rubles. The difference between the smokers and the equal-sized non-smoking population is 327.6 billion rubles. The difference between the smokers and the equalsized population of quitters was 216.1 billion rubles.Conclusion. Costs associated with smoking are sizable. Helping quit tobacco smoking (government anti-smoking measures, pharmacotherapy etc.) will not only improve the quality of life and health expectancy of smokers but also save a considerable amount of budget funds.

Background: Major neurocognitive disorders (major NCD) predominantly affect the elderly. Major NCD results in significant morbidity and socioeconomic burden.Objectives: To estimate the individual cost of care of a person with major NCD according to disease severity and component costs.Methods and Material: Fifty patients of major NCD with primary caregivers attending memory clinic of tertiary care center were included. A detailed questionnaire administered after inclusion provided demographic and clinical information. Caregivers were interviewed about details of care provided. Cognitive function was assessed by Hindi mental state examination (HMSE), and major NCD severity was determined by clinical dementia rating scale (CDR).Results: The annual cost of care per patient with mild to moderate and severe major MCD was INR 78288 and INR 167808, respectively. Costs increased with increasing severity of the disease. Direct nonmedical costs were significantly higher than direct medical costs in severe major NCD group and vice versa was found in mild to moderate major NCD group.Conclusion: Increasing population of elderly and prevalence of major NCD suggest an economic burden on caring families and hence the government. Comprehensive health policy toward providing affordable care to people with major NCD is the need of the hour. [ABSTRACT FROM AUTHOR]

Introduction: It is essential to use the correct injection technique (IT) to avoid skin complications such as lipohypertrophy (LH), local inflammation, bruising, and consequent repeated unexplained hypoglycemia episodes (hypos) as well as high HbA1c (glycated hemoglobin) levels, glycemic variability (GV), and insulin doses. Structured education plays a prominent role in injection technique improvement. The aim was to assess the ability of structured education to reduce (i) GV and hypos, (ii) HbA1c levels, (iii) insulin daily doses, and (iv) overall healthcare-related costs in outpatients with T2DM who were erroneously injecting insulin into LH. Methods: 318 patients aged 19–75 years who had been diagnosed with T2DM for at least 5 years, were being treated with insulin, were routinely followed by a private network of healthcare centers, and who had easily seen and palpable LH nodules were included in the study. At the beginning of the 6-month run-in period (T−6), all patients were trained to perform structured self-monitoring of blood glucose and to monitor symptomatic and severe hypos (SyHs and SeHs, respectively). After that (at T0), the patients were randomly and equally divided into an intervention group who received appropriate IT education (IG) and a control group (CG), and were followed up for six months (until T+6). Healthcare cost calculations (including resource utilization, loss of productivity, and more) were carried out based on the average NHS reimbursement price list. Results: Baseline characteristics were the same for both groups. During follow-up, the intra-LH injection rate for the CG progressively decreased to 59.9% (p < 0.001), a much smaller decrease than seen for the IG (1.9%, p < 0.001). Only the IG presented significant decreases in HbA1c (8.2 ± 1.2% vs. 6.2 ± 0.9%; p < 0.01), GV (247 ± 61 mg/dl vs. 142 ± 31 mg/dl; p < 0.01), insulin requirement (− 20.7%, p < 0.001), and SeH and SyH prevalence (which dropped dramatically from 16.4 to 0.6% and from 83.7 to 7.6%, respectively; p < 0.001). In the IG group only, costs—including those due to the reduced insulin requirement—decreased significantly, especially those relating to SeHs and SyHs, which dropped to €25.8 and €602.5, respectively (p < 0.001). Conclusion: Within a 6-month observation period, intensive structured education yielded consistently improved metabolic results and led to sharp decreases in the hypo rate and the insulin requirement. These improvements resulted in a parallel drop in overall healthcare costs, representing a tremendous economic advantage for the NHS. These positive results should encourage institutions to resolve the apparently intractable problem of LH by financially incentivizing healthcare teams to provide patients with intensive structured education on proper injection technique. Trial Registration: Trial registration no. 118/15.04.2018, approved by the Scientific and Ethics Committee of Campania University "Luigi Vanvitelli," Naples, Italy, and by the institutional review board (IRB Min. no. 9926 dated 05.05.2018). [ABSTRACT FROM AUTHOR]

ABSTRACT Carnivore depredation gives rise to direct costs for killed and injured animals as well as indirect costs due to productivity losses and additional labor requirements. Our aim was to investigate indirect costs to sheep farmers in Sweden due to carnivore depredation and presence. We estimated these costs using survey data describing conditions in 2013. Reproduction and time spent on fence maintenance and taking care of animals were analyzed to isolate effects of carnivore exposure from other factors that affect these variables. Results indicate that both high carnivore densities and attacks are associated with comparatively lower sheep reproduction. Farmers who experienced an attack spent much more on labor for maintaining fences, searching for lost animals, and bringing the animals in for the night. Results suggest that the indirect cost per adult female sheep is EUR23 for nonattacked herds in areas with high carnivore densities; EUR71 in herds that were attacked and where sheep are kept on fenced grazing land; and EUR100 on attacked summer‐pasture farms, where free‐range grazing is applied. A flat rate compensation per adult female sheep, differentiated between herds in areas with high carnivore density that have not been attacked and herds that have been attacked could be used to compensate sheep farmers for these costs. © 2019 The Wildlife Society.

The method of costs allocation for equipment maintenance and operation has been analyzed. It is especially important to properly allocate costs by type of product at those industrial enterprises, where a complex range of products is produced as a result of a single production process. The main method for calculating the product cost unit in industry is calculating the product cost and expense budget. Differentiated methods should be used in allocating indirect costs between particular products or types of products, depending on the nature of a cost, its economic nature, and its connection with the process of forming production cost. In calculating production cost, costs for production maintenance and management are identified, having a very diverse composition. A big group of expenses connected with equipment operation (depreciation on operating equipment and vehicles; maintenance repair of the equipment and shop-floor travelers; wear of low-value tools; the wages of workers engaged in equipment maintenance; maintenance materials) is singled out in a special spending pattern. It is established that quite accurate results are also used in a number of industries. For example, the method of allocation of indirect costs allows the maintenance costs and equipment operation costs to be reasonably allocated, thus making it possible to more accurately calculate the production cost and make management decisions on this basis. It should be noted that, since indirect costs include a large number of various production costs, which differ in many economic respects, allocation of all indirect costs should not be carried out on a single basis. [ABSTRACT FROM AUTHOR]

The purpose of this article is to analyse the available literature describing the economic burden of dementia and to compare costs between studies examining cost drivers. To shed light on this field, a systematic review is performed using PubMed, the Cochrane Library and Web of Science. An eight-year retrospective horizon was considered until 25 May 2018. Several papers were obtained from the database search (n = 23), being others (n = 3) identified through other sources (hand-searching) because we did not detect it through the three databases. The cost estimates were compared between three perspectives: state/publicly funded health services, third-party/private sector/not-for-profit organisations and patient and family and/or societal. The estimated total annual cost per person with dementia in Europe is on average €32,506.73 (n = 10), whereas for the United States, it gets €42,898.65 (n = 2). Furthermore, differences are appreciated by type of costs. Besides, differences by severity groups are also considered. Overall, the higher the severity the higher the associated costs. Dementia imposes a huge economic burden. The figures here presented provide a good framework to quantify these costs for both, economic experts and researchers, and policy decision makers. [ABSTRACT FROM AUTHOR]

There is insufficient data regarding the excess direct and indirect costs associated with attention deficit hyperactivity disorder (ADHD). Using the Danish National Patient Registry (2002–2016), we identified 83,613 people of any age with a diagnosis of ADHD or who were using central-acting medication against ADHD (primarily methylphenidate, with at least two prescriptions) and matched them to 334,446 control individuals. Additionally, 18,959 partners of patients aged ≥18 years with ADHD were identified, and compared with 74,032 control partners. Direct costs were based on data from the Danish Ministry of Health. Information about the use and costs of drugs were obtained from the Danish Medicines Agency. The frequencies of visits and hospitalizations, and costs of general practice were derived from data from the National Health Security. Indirect costs were obtained from Coherent Social Statistics. The average annual health care costs for people with ADHD and their partners were, respectively, €2636 and €477 higher than those of the matched controls. A greater percentage of people with ADHD and their partners compared with respective control subjects received social services (sick pay or disability pension). Those with ADHD had a lower income from employment than did controls for equivalent periods up to five years before the first diagnosis of ADHD. The additional direct and indirect annual costs (for those aged ≥18 years) including transfers of ADHD compared with controls were €23,072 for people with ADHD and €7,997 for their partners. ADHD has substantial socioeconomic consequences for individual patients, their partners and society. [ABSTRACT FROM AUTHOR]

Margarethe E Wacker,1 Katharina Kitzing,1,2 Rudolf A Jörres,3 Reiner Leidl,1,4 Holger Schulz,5 Stefan Karrasch,3,5 Annika Karch,6 Armin Koch,6 Claus F Vogelmeier,7 Rolf Holle1 On behalf of the COSYCONET Study Group 1Institute of Health Economics and Health Care Management, Helmholtz Zentrum München GmbH, German Research Center for Environmental Health, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research, Neuherberg, 2Institute for Medical Information Processing, Biometrics and Epidemiology (IBE), LMU Munich, 3Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, 4Institute of Health Economics and Health Care Management, Munich Center of Health Sciences, Ludwig-Maximilians-Universität München, Munich, 5Institute of Epidemiology I, Helmholtz Zentrum Mu¨nchen GmbH, German Research Center for Environmental Health, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research, Neuherberg, 6Institute for Biostatistics, Hannover Medical School, Hannover, 7Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-University Marburg, Member of the German Center for Lung Research, Marburg, Germany Background: Although patients with COPD often have various comorbidities and symptoms, limited data are available on the contribution of these aspects to health care costs. This study analyzes the association of frequent comorbidities and common symptoms with the annual direct and indirect costs of patients with COPD. Methods: Self-reported information on 33 potential comorbidities and symptoms (dyspnea, cough, and sputum) of 2,139 participants from the baseline examination of the German COPD cohort COSYCONET was used. Direct and indirect costs were calculated based on self-reported health care utilization, work absence, and retirement. The association of comorbidities, symptoms, and COPD stage with annual direct/indirect costs was assessed by generalized linear regression models. Additional models analyzed possible interactions between COPD stage, the number of comorbidities, and dyspnea. Results: Unadjusted mean annual direct costs were €7,263 per patient. Other than COPD stage, a high level of dyspnea showed the strongest driving effect on direct costs (+33%). Among the comorbidities, osteoporosis (+38%), psychiatric disorders (+36%), heart disease (+25%), cancer (+24%), and sleep apnea (+21%) were associated with the largest increase in direct costs (p

We aimed to evaluate the excess direct and indirect costs associated with nonepileptic seizures. From the Danish National Patient Registry (2011–2016), we identified 1057 people of any age with a diagnosis of psychogenic nonepileptic seizures (PNESs) and matched them with 2113 control individuals. Additionally, 239 partners of patients with PNES aged ≥ 18 years were identified and compared with 471 control partners. Direct costs included frequencies and costs of hospitalizations and outpatient use weighted by diagnosis-related group, and specific outpatient costs based on data from the Danish Ministry of Health. The use and costs of drugs were based on data from the Danish Medicines Agency. The frequencies of visits and hospitalizations and costs of general practice were derived from National Health Security data. Indirect costs included labor supply-based income data, and all social transfer payments were obtained from Coherent Social Statistics. A higher percentage of people with PNES and their partners compared with respective control subjects received welfare benefits (sick pay, disability pension, home care). Those with PNES had a lower employment rate than did controls for equivalent periods up to three years before the diagnosis was made. The additional direct and indirect annual costs for those aged ≥ 18 years, including transfers to patients with PNES, compared with controls, were €33,697 for people with PNES and €15,121 for their partners. Psychogenic nonepileptic seizures have substantial socioeconomic consequences for individual patients, their partners, and society. • Psychogenic nonepileptic seizures (PNESs) are associated with elevated welfare costs. • Patients with PNES had a lower employment rate. • Welfare costs are significantly elevated in partners to patients with PNES. [ABSTRACT FROM AUTHOR]

Treatment of diseases entails different costs; both direct and indirect. These costs can be a deterrent to healthcare seeking leading to increased disease morbidity and mortality. This is especially so for diseases like diarrhea which is more prevalent among children from the lower economic strata. This can cause huge economic burden to a nation like India where a significant portion of the population is economically weak. Thus it is imperative that each element of the healthcare cost is well investigated and understood to formulate pragmatic health policies aimed at reducing the disease burden. This study is an attempt to quantify the treatment cost per episode of under 5 diarrhoea, one of the leading cause of childhood morbidity and mortality in India, by accounting for all direct and indirect elements in the household expenses incurred in treating an episode of the same. [ABSTRACT FROM AUTHOR]

Diabetes is projected to become one of the world's main disabler and killer within the next 25 years. Type 2 diabetes mellitus (T2DM) due to its chronicity and incident complications is not only consuming patient's household budget but also the overall healthcare budget. To estimate the annual cost incurred and proportion of family income spent for management of T2DM in the community, a community-based cross-sectional study was conducted among T2DM patients aged ≥ 40 years residing in the field practice area of a Medical College in Karnataka. A total of 809 subjects were included using stratified random sampling with proportionate sample technique. A pretested questionnaire was used to assess direct and indirect costs incurred for disease management in the last 1 year. Data was entered and analyzed using SPSS version 15.0. The annual median (IQR) total cost incurred for the management of diabetes mellitus was estimated to be USD 73.2 which included direct cost of USD 62.2 (27.9–138.2) and indirect cost of USD 6.7 (2.2–22.6). The direct medical cost included USD 5.2 (< 1–9.43), USD 5.2 (2.9–10.4), USD 58.6 (20.8–124.0), and USD 217.7 (116.1–718.6) per person annually for consultation, investigation, medications, and hospitalization, respectively. The direct non-medical cost included USD 3.8 (1.7–10.8) and USD 3.0 (2.0–5.2) annually for the travel and food. On an average, 3% and 21% of the total family income was spent on outpatient and inpatient services, respectively. Annual cost incurred predominantly included direct costs of which medication and hospitalization expenses contributed a major portion. [ABSTRACT FROM AUTHOR]

Carnivore depredation gives rise to direct costs for killed and injured animals as well as indirect costs due to productivity losses and additional labor requirements. Our aim was to investigate indirect costs to sheep farmers in Sweden due to carnivore depredation and presence. We estimated these costs using survey data describing conditions in 2013. Reproduction and time spent on fence maintenance and taking care of animals were analyzed to isolate effects of carnivore exposure from other factors that affect these variables. Results indicate that both high carnivore densities and attacks are associated with comparatively lower sheep reproduction. Farmers who experienced an attack spent much more on labor for maintaining fences, searching for lost animals, and bringing the animals in for the night. Results suggest that the indirect cost per adult female sheep is EUR23 for nonattacked herds in areas with high carnivore densities; EUR71 in herds that were attacked and where sheep are kept on fenced grazing land; and EUR100 on attacked summer‐pasture farms, where free‐range grazing is applied. A flat rate compensation per adult female sheep, differentiated between herds in areas with high carnivore density that have not been attacked and herds that have been attacked could be used to compensate sheep farmers for these costs. © 2019 The Wildlife Society. We investigated indirect costs to sheep farmers in Sweden due to carnivore depredation and presence in 2013. Results indicated that both high carnivore densities and attacks were associated with comparatively lower reproduction; farmers who have experienced an attack spent more labor on fence maintenance, searching for lost animals, and bringing animals in for the night. [ABSTRACT FROM AUTHOR]

Background: Malaria remains a major cause of burden of illness in sub-Saharan Africa. The objectives of this study were to measure the costs of a malaria case in terms of costs borne by households affected and healthcare systems (either ambulatory or hospitalized) comprehensively in a number of countries in Sub- Saharan Africa, collecting data prospectively and retrospectively using a common protocol, which included data on lost productivity and unpaid time of caregivers. Methods: We conducted community-based and health care facility-based studies on disease burden and cost of malaria disease in four sub-Sahara Africa (SSA), namely: Burkina-Faso, Ghana, Nigeria and Uganda. These were both prospective and retrospective studies that used a common protocol. The study population included children under five years old with febrile illness that met the World Health Organization's clinical case definition for malaria. To standardize measurements of economic impact across countries and facilitate comparisons and interpretations, we expressed all direct and indirect costs in 2019. The study incorporated empirical values for most of the components of health services used, and most of their unit costs. Furthermore, it examined actual medical practices, rather than the more expensive setting of a formal prospective clinical study of laboratory confirmed malaria disease. We used the unit costs are they were in 2010 and 2011, when the field work was conducted, but then discounted them to the current year of 2019. Findings: The total household costs were highest in Ghana and lowest in Uganda. Health systems costs are significantly higher in Nigeria. As opposed to the three other countries, indirect costs in Ghana are lower than direct costs. It was found that in general richer households tended to spend more on treating OPD and IPD cases in the four countries and a majority of Ghana respondents were insured (67%) while in the three other countries, out of pockets spending were high (from different sources), followed by subsidies from social institutions. Conclusion: Malaria remains a major contributor the high economic burden of disease in SSA. The reasons that our estimates are higher than previous estimates could be the fact that we included as much as possible costs incurred by households before arriving at the facility where they were interviewed, comprising informal sector payment. Malaria endemic countries should not relent, but should rather redouble efforts to control and eliminate malaria as a major public health burden in SSA. [ABSTRACT FROM AUTHOR]

Objectives To assess the cost-effectiveness of erenumab 140 mg ("erenumab") for the prophylactic treatment of episodic migraine and chronic migraine. Study design A hybrid Monte Carlo patient simulation and Markov cohort model was constructed to compare erenumab to no preventive treatment or onabotulinumtoxinA among adult ( ≥ 18 years) patients with episodic migraine and chronic migraine who failed prior preventive therapy from the US societal and payer perspectives. Methods Patients entered the model one at a time and were assigned to a post-treatment monthly migraine day category based on baseline monthly migraine days and treatment effect. Using monthly cycles, patients were followed for 2 years and accumulated costs and utilities associated with their post-treatment monthly migraine days. The primary outcome included the incremental cost-effectiveness ratio presented as cost per quality-adjusted life year gained. Results With an annual drug price of erenumab of $6900, treatment with erenumab in the societal perspective ranges from a dominant strategy versus no preventive treatment among chronic migraine patients to an incremental cost-effectiveness ratio of $122,167 versus no preventive treatment among episodic migraine patients. When excluding indirect costs (i.e. payer perspective), the incremental cost-effectiveness ratios are cost-effective among chronic migraine patients ($23,079 and $65,720 versus no preventive treatment and onabotulinumtoxinA, respectively), but not among episodic migraine patients ($180,012 versus no preventive treatment). Model results were sensitive to changes in monthly migraine days, health utilities, and treatment costs. Conclusion The use of erenumab may be a cost-effective approach to preventing monthly migraine days among patients with chronic migraine versus onabotulinumtoxinA and no preventive treatment in the societal and payer perspectives, but is less likely to offer good value for money for those with episodic migraine, unless lost productivity costs are considered. [ABSTRACT FROM AUTHOR]

Operating cost control is essential to making the right decision for farmers, managers, etc. in the agriculture. Machinery operating costs form a signifi cant proportion of the expenses involved in agricultural production and, thus, the appropriate or inappropriate use of machinery can signifi cantly infl uence the effi ciency of farming. The primary goal of this study is to examine operating costs and analyse the causes of changes in the Hungarian machinery market during the past few years. Expenses can be reduced in every farm and, thus, my aim is to summarise cost reduction possibilities. My research shows that the EU co-fi nanced support for machinery and equipment investment has a great impact on the replacement and average annual usage of power machines because, after the end of EU subsidies, the number of agricultural machines sold has decreased. [ABSTRACT FROM AUTHOR]

Background. This paper presents a case study of an automated clinical laboratory in a large urban academic teaching hospital in the North of Italy, the Spedali Civili in Brescia, where four laboratories were merged in a unique laboratory through the introduction of laboratory automation. Materials and Methods. The analysis compares the preautomation situation and the new setting from a cost perspective, by considering direct and indirect costs. It also presents an analysis of the turnaround time (TAT). The study considers equipment, staff and indirect costs. Results. The introduction of automation led to a slight increase in equipment costs which is highly compensated by a remarkable decrease in staff costs. Consequently, total costs decreased by 12.55%. The analysis of the TAT shows an improvement of nonemergency exams while emergency exams are still validated within the maximum time imposed by the hospital. Conclusions. The strategy adopted by the management, which was based on re-using the available equipment and staff when merging the pre-existing laboratories, has reached its goal: introducing automation while minimizing the costs.

Modern dünyada inşaat projelerinin maliyetleri: henüz ”ihtiyaç” ortaya çıktığı andan itibaren önemle üzerinde çalışılması; tasarım, ölçüm, ön maliyet uygulama ve kullanım evreleri ile birlikte yıkım ve temizleme işlemlerini de içeren “yaşam boyu maliyet” döngüsü içinde irdelenmesi gereken bir konu mahiyetinde bulunmaktadır. Tarih boyunca önemli inşaat projelerinin dizayn ve yönetim uygulamaları ile hayata geçirdikleri uygulamaların içinde maliyet hesaplama ve yönetim uygulamalarının da büyük önem arz ettiği malumdur. Yapımları yüzlerce yıl süren yapıların sadece teknik yetersizlikten değil ekonomik şartlardan da zamansal olarak etkilendiği bilinmektedir. Projelendirme ve süre sınırları belirlenen bir yapım projesinin ihaleye çıkılması demek, bu projenin belirtilen kalite ve süre şartları kapsamında en uygun maliyetle nasıl ve kim tarafından vücuda getirilebileceğinin belirlenmesi anlamına gelmektedir. Her yapım projesi kendine has nitelikler içermekte ve her proje üzerinde tüm teknik, mali, ekonomik analizlerin yapılmasının yanı sıra maliyet analizlerinin de gereken doğrulukta ve nitelikte yapılarak sürekli izlenmesi; proje amaçlarının gerçekleştirilmesi yolunda en önemli uygulamalar arasında yer almaktadır. Her taahhütçü firmada bu doğrultuda hesaplamalar ve uygulamalar yaparak; geçmiş bilgilerini harmonize edip sürekli gelişen bir bilgi bankası oluşturarak hayati kıymeti olan verilerini kendi kullanımına hazır hale getirmelidir. Bu çalışmada; yurdumuzda ve dünyada yapım firmalarının maliyet belirleme ve yönetme uygulamalarına ait literatür araştırılıp, Bursa’da faaliyet gösteren orta ve küçük ölçekli inşaat firmalarında görev yapan uzman teknik ve idari personellere yapılan bir anket yardımı ile bu firmalarca; hangi tip inşaat projeleri için hangi maliyet hesaplama yaklaşımlarının kullanıldığı, direk ve endirekt maliyetlerin ilişkilerinin nasıl gerçekleştirildiği ve maliyet yönetimi/kontrolü uygulamalarının nasıl yapıldığı ile ilgili veriler elde edilmiştir. Edinilen bilgiler, tablolar ve grafikler yardımı ile anlamlandırılmış, istatistiki analizler yapılmıştır. Elde edilen bulgular yardımı ile daha bilinçli ve donanımlı tercihler ve uygulamalar yapması beklenen yapım firmalarımızın; hata düzeyi en düşük derecede olan maliyet tahminleri yapmaları ve ulusal ekonominin gelişimine dünya inşaat sektöründe daha fazla yer almaları için katkıda bulunulması ümit edilmektedir

This paper examines the possibility of application of the activity-based costing in a company engaged in drying fruit. Activity Based Costing (ABC) was developed due to the shortcomings of traditional cost accounting systems, which was shown to have serious limitations, on one hand, and due to the need for more accurate cost price, on the other. This is of great importance for business decision making, which requires quality data and information, because the intense technical and technological progress has significantly altered the environment companies operate in. Along with this fact, major changes in cost structure occurred, which reflected through the increase of the indirect cost portion, and decrease of direct labor and material costs. Traditional cost accounting methods allocate indirect production costs using keys which are no longer appropriate for the new circumstances, and therefore typically allocate unreasonably high amount of indirect costs to those products which are produced in larger series. ABC cost accounting system firstly allocates indirect costs to pre-defined activities, and afterwards carries them to cost and profit drivers. The application of ABC costing in Serbia is at the very beginning. Having in mind that the privatization and the restructuring phase in the economy is followed by the establishment of a new management with fresh ideas, this can be a good timing for companies to introduce modern approach and modern methods of cost accounting. ABC method is very convenient for application in service companies, food processing industry, confectionery companies, driers, sugar refineries, breweries, dairies, mills etc. [Projekat Ministarstva nauke Republike Srbije, br. III 46001, Razvoj i primena novih i tradicionalnih tehnologija u proizvodnji konkurentnih prehrambenih proizvoda sa dodatom vrednošću na evropsko i svetsko tržište - Stvorimo bogatstvo iz bogatstva Srbije]

Purpose: We aimed to evaluate the excess direct and indirect costs associated with epilepsy.Methods: From the Danish National Patient Registry (1998-2013), we identified people within all ages with an epilepsy diagnosis and matched them to control individuals. Additionally, partners of people with epilepsy were identified, who were compared with control partners. Direct costs included frequencies and costs of hospitalizations and weighted outpatient use according to diagnosis-related group, and specific outpatient costs based on data from the Danish Ministry of Health. The use and costs of drugs were based on data from the Danish Medicines Agency. The frequencies of visits and hospitalizations, and costs from general practice were derived from data from the National Health Security. Indirect costs included labor supply-based income data, and all social transfer payments obtained from Coherent Social Statistics.Results: A greater percentage of people with epilepsy and their partners compared with respective control subjects received social services (sick pay or disability pension). Those with epilepsy had a lower employment rate than did controls for equivalent periods up to eight years before the diagnosis was made. Mortality was significantly higher in people with epilepsy than in control individuals (hazard ratio 2.38 (95% CI: 2.34, 2.41). The additional direct and indirect annual costs of epilepsy compared with controls were €11,223 for persons with epilepsy and €2,494 for their partners.Conclusion: Epilepsy has major socioeconomic consequences for individual patients, their partners and society. [ABSTRACT FROM AUTHOR]

Se realizó un estudio descriptivo y retrospectivo para la evaluación económica parcial, del tipo descripción de costos, de la atención hospitalaria y vigilancia de laboratorio de 22 196 pacientes con presunto diagnóstico de dengue, ingresados en 3 hospitales del municipio de Santiago de Cuba durante la epidemia ocurrida en el bienio 2006-2007. Se determinaron los costos directos e indirectos de hospitalización y vigilancia de laboratorio, y se revisó detalladamente la documentación económica existente en los diferentes centros de costes. De la población santiaguera, 2,3 % estaba afectada por dengue, con preponderancia de la forma clásica y confirmación en 50 % de los que ingresaron. Predominaron los costos totales por concepto de hospitalización ($ 11 246 037,18), que representaron 95,1 %, de los cuales 79,8 % provenían de gastos directos y eran superiores a los originados por la vigilancia de laboratorio. Se recomendó realizar una estimación de los gastos generados por la lucha antivectorial y las campañas educativas durante esta epidemia, como complemento de esta investigación.A descriptive and retrospective study was carried out for the partial economic evaluation, of cost description type, of the hospital care and laboratory monitoring of 22 196 patients with presumptive diagnosis of dengue, admitted in 3 hospitals of Santiago de Cuba municipality during the epidemic occurred in 2006 - 2007. The direct and indirect costs of hospitalization and laboratory monitoring were determined, and the existing economic data were reviewed in detail in different cost centers. Of the Santiago population, 2.3% were affected by dengue, with a predominance of the classic form and confirmation in 50% of those admitted The total expenses for hospitalization ($11 246 037,18) prevailed, representing 95.1%, of which 79.8% came from direct expenses and were higher than those arising from laboratory monitoring. It was recommended to estimate the expenses incurred by the vector control and educational campaigns during this epidemic as a complement of this study.

Background and Aims: To obtain an accurate picture of the total costs of hypoglycemia, including the indirect costs and comparing the differences between type 1 (T1DM) and type 2 diabetes mellitus (T2DM).Methods and Results: HYPOS-1 was a multicenter, retrospective cohort study which analyzed the data of 2229 consecutive patients seen at 18 diabetes clinics. Data on healthcare resource use and indirect costs by diabetes type were collected via a questionnaire. The domains of inpatient admission and hospital stay, work days lost, and third-party assistance were also explored. Resource utilization was reported as estimated incidence rates (IRs) of hypoglycemic episodes per 100 person-years and estimated costs as IRs per person-years. For every 100 patients with T1DM, 9 emergency room (ER) visits and 6 emergency medical service calls for hypoglycemia were required per year; for every 100 patients with T2DM, 3 ER visits and 1 inpatient admission were required, with over 3 nights spent in hospital. Hypoglycemia led to 58 work days per 100 person-years lost by the patient or a family member in T1DM versus 19 in T2DM. The costs in T1DM totaled €90.99 per person-year and €62.04 in T2DM. Direct and indirect costs making up the total differed by type of diabetes (60% indirect costs in T1DM versus 43% in T2DM). The total cost associated with hypoglycemia in Italy is estimated to be €107 million per year.Conclusions: Indirect costs meaningfully contribute to the total costs associated with hypoglycemia. As compared with T1DM, T2DM requires fewer ER visits and incurs lower indirect costs but more frequent hospital use. [ABSTRACT FROM AUTHOR]

One of the most important public health concerns in both developing and developed countries is viral hepatitis B. It is an autoimmune liver disease, which imposes a high economic burden on individuals and the society. The aim of our study was to determine economic burden of hepatitis B virus (HBV) infection in Iran. To this end, 300 patients with HBV infection, who referred to hospitals in three cities of Iran during the year 2015, were randomly selected. To estimate the total burden of hepatitis, direct and indirect costs, costs of DALYs and social welfare were calculated which gave the costs of 7500.93 PPP$ and 96782 PPP$, respectively. Finally, our results showed that the total economic burden of HBV in Iran is dramatic which can lead to decreased quality of life of household members and damage the economy of the society. Therefore, the benefit of prevention and control measures will justify the costs from social perspective. [ABSTRACT FROM AUTHOR]