Green building construction typically incurs higher costs than conventional methods.To facilitate broader adoption by construction entities,cost optimization is essential.Firms must align with technological advancemen...Green building construction typically incurs higher costs than conventional methods.To facilitate broader adoption by construction entities,cost optimization is essential.Firms must align with technological advancements,judiciously apply emerging technologies,and ensure resource efficiency through context-specific strategies.Proactive and precise scheduling is critical to avert delays from unforeseen events.Additionally,construction units should enhance on-site safety training,promote mastery of innovative techniques,and foster environmental awareness among personnel.Finally,companies ought to capitalize on government incentives for green materials while adopting bulk procurement from local sources to minimize transportation costs and secure lower unit prices.展开更多
To the editor:Peer workers-people with personal experiences of using mental health services,trained to provide support to others currently using similar services--are increasingly integrated into the workforce of ment...To the editor:Peer workers-people with personal experiences of using mental health services,trained to provide support to others currently using similar services--are increasingly integrated into the workforce of mental health systems internationally.展开更多
BACKGROUND Although substantial evidence supports the advantages of cold snare polypectomy(CSP)in terms of polypectomy efficacy and reduced postoperative adverse events,few studies have examined the cost differences b...BACKGROUND Although substantial evidence supports the advantages of cold snare polypectomy(CSP)in terms of polypectomy efficacy and reduced postoperative adverse events,few studies have examined the cost differences between CSP and traditional endoscopic mucosal resection(EMR)for the treatment of intestinal polyps.AIM To compare the efficacy-cost of EMR and CSP in the treatment of intestinal polyps.METHODS A total of 100 patients with intestinal polyps were included in the retrospective data of our hospital from April 2022 to May 2023.According to the treatment methods,they were divided into EMR(n=46)group and CSP(n=54)group.The baseline data of the two groups were balanced by 1:1 propensity score matching(PSM),and the cost-effectiveness analysis was performed on the two groups after matching.The recurrence rate of the two groups of patients was followed up for 1 year,and they were divided into recurrence group and non-recurrence group according to whether they recurred.Multivariate logistic regression analysis was used to screen out the influencing factors affecting the recurrence of intestinal polyps after endoscopic resection.RESULTS Significant disparities were observed in the number of polyps and smoking background between the two groups before PSM(P<0.05).Following PSM,the number of polyps and smoking history were well balanced between the EMR and CSP groups.The direct cost incurred by the CSP group was markedly higher than that incurred by the EMR group.Concurrently,the cost-effectiveness ratio in the CSP group was substantially reduced when juxtaposed with that in the EMR group(P<0.05).Upon completion of the 1-year follow-up,the rate of recurrence after endoscopic intestinal polypectomy was 38.00%.Multivariate methods revealed that age≥60 years,male sex,number of polyps≥3,and pathological type of adenoma were risk factors for recurrence after endoscopic intestinal polypectomy(all P<0.05).CONCLUSION CSP was more cost-effective for the treatment of intestinal polyps.An age≥60 years,male sex,having a number of polyps≥3,and pathological type of adenoma are independent influencing factors for recurrence.展开更多
Pavement performance and economic efficiency are researched on the perpetual test pavement of Yijiang-Suzhou Express Highway in Jiangsu province, China. Test sections were continuously monitored. The conditions and de...Pavement performance and economic efficiency are researched on the perpetual test pavement of Yijiang-Suzhou Express Highway in Jiangsu province, China. Test sections were continuously monitored. The conditions and developing laws of deflection, rutting and cracking are compared among the perpetual pavement with the rich binder layer （RBL）, the perpetual pavement without the RBL, and the conventional semi-rigid asphalt pavement in the past eight years after opening for traffic. Economical evaluation is conducted via life cycle cost analysis （LCCA）. Based on the performance comparison and LCCA analysis, sections with the RBL have good crack resistance, but they are not very satisfactory in the aspect of permanent deformation; the conventional semi-rigid asphalt pavement is the least economic one due to requiring more frequent maintenance. Research results show that the perpetual pavement without RBL is a more appropriate structure for the test site.展开更多
Objective:Treatment options for metastatic castration resistant prostate cancer(mCRPC)have expanded rapidly in recent years.Given the significant economic burden,we sought perform a cost-effectiveness analysis(CEA)of ...Objective:Treatment options for metastatic castration resistant prostate cancer(mCRPC)have expanded rapidly in recent years.Given the significant economic burden,we sought perform a cost-effectiveness analysis(CEA)of the contemporary treatment paradigm for mCRPC.Methods:We devised a treatment protocol consisting of sipuleucel-T,enzalutamide,abiraterone,docetaxel,radium-223,and cabazitaxel.We estimated number and length of treatments for each therapy using dosing schedules or progression free survival data from published clinical trials.We estimated treatment cost using billing data and Medicare reimbursement values and performed a CEA.Our analysis assumed US$100,000 per life year saved(LYS)as the threshold societal willingness to pay.Results:Incremental cost-effectiveness ratios(ICER)for strategies incorporating sipuleucel-T that were not eliminated by extended dominance exceeded the societal threshold willingnessto-pay of US$100,000 per LYS,the lowest of which was sipuleucel-T+enzalutamide+abiraterone+docetaxel at US$207,714 per LYS.Enzalutamide+abiraterone+docetaxel exhibited the most favorable ICER among strategies without sipuleucel-T at US$165,460 per LYS.Conclusion:Based on the available survival data and current costs of treatment,all treatment strategies greatly exceed a commonly assumed societal willingness-to-pay threshold of US$100,000 per LYS.Improvements in this regard can only comewith a reduction in pricing,better tailoring of treatment or significant enhancements in survival with clinical use of treatment combinations or sequences.展开更多
In this paper,a new price is given to the online decision maker at the beginning of each day.The trader must decide how many items to purchase according to the current price.We present three variants and an online alg...In this paper,a new price is given to the online decision maker at the beginning of each day.The trader must decide how many items to purchase according to the current price.We present three variants and an online algorithm based on cost function.The competitive ratio of the online algorithm is given for each variant,which is a performance measure of an online algorithm.More importantly,we show that the online algorithm is optimal.展开更多
AIM: To evaluate the management, clinical outcome and cost implications of three different treatment regimes for simple elbow dislocations.METHODS: Following institutional board approval, we performed a retrospective ...AIM: To evaluate the management, clinical outcome and cost implications of three different treatment regimes for simple elbow dislocations.METHODS: Following institutional board approval, we performed a retrospective review of all consecutive patients treated for simple elbow dislocations in a Level Ⅰ trauma centre between January 2008 and December 2010. Based on the length of elbow immobilisation(LOI), patients were divided in three groups(Group I, < 2 wk; Group Ⅱ, 2-3 wk; and Group Ⅲ, > 3 wk). Outcome was considered satisfactory when a patient could achieve a pain-free range of motion ≥ 100°(from 30° to 130°). The associated direct medical costs for the treatment of each patient were then calculated and analysed.RESULTS: We identified 80 patients who met the inclusion criteria. Due to loss to follow up, 13 patients were excluded from further analysis, leaving 67 patients for the final analysis. The mean LOI was 14 d(median 15 d; range 3-43 d) with a mean duration of hospital engagement of 67 d(median 57 d; range 10-351 d). Group Ⅲ(prolonged immobilisation) had a statistically significant worse outcome in comparison to Group Ⅰ?and Ⅱ(P = 0.04 and P = 0.01 respectively); however, there was no significant difference in the outcome between groups Ⅰ?and Ⅱ(P = 0.30). No statistically significantdifference in the direct medical costs between the groups was identified.CONCLUSION: The length of elbow immobilization doesn't influence the medical cost; however immobilisation longer than three weeks is associated with persistent stiffness and a less satisfactory clinical outcome.展开更多
Accurate cost estimation at the early stage of a construction project is key factor in a project’s success. But it is difficult to quickly and accurately estimate construction costs at the planning stage, when drawin...Accurate cost estimation at the early stage of a construction project is key factor in a project’s success. But it is difficult to quickly and accurately estimate construction costs at the planning stage, when drawings, documentation and the like are still incomplete. As such, various techniques have been applied to accurately estimate construction costs at an early stage, when project information is limited. While the various techniques have their pros and cons, there has been little effort made to determine the best technique in terms of cost estimating performance. The objective of this research is to compare the accuracy of three estimating techniques (regression analysis (RA), neural network (NN), and support vector machine techniques (SVM)) by performing estimations of construction costs. By comparing the accuracy of these techniques using historical cost data, it was found that NN model showed more accurate estimation results than the RA and SVM models. Consequently, it is determined that NN model is most suitable for estimating the cost of school building projects.展开更多
Agroforestry and beekeeping are widely promoted as prospective Nature-</span></span><span><span><span style="font-family:""> </span></span></span><span...Agroforestry and beekeeping are widely promoted as prospective Nature-</span></span><span><span><span style="font-family:""> </span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">Based Income Generating Activities (NIGAs) to improve livelihoods while at </span><span style="font-family:Verdana;">the same time enhancing biodiversity conservation in degrading</span><span style="font-family:Verdana;"> agro-ecologies. These activities can diversify and increase famers’ incomes and support in</span><span style="font-family:Verdana;">stinctive biota and fauna resilience. However, evidence to showcase and compare their long-term benefits is scant. We use the case of Uluguru</span><span style="font-family:Verdana;"> Mountains in Tanzania to evaluate and compare viability of agroforestry and beekeeping projects using the Cost</span></span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">Benefit Analysis (CBA) approach. The results of analysis yielded positive NPVs for both agroforestry and beekeeping projects at discount rates not higher than 8.2% and 8.5% respectively. Overall, the comparison of economic viability between agroforestry and beekeeping projects revealed that the former was relatively more profitable than the later in terms of both the NPV and Benefit</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">Cost Ratio (BCR) criteria. However, the Internal Rate of Return (IRR) for beekeeping was slightly higher than that of agroforestry. Yet, we underscore the fact that these two projects can jointly be implemented to enhance livelihoods of farmers and support biodiversity conservation in the study </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">area </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">and other parts with similar agro-ecologies in developing countries. However, farmers in these agro-ecologies need to be supported by governments and non-government development partners in terms of training and inspiration to shift from orthodox farming to sustainable NIGAs.展开更多
Anthrax is an infection caused by bacteria and it affects both human and animal populations. The disease can be categorized under zoonotic diseases and humans can contract infections through contact with infected anim...Anthrax is an infection caused by bacteria and it affects both human and animal populations. The disease can be categorized under zoonotic diseases and humans can contract infections through contact with infected animals, ingest contaminated dairy and animal products. In this paper, we developed a mathematical model for anthrax transmission dynamics in both human and animal populations with optimal control. The qualitative solution of the model behaviour was analyzed by determining Rhv, equilibrium points and sensitivity analysis. A vaccination class was incorporated into the model with waning immunity. Local and global stability of the model’s equilibria was found to be locally asymptotically stable whenever Rhv Rhv. It was revealed that reducing animal and human interaction rate, would decrease Rhv. We extended the model to optimal control in order to find the best control strategy in reducing anthrax infections. It showed that the effective strategy in combating the anthrax epidemics is vaccination of animals and prevention of humans.展开更多
This study analyzes the sample influx (samples per case file) into forensic science laboratory (FSL) and the corresponding analysis costs and uses arbitrary re-sampling plans to establish the minimum cost function. Th...This study analyzes the sample influx (samples per case file) into forensic science laboratory (FSL) and the corresponding analysis costs and uses arbitrary re-sampling plans to establish the minimum cost function. The demand for forensic analysis increased for all disciplines, especially biology/DNA between 2014 and 2015. While the average distribution of case files was about 42.5%, 40.6% and 17% for the three disciplines, the distribution of samples was rather different being 12%, 82.5% and 5.5% for samples requiring forensic biology, chemistry and toxicology analysis, respectively. Results show that most of the analysis workload was on forensic chemistry analysis. The cost of analysis for case files and the corresponding sample influx varied in the ratio of 35:6:1 and 28:12:1 for forensic chemistry, biology/DNA and toxicology for year 2014 for 2015, respectively. In the two consecutive years, the cost for forensic chemistry analysis was comparatively very high, necessitating re-sampling. The time series of sample influx in all disciplines are strongly stochastic, with higher magnitude for chemistry, biology/DNA and toxicology, in this order. The PDFs of sample influx data are highly skewed to the right, especially forensic toxicology and biology/DNA with peaks at 1 and 3 samples per case file. The arbitrary re-sampling plans were best suited to forensic chemistry case files (where re-sampling conditions apply). The locus of arbitrary number of samples to take from the submitted forensic samples was used to establish the minimum and scientifically acceptable samples by applying minimization function developed in this paper. The cost minimization function was also developed based on the average cost per sample and choice of re-sampling plans depending on the range of sample influx, from which the savings were determined and maximized. Thus, the study gives a forensic scientist a business model and scientific decision making tool on minimum number of samples to analyze focusing on savings on analysis cost.展开更多
AIM: To analyze and calculate the relative cost of various childhood glaucoma surgical interventions per mm Hg intraocular pressure(IOP) reduction($/mm Hg).METHODS: Representative index studies were reviewed to quanti...AIM: To analyze and calculate the relative cost of various childhood glaucoma surgical interventions per mm Hg intraocular pressure(IOP) reduction($/mm Hg).METHODS: Representative index studies were reviewed to quantitate the reduction of mean IOP and glaucoma medications for each surgical intervention in childhood glaucoma. A US perspective was adopted, using Medicare allowable costs to calculate cost/mm Hg IOP reduction($/mm Hg) at 1y postoperatively.RESULTS: At 1y postoperatively, the cost/mm Hg IOP reduction was $226/mm Hg for microcatheter-assisted circumferential trabeculotomy, $284/mm Hg for cyclophotocoagulation, $288/mm Hg for conventional ab-externo trabeculotomy, $338/mm Hg for Ahmed glaucoma valve, $350/mm Hg for Baerveldt glaucoma implant, $351/mm Hg for goniotomy, and $400/mm Hg for trabeculectomy.CONCLUSION: Microcatheter-assisted circumferential trabeculotomy is the most cost-efficient surgical method to lower IOP in childhood glaucoma, while trabeculectomy is the least cost-efficient surgical method.展开更多
Three data envelopment analysis (DEA) models were used to analyse the relative efficiencies of four AIDS treatments in AIDS Clinical Trial Group (ACTG) Study 193A(1 309 patients in total, classified into 4 age groups)...Three data envelopment analysis (DEA) models were used to analyse the relative efficiencies of four AIDS treatments in AIDS Clinical Trial Group (ACTG) Study 193A(1 309 patients in total, classified into 4 age groups). Results from the output-oriented BCC model show that Treatment 4 ( 600 mg of zidovudine plus 400 mg of didanosine plus 400 mg of nevirapine) is particularly efficient for age group 14—25, but not efficient for the older age groups; Treatment 1 (600 mg of zidovudine alternating monthly with 400 mg of didanosine)and Treatment 2 (600 mg of zidovudine plus 2.25 mg of zalcitabine) are efficient for the age groups 35—45 and 45— ; age group 25—35 does not have a particularly efficient treatment, but Treatments 1 and 2 are relatively good. The cost efficiency BCC model, which takes the treatment cost into account, gives similar results as the output-oriented model. Results from the indirect output-oriented BCC model, which allows the replacement among medicines, show that the efficiency of Treatment 2 has greatly decreased compared with that of the output-oriented model, and a set of optimal medicine amounts for different age groups is obtained.展开更多
Parabolic trough collectors （PTCs） are employed for a variety of applications including steam generation and hot water generation. This paper deals with the experimental results and an economic analysis of a new fib...Parabolic trough collectors （PTCs） are employed for a variety of applications including steam generation and hot water generation. This paper deals with the experimental results and an economic analysis of a new fibre reinforced plastic （FRP） based solar PTC with an embedded electronic controlled tracking system designed and developed for hot water generation in a restaurant in Madurai, India. The new collector performance has been tested according to ASHRAE Standard 93 （1986）. The performance of a new PTC hot water generation system with a well mixed hot water storage tank is investigated by a series of extensive tests over ten months period. The average maximum storage tank water temperature observed was 74.91℃, when no energy is withdrawn from the tank to the load during the collection period. The total cost of the new economic FRP based solar PTC for hot water generation with an embedded electronic controlled tracking system is Rs. 25000 （US$ 573） only. In the present work, life cycle savings （LCS） method is employed for a detailed economic analysis of the PTC system. A computer program is used as a tool for the economic analysis. The present worth of life cycle solar savings is evaluated for the new solar PTC hot water generation system that replaces an existing electric water heating system in the restaurant and attains a value of Rs. 23171.66 after 15 years, which is a significant saving. The LCS method and the MATLAB computer simulation program presented in this paper can be used to estimate the LCS of other renewable energy systems.展开更多
AIM:To study the cost-effectiveness of high-resolution microendoscopy(HRME)in an esophageal squamous cell carcinoma(ESCC)screening program in China.METHODS:A decision analytic Markov model of ESCC was developed.Separa...AIM:To study the cost-effectiveness of high-resolution microendoscopy(HRME)in an esophageal squamous cell carcinoma(ESCC)screening program in China.METHODS:A decision analytic Markov model of ESCC was developed.Separate model analyses were conducted for cohorts consisting of an averagerisk population or a high-risk population in China.Hypothetical 50-year-old individuals were followed until age 80 or death.We compared three different strategies for both cohorts:(1)no screening;(2)standard endoscopic screening with Lugol’s iodine staining;and(3)endoscopic screening with Lugol’s iodine staining and an HRME.Model parameters were estimated from the literature as well as from GLOBOCAN,the Cancer Incidence and Mortality Worldwide cancer database.Health states in the model included non-neoplasia,mild dysplasia,moderate dysplasia,high-grade dysplasia,intramucosal carcinoma,operable cancer,inoperable cancer,and death.Separate ESCC incidence transition rates were generated for the average-risk and high-risk populations.Costs in Chinese currency were converted to international dollars(I$)and were adjusted to 2012dollars using the Consumer Price Index.RESULTS:The main outcome measurements for this study were quality-adjusted life years(QALYs)and incremental cost-effectiveness ratio(ICER).For the average-risk population,the HRME screening strategy produced 0.043 more QALYs than the no screening strategy at an additional cost of I$646,resulting in an ICER of I$11808 per QALY gained.Standard endoscopic screening was weakly dominated.Among the high-risk population,when the HRME screening strategy was compared with the standard screening strategy,the ICER was I$8173 per QALY.For both the high-risk and average-risk screening populations,the HRME screening strategy appeared to be the most cost-effective strategy,producing ICERs below the willingness-topay threshold,I$23500 per QALY.One-way sensitivity analysis showed that,for the average-risk population,higher specificity of Lugol’s iodine(>40%)and lower specificity of HRME(<70%)could make Lugol’s iodine screening cost-effective.For the high-risk population,the results of the model were not substantially affected by varying the follow-up rate after Lugol’s iodine screening,Lugol’s iodine test characteristics(sensitivity and specificity),or HRME specificity.CONCLUSION:The incorporation of HRME into an ESCC screening program could be cost-effective in China.Larger studies of HRME performance are needed to confirm these findings.展开更多
AIM: To examine the cost benefit conferred by the perioperative administration of intravenous tranexamic acid(TXA) in lower limb arthroplasty.METHODS: This study evaluates the use of TXA in 200 consecutive lower limb ...AIM: To examine the cost benefit conferred by the perioperative administration of intravenous tranexamic acid(TXA) in lower limb arthroplasty.METHODS: This study evaluates the use of TXA in 200 consecutive lower limb arthroplasties performed in a single surgeon series. The initial 100 patients(control group) underwent surgery without perioperative administration of TXA while the subsequent 100 patients(TXA group) all received 1 g TXA at the time of induction of anaesthesia. Pre- and post-operative haemoglobin, platelet count, haematocrit, the use of blood product post-operatively, length of stay were examined. A financial analysis of both groups was then undertaken. RESULTS: The mean age of patients in both groups was 63 ± 13 years. There were no significant differences between groups in terms of gender(P = 0.47), proportion of total hip replacement to total knee replacement(P = 0.25) or pre-operative haemoglobin(P = 0.43). In the control group, the transfusion rate was 22%. In the TXA group, the transfusion rate dropped to 2%(P < 0.001). The mean post-operative haemoglobin was 10.82 ± 1.55g/dL in the control group vs 11.33 ± 1.27 g/dL in the TXA group(P = 0.01). The total cost of transfused blood products was €11055 and €603 respectively. The mean length of stay in the control group was 6.53 ± 5.93 d vs 5.47 ± 4.26 d in the TXA group(P = 0.15) leading to an estimated financial saving of €114586. There was one pulmonary embolus in the control group and one deep venous thrombosis in the TXA group.CONCLUSION: Intravenous TXA reduces blood loss in lower limb arthroplasty. This leads to lower transfusion rates, shorter length of stay in hospital and significant financial savings.展开更多
Costs for seawater desalination have dropped significantly over the past decade due to technological advances. This has increased the attractiveness of desalination to policy-makers as a means to address water supply ...Costs for seawater desalination have dropped significantly over the past decade due to technological advances. This has increased the attractiveness of desalination to policy-makers as a means to address water supply shortages. Israel, a country that faces chronic water scarcity, is in the process of developing wide-scale desalination capacity that is projected to supply all of the nation's domestic water use within a few years. Two issues are often neglected, however, by policy-makers pursuing desalination. The first is that seawater desalination is associated with a number of external costs, consideration of which may influence the optimal scale and timing of desalination implementation. The second is that alternative measures for managing water scarcity, including conservation techniques, are often more cost-efficient. This study estimates the full cost of desalination in Israel, including externalities, and then compares this to the costs of several alternative options for addressing water scarcity, including both demand management and supply augmentation measures. We find that desalination, despite being the primary policy option pursued by Israel, is among the least cost-efficient of all the alternatives considered, even without taking into account the externalities involved.展开更多
Background:Soccer injuries constitute an important public health problem and cause a high economic burden.Nevertheless,comprehensive data regarding injury costs in nonprofessional soccer are missing.The aim of this st...Background:Soccer injuries constitute an important public health problem and cause a high economic burden.Nevertheless,comprehensive data regarding injury costs in nonprofessional soccer are missing.The aim of this study was to determine which groups of nonprofessional soccer athletes,injury types,and injury situations caused high injury costs.Methods:A cross-sectional,retrospective telephone survey was carried out with a random sample of persons who had sustained a soccer injury between July 2013 and June 2014 and who had reported this accident to the Swiss National Accident Insurance Fund(Suva).One year after the corresponding accident,every injury was linked to its costs and to the answers obtained in the interview about injury setting,injury characteristics,and injury causes.Finally,the costs of 702 injuries were analyzed.Results:The average cost of an injury in nonprofessional soccer amounted to€4030(bias-corrected and accelerated 95%confidence interval(BCa 95%CI):3427-4719).Persons aged 30 years and older experienced 35%of soccer injuries but accounted for 49%of all costs.A total of58%of all costs were the result of injuries that occurred during amateur games.In particular,game injuries sustained by players in separate leagues for players aged 30+/40+years led to high average costs of€8190(BCa 95%CI:5036-11,645).Knee injuries accounted for 25%of all injuries and were responsible for 53%of all costs.Although contact and foul play did not lead to above-average costs,twisting or turning situations were highly cost relevant,leading to an average sum of€7710(BCa 95%CI:5376-10,466)per injury.Conclusion:Nonprofessional soccer players aged 30 years and older and particularly players in 30+/40+leagues had above-average injury costs.Furthermore,the prevention of knee injuries,noncontact and nonfoul play injuries,and injuries caused by twisting and turning should be of highest priority in decreasing health care costs.展开更多
BACKGROUND Increasing numbers of total joint arthroplasties and consecutive revision surgery are associated with the risk of periprosthetic joint infections (PPJI). Treatment of PPJI is complex and associated with imm...BACKGROUND Increasing numbers of total joint arthroplasties and consecutive revision surgery are associated with the risk of periprosthetic joint infections (PPJI). Treatment of PPJI is complex and associated with immense socio-economic burden. One treatment aspect is parenteral antiinfective therapy, which usually requires an inpatient setting [Inpatient parenteral antibiotic therapy (IPAT)]. An alternative is outpatient parenteral treatment [Outpatient parenteral antibiotic therapy (OPAT)]. To conduct a health economic cost-benefit analysis of OPAT, a detailed cost analysis of IPAT and OPAT is required. So far, there is a lack of knowledge on the health economic effects of IPAT and OPAT for PPJI. AIM To review an economic comparison of IPAT and OPAT. METHODS A systematic literature review was performed through Medline following the PRISMA guidelines. RESULTS Of 619 identified studies, 174 included information of interest and 21 studies were included for quantitative analysis of OPAT and IPAT costs. Except for one study, all showed relevant cost savings for OPAT compared to IPAT. Costs for IPAT were between 1.10 to 17.34 times higher than those for OPAT. CONCLUSION There are only few reports on OPAT for PPJI. Detailed analyses to support economic or clinical guidelines are therefore limited. There is good clinical evidence supporting economic benefits of OPAT, but more high quality studies are needed for PPJI.展开更多
文摘Green building construction typically incurs higher costs than conventional methods.To facilitate broader adoption by construction entities,cost optimization is essential.Firms must align with technological advancements,judiciously apply emerging technologies,and ensure resource efficiency through context-specific strategies.Proactive and precise scheduling is critical to avert delays from unforeseen events.Additionally,construction units should enhance on-site safety training,promote mastery of innovative techniques,and foster environmental awareness among personnel.Finally,companies ought to capitalize on government incentives for green materials while adopting bulk procurement from local sources to minimize transportation costs and secure lower unit prices.
基金funded by National Institute for Health Research(NIHR)(RP-PG-1212-20019)。
文摘To the editor:Peer workers-people with personal experiences of using mental health services,trained to provide support to others currently using similar services--are increasingly integrated into the workforce of mental health systems internationally.
文摘BACKGROUND Although substantial evidence supports the advantages of cold snare polypectomy(CSP)in terms of polypectomy efficacy and reduced postoperative adverse events,few studies have examined the cost differences between CSP and traditional endoscopic mucosal resection(EMR)for the treatment of intestinal polyps.AIM To compare the efficacy-cost of EMR and CSP in the treatment of intestinal polyps.METHODS A total of 100 patients with intestinal polyps were included in the retrospective data of our hospital from April 2022 to May 2023.According to the treatment methods,they were divided into EMR(n=46)group and CSP(n=54)group.The baseline data of the two groups were balanced by 1:1 propensity score matching(PSM),and the cost-effectiveness analysis was performed on the two groups after matching.The recurrence rate of the two groups of patients was followed up for 1 year,and they were divided into recurrence group and non-recurrence group according to whether they recurred.Multivariate logistic regression analysis was used to screen out the influencing factors affecting the recurrence of intestinal polyps after endoscopic resection.RESULTS Significant disparities were observed in the number of polyps and smoking background between the two groups before PSM(P<0.05).Following PSM,the number of polyps and smoking history were well balanced between the EMR and CSP groups.The direct cost incurred by the CSP group was markedly higher than that incurred by the EMR group.Concurrently,the cost-effectiveness ratio in the CSP group was substantially reduced when juxtaposed with that in the EMR group(P<0.05).Upon completion of the 1-year follow-up,the rate of recurrence after endoscopic intestinal polypectomy was 38.00%.Multivariate methods revealed that age≥60 years,male sex,number of polyps≥3,and pathological type of adenoma were risk factors for recurrence after endoscopic intestinal polypectomy(all P<0.05).CONCLUSION CSP was more cost-effective for the treatment of intestinal polyps.An age≥60 years,male sex,having a number of polyps≥3,and pathological type of adenoma are independent influencing factors for recurrence.
基金The Science and Technology Project of Jiangsu Provincial Communications Department(No.7621000078)
文摘Pavement performance and economic efficiency are researched on the perpetual test pavement of Yijiang-Suzhou Express Highway in Jiangsu province, China. Test sections were continuously monitored. The conditions and developing laws of deflection, rutting and cracking are compared among the perpetual pavement with the rich binder layer （RBL）, the perpetual pavement without the RBL, and the conventional semi-rigid asphalt pavement in the past eight years after opening for traffic. Economical evaluation is conducted via life cycle cost analysis （LCCA）. Based on the performance comparison and LCCA analysis, sections with the RBL have good crack resistance, but they are not very satisfactory in the aspect of permanent deformation; the conventional semi-rigid asphalt pavement is the least economic one due to requiring more frequent maintenance. Research results show that the perpetual pavement without RBL is a more appropriate structure for the test site.
文摘Objective:Treatment options for metastatic castration resistant prostate cancer(mCRPC)have expanded rapidly in recent years.Given the significant economic burden,we sought perform a cost-effectiveness analysis(CEA)of the contemporary treatment paradigm for mCRPC.Methods:We devised a treatment protocol consisting of sipuleucel-T,enzalutamide,abiraterone,docetaxel,radium-223,and cabazitaxel.We estimated number and length of treatments for each therapy using dosing schedules or progression free survival data from published clinical trials.We estimated treatment cost using billing data and Medicare reimbursement values and performed a CEA.Our analysis assumed US$100,000 per life year saved(LYS)as the threshold societal willingness to pay.Results:Incremental cost-effectiveness ratios(ICER)for strategies incorporating sipuleucel-T that were not eliminated by extended dominance exceeded the societal threshold willingnessto-pay of US$100,000 per LYS,the lowest of which was sipuleucel-T+enzalutamide+abiraterone+docetaxel at US$207,714 per LYS.Enzalutamide+abiraterone+docetaxel exhibited the most favorable ICER among strategies without sipuleucel-T at US$165,460 per LYS.Conclusion:Based on the available survival data and current costs of treatment,all treatment strategies greatly exceed a commonly assumed societal willingness-to-pay threshold of US$100,000 per LYS.Improvements in this regard can only comewith a reduction in pricing,better tailoring of treatment or significant enhancements in survival with clinical use of treatment combinations or sequences.
基金Supported by the Natural Science Foundation of China(11201428,11471286,11701518)the Natural Science Foundation of Zhejiang Province(Y6110091)the Graduate Innovation Project of Zhejiang Sci-Tech University(YCX12001,YCX13005)
文摘In this paper,a new price is given to the online decision maker at the beginning of each day.The trader must decide how many items to purchase according to the current price.We present three variants and an online algorithm based on cost function.The competitive ratio of the online algorithm is given for each variant,which is a performance measure of an online algorithm.More importantly,we show that the online algorithm is optimal.
文摘AIM: To evaluate the management, clinical outcome and cost implications of three different treatment regimes for simple elbow dislocations.METHODS: Following institutional board approval, we performed a retrospective review of all consecutive patients treated for simple elbow dislocations in a Level Ⅰ trauma centre between January 2008 and December 2010. Based on the length of elbow immobilisation(LOI), patients were divided in three groups(Group I, < 2 wk; Group Ⅱ, 2-3 wk; and Group Ⅲ, > 3 wk). Outcome was considered satisfactory when a patient could achieve a pain-free range of motion ≥ 100°(from 30° to 130°). The associated direct medical costs for the treatment of each patient were then calculated and analysed.RESULTS: We identified 80 patients who met the inclusion criteria. Due to loss to follow up, 13 patients were excluded from further analysis, leaving 67 patients for the final analysis. The mean LOI was 14 d(median 15 d; range 3-43 d) with a mean duration of hospital engagement of 67 d(median 57 d; range 10-351 d). Group Ⅲ(prolonged immobilisation) had a statistically significant worse outcome in comparison to Group Ⅰ?and Ⅱ(P = 0.04 and P = 0.01 respectively); however, there was no significant difference in the outcome between groups Ⅰ?and Ⅱ(P = 0.30). No statistically significantdifference in the direct medical costs between the groups was identified.CONCLUSION: The length of elbow immobilization doesn't influence the medical cost; however immobilisation longer than three weeks is associated with persistent stiffness and a less satisfactory clinical outcome.
文摘Accurate cost estimation at the early stage of a construction project is key factor in a project’s success. But it is difficult to quickly and accurately estimate construction costs at the planning stage, when drawings, documentation and the like are still incomplete. As such, various techniques have been applied to accurately estimate construction costs at an early stage, when project information is limited. While the various techniques have their pros and cons, there has been little effort made to determine the best technique in terms of cost estimating performance. The objective of this research is to compare the accuracy of three estimating techniques (regression analysis (RA), neural network (NN), and support vector machine techniques (SVM)) by performing estimations of construction costs. By comparing the accuracy of these techniques using historical cost data, it was found that NN model showed more accurate estimation results than the RA and SVM models. Consequently, it is determined that NN model is most suitable for estimating the cost of school building projects.
文摘Agroforestry and beekeeping are widely promoted as prospective Nature-</span></span><span><span><span style="font-family:""> </span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">Based Income Generating Activities (NIGAs) to improve livelihoods while at </span><span style="font-family:Verdana;">the same time enhancing biodiversity conservation in degrading</span><span style="font-family:Verdana;"> agro-ecologies. These activities can diversify and increase famers’ incomes and support in</span><span style="font-family:Verdana;">stinctive biota and fauna resilience. However, evidence to showcase and compare their long-term benefits is scant. We use the case of Uluguru</span><span style="font-family:Verdana;"> Mountains in Tanzania to evaluate and compare viability of agroforestry and beekeeping projects using the Cost</span></span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">Benefit Analysis (CBA) approach. The results of analysis yielded positive NPVs for both agroforestry and beekeeping projects at discount rates not higher than 8.2% and 8.5% respectively. Overall, the comparison of economic viability between agroforestry and beekeeping projects revealed that the former was relatively more profitable than the later in terms of both the NPV and Benefit</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">Cost Ratio (BCR) criteria. However, the Internal Rate of Return (IRR) for beekeeping was slightly higher than that of agroforestry. Yet, we underscore the fact that these two projects can jointly be implemented to enhance livelihoods of farmers and support biodiversity conservation in the study </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">area </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">and other parts with similar agro-ecologies in developing countries. However, farmers in these agro-ecologies need to be supported by governments and non-government development partners in terms of training and inspiration to shift from orthodox farming to sustainable NIGAs.
文摘Anthrax is an infection caused by bacteria and it affects both human and animal populations. The disease can be categorized under zoonotic diseases and humans can contract infections through contact with infected animals, ingest contaminated dairy and animal products. In this paper, we developed a mathematical model for anthrax transmission dynamics in both human and animal populations with optimal control. The qualitative solution of the model behaviour was analyzed by determining Rhv, equilibrium points and sensitivity analysis. A vaccination class was incorporated into the model with waning immunity. Local and global stability of the model’s equilibria was found to be locally asymptotically stable whenever Rhv Rhv. It was revealed that reducing animal and human interaction rate, would decrease Rhv. We extended the model to optimal control in order to find the best control strategy in reducing anthrax infections. It showed that the effective strategy in combating the anthrax epidemics is vaccination of animals and prevention of humans.
文摘This study analyzes the sample influx (samples per case file) into forensic science laboratory (FSL) and the corresponding analysis costs and uses arbitrary re-sampling plans to establish the minimum cost function. The demand for forensic analysis increased for all disciplines, especially biology/DNA between 2014 and 2015. While the average distribution of case files was about 42.5%, 40.6% and 17% for the three disciplines, the distribution of samples was rather different being 12%, 82.5% and 5.5% for samples requiring forensic biology, chemistry and toxicology analysis, respectively. Results show that most of the analysis workload was on forensic chemistry analysis. The cost of analysis for case files and the corresponding sample influx varied in the ratio of 35:6:1 and 28:12:1 for forensic chemistry, biology/DNA and toxicology for year 2014 for 2015, respectively. In the two consecutive years, the cost for forensic chemistry analysis was comparatively very high, necessitating re-sampling. The time series of sample influx in all disciplines are strongly stochastic, with higher magnitude for chemistry, biology/DNA and toxicology, in this order. The PDFs of sample influx data are highly skewed to the right, especially forensic toxicology and biology/DNA with peaks at 1 and 3 samples per case file. The arbitrary re-sampling plans were best suited to forensic chemistry case files (where re-sampling conditions apply). The locus of arbitrary number of samples to take from the submitted forensic samples was used to establish the minimum and scientifically acceptable samples by applying minimization function developed in this paper. The cost minimization function was also developed based on the average cost per sample and choice of re-sampling plans depending on the range of sample influx, from which the savings were determined and maximized. Thus, the study gives a forensic scientist a business model and scientific decision making tool on minimum number of samples to analyze focusing on savings on analysis cost.
文摘AIM: To analyze and calculate the relative cost of various childhood glaucoma surgical interventions per mm Hg intraocular pressure(IOP) reduction($/mm Hg).METHODS: Representative index studies were reviewed to quantitate the reduction of mean IOP and glaucoma medications for each surgical intervention in childhood glaucoma. A US perspective was adopted, using Medicare allowable costs to calculate cost/mm Hg IOP reduction($/mm Hg) at 1y postoperatively.RESULTS: At 1y postoperatively, the cost/mm Hg IOP reduction was $226/mm Hg for microcatheter-assisted circumferential trabeculotomy, $284/mm Hg for cyclophotocoagulation, $288/mm Hg for conventional ab-externo trabeculotomy, $338/mm Hg for Ahmed glaucoma valve, $350/mm Hg for Baerveldt glaucoma implant, $351/mm Hg for goniotomy, and $400/mm Hg for trabeculectomy.CONCLUSION: Microcatheter-assisted circumferential trabeculotomy is the most cost-efficient surgical method to lower IOP in childhood glaucoma, while trabeculectomy is the least cost-efficient surgical method.
基金National Natural Science Foundation of China (No 10571134)
文摘Three data envelopment analysis (DEA) models were used to analyse the relative efficiencies of four AIDS treatments in AIDS Clinical Trial Group (ACTG) Study 193A(1 309 patients in total, classified into 4 age groups). Results from the output-oriented BCC model show that Treatment 4 ( 600 mg of zidovudine plus 400 mg of didanosine plus 400 mg of nevirapine) is particularly efficient for age group 14—25, but not efficient for the older age groups; Treatment 1 (600 mg of zidovudine alternating monthly with 400 mg of didanosine)and Treatment 2 (600 mg of zidovudine plus 2.25 mg of zalcitabine) are efficient for the age groups 35—45 and 45— ; age group 25—35 does not have a particularly efficient treatment, but Treatments 1 and 2 are relatively good. The cost efficiency BCC model, which takes the treatment cost into account, gives similar results as the output-oriented model. Results from the indirect output-oriented BCC model, which allows the replacement among medicines, show that the efficiency of Treatment 2 has greatly decreased compared with that of the output-oriented model, and a set of optimal medicine amounts for different age groups is obtained.
文摘Parabolic trough collectors （PTCs） are employed for a variety of applications including steam generation and hot water generation. This paper deals with the experimental results and an economic analysis of a new fibre reinforced plastic （FRP） based solar PTC with an embedded electronic controlled tracking system designed and developed for hot water generation in a restaurant in Madurai, India. The new collector performance has been tested according to ASHRAE Standard 93 （1986）. The performance of a new PTC hot water generation system with a well mixed hot water storage tank is investigated by a series of extensive tests over ten months period. The average maximum storage tank water temperature observed was 74.91℃, when no energy is withdrawn from the tank to the load during the collection period. The total cost of the new economic FRP based solar PTC for hot water generation with an embedded electronic controlled tracking system is Rs. 25000 （US$ 573） only. In the present work, life cycle savings （LCS） method is employed for a detailed economic analysis of the PTC system. A computer program is used as a tool for the economic analysis. The present worth of life cycle solar savings is evaluated for the new solar PTC hot water generation system that replaces an existing electric water heating system in the restaurant and attains a value of Rs. 23171.66 after 15 years, which is a significant saving. The LCS method and the MATLAB computer simulation program presented in this paper can be used to estimate the LCS of other renewable energy systems.
基金Supported by National Institutes of Health,United States,No.R01-CA140574 and No.U01-CA152926(to Hur C)No.R21-CA156704 and No.R01-CA181275(to Anandasabapathy S)and No.K25-CA133141(to Kong CY)
文摘AIM:To study the cost-effectiveness of high-resolution microendoscopy(HRME)in an esophageal squamous cell carcinoma(ESCC)screening program in China.METHODS:A decision analytic Markov model of ESCC was developed.Separate model analyses were conducted for cohorts consisting of an averagerisk population or a high-risk population in China.Hypothetical 50-year-old individuals were followed until age 80 or death.We compared three different strategies for both cohorts:(1)no screening;(2)standard endoscopic screening with Lugol’s iodine staining;and(3)endoscopic screening with Lugol’s iodine staining and an HRME.Model parameters were estimated from the literature as well as from GLOBOCAN,the Cancer Incidence and Mortality Worldwide cancer database.Health states in the model included non-neoplasia,mild dysplasia,moderate dysplasia,high-grade dysplasia,intramucosal carcinoma,operable cancer,inoperable cancer,and death.Separate ESCC incidence transition rates were generated for the average-risk and high-risk populations.Costs in Chinese currency were converted to international dollars(I$)and were adjusted to 2012dollars using the Consumer Price Index.RESULTS:The main outcome measurements for this study were quality-adjusted life years(QALYs)and incremental cost-effectiveness ratio(ICER).For the average-risk population,the HRME screening strategy produced 0.043 more QALYs than the no screening strategy at an additional cost of I$646,resulting in an ICER of I$11808 per QALY gained.Standard endoscopic screening was weakly dominated.Among the high-risk population,when the HRME screening strategy was compared with the standard screening strategy,the ICER was I$8173 per QALY.For both the high-risk and average-risk screening populations,the HRME screening strategy appeared to be the most cost-effective strategy,producing ICERs below the willingness-topay threshold,I$23500 per QALY.One-way sensitivity analysis showed that,for the average-risk population,higher specificity of Lugol’s iodine(>40%)and lower specificity of HRME(<70%)could make Lugol’s iodine screening cost-effective.For the high-risk population,the results of the model were not substantially affected by varying the follow-up rate after Lugol’s iodine screening,Lugol’s iodine test characteristics(sensitivity and specificity),or HRME specificity.CONCLUSION:The incorporation of HRME into an ESCC screening program could be cost-effective in China.Larger studies of HRME performance are needed to confirm these findings.
文摘AIM: To examine the cost benefit conferred by the perioperative administration of intravenous tranexamic acid(TXA) in lower limb arthroplasty.METHODS: This study evaluates the use of TXA in 200 consecutive lower limb arthroplasties performed in a single surgeon series. The initial 100 patients(control group) underwent surgery without perioperative administration of TXA while the subsequent 100 patients(TXA group) all received 1 g TXA at the time of induction of anaesthesia. Pre- and post-operative haemoglobin, platelet count, haematocrit, the use of blood product post-operatively, length of stay were examined. A financial analysis of both groups was then undertaken. RESULTS: The mean age of patients in both groups was 63 ± 13 years. There were no significant differences between groups in terms of gender(P = 0.47), proportion of total hip replacement to total knee replacement(P = 0.25) or pre-operative haemoglobin(P = 0.43). In the control group, the transfusion rate was 22%. In the TXA group, the transfusion rate dropped to 2%(P < 0.001). The mean post-operative haemoglobin was 10.82 ± 1.55g/dL in the control group vs 11.33 ± 1.27 g/dL in the TXA group(P = 0.01). The total cost of transfused blood products was €11055 and €603 respectively. The mean length of stay in the control group was 6.53 ± 5.93 d vs 5.47 ± 4.26 d in the TXA group(P = 0.15) leading to an estimated financial saving of €114586. There was one pulmonary embolus in the control group and one deep venous thrombosis in the TXA group.CONCLUSION: Intravenous TXA reduces blood loss in lower limb arthroplasty. This leads to lower transfusion rates, shorter length of stay in hospital and significant financial savings.
文摘Costs for seawater desalination have dropped significantly over the past decade due to technological advances. This has increased the attractiveness of desalination to policy-makers as a means to address water supply shortages. Israel, a country that faces chronic water scarcity, is in the process of developing wide-scale desalination capacity that is projected to supply all of the nation's domestic water use within a few years. Two issues are often neglected, however, by policy-makers pursuing desalination. The first is that seawater desalination is associated with a number of external costs, consideration of which may influence the optimal scale and timing of desalination implementation. The second is that alternative measures for managing water scarcity, including conservation techniques, are often more cost-efficient. This study estimates the full cost of desalination in Israel, including externalities, and then compares this to the costs of several alternative options for addressing water scarcity, including both demand management and supply augmentation measures. We find that desalination, despite being the primary policy option pursued by Israel, is among the least cost-efficient of all the alternatives considered, even without taking into account the externalities involved.
基金funded and supported by the Swiss National Accident Insurance Fund(Suva)。
文摘Background:Soccer injuries constitute an important public health problem and cause a high economic burden.Nevertheless,comprehensive data regarding injury costs in nonprofessional soccer are missing.The aim of this study was to determine which groups of nonprofessional soccer athletes,injury types,and injury situations caused high injury costs.Methods:A cross-sectional,retrospective telephone survey was carried out with a random sample of persons who had sustained a soccer injury between July 2013 and June 2014 and who had reported this accident to the Swiss National Accident Insurance Fund(Suva).One year after the corresponding accident,every injury was linked to its costs and to the answers obtained in the interview about injury setting,injury characteristics,and injury causes.Finally,the costs of 702 injuries were analyzed.Results:The average cost of an injury in nonprofessional soccer amounted to€4030(bias-corrected and accelerated 95%confidence interval(BCa 95%CI):3427-4719).Persons aged 30 years and older experienced 35%of soccer injuries but accounted for 49%of all costs.A total of58%of all costs were the result of injuries that occurred during amateur games.In particular,game injuries sustained by players in separate leagues for players aged 30+/40+years led to high average costs of€8190(BCa 95%CI:5036-11,645).Knee injuries accounted for 25%of all injuries and were responsible for 53%of all costs.Although contact and foul play did not lead to above-average costs,twisting or turning situations were highly cost relevant,leading to an average sum of€7710(BCa 95%CI:5376-10,466)per injury.Conclusion:Nonprofessional soccer players aged 30 years and older and particularly players in 30+/40+leagues had above-average injury costs.Furthermore,the prevention of knee injuries,noncontact and nonfoul play injuries,and injuries caused by twisting and turning should be of highest priority in decreasing health care costs.
文摘BACKGROUND Increasing numbers of total joint arthroplasties and consecutive revision surgery are associated with the risk of periprosthetic joint infections (PPJI). Treatment of PPJI is complex and associated with immense socio-economic burden. One treatment aspect is parenteral antiinfective therapy, which usually requires an inpatient setting [Inpatient parenteral antibiotic therapy (IPAT)]. An alternative is outpatient parenteral treatment [Outpatient parenteral antibiotic therapy (OPAT)]. To conduct a health economic cost-benefit analysis of OPAT, a detailed cost analysis of IPAT and OPAT is required. So far, there is a lack of knowledge on the health economic effects of IPAT and OPAT for PPJI. AIM To review an economic comparison of IPAT and OPAT. METHODS A systematic literature review was performed through Medline following the PRISMA guidelines. RESULTS Of 619 identified studies, 174 included information of interest and 21 studies were included for quantitative analysis of OPAT and IPAT costs. Except for one study, all showed relevant cost savings for OPAT compared to IPAT. Costs for IPAT were between 1.10 to 17.34 times higher than those for OPAT. CONCLUSION There are only few reports on OPAT for PPJI. Detailed analyses to support economic or clinical guidelines are therefore limited. There is good clinical evidence supporting economic benefits of OPAT, but more high quality studies are needed for PPJI.
