Analysis of the costs of teleconsultation for the treatment of diabetes mellitus in the SUS.

OBJECTIVE: To present the results of a cost analysis of remote consultations (teleconsultations) compared to in-person consultations for patients with type 2 diabetes, in the Brazilian public healthcare system (SUS) in the city of Joinville, Santa Catarina (SC). In addition to the costs from the local manager's perspective, the article also presents estimates from the patient's perspective, based on the transportation costs associated with each type of consultation. METHOD: Data were collected from 246 consultations, both remote and in-person, between 2021 and 2023, in the context of a randomized clinical trial on the impact of teleconsultation carried out in the city of Joinville, SC. Teleconsultations were carried out at Primary Health Units (PHU) and in-person consultations at the Specialized Health Center. The consultation costs were calculate by the method time and activity-based costing (TDABC), and for the estimate of transportation costs data was collected directly from the research participants . The mean costs and time required to carry out each type of consultation in different scenarios and perspectives were analyzed and compared descriptively. RESULTS: Considering only the local SUS manager's perspective, the costs for carrying out a teleconsultation were 4.5% higher than for an in-person consultation. However, when considering the transportation costs associated with each patient, the estimated value of the in-person consultation becomes 7.7% higher and, in the case of consultations in other municipalities, 15% higher than the teleconsultation. CONCLUSION: The results demonstrate that the incorporation of teleconsultation within the SUS can bring economic advantages depending on the perspective and scenario considered, in addition to being a strategy with the potential to increase access to specialized care in the public network.

Implementation of a multi-site neonatal simulation improvement program: a cost analysis.

BACKGROUND: To improve patient outcomes and provider team practice, the California Perinatal Quality Care Collaborative (CPQCC) created the Simulating Success quality improvement program to assist hospitals in implementing a neonatal resuscitation training curriculum. This study aimed to examine the costs associated with the design and implementation of the Simulating Success program. METHODS: From 2017-2020, a total of 14 sites participated in the Simulating Success program and 4 of them systematically collected resource utilization data. Using a micro-costing approach, we examined costs for the design and implementation of the program occurring at CPQCC and the 4 study sites. Data collection forms were used to track personnel time, equipment/supplies, space use, and travel (including transportation, food, and lodging). Cost analysis was conducted from the healthcare sector perspective. Costs incurred by CPQCC were allocated to participant sites and then combined with site-specific costs to estimate the mean cost per site, along with its 95% confidence interval (CI). Cost estimates were inflation-adjusted to 2022 U.S. dollars. RESULTS: Designing and implementing the Simulating Success program cost $228,148.36 at CPQCC, with personnel cost accounting for the largest share (92.2%), followed by program-related travel (6.1%), equipment/supplies (1.5%), and space use (0.2%). Allocating these costs across participant sites and accounting for site-specific resource utilizations resulted in a mean cost of $39,210.69 per participant site (95% CI: $34,094.52-$44,326.86). In sensitivity analysis varying several study assumptions (e.g., number of participant sites, exclusion of design costs, and useful life span of manikins), the mean cost per site changed from $35,645.22 to $39,935.73. At all four sites, monthly cost of other neonatal resuscitation training was lower during the program implementation period (mean = $1,112.52 per site) than pre-implementation period (mean = $2,504.01 per site). In the 3 months after the Simulating Success program ended, monthly cost of neonatal resuscitation training was also lower than the pre-implementation period at two of the four sites. CONCLUSIONS: Establishing a multi-site neonatal in situ simulation program requires investment of sufficient resources. However, such programs may have financial and non-financial benefits in the long run by offsetting the need for other neonatal resuscitation training and improving practice.

How do e-commerce platforms and retailers implement discount pricing policies under consumers are strategic?

In the era of the rapid development of e-commerce, many retailers choose to launch promotional activities to become consumers' first choice for shopping. Since price discounts can greatly attract consumers, the e-commerce platforms have also begun to implement discount pricing. It is urgent for e-commerce platforms and retailers to formulate reasonable discount strategies to achieve sustainable business. In this paper, we construct a dynamic game model for implementing discount pricing on an e-commerce platform and two retailers, we study the market equilibrium between the two retailers and the e-commerce platform under various scenarios that considering consumers' strategic waiting behavior and competition between the two retailers, we further discuss the effectiveness of retailer discount pricing and the double discount pricing of the platform and retailers. We show that the optimal pricing decreases as the difference in product quality narrows under both pricing strategies. Low-quality retailers implementing a double discount pricing strategy are in relatively higher demand only when the difference in product quality is small. High-quality retailers implementing the retailer discount pricing strategy are in relatively higher demand only when the product quality difference is large. Double discount pricing is desirable for both e-commerce platforms and retailers and can be used to effectively achieve Pareto improvement in the market by increasing their expected profit. Our results emphasize the role of product quality and the value of the double discount pricing strategy. The double discount pricing strategy weakens the profit advantage that retailers and platforms gain from it as the rebate intensity and rebate redemption rates increase.

Joint recommendations on cost calculation and estimation in paediatric clinical trials.

The conduct of clinical trials in paediatrics is essential to improve drug therapy in children. In Europe, paediatric clinical trials have been supported by the European Paediatric Regulation since 2007, but there is still a great need for high-quality clinical trials. The personnel and time required to conduct clinical trials in accordance with EU Regulations 536/2014 and 745/2017 is considerably higher compared to other studies, such as observational studies. It is important that this additional workload for the trial centre is fully compensated, also taking into account EU state aid rules. In paediatric trials, it is necessary to take into account the special requirements of paediatric and adolescent medicine when calculating the additional costs. Within the framework of the pan-European paediatric study network c4c/GermanNetPaeT, a working group dealt with specific aspects of cost calculation in order to support paediatric study centres in internal cost calculation as well as in the subsequent preparation of financing requirements for industrial sponsors or public funders. In several workshops the working group developed a cost calculation template with the content derived from the "Joint recommendations for a total services account as a factor in simplifying contracts" of the Deutsche Hochschulmedizin (DHM, German University Medicine), the Netzwerk der Koordinierungszentren für Klinische Studien (KKS Network, Network of Coordinating Centres for Clinical Trials) and the Verband Forschender Arzneimittelhersteller (vfa, German Association of Research-Based Pharmaceutical Companies). By estimating the specific time required for measures and investigations as part of a sample study, the background to the increased time required was discussed and a list with aspects to be considered for cost calculation was compiled together with the study centres. The paediatrics-specific aspects mentioned in detail are intended to increase understanding of the particular problem of higher costs for clinical trials involving children and adolescents and the need for correspondingly appropriate remuneration. This transparent and comprehensible presentation of the higher financial requirements for both the study centres and the financial supporters is intended to promote the high-quality conduct of clinical trials in paediatric study centres in the long term.

Customer Profitability Analysis in decision-making-The roles of customer characteristics, cost structures, and strategizing.

PURPOSE: This study investigates the interplay between strategic goals and calculative practices, specifically Customer Profitability Analysis (CPA). Drawing on practice-based theories, the research aims to understand how managers strategize with CPA, including the balancing of financial and strategic objectives and the interplay of institutionalized practices with individual practitioners' actions. DESIGN: The study uses a qualitative, revelatory, and exploratory case study approach at the sub-organizational level in a manufacturing company. The researchers compare CPA practices across six departments, guided by a phenomenological research design. Data collection methods include informal conversations, qualitative observations, written documentation, numerical evidence from the accounting system, and interviews. FINDINGS: The study offers four novel findings to the field. First, it highlights how managers employ procedural and interactive strategizing to reframe CPA practices. The sophistication of CPA practices increases with unevenly distributed customer volume, high customer-specific, controllable overhead, customer-to-customer interaction, and service complexity. Conversely, the sophistication of cost-focused CPA practices tends to decrease with diverse strategic goals. Additionally, CPA become more effective through the utilization of non-financial information, employee empowerment, localization, and strategic alignment. Second, CPA can be adapted through integrative strategizing where managers avoid using it as a financial benchmark for strategic initiatives. Third, accountants actively seek intermediary roles to incorporate arguments from strategy and marketing to balance strategic objectives-contrary to their portrayal as myopic guardians of profitability. Fourth, the localization of CPA practices to front-line employees compensates for a lack of sophisticated CPA practices. FUTURE RESEARCH: Future research should, investigate the adaptation of calculative practices in different cultures, and industries. Exploring additional contextual factors such as uncertainty, management characteristics, and linguistic framing of practices would be beneficial. Examining the interactions in utilizing CPA practices between front-line staff and customers would shed light on their effectiveness. Lastly, investigating the role of consultants in diffusing such practices would offer valuable perspectives.

Cost analysis for initiating an integrated package of essential non-communicable disease interventions (PEN-Plus) in Kondoa District Hospital, Tanzania: a time-driven activity-based costing (TDABC) study protocol.

INTRODUCTION: Non-communicable diseases (NCDs) constitute approximately 74% of global mortality, with 77% of these deaths occurring in low-income and middle-income countries. Tanzania exemplifies this situation, as the percentage of total disability-adjusted life years attributed to NCDs has doubled over the past 30 years, from 18% to 36%. To mitigate the escalating burden of severe NCDs, the Tanzanian government, in collaboration with local and international partners, seeks to extend the integrated package of essential interventions for severe NCDs (PEN-Plus) to district-level facilities, thereby improving accessibility. This study aims to estimate the cost of initiating PEN-Plus for rheumatic heart disease, sickle cell disease and type 1 diabetes at Kondoa district hospital in Tanzania. METHODS AND ANALYSIS: We will employ time-driven activity-based costing (TDABC) to quantify the capacity cost rates (CCR), and capital and recurrent costs associated with the implementation of PEN-Plus. Data on resource consumption will be collected through direct observations and interviews with nurses, the medical officer in charge and the heads of laboratory and pharmacy units/departments. Data on contact times for targeted NCDs will be collected by observing a sample of patients as they move through the care delivery pathway. Data cleaning and analysis will be done using Microsoft Excel. ETHICS AND DISSEMINATION: Ethical approval to conduct the study has been waived by the Norwegian Regional Ethics Committee and was granted by the Tanzanian National Health Research Ethics Committee NIMR/HQ/R.8a/Vol.IX/4475. A written informed consent will be provided to the study participants. This protocol has been disseminated in the Bergen Centre for Ethics and Priority Setting International Symposium, Norway and the 11th Muhimbili University of Health and Allied Sciences Scientific Conference, Tanzania in 2023. The findings will be published in peer-reviewed journals for use by the academic community, researchers and health practitioners.

Reducing delivery insurance costs through risk score model for food delivery company.

In this paper, we propose a novel pricing model for delivery insurance in a food delivery company in Latin America, with the aim of reducing the high costs associated with the premium paid to the insurer. To achieve this goal, a thorough analysis was conducted to estimate the probability of losses based on delivery routes, transportation modes, and delivery drivers' profiles. A large amount of data was collected and used as a database, and various statistical models and machine learning techniques were employed to construct a comprehensive risk profile and perform risk classification. Based on the risk classification and the estimated probability associated with it, a new pricing model for delivery insurance was developed using advanced mathematical algorithms and machine learning techniques. This new pricing model took into account the pattern of loss occurrence and high and low-risk behaviors, resulting in a significant reduction of insurance costs for both the contracting company and the insurer. The proposed pricing model also allowed for greater flexibility in insurance contracting, making it more accessible and appealing to delivery drivers. The use of estimated loss probabilities and a risk score for the pricing of delivery insurance proved to be a highly effective and efficient alternative for reducing the high costs associated with insurance, while also improving the profitability and competitiveness of the food delivery company in Latin America.

Disposable grasper-integrated flexible cystoscope for ureteral stent removal in transplanted patients; focus on feasibility, safety, and patient experience. Results and micro-cost analysis from a tertiary referral center.

INTRODUCTION & OBJECTIVES: To evaluate ureteral stent removal (SR) using a grasper-integrated disposable flexible cystoscope (giFC-Isiris ®, Coloplast ®) after kidney transplantation (KT), with a focus on feasibility, safety, patient experience, and costs. MATERIAL AND METHODS: All consecutive KT undergoing SR through giFC were prospectively enrolled from January 2020 to June 2023. Patient characteristics, KT and SR details, urine culture results, antimicrobial prescriptions, and the incidence of urinary tract infections (UTI) within 1 month were recorded. A micro-cost analysis was conducted, making a comparison with the costs of SR with a reusable FC and grasper. RESULTS: A total of 136 KT patients were enrolled, including both single and double KT, with 148 stents removed in total. The median indwelling time was 34 days [26, 47]. SR was successfully performed in all cases. The median preparation and procedure times were 4 min [3,5]. and 45 s[30, 60], respectively. The median Visual Analog Scale (VAS) score was 3 [1, 5], and 98.2% of patients expressed willingness to undergo the procedure again. Only one episode of UTI involving the graft (0.7%) was recorded. Overall, the estimated cost per SR procedure with Isiris ® and the reusable FC was 289.2€ and 151,4€, respectively. CONCLUSIONS: This prospective series evaluated the use of Isiris ® for SR in a cohort of KT patients, demonstrating feasibility and high tolerance. The UTI incidence was 0.7% within 1 month. Based on the micro-cost analysis, estimated cost per procedure favored the reusable FC.

Commentary: Pricing Cataract (and Other Straightforward) Surgeries - A Policy Perspective to Build Capacity, Value and Innovation.

Aligning with Crump and colleagues' (2024) conclusions on cataract surgery, this article champions a level playing field for expanding surgical capacities for straightforward surgeries. It is agnostic toward for-profit or not-for-profit models. It argues for experimenting with new ambulatory facilities to meet urgent needs, emphasizing Ontario's successful two-decade experience with models such as the Kensington Eye Institute. The discussion advances a three-tiered pricing framework, advocating for transparent, structured pricing to reduce wait times and improve public health outcomes. This approach seeks to balance annual commitments, quarterly adjustments and spot market needs, promoting innovation, cost-efficiency and quality care.

Investigation of the removal of diclofop methyl herbicide by peroxy electrocoagulation process and kinetic and cost analysis.

Pesticides containing chlorine, which are released during agricultural activities, are chemical substances that mix with surface and underground waters and have toxic, carcinogenic, and mutagenic effects on the entire living ecosystem. Due to their chemically stable structure, conventional water and wastewater treatment techniques such as coagulation, flocculation, and biological oxidation do not entirely remove these chemical substances. Therefore, before releasing them into the environmental receptor, these chemical substances must be transformed into harmless products or mineralized through advanced oxidation processes. When we look at the literature, there are not many studies on methods of removing diclofop methyl from aquatic media. Our study on the removal of diclofop methyl herbicide from aquatic media using the peroxy electrocoagulation method will provide the first information on this subject in the literature. In addition, this treatment method will contribute significantly to filling an important gap in the literature as an innovative approach for diclofop methyl removal. Moreover, peroxy electrocoagulation, which produces less sludge, provides treatment in a short time, and is economical, has been determined to be an advantageous process. The effects of conductivity, pH, H2O2 concentration, current, and time parameters on the removal of diclofop methyl were investigated using a GC-MS instrument. Kinetics, energy consumption, and cost calculations were also made. Under the optimum conditions determined (pH = 5, H2O2 = 500 mg/L, NaCl = 0.75 g/L, current density = 2.66 mA/cm2), the peroxydic electrocoagulation process resulted in a diclofop methyl removal efficiency of 79.2% after a 25-min reaction. When the experimental results were analyzed, it was found that the results fitted the pseudo-second-order kinetic model.

Development of novel low-cost readout electronics for large field-of-view gamma camera detectors.

PURPOSE: Large scintillation crystals-based gamma cameras play a crucial role in nuclear medicine imaging. In this study, a large field-of-view (FOV) gamma detector consisting of 48 square PMTs developed using a new readout electronics, reducing 48 (6 × 8) analog signals to 14 (6 + 8) analog sums of each row and column, with reduced complexity and cost while preserving image quality. METHODS: All 14 analog signals were converted to digital signals using AD9257 high-speed analog to digital (ADC) converters driven by the SPARTAN-6 family of field-programmable gate arrays (FPGA) in order to calculate the signal integrals. The positioning algorithm was based on the digital correlated signal enhancement (CSE) algorithm implemented in the acquisition software. The performance characteristics of the developed gamma camera were measured using the NEMA NU 1-2018 standards. RESULTS: The measured energy resolution of the developed detector was 8.7 % at 140 keV, with an intrinsic spatial resolution of 3.9 mm. The uniformity was within 0.6 %, while the linearity was within 0.1 %. CONCLUSION: The performance evaluation demonstrated that the developed detector has suitable specifications for high-end nuclear medicine imaging.

[Impact Analysis of a new, Cross-sector Service Provision of Gastroenterologic Endoscopic Services in Accordance with 115f SGB V (Hybrid-DRG): Allocation Matrix and Cost Analysis]. / Auswirkungsanalyse einer neuen, sektorenübergreifenden Erbringung bisher stationärer endoskopischer gastroenterologischer Leistungen entsprechend §115f SGB V (Hybrid-DRG): Zuordnungsmatrix und Kostenanalyse.

BACKGROUND: With the introduction of §115f SGB V, the prerequisites for "sector-equal remuneration" ('Hybrid DRG') have been created. In an impact analysis, we assigned inpatient gastroenterological endoscopic (GAEN) cases in a matrix of future hybrid DRG versus outpatient surgery (AOP) or inpatient treatment. METHODS: In selected DRGs (G47B, G67A, G67B, G67C, G71Z, H41D, H41E) an allocation matrix of GAEN cases was created on medical grounds. For this purpose, service groups from the DGVS service catalog ('Leistungskatalog') were assigned to the groups: 'Hybrid-DRG', 'AOP' and 'Inpatient' by a group of experts based on the DGVS position paper. Cost data from the DGVS-DRG project for the 2022 data year from 36 InEK calculation hospitals with a total of 232,476 GAEN cases were evaluated. RESULTS: 26 service groups from the DGVS service catalog were assigned to a "Hybrid-DRG", 24 to the "inpatient" group, and 12 to the "AOP" group. 7 performance groups were splitted "depending on the OPS code" and classified at this level. Cases with additional fees were excluded from a hybrid DRG because these cannot be agreed there.The cost analysis shows that services that are already in the AOP have a similar cost level to services that have been classified as 'Hybrid-DRG'. With the cost calculation, a cost level could be presented for the hybrid DRGs formed. CONCLUSION: Based on clearly defined structural, procedural and personnel requirements, services from suitable DRGs can be transferred to a hybrid DRG. Assigning services without the involvement of clinical experts seems extremely difficult. Case assignment based on arbitrary contextual factors increases complexity without demonstrably increasing the quality of the assignment and needs to be further developed. A cost analysis can be derived from the known inpatient costs and must serve as the basis for the 2025 Hybrid DRG catalog.

A life cycle cost analysis of different shore power incentive policies on both shore and ship sides based on system dynamics and a Chinese port case.

Shore power (SP) is widely recognized as an efficient strategy for reducing air pollution in port areas. Unfortunately, the adoption of SP has been relatively low, resulting in limited emission reductions and financial losses. To address these challenges, this paper focuses on enhancing the utilization rate of SP, which is meaningful for emission control and environmental protection. This paper combines system dynamics with a study of the benefits of SP, which bridges the research gap to some extent. We propose a system dynamics model that assesses the impact of various incentive policies on the economic and environmental benefits of SP. The model considers the life cycle cost and comprises four subsystems. By conducting a case study on Nansha Port, we find that price subsidies are more effective than construction subsidies in overcoming economic barriers. Furthermore, we observe that the overall economic benefits only increase when the electricity price decreases. This is because lowering the electricity price enhances the profitability of ships without negatively affecting port revenue. Additionally, it is the proportion of the electricity price and service price that determines the overall economic benefits, rather than the SP price itself. Hence, it is recommended to provide preferential subsidies for the electricity price.

Shifting from techno-economic to socio-ecological priorities: Incorporating landscape preferences and ecosystem services into the siting of renewable energy infrastructure.

This study examines the siting scenarios for renewable energy installations (REI) in a mountainous region of Europe (Switzerland), incorporating the external costs of ecosystem services and, innovatively, social preferences. This approach challenges the prevalent techno-economic siting paradigm, which often overlooks these externalities. To minimize the external costs of the scenarios while maximizing energy yield, Marxan, an optimization software, was employed. The energy target for all scenarios is set at 25 TWh/a, stemming from the energy gap anticipated due to the phase-out of Swiss nuclear reactors by 2050. This target is met using renewable energy infrastructure such as wind, roof-mounted photovoltaic, and ground-mounted photovoltaic systems. By integrating social preferences into the optimization, this study showcases a promising implementation that transcends the software's intended applications. It complements techno-economic approaches and offers alternative decision-making avenues. The conventional "roof first" strategy proved ineffective in preventing extensive land use for the development of new renewable energy infrastructure. Strategies incorporating ground-mounted photovoltaic infrastructure were more spatially, ecologically, and socially efficient than those without. The strategy optimized for energy yield exhibited the highest spatial efficiency but incurred significant ecosystem service costs and, surprisingly, had low social costs. In contrast, the strategy prioritizing ecosystem services was the most efficient in terms of ecosystem service costs but had elevated social costs and was spatially less efficient than other strategies. The strategy optimized for social preferences incurred the lowest social costs and excelled in spatial efficiency and ecosystem service costs. Notably, this strategy employed a limited number of planning units linked to both high ecosystem service and social costs. The findings underscore that incorporating social preferences significantly enhances the evaluation of siting options. This inclusion allows for the social acceptance of investments to be factored into costs, facilitating more informed and inclusive decisions.

Mapping the global geography of cybercrime with the World Cybercrime Index.

Cybercrime is a major challenge facing the world, with estimated costs ranging from the hundreds of millions to the trillions. Despite the threat it poses, cybercrime is somewhat an invisible phenomenon. In carrying out their virtual attacks, offenders often mask their physical locations by hiding behind online nicknames and technical protections. This means technical data are not well suited to establishing the true location of offenders and scholarly knowledge of cybercrime geography is limited. This paper proposes a solution: an expert survey. From March to October 2021 we invited leading experts in cybercrime intelligence/investigations from across the world to participate in an anonymized online survey on the geographical location of cybercrime offenders. The survey asked participants to consider five major categories of cybercrime, nominate the countries that they consider to be the most significant sources of each of these types of cybercrimes, and then rank each nominated country according to the impact, professionalism, and technical skill of its offenders. The outcome of the survey is the World Cybercrime Index, a global metric of cybercriminality organised around five types of cybercrime. The results indicate that a relatively small number of countries house the greatest cybercriminal threats. These findings partially remove the veil of anonymity around cybercriminal offenders, may aid law enforcement and policymakers in fighting this threat, and contribute to the study of cybercrime as a local phenomenon.

Optimal power-heat-carbon scheduling strategy for interconnected heterogeneous multi-microgrid considering hydrogen fuel cell vehicles.

The scale of multi-microgrid (MMG) and hydrogen fuel cell vehicles (HFCVs) is increasing dramatically with the increase in the new energy penetration ratio, and developing an integrated energy system containing a multi-microgrid for hydrogen fuel vehicles brings great challenges to power grid operation. Focusing on the difficulties of the access of multiple microgrids for the low-carbon and economic operation of the system, this paper proposes an optimal interconnected heterogeneous multi-microgrid power-heat-carbon scheduling strategy for hydrogen-fueled vehicles. Firstly, an HFCV model is established, and then an optimal scheduling model is constructed for the cooperative trading of power-heat-carbon in a multi-microgrid, on the basis of which the low-carbon economic operation of the multi-microgrid is realized. The results of the case study show that the scheduling strategy in this paper reduces carbon emissions by about 7.12% and costs by about 3.41% compared with the independent operation of the multi-microgrid. The degrees of interaction of each multi-microgrid are also analyzed under different HFCV penetration rates.