The Design of Production Strategy Based on Risk Analysis Using Process Simulation

197. Modest cost reduction associated with initial ERAS implementation in lumbar spine fusion

Does low-skilled immigration increase profits? Evidence from Italian local labour markets

Chapter 16 The cyclical behavior of prices and costs

In condition-based maintenance (CBM) with periodic inspection, the system is preventively replaced if failure risk, which is calculated based on the information obtained from inspection, exceeds a pre-determined threshold. The determination of optimal replacement threshold is often based on the minimisation of average maintenance costs per unit time due to preventive and failure replacements over a long time horizon. It is often assumed that inspections are performed at equal time intervals with no cost. However, in practice, inspections require labour, specific test devices, and sometimes suspension of operations and, thus, it is reasonable to inspect less frequently during the time the system is in its early age and/or in a healthier state and to perform inspections more frequently as time passes and/or as the system degrades. In other words, an age-based inspection scheme. This paper proposes a novel two-phase approach for the determination of an optimal replacement threshold and an optimal age-based inspection scheme for CBM such that the total long-run average costs of replacements and inspections are minimised. First, it takes into account failure and preventive replacement costs to determine the optimal replacement threshold assuming that inspections are performed at equal time intervals with no cost. This assumption is, subsequently, relaxed and its consequences on total average cost are evaluated using a proposed iterative procedure based on A* search algorithm to obtain the optimal age-based inspection scheme. The proposed approach is illustrated through a numerical example.

To estimate the cost of implementing a clinical program designed to support safer use of antipsychotics in children and adolescents (youth) age 3-17years at the time of initiating an antipsychotic medication. We calculate the costs of implementing a psychiatric consultation and navigation program for youth prescribed antipsychotic medications across 4 health systems, which included an electronic health record (EHR) decision support tool, consultation with a child and adolescent psychiatrist, and up to 6months of behavioral health care navigation, as well as telemental health for patients (n = 348). Cost data were collected for both start-up and ongoing intervention phases and are estimated over a 1-year period. Data sources included study records and time-in-motion reports, analyzed from a health system perspective. Costs included both labor and nonlabor costs (2019 US dollars). The average total start-up and ongoing costs per health system were $34,007 and $185,174, respectively. The average total cost per patient was $2,128. The highest average ongoing labor cost components were telemental health ($901 per patient), followed by child and adolescent psychiatrist consultation ($659), and the lowest cost component was primary care/behavioral health provider time to review/respond to the EHR decision support tool and case consultation ($24). For health systems considering programs to promote safer and targeted use of antipsychotics among youth, this study provides estimates of the full start-up and ongoing costs of an EHR decision support tool, psychiatric consultation service, and psychotherapeutic services for patients and families.Trial registration: Clinicaltrials.gov, NCT03448575.

18092 Background: The IV method of chemotherapy administration imposes not only a time burden on patients and facilities, but also has cost implications for payers. This study aims to assess the costs associated with the IV administration of chemotherapies for patients with all forms of lung cancer and for a subset of patients with small cell lung cancer (SCLC) in a large employer-payer claims database. Methods: Using medical claims data from 5.5 million beneficiaries between 01/01/1998 and 01/31/2006, we identified 8,605 patients with lung cancer (ICD-9 codes 162.3–162.9, 176.4, or 197.0) receiving IV chemotherapies. We then identified a subset of 942 patients likely to have SCLC by selecting those receiving chemotherapy regimens primarily used to treat SCLC and excluding patients receiving procedures and treatments often associated with NSCLC. Average total costs per day of IV chemotherapy administration (including drug, administration costs, etc.) were computed for all patients and for the SCLC subset based on the actual amount paid. Costs were also computed separately for: IV chemotherapy drugs, IV chemotherapy administration procedures, and other drugs and services such as IV administration of other drugs to treat side effects of chemotherapies, evaluation and management, and laboratory tests. Results: Average total cost per day of IV chemotherapy administration for all patients was $1,112, with $652 (59%) attributable to IV chemotherapy drugs, $85 (8%) to IV chemotherapy administration procedures, and $375 (34%) to other drugs and services. Among patients with SCLC, average total daily cost was $815, with $423 (52%) attributable to IV chemotherapy drugs, $89 (11%) to IV chemotherapy administration, and $303 (37%) to other drugs and services. Conclusions: IV chemotherapy administration procedures and other visit-related services accounted for 42% and 48% of total costs in patients with all forms of lung cancer and those with SCLC, respectively. The increased availability and use of oral chemotherapy drugs in lung cancer should provide savings to payers by avoiding the costs associated with IV administration. No significant financial relationships to disclose.

Background: Hospital-acquired infections (HAIs) are a major complication of hospital care in adult and children. Estimating the cost of infection control is important because HAIs cost a lot by extending patient length of stay this is a major risk factor for HAI. Objectives: Estimation of the direct cost of medical infection control measures and the direct cost of hospitalization among patients with and without hospital-acquired infections in the Pediatric Intensive Care Unit at Tanta University Hospital. Subjects and Methods: fifty infants and children (with and without HAI) who were admitted to PICU were subjected to clinical examination and investigation to diagnose infection. The direct cost included feeding requirements, investigations, procedures, medications and infection control measures. Prices used according to the period from October 2016 to September 2017 for calculating patients cost. Results: The average total direct cost of hospitalization, for cases with HAI was 8940.45 EP, which was significantly higher than that for patients without HAI (2935.63 EP). There was a significant difference in the average cost per day between patients with and without HAI. The average total direct cost of management for cases with HAI was 7068.77 E.P, which was significantly higher than that for patients without HAI (2191.66 E.P). The average total infection control cost for cases with HAI was 1871.69 E.P, which was significantly higher than that for cases without HAI (743.96 E.P). The mean length of stay (LOS) in PICU was significantly longer for patients with HAI (19.08 days), while in patients without HAI was 7.44 days (range 4-11). Conclusion: The cost of infection control is much lower than the cost of hospital-acquired infections management that prolongs hospital stay causing financial losses to the health system.

Price discrimination in Australia's retail electricity markets: An analysis of Victoria & Southeast Queensland

The Quality Cost Indicator (QCI) model supports value-based health care at the institutional level, by calculating disease-specific health outcomes per unit cost over time. The aim of this study was to adapt the QCI model for specialized burn care (the BC-QCI model) and explore its utilization using real-world data. Burn care outcome indicators were selected through an iterative process with multiple stakeholders. Threshold values were established per outcome indicator and average total healthcare costs were calculated. A cohort of adult burn patients (n = 1449) admitted for at least one day and/or had undergone surgery in Dutch burn centers between 2020 and 2023 was used, with a follow-up period of 12 months. The proportion of patients who achieved textbook outcome (i.e., having achieved all the outcome indicators), the average total costs per patient, and QCI values were calculated. Of all patients, 54% achieved all five outcome indicators (i.e., length of stay, wound infections, other complications, discharge destination, and predicted mortality). The most successful outcome indicator was ‘predicted mortality’ (passed by 99% of the population), the least successful outcome indicator was ‘length of stay’ (62%). The patients who failed to achieve one or more outcome indicators (46%) had significantly higher average total costs compared to the patients who achieved textbook outcome (54%) (€50,134 [€47,810-€52,850] vs. €11,721 [€11,096-€12,429]). The BC-QCI model is a solid foundation to provide insights into the outcomes and costs for specialized burn care at the institutional level.

This study retrospectively estimated costs for a convenience sample of school-located vaccination (SLV) clinics conducted in Maine during the 2009-2010 influenza season. Surveys were developed to capture the cost of labor including unpaid volunteers as well as supplies and materials used in SLV clinics. Six nurses from different school districts completed a clinic day survey on staff time; four of the six also provided data for materials and supplies. For all clinics, average per-dose labor cost was estimated at $5.95. Average per-dose material cost, excluding vaccine, was $5.76. From the four complete clinic survey responses, total per-dose cost was estimated to be an average of $13.51 (range = $4.91-$32.39). Use of donated materials and uncompensated volunteer staff could substantially reduce per-dose cost. Average per-dose cost could also be lowered by increasing the number of doses administered in a clinic.

All physicians bear the responsibility of minimizing cost while providing care that meets or exceeds national quality benchmarks. Intraoperative anesthetic drug costs constitute a small but significant fraction of the total cost in the perioperative period. Previous studies have revealed that anesthesiologists are generally unaware of drug costs. In order to determine if experience and education improve anesthetic drug cost containment, we compared the total anesthetic drug cost per case as residents progressed through their rotations in cardiac anesthesia. We considered the total anesthetic drug cost for 202 adult cardiac cases, including coronary artery bypass grafting, mitral valve repair/replacement, and aortic valve repair/replacement. 77 of the cases analyzed were done by residents in their first month of cardiac anesthesia, and 125 were done by residents in their second month of cardiac anesthesia. In the interval between these rotations, residents participate in didactics and other educational activities including a practice management rotation in the CA-3 year where they are exposed to financial topics in healthcare. The average total drug cost per case for residents in their first month was $193.50; SD= $82.00. The average total cost per case for residents in their second month was $223.30; SD=$96.10. With multivariate analysis considering case type, length of procedure and patient age, the resident training level did not impact the cost in a significant way (p=0.062). In the multivariate analysis considering case type, length of procedure and patient age, more experienced residents did not have a significantly different total drug cost per case. This finding suggests that didactic educational efforts and implicit modeling over time did not reduce drug costs in the operating room during adult cardiac surgery.

19 Background: The Oncology Care Model (OCM) is a specialty care model developed by the Centers for Medicare & Medicaid (CMS) Innovation Center aimed at providing higher quality, more highly coordinated cancer care and reducing costs for patients undergoing chemotherapy. The OCM calculates costs of care in a novel way by anchoring costs within episodes of care, defined as six-month intervals triggered by initial anti-cancer treatment, as opposed to diagnosis date. The purpose of this study is to assess costs within the OCM episodes of care. Methods: This was a secondary analysis of Medicare administrative claims data for beneficiaries 65 and older with cancer who received anti-cancer drug treatment (chemotherapy, hormone therapy) between 2012-2015 at an institution in the UAB Cancer Community Network (CCN). Total and service-specific costs (Medicare reimbursement to providers) per patient-episode were summed from inpatient, outpatient, chemotherapy, radiation therapy, testing/pathology, evaluation and management (E/M), home health, skilled nursing facility (SNF), and hospice claims. Prescription drug costs were not included. Mean costs for the first three OCM episodes were calculated and compared to (1) diagnosis-based costs (six-month intervals starting at cancer diagnosis) and (2) service type. Results: Average total cost in the first three OCM episodes of care was $24,922 (n=13,902), $18,534 (n=6,618), and $16,548 (n=4,672). Compared to episode-based cost, average total diagnosis-based cost was higher in the first episode of care ($33,244, n=9,615), and lower in the second and third episodes ($17,143, n=9,110; $12,897, n=8,002). Episode-based outpatient, inpatient, and chemotherapy costs were the highest service-specific costs in all three episodes of care (1st: $8,374, $5,493, $2,445; 2nd: $6,188, $3,913, $3,158; 3rd: $5,909, $3,251, $3,399). Conclusions: Costly chemotherapy and inpatient and outpatient visits indicate an opportunity for targeted improvement resulting in higher value care. Knowledge of current costs of care will aid oncology practices in transition to the OCM and in usage of value-based services for better quality cancer care.

Cost of shoulder surgery

An inventory model has been proposed for intangible deteriorating items with demand-dependent deteriorating rate under the circumstance in which the demand rate is changing exponentially with time. The production rate is the function of demand rate and inventory level and shortages are not allowed in the inventory model. This inventory model is suitable for the situation in which the deterioration is intangible and the demand rate is changing exponentially with time. The total average inventory cost is derived and the optimal expression can be obtained for production scheduling period, maximum inventory level, total average cost and the cycle time of inventory replenishment in this paper. At last, numerical examples are performed and discussed.

Sorghum is an important fodder crop of summer and rainy season and suitable for silage making. It is the fast growing crop and can provide two-three fodder cuttings. the economics of sorghum seed production crop (cv. MP Chari) was analysed for the period Kharif 2010–11, Kharif 2011–12 and Kharif 2012–13 in IGFRI, Jhansi to inform the farmers about the profitability of seed production process. The highest cost was incurred on harvesting and pooling of mature crop. The average total expenditure incurred on that was 4933.3 and it was 17.28 percent of total cost. The average total working capital was found as: 19073.3 per hectare (66.82% of total cost) and total variable cost is: 19645.5 which is 68.82 percent of total cost. The average total cost is found as: 28544.1 per hectare. The average total labour man days used per hectare are 84.64. The average total expenditure incurred on labour is: 12120.28 (42.46%) which is found as highest expenditure in total cost. The highest expenditure in percentage term is incurred on labour followed by manures, draft power and seed cost. On per hectare basis the average quality seed production was 857.00 kilogram. The average rate of quality seed was: 35 per kilogram. The total return was found as: 51899.41 per hectare. The average net return is: 22161.33 per hectare. The average benefit cost ratio at is found as 1.72. The cost of production of seed when only main product quality seed only) was considered for selling was: 35.11 per kilogram of seed. The cost of production of seed when both main product (quality seed only) and other by products (dry fodder, rejected seed etc.) was considered for selling was: 11.18 per kilogram of seed. Thus, it is clear from the study that seed production of sorghum is highly profitable and has wide market available for it.