Incremento de los costos del Programa Nacional de Inmunización por la introducción del candidato vacunal contra neumococo / Increase in the costs of the National Immunization Program due to the introduction of the pneumococcal vaccine candidate

Introducción: La industria nacional ha desarrollado un candidato vacunal contra neumococo. Ante su posible introducción en el sistema de salud debe valorarse el costo incremental que acarrearía. Objetivo: Estimar el incremento de los costos del Programa Nacional de Inmunización por la introducción del candidato vacunal contra neumococo. Métodos: Estudio de descripción de costos desde la perspectiva social para el año 2021. Se estudiaron ocho policlínicos de La Habana y se entrevistaron 38 familiares de lactantes. Se estimó el costo institucional, el gasto de bolsillo y el costo indirecto mediante microcosteo. Se estimó el costo incremental para un esquema de tres dosis (2p+1), concomitantes con otras vacunas. Resultados: El costo total para el Programa Nacional de Inmunización en estos policlínicos estuvo entre los 337 000,00 CUP y los 513 000,00 CUP, con un costo por dosis entre 33,11 CUP y 47,30 CUP. El 31,6 por ciento de las familias reportó gastos en transportación de entre 5,00 CUP y 40,00 CUP. La introducción de la vacuna representaría un incremento entre 8,43 por ciento y 18,99 por ciento del costo base del Programa Nacional de Inmunización en los policlínicos. El costo por dosis sería de entre 34,17 CUP y 47,82 CUP, para un incremento de entre 0,28 CUP y 1,33 CUP. Conclusiones: La mayor parte del costo del Programa Nacional de Inmunización lo asume el Estado. La aplicación de la vacuna cubana contra neumococo solo aumentaría muy levemente el costo por dosis(AU)

Introduction: The national industry has developed a vaccine candidate against pneumococcus. Given its possible introduction into the health system, the incremental cost that it would entail must be assessed. Objective: To estimate the increase in the costs of the National Immunization Program due to the introduction of the pneumococcal vaccine candidate. Methods: Study of cost description from the social perspective for the year 2021. Eight polyclinics in Havana were studied and 38 relatives of infants were interviewed. Institutional cost, out-of-pocket costs and indirect costs were estimated through microcost. The incremental cost was estimated for a three-dose schedule (2p+1), concomitant with other vaccines. Results: The total cost for the National Immunization Program in these polyclinics was between 337,000.00 CUP and 513,000.00 CUP, with a cost per dose between 33.11 CUP and 47.30 CUP. 31.6percent of families reported transportation expenses from 5.00 CUP to 40.00 CUP. The introduction of the vaccine would represent an increase between 8.43 percent and 18.99 percent of the base cost of the National Immunization Program in polyclinics. The cost per dose would be between 34.17 CUP and 47.82 CUP, for an increase of between 0.28 CUP and 1.33 CUP. Conclusions: Most of the cost of the National Immunization Program is borne by the State. The application of the Cuban pneumococcal vaccine would only slightly increase the cost per dose(AU)

Pricing and assembly rate decisions for a prefabricated construction supply chain under subsidy policies.

Prefabricated construction has attracted worldwide concern and promotion due to its environmental friendliness, high quality, and high efficiency. In China, the application of prefabricated construction still lags due to its high cost. To improve prefabricated construction development, the Chinese government and provinces have launched subsidy policies for different objects that offer subsidies to the assembler, the manufacturer, or consumers. Subsidy policies for different subsidy objects have different impacts on the manufacturer wholesale price and assembler retail price and assembly rate and make their decisions more complicated. Therefore, this study uses game theory and builds three models to analyze the effects of government subsidies on manufacturer pricing, assembler pricing, assembly rate decisions, and profit. We find that government subsidy policies can bring more profit to prefabricated construction enterprises, reduce their costs, and benefit the promotion of prefabricated construction. Through comparison and numerical analysis, we also find that when the government subsidizes enterprises more, it is better to subsidize the assembler, because it is good for all three parties. First, consumers can obtain a lower retail price. Second, enterprises can obtain more profits. Finally, for the government, this approach can increase the demand for prefabricated construction and increase the assembly rate, which is conducive to the promotion of prefabricated construction. When the government subsidizes customers more, it is better for the assembler and the manufacturer to subsidize customers, because they can obtain more profits. It is better for the government and customers to subsidize the assembler or the manufacture, because consumers can get the lower retail price. Although the assembly rate and enterprises' profits are not optimal, they have also been improved. In addition, when the government directly subsidizes enterprises, the enterprises will actively cooperate with the subsidy policy and are more willing to adopt prefabricated construction. This approach will benefit the promotion of prefabricated construction.

Diagnostic costs: a research in a family medicine outpatient clinic

The aim of this study is to evaluate the direct diagnostic costs for disease groups and other variables (such as gender, age, seasons) that are related to the direct diagnostic costs based on a 3-year data. The population of the study consisted of 31,401 patients who applied to family medicine outpatient clinic in Turkey between January 1st, 2016 and December 31st, 2018. With this study, we determined in which disease groups of the family medicine outpatient clinic weremost frequently admitted. Then, total and average diagnostic costs for these disease groups were calculated. Three-year data gave us the opportunity to examine the trend in diagnostic costs. Based on this, we demonstratedwhich diseases' total and average diagnostic costs increased or decreased during 3 years. Moreover, we examined how diagnostic costs showed a trend in both Turkish liras and USA dollars' rate for 3 years. Finally, we analysedwhether the diagnostic costs differed according to variables such as age, gender and season. There has been relatively little analysis on the diagnostic costs in the previous literature. Therefore, we expect to contribute to both theoristsand healthcare managers for diagnostic costs with this study.

A methodology for identifying high-need, high-cost patient personas for international comparisons.

OBJECTIVE: To establish a methodological approach to compare two high-need, high-cost (HNHC) patient personas internationally. DATA SOURCES: Linked individual-level administrative data from the inpatient and outpatient sectors compiled by the International Collaborative on Costs, Outcomes, and Needs in Care (ICCONIC) across 11 countries: Australia, Canada, England, France, Germany, the Netherlands, New Zealand, Spain, Sweden, Switzerland, and the United States. STUDY DESIGN: We outline a methodological approach to identify HNHC patient types for international comparisons that reflect complex, priority populations defined by the National Academy of Medicine. We define two patient profiles using accessible patient-level datasets linked across different domains of care-hospital care, primary care, outpatient specialty care, post-acute rehabilitative care, long-term care, home-health care, and outpatient drugs. The personas include a frail older adult with a hip fracture with subsequent hip replacement and an older person with complex multimorbidity, including heart failure and diabetes. We demonstrate their comparability by examining the characteristics and clinical diagnoses captured across countries. DATA COLLECTION/EXTRACTION METHODS: Data collected by ICCONIC partners. PRINCIPAL FINDINGS: Across 11 countries, the identification of HNHC patient personas was feasible to examine variations in healthcare utilization, spending, and patient outcomes. The ability of countries to examine linked, individual-level data varied, with the Netherlands, Canada, and Germany able to comprehensively examine care across all seven domains, whereas other countries such as England, Switzerland, and New Zealand were more limited. All countries were able to identify a hip fracture persona and a heart failure persona. Patient characteristics were reassuringly similar across countries. CONCLUSION: Although there are cross-country differences in the availability and structure of data sources, countries had the ability to effectively identify comparable HNHC personas for international study. This work serves as the methodological paper for six accompanying papers examining differences in spending, utilization, and outcomes for these personas across countries.

Fishing trip cost modeling using generalized linear model and machine learning methods - A case study with longline fisheries in the Pacific and an application in Regulatory Impact Analysis.

Fishing trip cost is an important element in evaluating economic performance of fisheries, assessing economic effects from fisheries management alternatives, and serving as input for ecosystem and bioeconomic modeling. However, many fisheries have limited trip-level data due to low observer coverage. This article introduces a generalized linear model (GLM) utilizing machine learning (ML) techniques to develop a modeling approach to estimate the functional forms and predict the fishing trip costs of unsampled trips. GLM with Lasso regularization and ML cross-validation of model are done simultaneously for predictor selection and evaluation of the predictive power of a model. This modeling approach is applied to estimate the trip-level fishing costs using the empirical sampled trip costs and the associated trip-level fishing operational data and vessel characteristics in the Hawaii and American Samoa longline fisheries. Using this approach to build models is particularly important when there is no strong theoretical guideline on predictor selection. Also, the modeling approach addresses the issue of skewed trip cost data and provides predictive power measurement, compared with the previous modeling efforts in trip cost estimation for the Hawaii longline fishery. As a result, fishing trip costs for all trips in the fishery can be estimated. Lastly, this study applies the estimated trip cost model to conduct an empirical analysis to evaluate the impacts on trip costs due to spatial regulations in the Hawaii longline fishery. The results show that closing the Western and Central Pacific Ocean (WCPO) could induce an average 14% increase in fishing trip costs, while the trip cost impacts of the Eastern Pacific Ocean (EPO) closures could be lower.

Protocol for safe, affordable, and reproducible isolation and quantitation of SARS-CoV-2 RNA from wastewater.

The following protocol describes our workflow for processing wastewater with the goal of detecting the genetic signal of SARS-CoV-2. The steps include pasteurization, virus concentration, RNA extraction, and quantification by RT-qPCR. We include auxiliary steps that provide new users with tools and strategies that will help troubleshoot key steps in the process. This protocol is one of the safest, cheapest, and most reproducible approaches for the detection of SARS-CoV-2 RNA in wastewater. Owing to a pasteurization step, it is safe for use in a BSL2 facility. In addition to making the protocol safe for the personnel involved, pasteurization had the added benefit of increasing the SARS-CoV-2 genetic signal. Furthermore, the RNA obtained using this protocol can be sequenced using both Sanger and Illumina sequencing technologies. The protocol was adopted by the New York City Department of Environmental Protection in August 2020 to monitor SARS-CoV-2 prevalence in wastewater in all five boroughs of the city. In the future, this protocol could be used to detect a variety of other clinically relevant viruses in wastewater and serve as a foundation of a wastewater surveillance strategy for monitoring community spread of known and emerging viral pathogens.

The sustainability of stock price fluctuations: Explanation from a recursive dynamic model.

The sustainability of stock price fluctuations indicated by many empirical studies hardly reconciles with the existing models in standard financial theories. This paper proposes a recursive dynamic asset pricing model based on the comprehensive impact of the sentiment investor, the information trader and the noise trader. The dynamic process of the asset price is characterized and a numerical simulation of the model is provided. The model captures the features of the actual stock price that are consistent with the empirical evidence on the sustainability of stock price fluctuations. It also offers a partial explanation for other financial anomalies, for example, asset price's overreaction, asset bubble and the financial crisis. The major finding is that investor sentiment is the key factor to understand the sustainability of stock price fluctuations.

Extracorporeal photopheresis chargemasters show haphazard billing practices.

BACKGROUND: United States healthcare spending continues to outpace other developed nations although efforts are being made to increase cost-transparency. Recent legislation requires hospitals to publish a chargemaster, a list of all billable procedure codes together with prices. Chargemaster prices have been shown to be highly variable, if available, and are not typically paid, but contribute to negotiated rates. Extracorporeal photopheresis (ECP) is performed for a limited number of indications and could serve as a marker of this variability. We investigated the availability of chargemaster documentation for ECP procedures and the variability of pricing as assessed by institutional characteristics. STUDY DESIGN AND METHODS: A list of centers with photopheresis systems was obtained from the device manufacturer and the institutional websites were analyzed for chargemaster list prices. Multivariate linear regressions were performed to compare impact of facility variables on chargemaster pricing. RESULTS: There are 139 locations in the US which are listed as referral centers for ECP; and chargemaster prices were available in 66.2% of these centers. The range was $571.48-183,452.00, maximum price 321 times greater than minimum, and the median price, after outlier exclusion, was $8989.06 (SD = $4361.72). ECP cost did not correlate with hospital size, facility type, ownership, number of hospitals in the referral region, hospital care intensity index, academic status, or region (p ≥ .05). CONCLUSIONS: Chargemaster costs for ECP procedures are highly variable and nonuniform, and the current data available for patients undergoing these specialized apheresis procedures is insufficient to afford patients the ability to compare prices.

Impact of diabetes mellitus on short-term prognosis, length of stay, and costs in patients with acute kidney injury: A nationwide survey in China.

BACKGROUND: International data suggest that people with diabetes mellitus (DM) are at increased risk for worse acute kidney injury (AKI) outcomes; however, the data in China are limited. Therefore, this study aimed to describe the association of DM with short-term prognosis, length of stay, and expenditure in patients with AKI. METHODS: This study was based on the 2013 nationwide survey in China. According to the 2012 Kidney Disease: Improving Global Outcomes (KDIGO) and expanded criteria of AKI, 7604 patients with AKI were identified, and 1404 and 6200 patients were with and without DM, respectively. Clinical characteristics, outcomes, length of stay, and costs of these patients were compared. Multivariate regression analyses were conducted to evaluate the association of DM with mortality, failed renal recovery, length of stay, and costs. RESULTS: Patients with AKI and DM were older, had higher male preponderance (61.9%), presented with more comorbidities, and had higher serum creatinine levels compared with those without DM. An apparent increase in all-cause in-hospital mortality, length of stay, and costs was found in patients with DM. DM was not independently associated with failed renal recovery (adjusted OR (95%CI): 1.08 (0.94-1.25)) and in-hospital mortality (adjusted OR (95%): 1.16 (0.95-1.41)) in multivariate models. However, the diabetic status was positively associated with the length of stay (ß = 0.06, p<0.05) and hospital expenditure (ß = 0.10, p<0.01) in hospital after adjusting for possible confounders. CONCLUSION: In hospitalized AKI patients, DM (vs. no DM) is independently associated with longer length of stay and greater costs, but is not associated with an increased risk for failed renal recovery and in-hospital mortality.

Budget Impact of Tyrosine Kinase Inhibitor Discontinuation in Chronic Myeloid Leukemia With Sustained Deep Molecular Response.

OBJECTIVES: Tyrosine kinase inhibitors (TKIs) account for the vast majority of healthcare expenditure on patients with chronic myeloid leukemia (CML), and it has been demonstrated that TKI discontinuation in patients in long-term deep molecular remission (DMR) is safe and improves quality of life. Our objective was to estimate the budget impact of TKI discontinuation in CML patients in long-term DMR from the perspective of the French healthcare system. METHODS: This analysis was conducted over a 5-year time horizon using a Markov model with cycles of 6 months. Transition probabilities were estimated through systematic reviews and meta-analyses. Costs were estimated from the French National Claims Database. Monte Carlo simulations were performed to take into account the uncertainty surrounding model parameters. Sensitivity analyses were carried out by varying the size of the target population and the cost of TKIs. RESULTS: Over a 5-year period and for a target population of 100 patients each year eligible and agreeing to stop TKI, the TKI discontinuation strategy would save €25.5 million (95% confidence interval -39.3 to 70.0). In this model, the probability that TKI discontinuation would be more expensive than TKI continuation was 12.0%. In sensitivity analyses, mean savings ranged from €14.9 million to €62.9 million. CONCLUSIONS: This study provides transparent, reproducible, and interpretable results for healthcare professionals and policy makers. Our results clearly show that innovative healthcare strategies can benefit both the healthcare system and patients. Savings from generalizing TKI discontinuation in CML patients in sustained DMR should yield health gains for other patients.