Detection and Control of Pregnancy Hypertension Using Self-Monitoring of Blood Pressure With Automated Telemonitoring: Cost Analyses of the BUMP Randomized Trials

BACKGROUND

Pregnancy hypertension continues to cause maternal and perinatal morbidity. Two linked UK randomized trials showed adding self-monitoring of blood pressure (SMBP) with automated telemonitoring to usual antenatal care did not result in earlier detection or better control of pregnancy hypertension. This article reports the trials' integrated cost analyses.

METHODS

Two cost analyses. SMBP with usual care was compared with usual care alone in pregnant individuals at risk of hypertension (BUMP 1 trial [Blood Pressure Monitoring in High Risk Pregnancy to Improve the Detection and Monitoring of Hypertension], n=2441) and with hypertension (BUMP 2 trial, n=850). Clinical notes review identified participant-level antenatal, intrapartum, and postnatal care and these were costed. Comparisons between trial arms used means and 95% CIs. Within BUMP 2, chronic and gestational hypertension cohorts were analyzed separately. Telemonitoring system costs were reported separately.

RESULTS

In BUMP 1, mean (SE) total costs with SMBP and with usual care were £7200 (£323) and £7063 (£245), respectively, mean difference (95% CI), £151 (-£633 to £936). For the BUMP 2 chronic hypertension cohort, corresponding figures were £13 384 (£1230), £12 614 (£1081), mean difference £323 (-£2904 to £3549) and for the gestational hypertension cohort were £11 456 (£901), £11 145 (£959), mean difference £41 (-£2486 to £2567). The per-person cost of telemonitoring was £6 in BUMP 1 and £29 in BUMP 2.

CONCLUSIONS

SMBP was not associated with changes in the cost of health care contacts for individuals at risk of, or with, pregnancy hypertension. This is reassuring as SMBP in pregnancy is widely prevalent, particularly because of the COVID-19 pandemic.

REGISTRATION

URL: https://www.clinicaltrials.gov; Unique identifier: NCT03334149.

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.

Time-Driven Activity-Based Cost Comparison of Osteoid Osteoma Ablation Techniques

OBJECTIVE

Compare the cost of performing an osteoid osteoma ablation using cone beam CT (CBCT) with overlay fluoroscopic guidance to ablation using conventional CT (CCT) guidance and microwave ablation (MWA) to radiofrequency ablation (RFA).

METHODS

An 11-year retrospective study was performed of all patients undergoing osteoid osteoma ablation. Ablation equipment included a Cool tip RFA probe (Covidien, Minneapolis, Minnesota) or a Neuwave PR MWA probe (Ethicon, Rariton, New Jersey). The room times as well as immediate recovery time were recorded for each case. Cost analysis was then performed using time-driven activity-based costing for rate-dependent variables including salaries, equipment depreciation, room time, and certain supplies. Time-independent costs included the disposable interventional radiology supplies and ablation systems. Costs were reported for each service providing care and using conventional cost accounting methods with variable and fixed expenditures.

RESULTS

A total of 91 patients underwent 96 ablation procedures in either CBCT (n = 66) or CCT (n = 30) using either MWA (n = 51) or RFA (n = 45). The anesthesia induction (22.7 ± 8.7 min versus 15.9 ± 7.2 min, P < .001), procedure (64.7 ± 27.5 min versus 47.3 ± 15.3 min; P = .001), and room times (137.7 ± 33.7 min versus 103.9 ± 22.6. min; P < .001) were significantly longer for CBCT procedures. The procedure time did not differ significantly between MWA and RFA (62.1 ± 27.4 min versus 56.1 ± 23.3 min; P = .27). Multiple regression analysis demonstrated lower age (P = .046), CBCT use (P = .001), RFA use (P = .02), and nonsupine patient position (P = .01) significantly increased the total procedural cost. After controlling for these variables, the total cost of CBCT ($5,981.32 ± $523.93 versus $5,378.93 ± $453.12; P = .001) remained higher than CCT and the total cost of RFA ($5,981.32 ± $523.93 versus $5,674.43 ± $549.14; P = .05) approached a higher cost than MWA.

CONCLUSION

The use of CBCT with overlay fluoroscopic guidance for osteoid osteoma ablation resulted in longer in-room times and greater cost when compared with CCT. These cost considerations should be weighed against potential radiation dose advantage of CBCT when choosing an image guidance modality. Younger age, RFA use, and nonsupine patient position additionally contributed to higher costs.

Mobile health in the aging surgical patient

Mobile health includes the use of mobile devices, patient monitoring devices, and digital assistants to improve the delivery of healthcare. Aging surgical patients (ie, 65 years and older) represent a unique patient population that demands increased resources to prepare for surgery and optimize recovery. Mobile health has the potential to improve surgical patient outcomes by increasing the accessibility of personalized care and reducing costs. However, there are some challenges to consider when using mobile health in older surgical patients, such as technological literacy, visual and hearing impairment, and cognitive changes before or after anesthesia. Despite the rapid uptake of mobile health in medical specialties, its application in the surgical field is gradual. The complexity of aging surgical patients requires surgical care teams, surgical leaders, and healthcare policymakers to consider unique solutions, such as mobile health, to address this growing population's needs before and after surgery. This article will discuss the potential benefits and challenges of mobile health among aging surgical patients, as well as opportunities to support these patients and families with customizable tools to meet their preferences and needs.

Achieving dynamic efficiency in pharmaceutical innovation: Identifying the optimal share of value and payments required

It has been argued that cost-effectiveness analysis of branded pharmaceuticals only considers static efficiency, neglects dynamic effects and undermines incentives for socially valuable innovation. We present a framework for designing pharmaceutical pricing policy to achieve dynamic efficiency. We develop a coherent framework that identifies the long-term static and dynamic benefits and costs of offering manufacturers different levels of reward. The share of value that would maximise long-term population health depends on how the quantity and quality of innovation responds to payment. Using evidence of the response of innovation to payment, the optimal share of value of new pharmaceuticals to offer to manufacturers is roughly 20% (range: 6%-51%). Reanalysis of a sample of NICE technology appraisals suggests that, in most cases, the share of value offered to manufacturers and the price premium paid by the English NHS were too high. In the UK, application of optimal shares would offer considerable benefits under both a public health objective and a broader view of social welfare. We illustrate how an optimal share of value can be delivered through a range of payment mechanisms including indirect price regulation via the use of different approval norms by an HTA body.

Carbon tax and low-carbon credit: Which policy is more beneficial to the capital-constrained manufacturer's remanufacturing activities?

Remanufacturing has attracted much attention for its enormous potential in resource recycling and low-carbon emission reduction. To investigate the effects of different government intervention policies on remanufacturing and carbon emissions, two profit maximization models of the capital-constrained manufacturer under carbon tax and low-carbon credit policies are constructed respectively. Then, through theoretical and numerical analyses, some significant findings are drawn: (1) Both carbon tax and low-carbon credit policies can encourage capital-constrained manufacturers to produce more remanufactured products, but which intervention policy is more advantageous also depends on the carbon emission cost of new products or financing cost of the remanufactured products. (2) Although carbon tax policy can effectively control carbon emissions, it is always at the expense of both capital-constrained manufacturers and consumers; while low-carbon credit policy can help capital-constrained manufacturers achieve the goal of win-win economic and environmental benefits when the remanufacturing carbon savings advantages are more apparent. (3) From the perspective of consumer benefits, carbon tax is more advantageous when the consumer willingness to pay for remanufactured products is higher; otherwise, low-carbon credit policy should be implemented. (4) The higher the environmental damage coefficient is, the more it can highlight the advantages of the two intervention policies in social welfare enhancement, especially the carbon tax policy; and when the environmental damage coefficient is given, the stronger the consumers' willingness to pay for remanufactured products is, the more it is conducive to reducing the negative effects caused by the carbon tax or low-carbon credit policy in social welfare enhancement, or increasing the corresponding positive effects. Based on above findings, some managerial insights and policy implications are provided to capital-constrained manufacturers and policy-makers.

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.

Community Health Worker Implementation and Cost Analysis of a Plant-Based Nutrition Program

OBJECTIVE

This study describes program implementation through a research-restaurant partnership and assesses participant satisfaction, program costs, and percent body weight changes.

METHODS

Participants (n = 60) in a virtual synchronous (n = 43) or virtual asynchronous (n = 17) 12-week plant-based nutrition program received restaurant vouchers. Class satisfaction data were collected weekly. Assessments were completed at baseline, 3 months, and 9 months, along with interviews (n = 13) between 3 and 9 months. The costing approach estimated costs per participant. Interviews were coded using a content analysis and constant comparative method.

RESULTS

Participants rated the intervention favorably. Program costs were $198.63/participant, and participants' willingness to pay postintervention was $101.50 ± $63.90. Participants shared satisfaction with course content, the restaurant partnership, and suggestions for future delivery. No changes in participants' percent body weight were observed between 3 and 9 months (P = 0.98), indicating maintenance of 3-month weight loss.

CONCLUSIONS AND IMPLICATIONS

A research-restaurant partnership successfully implemented a nutrition program and generated positive feedback. With the lifting of coronavirus disease 2019 pandemic restrictions, future research can now test alternative implementation methods (in person vs online) in other restaurants.

The incidence of surgical site infections in China

Surgical site infections (SSIs) are a common type of healthcare-associated infection. We performed a literature review to demonstrate the incidence of SSIs in mainland China based on studies since 2010. We included 231 eligible studies with ≥30 postoperative patients, comprising 14 providing overall SSI data regardless of surgical sites and 217 reporting SSIs for a specific site. We found that the overall SSI incidence was 2.91% (median; interquartile range: 1.05%, 4.57%) or 3.18% (pooled; 95% confidence interval: 1.85%, 4.51%) and the SSI incidence varied remarkably according to the surgical site between the lowest (median, 1.00%; pooled, 1.69%) in thyroid surgeries and the highest (median, 14.89%; pooled, 12.54%) in colorectal procedures. We uncovered that Enterobacterales and staphylococci were the most common types of micro-organisms associated with SSIs after various abdominal surgeries and cardiac or neurological procedures, respectively. We identified two, nine, and five studies addressing the impact of SSIs on mortality, the length of stay (LOS) in hospital, and additional healthcare-related economic burden, respectively, all of which demonstrated increased mortality, prolonged LOS, and elevated medical costs associated with SSIs among affected patients. Our findings illustrate that SSIs remain a relatively common, serious threat to patient safety in China, requiring more action. To tackle SSIs, we propose to establish a nationwide network for SSI surveillance using unified criteria with the aid of informatic techniques and to tailor and implement countermeasures based on local data and observation. We highlight that the impact of SSIs in China warrants further study.

Quality of life measures and cost analysis of biologic versus synthetic mesh for ventral hernia repair: The Preventing Recurrence in Clean and Contaminated Hernias randomized clinical trial

BACKGROUND

Although the most durable method for ventral hernia repairs involves using mesh, whether to use biologic mesh versus synthetic mesh remains controversial. This study aimed to compare synthetic and biologic meshes with respect to patient-reported quality of life scores and costs after ventral hernia repair surgeries.

METHODS

This study is part of the Preventing Recurrence in Clean and Contaminated Hernias (PRICE) pragmatic randomized control trial conducted from March 2014 through October 2018. Patients were randomized 1:1 to undergo ventral hernia repair using either a biologic or synthetic mesh. The coprimary outcomes were 2-year changes in Visual Analog Scale, Activities Assessment Scale, Hernia-Related Quality-of-Life Survey, and Short-Form 36 Health Survey (SF-36) quality-of-life scores from repair. The secondary outcome was the overall cost per patient.

RESULTS

Among the 165 patients included in the study, 82 were randomized to biologic meshes and 83 to synthetic meshes. There were no significant differences in the performance between the 2 mesh types with regard to quality-of-life measures using a mixed model approach. This result was consistent even when performing subgroup analysis based on wound contamination. However, nonparametric tests comparing the differences in quality-of-life measures from preoperative to 24-month postoperative timepoints revealed that the synthetic mesh group showed a greater reduction in disability than biologic mesh for the SF-36 (median [interquartile range] of 20 [5-30] vs 6 [1-20], P = .025). This difference was due to reductions in the physical role limitations (62 [0-100] vs 0 [0-50], P = .018) and the pain (38 [12-50] vs 12 [0-25], P = .012) domains of the SF-36. Overall cost per patient was greater for biologic meshes (mean [95% confidence interval] of $80,420 [$66,485-$94,355] vs $61,036 [$48,946-$73,125], P = .038), regardless of insurance type.

CONCLUSION

In this randomized clinical trial, there were no differences in changes in quality-of-life scores at the 2-year timepoint except for the SF-36, where the synthetic mesh may be associated with less pain and physical role limitations than the biologic mesh. Overall costs per patient were less for synthetic than biologic mesh.

A European Salk Institute Could Ensure Accessible and Affordable Medicines

Many researchers, consumer groups, activists and civil society organizations agree that the pharmaceutical sector has been left too much to the private sector, which is solely driven by a profit motive. Therefore, it is imperative to take a bold initiative to turn the idea of medicine, pharmaceutical products, and health technology as a common good into a reality. We propose to establish a European institute that can oversee an ambitious research portfolio. This institute can provide research grants or do in-house research but, in any case, any intellectual property rights emanating from the research will have to be shared in the interest of the public good. A collective knowledge pool, where all results and technological knowledge are gathered and shared, will likewise be part of the institute. Any final product developed within the Institute will be subject to an open license. We ensure that all necessary data and information remain public and that know-how about the production of a medicine can be passed on to those who need it. Finally, this institute should have a focus on production and distribution. Price, quality, availability and even working conditions of the staff will be criteria in any bidding process.

There Is Wide Variation in Platelet-rich Plasma Injection Pricing: A United States Nationwide Study of Top Orthopaedic Hospitals

BACKGROUND

Demand for platelet-rich plasma (PRP) injections for osteoarthritis has dramatically increased in recent years despite conflicting evidence regarding its efficacy and highly variable pricing in the top orthopaedic centers in the United States, because PRP is typically not covered by insurance. A previous study investigating the mean price of PRP injections obtained information only from centers advertising online the availability of PRP injections. Thus, there is a need for further clarification of the overall availability and variability in cost of PRP injections in the orthopaedic community as well as an analysis of relevant regional demographic and hospital characteristics that could be associated with PRP pricing.

QUESTIONS/PURPOSES

Our study purposes were to (1) report the availability and price variation of knee PRP injections at top-ranked United States orthopaedic centers, (2) characterize the availability of pricing information for a PRP injection over the telephone, (3) determine whether hospital characteristics (Orthopaedic Score [ U . S. News & World Report measure of hospital orthopaedic department performance], size, teaching status, and rural-urban status) were associated with PRP injection availability and pricing, and (4) characterize the price variation, if it exists, of PRP injections in three metropolitan areas and individual institutions.

METHODS

In this prospective study, a scripted telephone call to publicly listed clinic telephone numbers was used to determine the availability and price estimate (amount to be paid by the patient) of a PRP injection for knee osteoarthritis from the top 25 hospitals from each United States Census region selected from the U.S. News & World Report ranking of best hospitals for orthopaedics. Univariable analyses examined factors associated with PRP injection availability and willingness to disclose pricing, differences across regions, and the association between hospital characteristics (Orthopaedic Score, size, teaching status, and rural-urban status) and pricing. The Orthopaedic Score is a score assigned to each hospital by U . S. News & World Report as a measure of hospital performance based partly on patient outcomes, with higher scores indicating better outcomes.

RESULTS

Overall, 87% (87 of 100) of respondents stated they offered PRP injections. Pricing ranged from USD 350 to USD 2815 (median USD 800) per injection, with the highest prices in the Northeast. The largest price range was in the Midwest, where more than two-thirds of PRP injections given at hospitals that disclosed pricing cost USD 500 to USD 1000. Of the hospitals that offered PRP injections, 68% (59 of 87) were willing to disclose price information over the telephone. PRP injection pricing was inversely correlated with hospital Orthopaedic Score (-3% price change [95% CI -5% to -1%]; p = 0.01) and not associated with any of the other hospital characteristics that were studied, such as patient population median income and total hospital expenses. An intracity analysis revealed wide variations in PRP pricing in all metropolitan areas that were analyzed, ranging from a minimum of USD 300 within 10 miles of metropolitan area B to a maximum of USD 1269 within 20 miles of metropolitan area C.

CONCLUSION

We found that although PRP injections are widely available, pricing continues to be a substantial financial burden on patients, with large price variability among institutions. We also found that if patients are willing to shop around in a metropolitan area, there is potential to save a meaningful amount of money.

CLINICAL RELEVANCE

As public interest in biologics in orthopaedic surgery increases, knowledge of its pricing should be clarified to consumers. The debated efficacy of PRP injections, combined with our findings that it is an expensive out-of-pocket procedure, suggests that PRP has limited cost-effectiveness, with variable, discrete pricing. As such, the price of PRP injections should be clearly disclosed to patients so they can make informed healthcare decisions.

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.

The increasing costs of medicines and their implications for patients, physicians and the health system

Most new medicines entering the market are high-cost speciality drugs. These drugs can cost tens to hundreds of thousands of dollars per course of treatment and in some cases millions of dollars per dose. Approximately half of all spending on medicines is projected to target only 2-3% of patients, raising important questions about resource allocation. While there is no doubt that breakthrough innovations have transformed clinical care in some disciplines, it is also true that cost is becoming one of the primary barriers to treatment access and that many new medicines do not provide value commensurate with their prices. This article examines pricing trends, the reasons for high prices and their implications for access and clinical practice.

What did we learn about changing behaviour during the COVID-19 pandemic? A systematic review of interventions to change hand hygiene and mask use behaviour

BACKGROUND

behaviour change interventions were central in the COVID-19 response and are vital for strengthening pandemic preparedness and resilience. To be effective, interventions must target specific behavioural determinants, but determinants are complex and multifaceted and there is a gap in robust, theory driven evidence on which behavioural determinants are most effective at changing mask usage and hand hygiene behaviour.

PURPOSE

to map available evidence on the types of hand hygiene and mask usage behaviour change interventions conducted during the COVID-19 pandemic and assess their effectiveness, feasibility and acceptability.

METHODS

we conducted a systematic review, searching four peer-reviewed databases for terms related to COVID-19, targeted behaviours (hand hygiene and mask usage) and interventions. Eligible studies were those which focused on adults or children in naturalistic, non-experimental settings; reported on an intervention designed to change hand hygiene and or mask usage to reduce COVID-19 transmission; provided clear outcome measures, including through self-report, proxy indicators or observation. Studies were excluded if they were purely qualitative, opinion pieces or based on secondary data alone; focused on health workers; measured intended rather than enacted behaviour; were conducted in laboratory or health care-based settings; involved infants; were published before the 11th of March 2020 (when COVID-19 was declared a pandemic) and published in a language other than English. There were no geographical limits set. Descriptive summaries were produced and the quality of evidence and reporting was evaluated. Studies were divided into three sub-groups according to the behaviour targeted and behaviour change techniques (BCTs) were mapped. Effect estimates were summarised and the relationship between BCTs and effect was explored. Feasibility and acceptability was summarised where reported. Due to the heterogeneity of studies included, meta-analysis could not be conducted.

FINDINGS

sixteen citations met the criteria, with sub-studies (two citations including multiple studies) totalling nineteen eligible studies. The majority were randomised controlled trials which targeted hand hygiene only and were conducted in high income nations, with none conducted in crisis settings. Due to the constraints of the pandemic, many interventions were delivered online. The quality of studies was low, with the majority demonstrating a medium risk of bias (Likert scale: low, medium, high). Whilst acceptability and feasibility was good, both were rarely evaluated. 'Natural consequences' was the most commonly used BCT group. Fourteen of the studies elicited positive or potentially positive effects in at least one intervention arm and/or targeted behaviour. Effective interventions typically targeted multiple individual BCTs, including 'Instruction on how to perform a behaviour', 'Information about health consequences', and group 'Reward and threat', through repeated engagement over a sustained period of time.

CONCLUSION

there is a substantial knowledge gap, particularly in low resource and crisis settings, and available evidence is of low quality. We must address these gaps to enable evidence-based practice and strengthen pandemic preparedness and resilience. Future research should include another systematic review which includes grey literature and different languages, as well as more robust evaluations which use implementation research to explore the impact of multiple BCTs in low resource and crisis settings. Evaluations should include assessments of acceptability, practicability, affordability and equity.

Environmental implications and levelized cost analysis of E-fuel production under photovoltaic energy, direct air capture, and hydrogen

The ecological transition in the transport sector is a major challenge to tackle environmental pollution, and European legislation will mandate zero-emission new cars from 2035. To reduce the impact of petrol and diesel vehicles, much emphasis is being placed on the potential use of synthetic fuels, including electrofuels (e-fuels). This research aims to examine a levelised cost (LCO) analysis of e-fuel production where the energy source is renewable. The energy used in the process is expected to come from a photovoltaic plant and the other steps required to produce e-fuel: direct air capture, electrolysis and Fischer-Tropsch process. The results showed that the LCOe-fuel in the baseline scenario is around 3.1 €/l, and this value is mainly influenced by the energy production component followed by the hydrogen one. Sensitivity, scenario and risk analyses are also conducted to evaluate alternative scenarios, and it emerges that in 84% of the cases, LCOe-fuel ranges between 2.8 €/l and 3.4 €/l. The findings show that the current cost is not competitive with fossil fuels, yet the development of e-fuels supports environmental protection. The concept of pragmatic sustainability, incentive policies, technology development, industrial symbiosis, economies of scale and learning economies can reduce this cost by supporting the decarbonization of the transport sector.

Application of a Precision-Dosing Model to a Real-World Cohort of Patients on Infliximab Maintenance Therapy: Drug Usage and Cost Analysis

Precision-dosing models forecast infliximab doses to achieve targeted trough concentrations in patients with inflammatory bowel disease (IBD). These models have shown to reduce nonresponse and improve patient outcomes. We compared infliximab doses determined by iDOSE precision dosing with standard dosing, and the associated drug costs, in patients with IBD. In this retrospective study, patients with IBD treated with infliximab every 8 weeks at 5 mg/kg were included. An infliximab dose was named dose X if 3 previous infliximab doses, laboratory values including trough infliximab concentrations, and the patient's weight were recorded. The actual dose X was compared to an iDOSE-predicted dose X. Net drug use and costs were evaluated. A total of 174 patients-56% men; median age, 36 (interquartile range, 29-47) years; 135 with Crohn disease; and 31 with ulcerative colitis-were included, with 417 dose X recordings. Median prior infliximab therapy was 2 (0-4) years. Comparing actual dose X with predicted dose X, 52% and 32% of doses were subtherapeutic when aiming for trough concentrations of 5-10 and 3-7 μg/mL, respectively. Treatment costs increased by 102% and 29% for the 2 trough ranges, respectively. On multivariate regression analysis, subtherapeutic infliximab concentrations were associated with ulcerative colitis compared with Crohn disease (odds ratio, 9.81; 95% confidence interval, 1.28-75.40; P = .028) and predose X infliximab trough concentration [odds ratio, 0.07; 95% confidence interval, 0.03-0.15; P < .001]. Over half of maintenance infliximab drug doses were too low to achieve infliximab blood concentrations of 5 μg/mL or greater. While applying precision dosing may improve patient outcomes, drug costs could be considerably greater.

Impact of bi-directional electric vehicle and demand response on residential distributed PV capacity planning based on TOU pricing

The widespread deployment of residential distributed photovoltaic (RDPV) remains complex and challenging due to photovoltaic output intermittency, fluctuating electricity demand, and rising electric vehicle (EV) adoption. Simultaneously, the energy storage capabilities of EVs and residential demand response (DR) offer solutions for optimizing RDPV applications. This study proposes an integrated RDPV capacity planning model by encompassing EV charging, vehicle-to-home, and flexible load DR. Five scenarios are established to reveal the impact of various factors on the optimal photovoltaic installation capacity, electricity cost, self-consumption and self-sufficiency rate. A case study of three typical residential electricity demand patterns indicates that DR and vehicle-to-home significantly reduce the optimal photovoltaic installation capacity and total electricity cost. When the feed-in tariff during photovoltaic generation periods is higher than the off-peak pricing, DR results in a reduction in photovoltaic self-sufficiency rate and an increase in photovoltaic self-consumption rate. EV charging and vehicle-to-home have minimal impact on photovoltaic self-consumption rate, while EV charging significantly decreases self-sufficiency rate and vehicle-to-home exacerbates this effect.

Usability of Health Care Price Transparency Data in the United States: Mixed Methods Study

BACKGROUND

Increasing health care expenditure in the United States has put policy makers under enormous pressure to find ways to curtail costs. Starting January 1, 2021, hospitals operating in the United States were mandated to publish transparent, accessible pricing information online about the items and services in a consumer-friendly format within comprehensive machine-readable files on their websites.

OBJECTIVE

The aims of this study are to analyze the available files on hospitals' websites, answering the question-is price transparency (PT) information as provided usable for patients or for machines?-and to provide a solution.

METHODS

We analyzed 39 main hospitals in Florida that have published machine-readable files on their website, including commercial carriers. We created an Excel (Microsoft) file that included those 39 hospitals along with the 4 most popular services-Current Procedural Terminology (CPT) 45380, 29827, and 70553 and Diagnosis-Related Group (DRG) 807-for the 4 most popular commercial carriers (Health Maintenance Organization [HMO] or Preferred Provider Organization [PPO] plans)-Aetna, Florida Blue, Cigna, and UnitedHealthcare. We conducted an A/B test using 67 MTurkers (randomly selected from US residents), investigating the level of awareness about PT legislation and the usability of available files. We also suggested format standardization, such as master field names using schema integration, to make machine-readable files consistent and usable for machines.

RESULTS

The poor usability and inconsistent formats of the current PT information yielded no evidence of its usefulness for patients or its quality for machines. This indicates that the information does not meet the requirements for being consumer-friendly or machine readable as mandated by legislation. Based on the responses to the first part of the experiment (PT awareness), it was evident that participants need to be made aware of the PT legislation. However, they believe it is important to know the service price before receiving it. Based on the responses to the second part of the experiment (human usability of PT information), the average number of correct responses was not equal between the 2 groups, that is, the treatment group (mean 1.23, SD 1.30) found more correct answers than the control group (mean 2.76, SD 0.58; t65=6.46; P<.001; d=1.52).

CONCLUSIONS

Consistent machine-readable files across all health systems facilitate the development of tools for estimating customer out-of-pocket costs, aligning with the PT rule's main objective-providing patients with valuable information and reducing health care expenditures.

Tobacco use among in-school young adolescents in Indonesia: Exploring availability, affordability, and accessibility

The research on Indonesian adolescents' perception of tobacco control in schools is limited. This study aimed to explore the availability, affordability, and accessibility of tobacco among young adolescents in Yogyakarta Municipality, Indonesia, with a focus on advocating for school teenagers. Focus groups, comprising participants from diverse backgrounds and stakeholders, were conducted in Yogyakarta, Indonesia, to systematically collect varied data. The subsequent analysis employed a robust thematic approach, combining both inductive and deductive processes to ensure a nuanced exploration of emerging patterns and pre-existing frameworks. In addition to focus group data, the study incorporated insights from extensive field observations and research group discussions. The multifaceted approach enhanced the depth of analysis but also facilitated a comprehensive understanding of the complex dynamics. The findings of this study revealed that young adolescents found it extremely easy to purchase cigarettes from local markets. The smoking prevalence among young adolescents was relatively low, with only 10% of the respondents admitting to smoking. Although the Indonesian government has increased surveillance and regulations regarding smoking among young individuals, the actual implementation and effectiveness of these measures remain questionable. The existing anti-smoking approaches in Indonesia have been unsuccessful in curbing smoking among Indonesian school students. The study argues that it is crucial to recognize and value students' perceptions of smoking, as their knowledge of smoking is actively constructed. To address this issue, future anti-smoking education in schools should incorporate interactive sessions rather than solely relying on didactic approaches that highlight the harms of smoking. By engaging students in interactive discussions, they can actively participate in constructing their understanding of the consequences of smoking. Additionally, efforts should be made to enhance the implementation of tobacco control measures within schools and extend the reach of these measures to off-campus environments.

Pricing decision and channel selection of fresh agricultural products dual-channel supply chain based on blockchain

The application of blockchain can effectively improve the efficiency of fresh agricultural product circulation and consumer trust, but it can also increase investment costs. In this context, this paper introduces parameters such as blockchain unit variable cost, the level of blockchain technology investment, and consumer channel preference in two dual-channel supply chain systems dominated by fresh agricultural product manufacturers: online direct sales and distribution. It compares and analyzes pricing and channel selection strategies in both cases of not using and using blockchain. The research shows that when blockchain is used, manufacturer profits are higher in the direct sales model than in the distribution model. Traditional retailers' profits are lower in the direct sales model than in the distribution model. Total supply chain profits are higher in the direct sales model than in the distribution model, and they exhibit an inverted "U" shape as the level of blockchain investment increases. In the online direct sales model, if the blockchain technology unit variable cost is within a certain threshold range, manufacturer profits, traditional retailer profits, and total supply chain profits are all higher than when blockchain technology is not used. In the online distribution model, when the blockchain variable cost and blockchain usage level meet certain conditions, manufacturers, traditional retailers, and online distributors all have higher profits when using blockchain technology than when not using it. This study provides theoretical guidance for the practical application of blockchain technology in dual-channel fresh agricultural product supply chains.

Selection of presale models for innovative products considering channel preferences and valuation differences

To reduce financial pressure and operational risk, and improve match between supply and demand, an increasing number of enterprises are adopting presales to launch new products. In this context, this paper investigates three presale models for innovative products, namely, the no-presale model, the manufacturer presale model and the retailer presale model. A Hotelling model is used to describe the impact of channel preferences and valuation differences on the two-stage competition between innovative products. Aiming at evaluating the purchase behavior of consumers under three presale modes, a game optimization model is established to analyze the presale decision problem for innovative products under different presale entities. The research shows that: (1) Compared with no-presale, presales can help enterprises obtain more profits. The overall profit of the supply chain is optimal under the retailer presale mode. (2) When the difference in channel preferences is small, the manufacturer obtains the greatest profit by choosing the direct presale model. In contrast, the selection of different presale entities has a significant impact on product sales and supply chain enterprise profits. At this point, the manufacturer should choose the retailer presale model. (3) When the product valuation discount is high, the manufacturer can increase the spot and wholesale prices to induce consumers to choose the presale method to purchase the product. In the opposite situation, the manufacturer should lower the presale price to improve the presale utility of consumers and encourage them to participate in the presale. These conclusions provide more targeted suggestions for enterprises to formulate presale strategies, which can help them grasp market demand and improve market competitiveness.