scholarly journals PMO-24 Intestinal ultrasound instead of magnetic resonance enterography: large potential cost savings with limited clinical downsides

2021 ◽  
Author(s):  
Raphael Luber ◽  
Bianca Petri ◽  
Nyree Griffin ◽  
Peter Irving
Keyword(s):  
Magnetic Resonance ◽  
Cost Savings ◽  
Magnetic Resonance Enterography ◽  
Potential Cost ◽  
Large Potential

scholarly journals P241 Gastrointestinal ultrasound instead of magnetic resonance enterography: Large potential cost savings with limited clinical downsides

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S285-S286
Author(s):  
R Luber ◽  
B Petri ◽  
N Griffin ◽  
P Irving
Keyword(s):  
Magnetic Resonance ◽  
Intestinal Inflammation ◽  
Gastrointestinal Disease ◽  
Cost Savings ◽  
Magnetic Resonance Enterography ◽  
Pancreatic Cysts ◽  
Potential Cost ◽  
Gastrointestinal Ultrasound ◽  
Surgical History ◽  
Upper Gastrointestinal

Abstract Background Gastrointestinal ultrasound (GIUS) is a non-invasive imaging modality capable of detecting intestinal inflammation & associated complications. It has comparable sensitivity & specificity to magnetic resonance enterography (MRE) in detecting ileocolonic disease, however it is less expensive (£24 vs £180) & can be performed at point of care. We aimed to establish the proportion of MREs that could have been performed as GIUS at a tertiary inflammatory bowel disease (IBD) unit, the potential cost savings, & the predicted pathology miss-rates. Methods All MREs performed in January 2018 were retrospectively reviewed. Demographics, scan indication, IBD characteristics, surgical history, & gastrointestinal & non-gastrointestinal findings were collected. Indications deemed suitable for GIUS included: assessment of disease activity of known small bowel (SB) Crohn’s disease; first assessment for presence of SB disease in IBD; & investigation for SB disease in patients without a known diagnosis of IBD. Obesity, complicated surgical history (>1 resection or strictureplasty involving different segments, or stoma), & known proximal SB disease were deemed unsuitable. Results 105 MREs were performed in January 2018. 59 (56%) were deemed suitable for GIUS instead of MRE. Most common reasons for unsuitability included complex surgical history (n=17, 37%), obesity (n=14, 30%), non-appropriate indication (n=12, 26%) & known upper gastrointestinal disease (n=10, 22%). Of suitable cases, 32/59 (54%) had active inflammation detected including 17 (53%) isolated ileal, 8 (25%) ileocolonic, & 6 (19%) isolated colonic. In one case performed as first assessment for SB disease, both ileal & jejunal disease were found, the latter likely to be missed with GIUS. No cases of isolated upper gastrointestinal inflammation were found. Regarding non-gastrointestinal findings in potential GIUS patients, there were two cases of pancreatic cysts necessitating further investigation with serial MRIs & endoscopic ultrasound, yielding a side branch intraductal papillary mucinous neoplasm & a benign serous cyst adenoma. One case of multiple high T2 skeletal lesions was deemed clinically insignificant following further investigations. No other significant extra-intestinal findings not expected to be seen on GIUS were identified. Conclusion Over 50% of MREs could have been performed as GIUS instead, with a potential annual cost saving of over £110,000. No instances of inflammation would have been missed based on distribution, although in one case the full extent of disease may not have been identified on GIUS. Incidental non-gastrointestinal findings resulted in multiple investigations but were of limited clinical significance.

THE COST-EFFECTIVENESS OF MAGNETIC RESONANCE IMAGING FOR PATIENTS WITH INTERNAL DERANGEMENT OF THE KNEE

1999 ◽  
Vol 15 (2) ◽  
pp. 392-405 ◽  
Author(s):  
Maria E. Suarez-Almazor ◽  
Padma Kaul ◽  
Chris J. Kendall ◽  
L. Duncan Saunders ◽  
D.W.C. Johnston
Keyword(s):  
Magnetic Resonance Imaging ◽  
Cost Effectiveness ◽  
Magnetic Resonance ◽  
Cost Savings ◽  
Indirect Costs ◽  
Internal Derangement ◽  
Resonance Imaging ◽  
Potential Cost ◽  
Specificity And Sensitivity ◽  
New Diagnosis

Magnetic resonance imaging (MRI) has excellent specificity and sensitivity for the diagnosis of internal derangement of the knee (IDK). The use of MRI to screen patients with suspected IDK could avoid unnecessary arthroscopies with a reduction in costs. The purpose of this study was to evaluate the use of arthroscopy among patients with IDK, and to estimate the potential cost-effectiveness of MRI in these patients to avoid unnecessary arthroscopies. The study was based on a retrospective cohort of all patients attending three orthopedic clinics between April and September 1993 with a new diagnosis of IDK. Charts were reviewed in 1994 to allow for a follow-up of more than 6 months. An economic evaluation was performed based on cost-effectiveness ratios (per averted arthroscopy), including direct and indirect costs. There were 241 patients with a new diagnosis of IDK (67% males, mean age 35 ± 12 years), and 110 (46%) underwent arthroscopy. The remaining patients received conservative therapy and were not scheduled for arthroscopy within the period of observation. Using a priori established criteria, 10% of the arthroscopies could be considered diagnostic only (e.g., normal knee) and 27% were of doubtful efficacy from a therapeutic perspective (e.g., debridement alone). Many of these arthroscopies could have been avoided by performing a prior MRI. Using these findings, we conducted decision tree analyses of the use of MRI among patients requiring arthroscopy of the knee. A sensitivity analysis was performed to evaluate the various model assumptions. In general, MRI appeared to be a cost-effective diagnostic procedure for patients with IDK requiring arthroscopy of the knee, and there were cost savings associated with it in some of the models tested.

Integrated Tubulars Supply Model Provides Cost Savings to Drilling Projects

2020 ◽  
Author(s):  
M. Hamzah
Keyword(s):  
Supply Chain ◽  
Cost Savings ◽  
Asia Pacific ◽  
Potential Cost ◽  
Alternative Scheme ◽  
Safety Stocks ◽  
Storage Location ◽  
Supply Planning ◽  
Drilling Site ◽  
Drilling Project

Classical Oil Country Tubular Goods (OCTG) procurement approach has been practiced in the indus-try with the typical process of setting a quantity level of tubulars ahead of the drilling project, includ-ing contingencies, and delivery to a storage location close to the drilling site. The total cost of owner-ship for a drilling campaign can be reduced in the range of 10-30% related to tubulars across the en-tire supply chain. In recent decades, the strategy of OCTG supply has seen an improvement resulting in significant cost savings by employing the integrated tubular supply chain management. Such method integrates the demand and supply planning of OCTG of several wells in a drilling project and synergize the infor-mation between the pipes manufacturer and drilling operators to optimize the deliveries, minimizing inventory levels and safety stocks. While the capital cost of carrying the inventory of OCTG can be reduced by avoiding the procurement of substantial volume upfront for the entire project, several hidden costs by carrying this inventory can also be minimized. These include storage costs, maintenance costs, and costs associated to stock obsolescence. Digital technologies also simplify the tasks related to the traceability of the tubulars since the release of the pipes from the manufacturing facility to the rig floor. Health, Safety, and Environmental (HSE) risks associated to pipe movements on the rig can be minimized. Pipe-by-pipe traceability provides pipes’ history and their properties on demand. Digitalization of the process has proven to simplify back end administrative tasks. The paper reviews the OCTG supply methods and lays out tangible improvement factors by employ-ing an alternative scheme as discussed in the paper. It also provides an insight on potential cost savings based on the observed and calculated experiences from several operations in the Asia Pacific region.

Improved Oxygen Dissolution Control for Oxygen Activated Sludge

1988 ◽  
Vol 20 (4-5) ◽  
pp. 101-108 ◽  
Author(s):  
R. C. Clifft ◽  
M. T. Garrett
Keyword(s):  
Activated Sludge ◽  
Control Method ◽  
Control Strategies ◽  
Cost Savings ◽  
Utilization Efficiency ◽  
Oxygen Production ◽  
Oxygen Utilization ◽  
Potential Cost ◽  
Oxygen Dissolution ◽  
The City

Now that oxygen production facilities can be controlled to match the requirements of the dissolution system, improved oxygen dissolution control can result in significant cost savings for oxygen activated sludge plants. This paper examines the potential cost savings of the vacuum exhaust control (VEC) strategy for the City of Houston, Texas 69th Street Treatment Complex. The VEC strategy involves operating a closed-tank reactor slightly below atmospheric pressure and using an exhaust apparatus to remove gas from the last stage of the reactor. Computer simulations for one carbonaceous reactor at the 69th Street Complex are presented for the VEC and conventional control strategies. At 80% of design loading the VEC strategy was found to provide an oxygen utilization efficiency of 94.9% as compared to 77.0% for the conventional control method. At design capacity the oxygen utilization efficiency for VEC and conventional control was found to be 92.3% and 79.5%, respectively. Based on the expected turn-down capability of Houston's oxygen production faciilities, the simulations indicate that the VEC strategy will more than double the possible cost savings of the conventional control method.

Cost-minimization analysis of drugs used in the treatment of Asthma and COPD diseases in India

2020 ◽  
Vol 15 ◽  
Author(s):  
Billu Payal ◽  
Anoop Kumar ◽  
Harsh Saxena
Keyword(s):  
Generic Drugs ◽  
Cost Minimization ◽  
Cost Savings ◽  
Chronic Obstructive ◽  
Pulmonary Medicine ◽  
Potential Cost ◽  
Maximum Cost ◽  
Cost Minimization Analysis ◽  
Cost Variation ◽  
The Cost

Background: Asthma and Chronic Obstructive Pulmonary Diseases (COPD) are well known respiratory diseases affecting millions of peoples in India. In the market, various branded generics, as well as generic drugs, are available for their treatment and how much cost will be saved by utilizing generic medicine is still unclear among physicians. Thus, the main aim of the current investigation was to perform cost-minimization analysis of generic versus branded generic (high and low expensive) drugs and branded generic (high expensive) versus branded generic (least expensive) used in the Department of Pulmonary Medicine of Era Medical University, Lucknow for the treatment of asthma and COPD. Methodology: The current index of medical stores (CIMS) was referred for the cost of branded drugs whereas the cost of generic drugs was taken from Jan Aushadi scheme of India 2016. The percentage of cost variation particularly to Asthma and COPD regimens on substituting available generic drugs was calculated using standard formula and costs were presented in Indian Rupees (as of 2019). Results: The maximum cost variation was found between the respules budesonide high expensive branded generic versus least expensive branded generic drugs and generic versus high expensive branded generic. In combination, the maximum cost variation was observed in the montelukast and levocetirizine combination. Conclusion: In conclusion, this study inferred that substituting generic antiasthmatics and COPD drugs can bring potential cost savings in patients.

Inpatient Insulin Pen Implementation, Waste, and Potential Cost Savings: A Community Hospital Experience

2021 ◽  
pp. 193229682110025
Author(s):  
Urooj Najmi ◽  
Waqas Zia Haque ◽  
Umair Ansari ◽  
Eyerusalem Yemane ◽  
Lee Ann Alexander ◽  
...  
Keyword(s):  
Insulin Aspart ◽  
Community Hospital ◽  
Task Force ◽  
Hospital Setting ◽  
Cost Savings ◽  
Self Management ◽  
Self Administration ◽  
Potential Cost ◽  
Hospital Leadership ◽  
Insulin Pens

Background: Insulin pen injectors (“pens”) are intended to facilitate a patient’s self-administration of insulin and can be used in hospitalized patients as a learning opportunity. Unnecessary or duplicate dispensation of insulin pens is associated with increased healthcare costs. Methods: Inpatient dispensation of insulin pens in a 240-bed community hospital between July 2018 and July 2019 was analyzed. We calculated the percentage of insulin pens unnecessarily dispensed for patients who had the same type of insulin pen assigned. The estimated cost of insulin pen waste was calculated. A pharmacist-led task force group implemented hospital-wide awareness and collaborated with hospital leadership to define goals and interventions. Results: 9516 insulin pens were dispensed to 3121 patients. Of the pens dispensed, 6451 (68%) were insulin aspart and 3065 (32%) were glargine. Among patients on insulin aspart, an average of 2.2 aspart pens was dispensed per patient, but only an estimated 1.2 pens/patient were deemed necessary. Similarly, for inpatients prescribed glargine, an average of 2.1 pens/patient was dispensed, but only 1.3 pens/patient were necessary. A number of gaps were identified and interventions were undertaken to reduce insulin pen waste, which resulted in a significant decrease in both aspart (p = 0.0002) and glargine (p = 0.0005) pens/patient over time. Reductions in pen waste resulted in an estimated cost savings of $66 261 per year. Conclusions: In a community hospital setting, identification of causes leading to unnecessary insulin dispensation and implementation of hospital-wide staff education led to change in insulin pen dispensation practice. These changes translated into considerable cost savings and facilitated diabetes self-management education.

scholarly journals Constrained Urban Airspace Design for Large-Scale Drone-Based Delivery Traffic

Aerospace ◽  
2021 ◽  
Vol 8 (2) ◽  
pp. 38
Author(s):  
Malik Doole ◽  
Joost Ellerbroek ◽  
Victor L. Knoop ◽  
Jacco M. Hoekstra
Keyword(s):  
Traffic Congestion ◽  
Urban Areas ◽  
Large Scale ◽  
Cost Savings ◽  
Future Research ◽  
Fast Time ◽  
Potential Cost ◽  
Horizontal Structure ◽  
Traffic Demand ◽  
Demand Patterns

Large-scale adoption of drone-based delivery in urban areas promise societal benefits with respect to emissions and on-ground traffic congestion, as well as potential cost savings for drone-based logistic companies. However, for this to materialise, the ability of accommodating high volumes of drone traffic in an urban airspace is one of the biggest challenges. For unconstrained airspace, it has been shown that traffic alignment and segmentation can be used to mitigate conflict probability. The current study investigates the application of these principles to a highly constrained airspace. We propose two urban airspace concepts, applying road-based analogies of two-way and one-way streets by imposing horizontal structure. Both of the airspace concepts employ heading-altitude rules to vertically segment cruising traffic according to their travel direction. These airspace configurations also feature transition altitudes to accommodate turning flights that need to decrease the flight speed in order to make safe turns at intersections. While using fast-time simulation experiments, the performance of these airspace concepts is compared and evaluated for multiple traffic demand densities in terms of safety, stability, and efficiency. The results reveal that an effective way to structure drone traffic in a constrained urban area is to have vertically segmented altitude layers with respect to travel direction as well as horizontal constraints imposed to the flow of traffic. The study also makes recommendations for areas of future research, which are aimed at supporting dynamic traffic demand patterns.

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