Centralization impact and cost-saving study in a Moroccan hospital’s centralized unit of chemotherapy preparation

2020 ◽  
Vol 26 (7) ◽  
pp. 1630-1636 ◽  
Author(s):  
Casimir A Adade ◽  
Majda Benabbes ◽  
Mohammed J Belahcen ◽  
Younes Rahali
Keyword(s):  
Waste Reduction ◽  
Economic Interest ◽  
Potential Drug ◽  
Single Centre ◽  
Data Collection Sheet ◽  
Secondary Objective ◽  
One Year ◽  
Drug Waste ◽  
The Cost ◽  
Theoretical Amount

Purpose The purpose of this study was to assess the cost saved and the amount of drug wasted when compounding anticancer drugs in the centralized unit for chemotherapy preparation. A secondary objective was to estimate the centralization impact of activities related to the preparation of chemotherapies. Methods This was a two-month, single-centre, prospective study conducted at the National Oncology Institute in Rabat. The cost saved and the amount of drug wasted were calculated using a standardized data collection sheet (the prescribed dose, the amount of drug deployed, the amount remaining after compounding, the amount of drug saved and the drug wastage). The centralization impact was calculated using the amount of drug wasted in the centralized unit for chemotherapy preparation and a theoretical amount of drug wasted without centralization of preparation. Results During the study period, the total amount of drug saved was 249,959.5 mg (7.2% of drug used), which represented 96,657 USD. The amount of drug wasted was 89,290.5 mg or 42275.5 USD. The drug waste per dilution and per drug was 6.4 mg [1.6-16.1]. While the potential savings over one year (580,000 USD) reached 13.9% of the cytostatic drugs budget for 2018, the potential drug waste cost reached 6.1%. The centralization impact is estimated at an average of 79.5% ± 13.7% waste reduction. Conclusion The outcome of our study showed that the grouping of prescriptions in centralized unit for chemotherapy preparation could result in significant savings on the amount of drugs deployed. The centralization of cytostatic preparations is of economic interest.

Sonographically guided, transcatheter foam sclerotherapy of the great saphenous vein

Phlebologie ◽  
2007 ◽  
Vol 36 (06) ◽  
pp. 309-312 ◽  
Author(s):  
T. Schulz ◽  
M. Jünger ◽  
M. Hahn
Keyword(s):  
Saphenous Vein ◽  
Great Saphenous Vein ◽  
Clinical Stage ◽  
Clinical Signs ◽  
Cost Effective ◽  
Duplex Sonography ◽  
Foam Sclerotherapy ◽  
Average Loss ◽  
One Year ◽  
The Cost

Summary Objective: The goal of the study was to assess the effectiveness and patient tolerability of single-session, sonographically guided, transcatheter foam sclerotherapy and to evaluate its economic impact. Patients, methods: We treated 20 patients with a total of 22 varicoses of the great saphenous vein (GSV) in Hach stage III-IV, clinical stage C2-C5 and a mean GSV diameter of 9 mm (range: 7 to 13 mm). We used 10 ml 3% Aethoxysklerol®. Additional varicoses of the auxiliary veins of the GSV were sclerosed immediately afterwards. Results: The occlusion rate in the treated GSVs was 100% one week after therapy as demonstrated with duplex sonography. The cost of the procedure was 207.91 E including follow-up visit, with an average loss of working time of 0.6 days. After one year one patient showed clinical signs of recurrent varicosis in the GSV; duplex sonography showed reflux in the region of the saphenofemoral junction in a total of seven patients (32% of the treated GSVs). Conclusion: Transcatheter foam sclerotherapy of the GSV is a cost-effective, safe method of treating varicoses of GSV and broadens the spectrum of therapeutic options. Relapses can be re-treated inexpensively with sclerotherapy.

Pareto Set as a Model for Dispatching Resources in Emergency Centres (Preprint)

2018 ◽  
Author(s):  
Ricardo Guedes ◽  
Vasco Furtado ◽  
Tarcísio Pequeno ◽  
Joel Rodrigues
Keyword(s):  
Operational Research ◽  
Real Data ◽  
Pareto Set ◽  
Multi Objective Optimization ◽  
Pareto Dominance ◽  
Four Dimensions ◽  
Multi Objective ◽  
The Best Approximation ◽  
One Year ◽  
The Cost

UNSTRUCTURED The article investigates policies for helping emergency-centre authorities for dispatching resources aimed at reducing goals such as response time, the number of unattended calls, the attending of priority calls, and the cost of displacement of vehicles. Pareto Set is shown to be the appropriated way to support the representation of policies of dispatch since it naturally fits the challenges of multi-objective optimization. By means of the concept of Pareto dominance a set with objectives may be ordered in a way that guides the dispatch of resources. Instead of manually trying to identify the best dispatching strategy, a multi-objective evolutionary algorithm coupled with an Emergency Call Simulator uncovers automatically the best approximation of the optimal Pareto Set that would be the responsible for indicating the importance of each objective and consequently the order of attendance of the calls. The scenario of validation is a big metropolis in Brazil using one-year of real data from 911 calls. Comparisons with traditional policies proposed in the literature are done as well as other innovative policies inspired from different domains as computer science and operational research. The results show that strategy of ranking the calls from a Pareto Set discovered by the evolutionary method is a good option because it has the second best (lowest) waiting time, serves almost 100% of priority calls, is the second most economical, and is the second in attendance of calls. That is to say, it is a strategy in which the four dimensions are considered without major impairment to any of them.

Highly selective diversion with proactive leakage management after low anterior resection for rectal cancer

2021 ◽  
Author(s):  
K Talboom ◽  
I Vogel ◽  
R D Blok ◽  
S X Roodbeen ◽  
C Y Ponsioen ◽  
...  
Keyword(s):  
Low Anterior Resection ◽  
Case Series ◽  
Fecal Diversion ◽  
Single Center ◽  
Single Centre ◽  
Diverting Stoma ◽  
Faecal Diversion ◽  
One Year ◽  
Diversion Rate

Abstract In this single center case series with nine percent primary diversion, 86 of 94 patients alive and with complete follow-up at one year had a functioning anastomosis. Seventy-five of the initial 99 patients never had a stoma. Meaning: Highly selective fecal diversion in combination with proactive leakage management, low anastomoses can be preserved safely, and the majority of patients will be spared all disadvantages of a diverting stoma. In this single-centre case series, with a primary diversion rate of 9 per cent, 86 of 94 patients who were alive and had complete follow-up at 1 year had a functioning anastomosis. Seventy-five of the initial 99 patients never had a stoma. The results indicate that, with highly selective faecal diversion in combination with proactive leakage management, low anastomoses can be preserved safely, and the majority of patients will be spared the disadvantages of a diverting stoma.

scholarly journals Black Soldier Fly Larval Valorization Benefitting from Ex-Situ Fungal Fermentation in Reducing Coconut Endosperm Waste

Processes ◽  
2021 ◽  
Vol 9 (2) ◽  
pp. 275
Author(s):  
Chung Yiin Wong ◽  
Kunlanan Kiatkittipong ◽  
Worapon Kiatkittipong ◽  
Seteno K. O. Ntwampe ◽  
Man Kee Lam ◽  
...  
Keyword(s):  
Principal Component ◽  
Correlation Study ◽  
Statistical Correlation ◽  
Waste Reduction ◽  
Ex Situ ◽  
Larval Feeding ◽  
Rhizopus Oligosporus ◽  
Black Soldier Fly ◽  
The Cost

Oftentimes, the employment of entomoremediation to reduce organic wastes encounters ubiquitous shortcomings, i.e., ineffectiveness to valorize recalcitrant organics in wastes. Considering the cost-favorability, a fermentation process can be employed to facilitate the degradation of biopolymers into smaller organics, easing the subsequent entomoremediation process. However, the efficacy of in situ fermentation was found impeded by the black soldier fly larvae (BSFL) in the current study to reduce coconut endosperm waste (CEW). Indeed, by changing into ex situ fermentation, in which the fungal Rhizopus oligosporus was permitted to execute fermentation on CEW prior to the larval feeding, the reduction of CEW was significantly enhanced. In this regard, the waste reduction index of CEW by BSFL was almost doubled as opposed to in situ fermentation, even with the inoculation of merely 0.5 wt % of Rhizopus oligosporus. Moreover, with only 0.02 wt % of fungal inoculation size to execute the ex situ fermentation on CEW, it could spur BSFL growth by about 50%. Finally, from the statistical correlation study using principal component analysis, the presence of Rhizopus oligosporus in a range of 0.5–1.0 wt % was regarded as optimum to ferment CEW via ex situ mode, prior to the valorization by BSFL in reducing the CEW.

scholarly journals Surgical instrumentation: the true cost of instrument trays and a potential strategy for optimization

2015 ◽  
Vol 4 (6) ◽  
pp. 82 ◽  
Author(s):  
Julie M. Mhlaba ◽  
Emily W. Stockert ◽  
Martin Coronel ◽  
Alexander J. Langerman
Keyword(s):  
United States ◽  
Cost Savings ◽  
Cost Effective ◽  
The United States ◽  
Waste Reduction ◽  
Significant Cost ◽  
Instrument Type ◽  
Hospital Revenue ◽  
Potential Strategy ◽  
The Cost

Objective: Operating rooms (OR) generate a large portion of hospital revenue and waste. Consequently, improving efficiency and reducing waste is a high priority. Our objective was to quantify waste associated with opened but unused instruments from trays and to compare this with the cost of individually wrapping instruments.Methods: Data was collected from June to November of 2013 in a 550-bed hospital in the United States. We recorded the instrument usage of two commonly-used trays for ten cases each. The time to decontaminate and reassemble instrument trays and peel packs was measured, and the cost to reprocess one instrument was calculated.Results: Average utilization was 14% for the Plastic Soft Tissue Tray and 29% for the Major Laparotomy Tray. Of 98 instruments in the Plastics tray (n = 10), 0% was used in all cases observed and 59% were used in no observed cases. Of 110 instruments in the Major Tray (n = 10), 0% was used in all cases observed and 25% were used in no observed cases. Average cost to reprocess one instrument was $0.34-$0.47 in a tray and $0.81-$0.84 in a peel pack, or individually-wrapped instrument.Conclusions: We estimate that the cost of peel packing an instrument is roughly two times the cost of tray packing. Therefore, it becomes more cost effective from a processing standpoint to package an instrument in a peel pack when there is less than a 42%-56% probability of use depending on instrument type. This study demonstrates an opportunity for reorganization of instrument delivery that could result in a significant cost-savings and waste reduction.

scholarly journals Reproductive and cost assessment of a seasonal breeding program with Bos indicus in tropical Mexico

2021 ◽  
Vol 26 (2) ◽  
pp. e2130
Author(s):  
José Francisco Martínez-Albarrán ◽  
Carlos Salvador Galina-Hidalgo ◽  
Ivette Rubio-Gutiérrez ◽  
Wendy Leticia Balam-Villarreal ◽  
Manuel D. Corro-Morales
Keyword(s):  
Pregnancy Rate ◽  
Breeding Season ◽  
Phase 1 ◽  
Bos Indicus ◽  
Fixed Time ◽  
Breeding Program ◽  
Tropical Region ◽  
Two Phases ◽  
One Year ◽  
The Cost

Objective. To compare the reproductive performance of postpartum and open Bos indicus cows and to study the cost effectiveness of retaining non-pregnant animals after a short breeding season in tropical region of Mexico. Material and Methods. A total of 128 Bos indicus were included, 87 postpartum cows (PP) with ≤90 days after calving and 41 open cows (OC) with >90 days open. The study was divided into three phases: 1) Estrus synchronization followed by FTAI (day 0-10), 2) Estrus detection and AI (day 11-45) and 3) Natural mating (day 46-90). For the first phase, all animals were synchronized and AI at fixed time (day 10). Cows displaying overt signs of estrus (day 11-45) were AI. Open cows during the previous two phases were exposed to the bull. Results. Pregnancy in phase 1 was different (p<0.01) for PP and OC groups, 58.6% and 34.1%, respectively. Overall pregnancy percentage over the second service was 42.5% (p>0.05). No differences (p>0.05) were observed at phase 3, average 44.2%. By the end of the breeding season, the cost of OC, was 3 times more than PP cows. Conclusions. Pregnancy rate at first phase was higher in PP cows than OC cows. At the end of breeding season, a pregnancy rate of 80% was found. Incorporation of open cows from previous breeding season was more expensive than PP cows in all phases of the breeding program. Retaining an open cow for rebreeding one year or more could not be economically feasible.

scholarly journals Sepsis in a university hospital: a prospective study for the cost analysis of patients' hospitalization

2016 ◽  
Vol 50 (2) ◽  
pp. 302-308 ◽  
Author(s):  
Maynara Fernanda Carvalho Barreto ◽  
Mara Solange Gomes Dellaroza ◽  
Gilselena Kerbauy ◽  
Cintia Magalhães Carvalho Grion
Keyword(s):  
Severe Sepsis ◽  
Public Hospital ◽  
Epidemiological Data ◽  
University Hospital ◽  
Preventive Actions ◽  
Focus Of Infection ◽  
One Year ◽  
A Prospective Study ◽  
The Cost ◽  
Pulmonary Focus

Abstract OBJECTIVE To estimate the cost of hospitalization of patients with severe sepsis or septic shock admitted or diagnosed in the Urgent and Emergency sector at a university hospital and followed until the clinical outcome. METHOD An epidemiological, prospective, observational study conducted in a public hospital in southern Brazil for the period of one year (August 2013 to August 2014). Sepsis notification forms, medical records and data of the cost sector were used for the collection of clinical and epidemiological data. RESULTS The sample comprised 95 patients, resulting in a total high cost of hospitalization (R$ 3,692,421.00), and an average of R$ 38,867.60 per patient. Over half of the total value of the treatment of sepsis (R$ 2,215,773.50) was assigned to patients who progressed to death (59.0%). The higher costs were related to discharge, diagnosis of severe sepsis, the pulmonary focus of infection and the age group of up to 59 years. CONCLUSION The high cost of the treatment of sepsis justifies investments in training actions and institution of protocols that can direct preventive actions, and optimize diagnosis and treatment in infected and septic patients.

Enterprise Inventory Management and Simulation

2014 ◽  
Vol 933 ◽  
pp. 874-878
Author(s):  
Yun Rui Wang
Keyword(s):  
Computer Simulation ◽  
Supply Chain ◽  
Inventory Management ◽  
Simulation Software ◽  
Total Cost ◽  
The Third ◽  
Inventory Strategy ◽  
One Year ◽  
The Cost ◽  
Operation Cost

Inventory is an important link in supply chain, according to characteristics and objectives of inventory control, the reasonable safety inventory, order point, the highest inventory and inventory strategy were determined based on historical sales data. Using Witness simulation software, the optimal strategy was selected from nine inventory strategies by running simulation model for one year. If goods shortage was allowing, the seventh schemes (72000,158100) was better ,the minimum total cost was 888158 yuan ; considering allowing a small amount of shortage, the cost of eighth schemes ( 82000,158100) was least of 1095167; the third scenarios (92000,138100) was selected if without shortage, and the minimum total cost was 1254909 yuan. This shows, the application of computer simulation to assist in the management of inventory is scientific and feasible, it can help enterprises to save the order and operation cost.

23. Value Added Tax

2020 ◽  
pp. 231-234
Author(s):  
J. Scott Slorach ◽  
Jason Ellis
Keyword(s):  
Value Added ◽  
Value Added Tax ◽  
Goods And Services ◽  
One Year ◽  
The Uk ◽  
The Cost ◽  
Made In

This chapter discusses value added tax (VAT) in the UK. VAT is charged on supplies of goods and services made in the UK. Where a person makes taxable supplies in excess of a set limit in any one-year period, he must register with Her Majesty’s Revenue and Customs (HMRC). He must then account to HMRC for VAT on all taxable supplies made. The total amount payable may be reduced by the amount of VAT paid on certain taxable supplies made to him. The liability to pay VAT to HMRC rests on suppliers of goods and services. However, the cost of the tax is actually borne by suppliers’ customers who are charged VAT on the goods and services they purchase. VAT is charged in the UK under the Value Added Tax Act (VATA) 1994.

scholarly journals 2694. Incidence of Pneumocytis jiroveci (PJP) Infection with 3-Month Prophylaxis of Aerosolized Pentamidine (AP) in Autologous Hematopoietic Stem Cell Transplantation (HSCT)

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S947-S947
Author(s):  
Sarah Perreault ◽  
Dayna McManus ◽  
Rebecca Pulk ◽  
Jeffrey E Topal ◽  
Francine Foss ◽  
...  
Keyword(s):  
Cost Savings ◽  
Cost Comparison ◽  
High Dose ◽  
Potential Cost ◽  
Hematopoietic Stem ◽  
Increased Risk ◽  
One Year ◽  
Relapsed Disease ◽  
The Cost ◽  
Autologous Hsct

Abstract Background HSCT patients are at an increased risk of developing PJP after transplant due to treatment induced immunosuppression. Given the risk of cytopenias with co-trimoxazole, AP is utilized as an alternative for PJP prophylaxis. A prior study revealed a 0% (0/19 patients) incidence when AP prophylaxis was given for one year post autologous HSCT. Current guidelines recommend a duration of 3 – 6 months for PJP prophylaxis in autologous HSCT. The primary endpoint of this study was to assess the incidence of PJP infection within one year post autologous HSCT in patients who received 3 months of AP. Secondary endpoint was a cost comparison of 3 months compared with 6 months of AP. Methods A single-center, retrospective study of adult autologous HSCT patients at Yale New Haven Hospital between February 2013 and December 2017 was performed. Patients were excluded if: <18 years of age, received < or >3 months of AP, changed to alternative PJP prophylactic agent or received no PJP prophylaxis, received tandem HSCT, deceased prior to one year post-transplant from a non PJP-related infection, HIV positive, or lost to follow-up. Pentamidine was given as a 300 mg inhalation monthly for 3 months starting Day +15 after autologous HSCT. Results A total of 288 patients were analyzed, no PJP infections occurred within one year post HSCT. Additionally, 187 (65%) patients received treatment post HSCT with 135/215 (63%) receiving maintenance immunomodulatory drugs for myeloma and 40/288 (14%) patients developing relapsed disease. 43% of the chemotherapy regimens for relapsed disease included high dose corticosteroids. The cost difference of using 3 months vs. 6 months of AP is $790, reflecting the cost of drug and its administration. Applying our incidence of 0%, potential cost savings of 3 months vs. 6 months of AP would be $330,000 over 5 years or $66,000 per year. Conclusion Three months of AP for PJP prophylaxis in autologous HSCT patients is safe and effective as well as cost-effective compared with a 6 month regimen. Disclosures All authors: No reported disclosures.

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