Cost-effectiveness of noninvasive telemedical interventional management in patients with heart failure: health economic analysis of the TIM-HF2 trial

Background Noninvasive remote patient management (RPM) in patients with heart failure (HF) has been shown to reduce the days lost due to unplanned cardiovascular hospital admissions and all-cause mortality in the Telemedical Interventional Management in Heart Failure II trial (TIM-HF2). The health economic implications of these findings are the focus of the present analyses from the payer perspective. Methods and results A total of 1538 participants of the TIM-HF2 randomized controlled trial were assigned to the RPM and Usual Care group. Health claims data were available for 1450 patients (n = 715 RPM group, n = 735 Usual Care group), which represents 94.3% of the original TIM-HF2 patient population, were linked to primary data from the study documentation and evaluated in terms of the health care cost, total cost (accounting for intervention costs), costs per day alive and out of hospital (DAOH), and cost per quality-adjusted life year (QALY). The average health care costs per patient year amounted to € 14,412 (95% CI 13,284–15,539) in the RPM group and € 17,537 (95% CI 16,179–18,894) in the UC group. RPM led to cost savings of € 3125 per patient year (p = 0.001). After including the intervention costs, a cost saving of € 1758 per patient year remained (p = 0.048). Conclusion The additional noninvasive telemedical interventional management in patients with HF was cost-effective compared to standard care alone, since such intervention was associated with overall cost savings and superior clinical effectiveness. Graphical abstract

Asphaltene Management Leading to Significant Reduction of Production Deferment Through New Technology Trial MFC Tool

In Southern Oman, PDO is producing from several high pressure (500-1000 bar), deep (3-5 km) and sour fields (1-10 mol % H2S). Over time, wells from one field (S A3) started having asphaltene deposition in the wellbore. Recently, the impact on production became severe resulting in high deferment, increased HSE exposure with plugging and high intervention costs. Asset team kicked off an asphaltene management project to tackle this problem, with one initiative being a field trial of a new technology, Magnetic Fluid Conditioner (MFC) to avoid/delay asphaltene plugging in the wellbore. This paper discusses the asphaltene management strategy and field trial results from this new tool deployed to prevent/delay asphaltene deposition.

Cost of TB services in healthcare facilities in Kenya (No 3)

BACKGROUND: The reduction of Kenya´s TB burden requires improving resource allocation both to and within the National TB, Leprosy and Lung Disease Program (NTLD-P). We aimed to estimate the unit costs of TB services for budgeting by NTLD-P, and allocative efficiency analyses for future National Strategic Plan (NSP) costing.METHODS: We estimated costs of all TB interventions in a sample of 20 public and private health facilities from eight counties. We calculated national-level unit costs from a health provider´s perspective using bottom-up (BU) and top-down (TD) approaches for the financial year 2017–2018 using Microsoft Excel and STATA v16.RESULTS: The mean unit cost for passive case-finding (PCF) was respectively US$38 and US$60 using the BU and TD approaches. The unit BU and TD costs of a 6-month first-line treatment (FLT) course, including monitoring tests, was respectively US$135 and US$160, while those for adult drug-resistant TB (DR-TB) treatment was respectively US$3,230.28 and US$3,926.52 for the 9-month short regimen. Intervention costs highlighted variations between BU and TD approaches. Overall, TD costs were higher than BU, as these are able to capture more costs due to inefficiency (breaks/downtime/leave).CONCLUSION: The activity-based TB unit costs form a comprehensive cost database, and the costing process has built-in capacity within the NTLD-P and international TB research networks, which will inform future TB budgeting processes.

Non-Inferiority of a Group LiFE Version Compared to the Original, Individual LiFE to Prevent Falls

The ‘Lifestyle-integrated Functional Exercise’ (LiFE) program has been shown to reduce risk of falling via improvements in balance and strength while increasing physical activity in older adults. Its one-to-one delivery comes with considerable costs hampering large scale implementability. To potentially reduce costs, a group format (gLiFE) was developed and analyzed for its non-inferiority to LiFE in reducing activity-adjusted fall incidence after 6 months. Further, intervention costs and physical activity were analyzed. Older adults (70+ years) at risk of falling were included in this multi-centre, single-blinded, randomized non-inferiority trial. LiFE was delivered in nine intervention sessions to increase balance, strength, and physical activity, either in a group (gLiFE) or at the participant’s home (LiFE). 309 persons were randomized into gLiFE (n=153) and LiFE (n=156). Non-inferiority for activity-adjusted falls was inconclusive; the incidence risk ratio (IRR) of gLiFE was 1.350 (95% CI: 0.856; 2.128) at 6 months. Falls were largely reduced in both groups. Physical activity was superior in the gLiFE group (gLiFE +880 steps; CI 252, 1,509) which also had a cost advantage under study conditions as well as real world estimations. GLiFE was associated with lower intervention costs, making it a cost-efficient alternative to the individually delivered LiFE. The added value of gLiFE is the greater effect on physical activity, making it particularly attractive for large scale PA promotion in public health concepts. Depending on individual needs and preferences, both formats could be offered to individuals, with a greater focus on either fall prevention (LiFE) or physical activity promotion (gLiFE).

Optimizing Non-Pharmaceutical Intervention Strategies Against COVID-19 Using Artificial Intelligence

One key task in the early fight against the COVID-19 pandemic was to plan non-pharmaceutical interventions to reduce the spread of the infection while limiting the burden on the society and economy. With more data on the pandemic being generated, it became possible to model both the infection trends and intervention costs, transforming the creation of an intervention plan into a computational optimization problem. This paper proposes a framework developed to help policy-makers plan the best combination of non-pharmaceutical interventions and to change them over time. We developed a hybrid machine-learning epidemiological model to forecast the infection trends, aggregated the socio-economic costs from literature and expert knowledge, and used a multi-objective optimization algorithm to find and evaluate various intervention plans. The framework is modular and easily adjustable to a real-world situation, it is trained and tested with data collected from almost all countries of the world, and its proposed intervention plans generally outperform those used in real life in terms of both the number of infections and intervention costs.

Case management intervention of High Users of the Emergency Department of a Portuguese hospital: a before-after design analysis

Background: Emergency department (ED) High users (HU), defined as having more than ten visits to the ED per year, are a small group of patients that use a significant proportion of ED resources. The High Users Resolution Group(GRHU) identifies and provides care toHUto improve their health situation and reduce their visit frequency to the ED by delivering patient-centered, case management integrated care. Objectives: The main objective of this study was to measure the impact in terms of hospital visits of the GRHU intervention. Additionally, we aim to compare the program costs against its potential savings or additional costs. Finally, we intend to study the impact of the intervention across different groups of patients. Methods: We studied The changes triggered by the GRHU program in a retrospective non-controlled before-after analysis of patients’ hospital utilization data on six and 12-month windows from the first appointment. The GRHU team provided the patients’ and cost data. Results: A total of 238 EDHUwere intervened. A sample of 88 patients was analyzed on the 12-month window as they fulfilled all inclusion criteria. This intervention was associated with a statistically significant reduction of 51% in ED use and hospitalizations, and a non-statistically significant increase in the total number of outpatient appointments. Overall costs reduced 43.56%. We estimated the intervention costs to be€162,847.82. The net cost saving was€104,305.25. The program’s Return on Investment (ROI) was estimated to be€2.3. Conclusions: Patient-centered case management for EDHUseems to effectively reduce ED visits and hospitalizations, leading to the more appropriate use of resources.

ESP and Completion Deployment using Dual Derrick Drill Ship Rigs

This paper presents an innovative concept to run Electrical Submersible Pumps (ESP) and upper completion utilizing dual derrick drillship rigs in deep water wells. The availability of a second deck to assemble, test and rack long assemblies brings the possibility to conduct a safer, efficient and reliable operation. The experience in Brazil running complex completions and high horsepower ESPs shows how important is to implement initiatives to reduce rig time. The main objective of the new process is to have every completion tool readily available in the drilling deck, requiring minimum time to connect it to the completion string. In the standard process, the tool sits in the pipe deck until completion string reaches its set position and only then the equipment is brought into the rig floor to be serviced and made up to the completion string. The methodology to assemble ESP and completion tools offline in the auxiliary derrick was developed in partnership with the operator, the service company, and the drilling rig contractor. The offline preparation concept was considered as part of the completion design phase analyzing every step of the upper completion run, looking for efficiency improvement and reduced total rig time. The modern automated pipe handling system was used to manipulate the long and heavy assemblies from the auxiliary deck to the racking system and from the racking system to the main deck without any safety concern, and with minimal human intervention. Eight deep-water operations were completed in Brazil using the new concept and the results brought important rig time reduction in the upper completion running time. The tools that were part of the completion included DHSV, permanent downhole gauges, chemical injection valves, 1600 HP ESP system and tubing test valves. The new process allows the team to service equipment without the usual operation rush reducing installation related failure therefore increasing equipment reliability. The methodology presented on this paper contributes to oil industry as a field-proven reference for offshore ESP and completion deployment technique reducing HSE exposure and total well construction cost. This is particularly important for deep and ultra-deepwater projects which are associated with high intervention costs. Dual derrick rigs were designed with focus to improve drilling operations and after the new process development, the modern robotized machinery empowers ESP and completion activities with improved efficiencies.

Preventing Asphaltene Deposition by Inhibitor Squeeze Injection: Case Studies from Giant Carbonate Abu Dhabi Fields

Asphaltene deposition is a notorious flow assurance problem faced by oil companies that causes production loss and large expenses for operators. The complex nature of asphaltenes and limited data available makes it challenging to develop a full field implementation strategy that is economically viable as well. Conducting asphaltene clean-up operations whenever wells get plugged up are the reactive approach to deal with asphaltene issues. However these approaches often result in prolonged well downtime, production losses and high well intervention costs. As part of proactive measures, chemical inhibitors were screened for formation squeeze and field trials conducted to assess their performance. Results from these trials helped to frame the full-field implementation strategy that is promising from a technical-economic standpoint. This paper describes the asphaltene mitigation journey of a major Abu Dhabi oil operator that resulted in multi-million dollar savings.

Cost-effectiveness of physical activity intervention in children – results based on the Physical Activity and Nutrition in Children (PANIC) study

Background We assessed the cost-effectiveness of a 2-year physical activity (PA) intervention combining family-based PA counselling and after-school exercise clubs in primary-school children compared to no intervention from an extended service payer’s perspective. Methods The participants included 506 children (245 girls, 261 boys) allocated to an intervention group (306 children, 60 %) and a control group (200 children, 40 %). The children and their parents in the intervention group had six PA counselling visits, and the children also had the opportunity to participate in after-school exercise clubs. The control group received verbal and written advice on health-improving PA at baseline. A change in total PA over two years was used as the outcome measure. Intervention costs included those related to the family-based PA counselling, the after-school exercise clubs, and the parents’ taking time off to travel to and participate in the counselling. The cost-effectiveness analyses were performed using the intention-to-treat principle. The costs per increased PA hour (incremental cost-effectiveness ratio, ICER) were based on net monetary benefit (NMB) regression adjusted for baseline PA and background variables. The results are presented with NMB and cost-effectiveness acceptability curves. Results Over two years, total PA increased on average by 108 h in the intervention group (95 % confidence interval [CI] from 95 to 121, p < 0.001) and decreased by 65.5 h (95 % CI from 81.7 to 48.3, p < 0.001) in the control group, the difference being 173.7 h. the incremental effectiveness was 87 (173/2) hours. For two years, the intervention costs were €619 without parents’ time use costs and €860 with these costs. The costs per increased PA hour were €6.21 without and €8.62 with these costs. The willingness to pay required for 95 % probability of cost-effectiveness was €14 and €19 with these costs. The sensitivity analyses revealed that the ICER without assuming this linear change in PA were €3.10 and €4.31. Conclusions The PA intervention would be cost-effective compared to no intervention among children if the service payer’s willingness-to-pay for a 1-hour increase in PA is €8.62 with parents’ time costs. Trial registration ClinicalTrials.gov: NCT01803776. Registered 4 March 2013 - Retrospectively registered, https://clinicaltrials.gov/ct2/results?cond=&term=01803776&cntry=&state=&city=&dist=.

Lifestyle-integrated functional exercise to prevent falls and promote physical activity: Results from the LiFE-is-LiFE randomized non-inferiority trial

Background The ‘Lifestyle-integrated Functional Exercise’ (LiFE) program successfully reduced risk of falling via improvements in balance and strength, additionally increasing physical activity (PA) in older adults. Generally being delivered in an individual one-to-one format, downsides of LiFE are considerable human resources and costs which hamper large scale implementability. To address this, a group format (gLiFE) was developed and analyzed for its non-inferiority compared to LiFE in reducing activity-adjusted fall incidence and intervention costs. In addition, PA and further secondary outcomes were evaluated. Methods Older adults (70 + years) at risk of falling were included in this multi-center, single-blinded, randomized non-inferiority trial. Balance and strength activities and means to enhance PA were delivered in seven intervention sessions, either in a group (gLiFE) or individually at the participant’s home (LiFE), followed by two “booster” phone calls. Negative binomial regression was used to analyze non-inferiority of gLiFE compared to LiFE at 6-month follow-up; interventions costs were compared descriptively; secondary outcomes were analyzed using generalized linear models. Analyses were carried out per protocol and intention-to-treat. Results Three hundred nine persons were randomized into gLiFE (n = 153) and LiFE (n = 156). Non-inferiority of the incidence rate ratio of gLiFE was inconclusive after 6 months according to per protocol (mean = 1.27; 95% CI: 0.80; 2.03) and intention-to-treat analysis (mean = 1.18; 95% CI: 0.75; 1.84). Intervention costs were lower for gLiFE compared to LiFE (-€121 under study conditions; -€212€ under “real world” assumption). Falls were reduced between baseline and follow-up in both groups (gLiFE: -37%; LiFE: -55%); increases in PA were significantly higher in gLiFE (+ 880 steps; 95% CI 252; 1,509). Differences in other secondary outcomes were insignificant. Conclusions Although non-inferiority of gLiFE was inconclusive, gLiFE constitutes a less costly alternative to LiFE and it comes with a significantly larger enhancement of daily PA. The fact that no significant differences were found in any secondary outcome underlines that gLiFE addresses functional outcomes to a comparable degree as LiFE. Advantages of both formats should be evaluated in the light of individual needs and preferences before recommending either format. Trial registration The study was preregistered under clinicaltrials.gov (identifier: NCT03462654) on March 12th 2018