Road Freight Transport Cost

The goal of this research was to measure the cost of road freight transport in the 20 European countries with the highest recorded quantity of tonne-kilometres and assess their competitiveness. Cost competitiveness was measured by four main cost categories: fuels, drivers' wages, tyres and tolls, and the results show large cost variances between countries. The countries with the lowest road freight transport cost were Bulgaria, Poland, and Romania, and those with the highest costs were Norway, Austria, and the UK. The largest differences in costs were met in tolls and other road taxes, followed by drivers' wages, fuels, and finally, tyres.

Stochastic preemptive goal programming of Air Force weapon systems mix

We demonstrate a new approach to conducting a military force structure study under uncertainty. We apply the stochastic preemptive goal program approach, described by Ledwith et al., to balance probabilistic goals for military force effectiveness and the force’s cost. We use the Bayesian Enterprise Analytic Model (BEAM), as described in “Probabilistic Analysis of Complex Combat Scenarios,” to evaluate effectiveness, expressed in terms of the probability of achieving campaign objectives, in three hypothetical scenarios. We develop cost estimates along with their uncertainty to evaluate the force’s research and development, production, and annual operating and support costs. Our summary depicts how the trade-off between various prioritized goals influences the recommended robust force. Our approach enables defense leaders to balance risk in both force effectiveness in various scenarios along with risk in different types of cost categories.

Relationships between Density and per Capita Municipal Spending in the United States

The objective of this research is to determine the relationship between land use, particularly density, and per capita spending levels in cities across the United States. A model was developed using data from the U.S. Census Bureau’s Annual Survey of State and Local Government Finances to estimate the impacts of population-weighted density and other factors on per capita municipal spending. This study focused on municipal spending for eight categories that theoretically could be influenced by land use development: fire protection, streets and highways, libraries, parks and recreation, police, sewer, solid waste management, and water. Density was found to be negatively associated with per capita municipal expenditures for the following cost categories: operational costs for fire protection, streets and highways, parks and recreation, sewer, solid waste management, and water; construction costs for streets and highways, parks and recreation, sewer, and water; and land and existing facility costs for police, sewer, and water. Results were insignificant for other cost categories, and a positive relationship was found for police operations costs. In general, results support the conclusion that increased density is associated with reduced per capita municipal spending for several cost categories.

Autism Tsunami: the Impact of Rising Prevalence on the Societal Cost of Autism in the United States

The cost of ASD in the U.S. is estimated using a forecast model that for the first time accounts for the true historical increase in ASD. Model inputs include ASD prevalence, census population projections, six cost categories, ten age brackets, inflation projections, and three future prevalence scenarios. Future ASD costs increase dramatically: total base-case costs of $223 (175–271) billion/year are estimated in 2020; $589 billion/year in 2030, $1.36 trillion/year in 2040, and $5.54 (4.29–6.78) trillion/year by 2060, with substantial potential savings through ASD prevention. Rising prevalence, the shift from child to adult-dominated costs, the transfer of costs from parents onto government, and the soaring total costs raise pressing policy questions and demand an urgent focus on prevention strategies.

Comparative study of prevalence and costs of depression and anxiety among elderly cancer patients.

6595 Background: Depression and anxiety are common among cancer patients and can worsen outcomes. We studied the occurrence of depression and anxiety in three common cancers to investigate whether healthcare costs were greater for cancer patients with two mental health disorders (MHD), depression and anxiety, compared to patients without MHD. Methods: This retrospective analysis used deidentified medical and pharmacy claims from a large national U.S. health insurer. Patients were Medicare Advantage enrollees ≥65 years diagnosed with breast, colorectal, or prostate cancer and continuously enrolled from 1/2018–12/2019. We determined statistically whether the annual prevalence of the two MHDs varied by cancer types. Total costs and costs exclusive of MHD-related expenses in five sub-categories were compared: inpatient, emergency room, non-inpatient medical, professional, and pharmacy. Costs from 2019 claims were presented as per-patient per-month (PPPM). Direct depression- and anxiety-related costs were from claims with depression/anxiety diagnoses or drugs. The impact of MHDs on 2019 healthcare spending was examined using multiple linear regression, controlling for demographic and clinical characteristics. LASSO was used for variable selection. Mann-Whitney U tests compared differences in costs by service types between patients with and without MHDs. Results: Of 19,304 study patients, 8,916 (46%) had coexisting depression or anxiety: (i) 4% depression only; (ii) 27% anxiety only; (iii) 7% depression and anxiety; and (iv) 8% were on antidepressant without MHDs diagnoses. There were significant differences in the rates of MHDs between the three cancer groups, with the highest frequency in breast cancer ( breast vs colorectal. 56% vs 49%, p < 0.0005 ; breast vs prostate. 56% vs 38%, p < 0.0005; colorectal vs prostate. 49% vs 38%, p < 0.0005). After excluding the MHDs-related costs (PPPM mean = $44), the monthly spending was 54% higher for patients with MHDs ($2,184 MHDs vs. $1,406 non-MHDs). After adjusting for covariates, the PPPM costs were 23%–58% higher for the MHD-cohort vs. the non-MHD cohort for each cancer type ( non-MHD vs. with depression only, CI 13%–34%, p < 0.0001; non-MHD vs. with anxiety only, CI 40%-52%, p < 0.0001; non-MHD vs. with depression and anxiety, CI 48%-70%, p < 0.0001; non-MHD vs. with antidepressant only, CI 28%-45%, p < 0.0001). Higher costs in MHD-cohort were observed in all cost categories (p < 0.0001). Conclusions: We found high prevalence of MHDs in patients diagnosed with cancer. Analyses showed that total spending was significantly higher in individuals with cancer and MHD for all cost categories. Explanations for higher costs are unclear, as costs remain high even after adjusting for MHD-related care costs. Research on specific healthcare services driving higher costs and the risk factors for depression and anxiety is needed to address broader MHDs to improve cancer care.

Passenger Preferences in Rail Transport in Poland as Regards Travelling Time and Cost

The paper includes an analysis of passengers’ preferences in the context of selected marketing activities conducted by leading railway companies operating in the passenger transport sector in Poland. Operators’ offers are highly varied, which may make it difficult to find the benefits expected by the passenger. Basing on earlier research, the main categories covered by operators’ classic marketing activities include the time and cost of the journey, and, less frequently, safety and comfort. The purpose of the analysis was to find whether the categories of time and price (cost categories) applied in most of the marketing activities, used for development of the operator’s offer, corresponded with contemporary passengers’ preferences. The conclusions are based on the results of primary research conducted on a random-quota sample of 1012 passengers. Research results—major factors determining preferences among long-distance passengers included trip duration and favorable departure hours, whereas the price was not a major issue. The importance of price increased with the age of respondents. Moreover, on short-distance routes, price and time were major factors depending on the domicile of respondents. The smaller the town, the more important these two factors were.

Minimization of resource utilization data collected within cost-effectiveness analyses conducted alongside Canadian Cancer Trials Group phase III trials

Background Cost-effectiveness analyses embedded within randomized trials allow for evaluation of value alongside conventional efficacy outcomes; however, collection of resource utilization data can require considerable trial resources. Methods We re-analyzed the results from four phase III Canadian Cancer Trials Group trials that embedded cost-effectiveness analyses to determine the impact of minimizing potential cost categories on the incremental cost-effectiveness ratios. For each trial, we disaggregated total costs into component incremental cost categories and recalculated incremental cost-effectiveness ratios using (1) only the top 3 cost categories, (2) the top 5 cost categories, and (3) all cost components. Using individual trial-level data, confidence intervals for each incremental cost-effectiveness ratio simulation were generated by bootstrapping and descriptively presented with the original confidence intervals (and incremental cost-effectiveness ratios) from the publications. Results Drug acquisition costs represented the highest incremental cost category in three trials, while hospitalization costs represented the other consistent cost driver and the top incremental cost category in the fourth trial. Recalculated incremental cost-effectiveness ratios based on fewer cost components (top 3 and top 5) did not differ meaningfully from the original published results. Based on conventional willingness-to-pay thresholds (US$50,000–US$100,000 per quality-adjusted life-year), none of the re-analyses would have changed the original perception of whether the experimental therapies were considered cost-effective. Conclusions These results suggest that the collection of resource utilization data within cancer trials could be narrowed. Omission of certain cost categories that have minimal impact on incremental cost-effectiveness ratio, such as routine laboratory investigations, could reduce the costs and undue burden associated with the collection of data required for cancer trial cost-effectiveness analyses.

Cost evaluation in adult ICU: α two-year study in a Greek State Hospital

Background: During the last decades the combination of international economic and healthcare crisis has led to pressure on healthcare systems and has made financial evaluations particularly important.Aim: To measure the total cost in ICUs, to analyze its components, and their changes during the study period.Method and Material: All cost components in four cost categories (direct-variable, direct-fixed, indirect-variable, and indirect-fixed) of all patients admitted in a 6-bed mixed type adult ICU in a general (non-university) hospital of northern Greece in two consecutive periods, with total duration 2 years was measured. The direct-variable cost (medications, consumables, and diagnostic tests) was assessed with bottom-up (micro-costing) method while for the cost components of rest three categories the top-down (attributable costing) was used. Results: In a 331 patients’ sample with 2823 total patient days, the sum cost was 2,417,788€ (1,370,420€ and 1,047,368€ in 1st and 2nd period respectively). The direct variable cost was 897,866.07€ (37.14%), the direct-fixed 1,049,068.6€ (43.39%), the indirect-variable 45,210.6€ (1.87%), and the indirect-fixed 425,643.0€ (17.60%). The mean daily cost per patient was 835.62€ and 885.35€, and the total cost per patient was 7,967.6€ and 6,587.2€ in the two periods of study respectively. The total cost of all non-survivors’ patients (N=85, 25.7%) was 595,009.1€ and the efficiency cost per survivor 9,828.4€. The mean daily cost and the total cost per survivor was 840.8€ and 7,409.7€ while for non-survivors was και 908.4€ and 7,000.1€ respectively. During the second study period, a reduction in total costs was observed and especially in direct-variable category attributed mainly to the prices of medicines consumables, and staff gradual costs reductions.Conclusions: Changes in cost categories vary over time due to social and financial factors while the variables as the ICU environment or patient’s characteristics as severity of disease are the main cost drivers. Monitoring and recording of cost components variance would help with valuable information to healthcare managers, doctors, or nursing leaders. Extending this study with a multicenter to more ICUs could provide clearer conclusions about cost variability.

External Costs in Inland Waterway Transport: An Analysis of External Cost Categories and Calculation Methods

Sustainable transport, such as using inland waterway transport (IWT), represents a major pillar of the European Green Deal to reduce global warming. To evaluate the different inland transport modes (road, rail, IWT), it is crucial to know the external costs of these modes. The goal of this paper is a critical review of external cost categories (e.g., accidents, noise, emissions) and external cost calculation methods of IWT to provide ideas for future research. We identified 13 relevant papers in a literature review dealing with external costs of IWT. In a meta-analysis, the papers were assigned to the seven external cost categories: accident, noise, congestion, habitat damage, air pollution, climate change and well-to-tank emissions. The most investigated external cost categories are climate change, air pollution and accidents. Two studies were identified as the major external cost calculation methods for IWT in the abstract. Our paper shows that the data basis of IWT is significantly lower than for road/rail. The measurement of energy consumption and related emissions of IWT needs to be qualitatively and quantitatively improved and brought up to the level of road traffic, to ensure an accurate comparison with other modes of transport.