Preliminary Cost Variance Modeling to Compare Autologous Intraovarian Platelet-Rich Plasma vs. Standard Hormone Replacement Therapy for Menopause Management

Background: Menopause symptoms and hormone replacement therapy (HRT) are among the most common reasons patients seek gynecological advice. Although at least half of all women in developed countries will take HRT during their lifetime, the treatment is not without risk and guidance on HRT is mixed. Greater awareness of negative HRT health effects from extended use has piqued interest in ‘safer options’. Menopause reversal with autologous ovarian platelet-rich plasma (OPRP) has brought this restorative approach forward for consideration, but appropriateness and cost-effectiveness require examination. Methods: HRT and OPRP data from USA were projected to compare cumulative 1yr patient costs using stochastic Monte Carlo modeling. Results: Mean±SD cost-to-patient for HRT including initial consult plus pharmacy refills was estimated at about $576±246/yr. While OPRP included no pharmacy component, an estimated 4 visits over 1yr for OPRP maintenance entailed ultrasound, phlebotomy/sample processing, surgery equipment, and incubation/laboratory expense, yielding mean±SD cost for OPRP at $8,710±4,911/yr (p<0.0001 vs. HRT, by t-test). Upper-bound estimates for annual HRT and OPRP costs were $1,341 and $22,232, respectively. Conclusions: While HRT and OPRP may have similar efficacy and safety for menopause therapy, they diverge sharply in cost-effectiveness. Most patients would likely find OPRP too complex, invasive, and expensive to be competitive vs. HRT. Although OPRP is an interesting and cautiously useful technique for selected menopause patients reluctant to use HRT, repurposing this infertility treatment for wider use appears inefficient compared to standard HRT currently available.

Evaluation Of Construction Project Time And Cost Control Based On Earned Value And Crash Project Method

Project development and how to control time and costs in the construction project of a public junior high school 1 Surabaya. This research was conducted with the aim of knowing and comparing the amount of duration and cost after acceleration by using the alternative Earned Value Analysis. The case study in this research takes the construction project of a public junior high school 1 Surabaya which is located in Surabaya. The data needed in this study include the S curve, recapitulation of project cost calculations, a list of budget plans (RAB), and a list of unit wage prices for workers. The research method used is to design network planning, calculate the cost variance and variance schedule for each activity that changes due to changes in the duration of implementation, acceleration of work duration, and determination of the optimum cost and duration due to the application of the Earned Value Analysis method. For the calculation of the variance Schedule on week 34 shows a positive result of Rp. 109,550,470. For the calculation of the cost variance from week 34 shows - Rp. 2,488,159. For the calculation of Estimate at completion (EAC) on week 34 of Rp. 6,663,998,229. For the calculation of Estimate temporary schedule, the evaluation week 34 experienced a delay of 53 days from the original schedule. So the work completion time is 233 calendar days

Value-Based Payments: Intellectual and Developmental Disabilities Quality Indicators Associated With Billing Expenditures

Although managed care is expanding into the intellectual and developmental disabilities (IDD) service system, there is little agreement about measurable and meaningful outcomes for people with IDD, including for use in value-based payments (VBP). In this study, we examined potential VBP metrics for people with IDD—relationships between quality and costs. We analyzed Basic Assurances data and long-term services and supports billing data from 68 human service organizations that supported 6,608 people with IDD. Our final hierarchical regression model predicted 66.40% of the variance of annual long-term services and supports (LTSS) billing per person. Our findings suggest quality assurance indicators can account for a significant portion of cost variance—quality metrics represent a potential for cost savings and efficient service delivery.

Bundling cancer subtypes in value-based care: A pilot analysis of lymphoma episodes in the Oncology Care Model.

e18850 Background: Value based models (VBMs) in which cancers are bundled are a growing alternative to fee for service, as in the Oncology Care Model (OCM). However, bundles in OCM may not capture the clinical granularity needed to predict resource utilization for cancer subtypes. One such bundle is lymphoma, which groups highly heterogeneous diseases with distinct treatments and differing intensity of care. Here, we compare OCM predicted episode costs (targets) to actual episode costs by lymphoma subtype. Methods: Our cohort study used OCM data from a large academic medical center (AMC) and large community oncology practice (COP). Six-month episodes of lymphoma beginning between July 2016 and June 2019 were categorized based on ICD-10 diagnoses on antineoplastic infusions and E&M visits, as well as disease and data modeling. Episodes were subdivided into follicular (FL), diffuse large B (DLBCL), small B (SBCL), mantle (MCL), Hodgkin (HL), Waldenstrom macroglobulinemia (WM), mature T/NK (T/NK), and Other. The distributional consistency of episode costs and targets for each subtype relative to the rest of the episodes was evaluated by Kolmogorov-Smirnov tests. We also compared the proportion of subtypes contributing to episodes in the AMC vs. COP. Results: A total of 1801 lymphoma episodes were identified (44% in AMC, 56% in COP). The most common subtypes (DLBCL and FL) contributed a larger proportion of episodes in the COP, while less frequent subtypes (T/NK, WM) were more prevalent at the AMC. Further, episode costs are significantly different across individual subtypes. Target variance was significantly lower than cost variance across subtypes. For example, the average target for WM was $50.4K, average costs were $40.2K, with 26% of episodes over target. In contrast, the average target for T/NK was $55.9K, average costs were $72.7K, with 64% of episodes over target. Conclusions: VBMs such as OCM currently aggregate cancer types and lack clinical granularity. Our evaluation of OCM episodes at an AMC and COP found considerable differences in lymphoma populations and in costs by subtype. Failure to account for clinical features (i.e. lymphoma history) could lead to inappropriate shifts of risk from payers to providers in VBMs.[Table: see text]

Quantitative risk analysis procedure for economic project sustainability.

The paper briefly explains the importance of quantitative procedures of risk analysis in large and medium scale projects for the sustenance of project economic sustainability. Globally, several construction projects are being descoped and tend to close out before attaining the initial project deliverables due to cost and schedule overruns. The quantitative methods can sieve the key factors and forecast the tangible impacts that can lead to schedule or cost variance in a project. It can guide the project stakeholders for timely decision making and mitigate the risks associated to achieve the project goals. Today, the quantitative methods are pivotal to analyze the impacts of Covid-19 crises in Construction industry which are increasingly apparent. Keywords- Project economic sustainability, Risk analysis, Quantitative methods

Combining simple motion measurement, lean analysis technique and historical data review for countering negative labor cost variance: A case study

Negative labor cost variance (NLCV) is an important problem in many manufacturing companies today. NLCV refers to the situation that expected or standard costs are less than actual labor costs in production. Management of NLCV, including the identification of causes for NLCV and the elimination or significant reduction of NLCV, is the topic discussed in this paper. The question studied in this paper is thus: what is an effective methodology in the environment of strong privacy protection to identify causes for NLCV and to significantly reduce it? The study presented in this paper proposed a methodology by combining a simple motion measurement (stopwatch), lean analysis techniques, and historical data review to study the NLCV problem. A case study was taken on a particular company called ABC to test the effectiveness of this methodology. Specifically, the result of the study revealed that (1) the employees in ABC waited for one reason or the other for almost 5 h (idle time) in a 16-h daily operation period (2 shifts running at 8 h each), which accounts for 32% of the total productive time, and (2) the elimination of the waiting time or idle time over the years concerned could account for 83% of all identified wastes in ABC. Through this case study, the effectiveness of the proposed methodology was demonstrated and the applicability of the proposed methodology was also implied.

Influence of Sector, Budget Size and Financing on Time and Cost Management of Czech International Development Projects

Research background: This article focuses on the official Czech international development (ID) aid and the factors affecting the project success in terms of cost and time variance from the plan. As per research by Ahsan and Gunawan (2010), ID projects by Asian Development Bank are finalised within their budget, however, with delays, and the result depends on the developing country. Previous article written by the author confirmed the findings also for the Czech development aid and established that cost variance is affected by the type of implementing agencies, whereas time variance depends on the developing countries. Purpose of the article: The purpose of this article is to further analyse ID projects by the Czech Development Agency and evaluate the influence of sector topics, budget size and type of financing on the time and budget management of Czech ID projects to determine what parameters could improve the efficiency of Czech ID projects. Methods: Information on all official projects conducted from 2016 to 2019 used in this article are non-public and have been received directly from the Czech Development Agency. They are first summarised in a descriptive statistics part and then analysed by non-parametric Kruskal-Wallis test. Findings & Value added: The results show that budget size, financing type and sector topics influence the cost variance, with smaller projects financed as public procurement achieving bigger savings. For time variance, there are significant differences only between different categories of the sector topics with projects focused on the environment leading to the biggest delays.