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BACKGROUND: Comprehensive stroke centres across England have developed investment proposals, showing the estimated increases in mechanical thrombectomy (MT) treatment volume that would justify extending the standard hours to a 24/7 service provision. These investment proposals have been developed taking a financial accounting perspective, that is by considering the financial revenues from tariff income. However, given the pressure put on local health authorities to provide value for money services, an affordability question emerges. That is, at what additional MT treatment volume the additional treatment costs are offset by the additional health economic benefits, that is quality-adjusted life years (QALYs) and societal cost savings, generated by administering MT compared to standard care. METHODS: A break-even analysis was conducted to identify the additional MT treatment volume required. The incremental hospital-related costs associated with the 24/7 MT extension were estimated using information and parameters from four relevant business cases. The additional societal cost savings and health benefits were estimated by adapting a previously developed Markov chain-based model. RESULTS: The additional hospital-related annual costs for extending MT to a 24/7 service were estimated at a mean of £3,756,818 (range £1,847,387 to £5,092,788). On average, 750 (range 246 to 1,571) additional eligible stroke patients are required to be treated with MT yearly for the proposed 24/7 service extension to be affordable from a health economic perspective. Overall, the additional facility and equipment costs associated with the 24/7 extension would affect this estimate by 20%. CONCLUSIONS: These findings support the ongoing debate regarding the optimal levels of MT treatment required for a 24/7 extension and respective changes in hospital organisational activities. They also highlight a need for a regional-level coordination between local authorities and hospital administrations to ensure equity provision in that stroke patients can benefit from MT and that the optimal MT treatment volume is reached. Future studies should contemplate reproducing the presented analysis for different health service provision settings and decision making contexts.

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Background: Tobacco use significantly increases the rate of wound complications in patients undergoing total ankle arthroplasty (TAA). Preoperative optimization through smoking cessation programs significantly minimizes the rate of infection and improves wound healing in arthroplasty procedures. Despite its utility, minimal research has examined the cost-effectiveness of preoperative smoking cessation programs to reduce the need for extracapsular irrigation and debridement (I&D) due to wound complications following TAA. Methods: The cost of an I&D procedure was obtained from our institution's purchasing records. Baseline wound complication rates among tobacco users who have undergone TAA and smoking cessation program cost were obtained from literature. A break-even economic analysis was performed to determine the absolute risk reduction (ARR) to economically justify the implementation of preoperative smoking cessation programs. Different smoking cessation program and I&D costs were tested to account for variations in each factor. ARR was then used to calculate the number needed to treat (NNT) to prevent a single I&D while remaining cost-effective. Results: Smoking cessation programs were determined to be economically justified if it prevents 1 I&D surgery out of 8 TAAs among tobacco users (ARR = 12.66%) in the early postoperative period (<30 days). ARR was the same at the literature high (27.3%) and weighted literature average (13.3%) complication rates when using the cost of I&D surgery at our institution ($1757.13) and the literature value for a smoking cessation program ($222.45). Cost-effectiveness was maintained with higher I&D surgery costs and lower costs of smoking cessation treatment. Conclusion: Our model's input data suggest that the routine use of smoking cessation programs among tobacco users undergoing TAA is cost-effective for risk reduction of I&D surgery in the early postoperative period. This intervention was also found to be economically warranted with higher I&D costs and lower smoking cessation program costs than those found in the literature and at our institution.Level of Evidence: Level III, economic and decision analysis.

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Background: Over 20% of healthcare workers (HCWs) are active smokers. Smoking is a targeted issue for workplace health promotion (WHP) programs. Objective: Our study aims to evaluate the effectiveness of the Stop Smoking Promotion (SSP) intervention, a 6-hour training course for HCWs, which took place from May 2018 to July 2019. Methods: We compared HCWs who successfully quit smoking (n = 15) to those who did not (n = 25) in terms of Sickness Absence Days (SADs). Moreover, we conducted an econometric analysis by calculating the return on investment and implementing a break-even analysis. Findings: Among the 40 enrolled workers, a success rate of 37.5% was observed after a span of over two years from the SSP intervention (with nurses and physicians showed the best success rate). Overall, participants showed a noticeable absenteeism reduction after the SSP intervention, with a reduction rate of 85.0% in a one-year period. The estimated ROI for the hospital was 1.90, and the break-even point was 7.85. In other words, the organization nearly doubled its profit from the investment, and the success of at least eight participants balanced costs and profits. Conclusion: Our pilot study confirms that WHP programs are simple and cost-saving tools which may help improve control over the smoking pandemic in healthcare settings.

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Torrefied pellets have gained more commercial importance due to their excellent performance in combustion, co-firing and gasification. The present investigation provides a conceptual design for torrefied fuel pellets production via combined torrefaction and pelletization technologies with and without additives. The entire design contains torrefaction unit, grinding, preparation of pellet formulation, pelletizing, and finally cooling of pellets. Two scenarios, scenario 1 (pelletization of torrefied biomass with additives) and scenario 2 (pelletization of torrefied biomass without any external additives) were tested and compared. The economic analysis suggests that both scenarios are profitable. Both scenarios were simulated using Aspen plus™, and economic feasibility was estimated using a complete cash flow analysis for a base case plant with 40,080 tonne/y capacity. For both cases, a discounted cash flow is a useful tool for estimating the minimal selling price for torrefied pellets as well as the capital investment, production cost and operating costs. The cost of the reactor used for torrefaction was found to be the most important component of combined torrefaction and pelletization system. The lowest selling price of generated torrefied pellets was found to be $103.4 and $105.1 per tonne at the plant gate for scenarios 1 and 2, respectively. Sensitivity analysis shows that, among all variable costs, labor cost has the highest influence on both net present value (NPV) and minimum selling price (MSP) in making pellets for both the scenarios. Furthermore, the internal rate of return was found to be25% and 22% at 10% discounted cash flow rate for scenarios 1 and 2, respectively. The framework that was created was found to lessen over-dependence on wood or fossil fuels and facilitate the promotion of bioenergy in rural areas.

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BACKGROUND: The use of tranexamic acid (TXA) has become widespread in orthopedics to promote hemostasis and has been successfully used to reduce blood loss and infection risk in joint arthroplasty. However, the cost effectiveness of routine TXA use for the prevention of periprosthetic infections in total shoulder arthroplasty remains unknown. METHODS: The acquisition cost of TXA ($5.22) for our institution, along with values from the literature for the average cost of infection-related care ($55,243) and the baseline infection rates for patients without TXA use (0.70%),were used to perform a break-even analysis. The absolute risk reduction (ARR) of infection necessary to justify the prophylactic use of TXA in shoulder arthroplasty was calculated from the nontreated and break-even infection rates. RESULTS: TXA is considered cost-effective if it prevents one infection out of 10,583 total shoulder arthroplasty's (ARR = 0.009%). It is economically justifiable with an ARR range of 0.001% at a cost of $0.50/g to 0.181% at $100/g. At varying costs of infection-related care ($10,000-$100,000) and varying baseline infection rates (0.50%-8.00%) and routine use of TXA remained cost-effective. CONCLUSION: The use of TXA is an economically viable practice for infection prevention following shoulder arthroplasty if it reduces the infection rate by 0.009%. Future, prospective studies should be conducted to observe whether TXA reduces the infection rate by more than 0.009%, showing cost effectiveness.

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This paper assesses the economic viability of the production process of an innovative form of digestate known as "microfiltered digestate", suitable for use as a fertilizer in driplines for permanent crops. A Break-Even Analysis was performed to determine the Break-Even Point which identifies the minimum quantity of products necessary to cover production costs at a certain selling price. Our results show that the production of microfiltered digestate provides positive economic viability for anaerobic digestion managers, providing them with an attractive market outlet and, at the same time, a new form of income. The experimental study was stated in Sicily, but it is replicable in any territorial context with anaerobic digestion plants. The results are in line with the principles of circular economy and are very current with reference to the use of organic fertilizers instead of chemical ones.

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OBJECTIVE: Patients mislabeled with a penicillin allergy are often unnecessarily given prophylactic clindamycin. Thus, otolaryngologists may cause harm due to clindamycin's associated risk of Clostridioides difficile infections (CDI) and surgical site infections (SSI). The objective of this study was to determine the economic feasibility of penicillin allergy testing in preventing unnecessary clindamycin use among patients with an unconfirmed penicillin allergy prior to otolaryngologic surgery. METHODS: A break-even analysis was performed using the average cost of penicillin allergy testing and a CDI/SSI to calculate the absolute risk reduction (ARR) in baseline CDI/SSI rate due to clindamycin required for penicillin testing to be economically sustainable. The binomial distribution was used to calculate the probability that current penicillin testing can achieve this study's ARR. RESULTS: Preoperative penicillin testing was found to be economically sustainable if it could decrease the baseline CDI rate by an ARR of 1.06% or decrease the baseline SSI rate by an ARR of 1.34%. The probability of penicillin testing achieving these ARRs depended on the baseline CDI and SSI rates. When the CDI rate was at least 5% or the SSI rate was at least 7%, penicillin allergy testing was guaranteed to achieve economic sustainability. CONCLUSION: In patients mislabeled with a penicillin allergy, preoperative penicillin allergy testing may be an economically sustainable option to prevent the unnecessary use of prophylactic clindamycin during otolaryngologic surgery. Current practice guidelines should be modified to recommend penicillin allergy testing in patients with an unconfirmed allergy prior to surgery. LEVEL OF EVIDENCE: NA Laryngoscope, 133:1086-1091, 2023.

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Background: Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia, and it increases the risk of stroke, heart failure, and other cardiac complications. Catheter ablation is well-established as a treatment for paroxysmal AF, and the recent PRECEPT (Prospective Review of the Safety and Effectiveness of the THERMOCOOL SMARTTOUCH SF Catheter Evaluated for Treating Symptomatic Persistent AF) clinical trial resulted in the catheter gaining approval for the treatment of persistent AF in the United States. Objectives: To construct an economic simulation model, based on the results of the PRECEPT trial, to monetize the impact of radiofrequency catheter ablation (RFCA) compared with medical therapy (MT). Methods: Cost-offset and break-even analyses were performed to assess the economic impact of RFCA vs MT for adult persistent AF patients. Three perspectives were considered: commercial payers, Medicare, and self-insured employers. A cohort-level decision tree model was developed and validated in TreeAge Pro 2019. Sensitivity analyses were performed to determine the robustness of findings. Results: For all 3 types of payer, RFCA had a higher initial cost compared with MT. However, reductions in health care utilization after ablation, driven by decreased cardiovascular hospitalizations, led to an annual cost offset of between $5037 and $8402 after the first year. Projecting this forward resulted in an estimated cost break-even after 5.9, 4.2, and 5.1 years for commercial payers, Medicare, and self-insured employers, respectively. Conclusion: In addition to providing clinical benefits, RFCA may be a valuable economic investment for U.S. payers, substantially reducing utilization after the first year.

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Data are the lifeblood of decision-making and provide a critical component into the complex mosaic from which decisions emerge. Evaluators and decision-makers should, therefore, continuously seek to explore the use of tools that can produce more meaningful, insightful, and useful data so that decision-making can be enhanced and improved. Traditional economic appraisal methods offer much and are very useful and relevant. Standard financial accounting reporting for tax purposes also provide insightful information on the organization's financial health and that of its individual programs. However, neither offer insight into cost behavior-an important consideration for making program operations more efficient and for long-term strategic planning, forecasting, and design of program operations. Before COVID-19, programs were already challenged with competition for donor dollars and the pursuit for financial sustainability. The COVID-19 environment has considerably exacerbated these challenges. In this current environment, it is more important than ever for nonprofits to optimize limited financial resources to do more societal good. This paper will illustrate how selected concepts from cost and management accounting can be used by both independent program evaluators to improve their recommendations, as well as program administrators in-charge of nonprofits to enhance decision-making.

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PURPOSE: Despite the commonplace use of tranexamic acid in total joint arthroplasty, much of the current data regarding its cost-effectiveness examines savings directly related to its hemostatic properties, without considering its protective effect against periprosthetic joint infections. Using break-even economic modeling, we calculated the cost-effectiveness of routine tranexamic acid administration for infection prevention in total joint arthroplasty. MATERIALS AND METHODS: The cost of intraoperative intravenous tranexamic acid, the cost of revision arthroplasty for periprosthetic joint infections, and the baseline rates of periprosthetic joint infections in patients who did not receive intraoperative tranexamic acid were obtained from the literature and institutional purchasing records. Break-even economic modeling incorporating these variables was performed to determine the absolute risk reduction in infection rate to make routine intraoperative tranexamic acid use economically justified. The number needed to treat was calculated from the absolute risk reduction. RESULTS: Routine use of intraoperative tranexamic acid is economically justified if it prevents at least 1 infection out of 3125 total joint arthroplasties (absolute risk reduction = 0.032%). Cost-effectiveness was maintained with varying costs of tranexamic acid, infection rates, and periprosthetic joint infection costs. CONCLUSION: The routine use of intraoperative tranexamic acid is a highly cost-effective practice for infection prevention in primary and revision total joint arthroplasty. The use of tranexamic acid is warranted across a wide range of costs of tranexamic acid, initial infection rates, and costs of periprosthetic joint infection treatment.

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INTRODUCTION: Despite the high incidence of respiratory depression on the general care floor and evidence that continuous monitoring improves patient outcomes, the cost-benefit of continuous pulse oximetry and capnography monitoring of general care floor patients remains unknown. This study modeled the cost and length of stay savings, investment break-even point, and likelihood of cost savings for continuous pulse oximetry and capnography monitoring of general care floor patients at risk for respiratory depression. METHODS: A decision tree model was created to compare intermittent pulse oximetry versus continuous pulse oximetry and capnography monitoring. The model utilized costs and outcomes from the PRediction of Opioid-induced respiratory Depression In patients monitored by capnoGraphY (PRODIGY) trial, and was applied to a modeled cohort of 2447 patients receiving opioids per median-sized United States general care floor annually. RESULTS: Continuous pulse oximetry and capnography monitoring of high-risk patients is projected to reduce annual hospital cost by $535,531 and cumulative patient length of stay by 103 days. A 1.5% reduction in respiratory depression would achieve a break-even investment point and justify the investment cost. The probability of cost saving is ≥ 80% if respiratory depression is decreased by ≥ 17%. Expansion of continuous monitoring to high- and intermediate-risk patients, or to all patients, is projected to reach a break-even point when respiratory depression is reduced by 2.5% and 3.5%, respectively, with a ≥ 80% probability of cost savings when respiratory depression decreases by ≥ 27% and ≥ 31%, respectively. CONCLUSION: Compared to intermittent pulse oximetry, continuous pulse oximetry and capnography monitoring of general care floor patients receiving opioids has a high chance of being cost-effective. TRIAL REGISTRATION: www.clinicaltrials.gov , Registration ID: NCT02811302.

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The spatial expansion of offshore wind farms (OWFs) is key for the transition to a carbon free energy sector. In the North Sea, the sprawl of OWFs is regulated by marine spatial planning (MSP) and results in an increasing loss of space for other sectors such as fisheries. Understanding fisheries benefits of OWFs and mitigating the loss of fishing grounds is key for co-location solutions in MSP. For the German exclusive economic zone (EEZ) of the North Sea we conducted a novel socio-ecological assessment of fisheries benefits which combines exploring potential spill-over from an OWF with an experimental brown crab (Cancer pagurus) pot fishery and an economic viability analysis of such a fishery. We arrayed a total of 205 baited pots along transects from an OWF located near the island of Helgoland. After a soaking time of 24 h we retrieved the pots and measured the carapace width (mm), weight (g), and sex of each individual crab. To conclude on cumulative spill-over potentials from all OWFs in the German EEZ and drivers of passive gear fisheries we analysed vessel monitoring system (VMS)-data and computed random forest regressions. Local spill-over mechanisms occurred up to distances of 300 to 500 m to the nearest turbines and revealed an increasing attraction of pot fishing activities to particular OWFs. This corresponds to the observation of constantly increasing fishing effort targeting brown crab likely due to both a growing international demand and stable resource populations at suitable habitats, including OWFs. Our break-even scenarios showed that beam trawlers have the capacities to conduct during summer an opportunistic but economically viable pot fishery. We argue that particularly in the North Sea, where space becomes limited, integrated assessments of the wider environmental and socio-economic effects of planning are crucial for a sustainable co-location of OWFs and fisheries.

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The progressive ageing of the working population and the increase in related chronic diseases tend to affect working capacity. The aim of this study was to evaluate a Workplace Disability Management Program (WDMP) within a pediatric hospital. Absenteeism due to healthcare workers' (HCWs) pre- and post- WDMP and the related costs were used for the program evaluation. The Return on Investment (ROI), the Break-Even Analysis (BEA) and the value of the average annual productivity of HCWs who took advantage of the Disability Management (DM) interventions to assess the economic impact of the program, were also used. The HCWs enrolled in the program were 131 (approximately 4% of hospital staff), of which 89.7% females and with an average age of 50.4 years (SD ± 8.99). Sick leave days of the HCWs involved decreased by 66.6% in the year following the end of WDMP compared to the previous one (p < 0.001). The total estimated cost reduction of absenteeism is 427,896€ over a year. ROI was equal to 27.66€. BEA indicated that the break-even point was reached by implementing the program on 3.27 HCWs. The program evaluation demonstrated the particular effectiveness of the implemented WDMP model, acting positively on the variables that affect productivity and the limitation to work.

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BACKGROUND: Newer strategies to decolonize the shoulder of Cutibacterium acnes may hold promise in minimizing the occurrence of infections after shoulder arthroplasty, but little is known about their cost-effectiveness. Break-even models can determine the economic viability of interventions in settings with low outcome event rates that would realistically preclude a randomized clinical trial. We used such modeling to determine the economic viability of benzoyl peroxide and hydrogen peroxide for infection prevention in shoulder arthroplasty. METHODS: Skin decolonization protocol costs ($11.76 for benzoyl peroxide; $0.96 for hydrogen peroxide), baseline infection rates for shoulder arthroplasty (0.70%), and infection-related care costs ($50,230) were derived from institutional records and the literature. A break-even equation incorporating these variables was developed to determine the absolute risk reduction (ARR) in the infection rate to make prophylactic use economically justified. The number needed to treat was calculated from the ARR. RESULTS: Topical benzoyl peroxide is considered economically justified if it prevents at least 1 infection out of 4348 shoulder arthroplasties (ARR = 0.023%). Hydrogen peroxide is economically justified if it prevents at least 1 infection out of 50,000 cases (ARR = 0.002%). These protocols remained economically viable at varying unit costs, initial infection rates, and infection-related care costs. CONCLUSIONS: The use of topical benzoyl peroxide and skin preparations with hydrogen peroxide are highly economically justified practices for infection prevention in shoulder arthroplasty. Efforts to determine drawbacks of routine skin decolonization strategies are warranted as they may change the value analysis.

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BACKGROUND: The implementation of an innovative and sustainable professional pharmacy service in routine care requires substantial resources borne by the pharmacy owner. Although a community pharmacy is a business setting, few studies have examined cost as a potential barrier to widespread implementation. Implementation costs, as the cost impact of an implementation effort, can be significant and hamper the decision to invest from the provider perspective. Traditional financial planning tools can be used to analyse and support business decision to implement a service by assessing the net impact of a new service on the provider's budget. This study aimed to estimate the implementation costs and the break-even point of an interprofessional medication adherence program for chronic patients in Switzerland. The program combines motivational interviews, medication adherence electronic monitoring and feedback reports to patient and physicians. METHODS: We used a 3-step approach: (i) micro-costing analysis: identification of implementation activities, quantification and valuation of required resources. Implementation costs, including service support costs and direct delivery costs, were analysed according to the implementation phase (installation, initial implementation, and full operation); (ii) break-even analysis: estimation of the required number of patients to follow up with to ensure that the generated revenue exceeded the total cost; and (iii) univariate sensitivity analyses. RESULTS: The estimated total cost of the installation phase was 8481 CHF, more than half of which represented the cost of the equipment. Direct delivery costs were 666 CHF per patient per year, with 68% of this value associated with the cost of workforce time. According to the Swiss national reimbursement system, a minimal of 16 [10-27] patients was required to cover the implementation costs of the installation phase. This break-even point decreased to 13 patients in the initial and full operation phases. CONCLUSIONS: These estimates lead to a better understanding of the real cost of implementing a professional pharmacy service in routine care. In a Swiss context, the current medication adherence support fee-for-service system allows pharmacists to reach the break-even point. Such information is important for community pharmacists to guide their implementation strategies. The replication of similar analyses in other settings and countries is paramount.

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ABSTRACT: This study aimed to evaluate the economic efficiency of DD treatment on milk yield in lame cows suffering from DD. A total of 33 Holstein dairy cows with DD were included in the study. The milk yields were assessed as (1st); beginning milk production (BMP), (2nd); peak milk production before the diagnosis (PMPBD), (3rd); diagnosis day milk production (DMP), and (4th); post-treatment milk production (TMP). In the first stage of analyses, using the E-views equity test of means program, cows were classified into three groups for diagnosis time of DD according to the day in milk (DIM) (Group 1: 0 ≤ DIM ≤ 50, Group 2: 51 ≤ DIM ≤ 100, and Group 3: 101 ≤ DIM ≤ 150). Analysis of variance (ANOVA F-Test) and the Welch F-Test were conducted to compare the means of TMP to BMP, PMPBD, and DMP. Differences between TMP and DMP were statistically significant in all three groups. In the second stage of analyses, a cost-benefit analysis was conducted to determine the break-even point for each group to cover treatment costs for increasing milk yield. The DIM of DMP was considered as the gained milk yield per cow. Treatment cost and the mean break-even DIM for each group was then calculated. After treatment, the mean optimum break-even day for Groups 1, 2, and 3 was determined as 18.68, 26.43, and 27.14, respectively. Results suggested that treatment of DD may be considered as favorable and useful for a dairy economy.

RESUMO: Esse estudo tem o objetivo de avaliar a eficiência econômica no tratamento da DD na produção de leite em vacas tratadas com claudicao. Foram incluidas no total 33 vacas leiteiras Holstein com DD nesse estudo. A produção de leite foi avaliada (1°); início da produção de leite (BMP), 2°; pico na produção de leite antes do diagnostico (PMPBD), (3°); dia de diagnostico da produção de leite (DMP), e (4°); produção de leite pós-tratamento (TMP). Na primeira etapa das análises, utilizamos o programa E-views Equity Test of Mean, as vacas foram classificadas em três grupos para o tempo de diagnostico de DD Segundo o dia do leite (DMI) (Grupo 1: 0 ≤ DIM ≤ 50, Grupo 2 : 51 ≤ DIM ≤ 100 e Grupo 3: 101 ≤ DIM ≤ 150).A análise de variância (ANOVA F-Test) e o Welch F-Test foram conduzidos para comparar as medias de TMP a BMP, PMPBD e DMP. Diferenças entre TMP e DMP foram estatisticamente significativas nos três grupos. No segundo estágio das análises, uma análise de custo-benefício foi realizada para determinar o ponto de equilíbrio para cada grupo para cobrir os custos de tratamento e aumentar a produção de leite. O DIM de DMP foi considerado como a produção de leite adquirida por vaca. O custo do tratamento e o DIM médio de equilíbrio para cada grupo foram então calculados. Após o tratamento, o dia de equilíbrio ideal médio para os Grupos 1, 2 e 3 foi determinado como 18,68; 26,43 e 27,14, respectivamente. Os resultados sugerem que o tratamento de DD pode ser considerado favorável e útil para uma economia leiteira.

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BACKGROUND: Increasing methicillin resistance and recognition of Propionibacterium acnes as a cause of infection in shoulder arthroplasty has led to the adoption of local vancomycin powder application as a more effective method to prevent expensive periprosthetic infections. However, no study has analyzed the cost effectiveness of vancomycin powder for preventing infection after shoulder replacement. METHODS: Cost data for infection-related care of 16 patients treated for deep periprosthetic shoulder infection was collected from our institution for the break-even analysis. An equation was developed and applied to the data to determine how effective vancomycin powder would need to be at reducing a baseline infection rate to make prophylactic use cost effective. RESULTS: The efficacy of vancomycin (absolute risk reduction [ARR]) was evaluated at different unit costs, baseline infection rates, and average costs of treating infection. We determined vancomycin to be cost effective if the initial infection rate decreased by 0.04% (ARR). Using the current costs of vancomycin reported in the literature (range: $2.50/1000 mg to $44/1000 mg), we determined vancomycin to be cost effective with an ARR range of 0.01% at a cost of $2.50/1000 mg to 0.19% at $44/1000 mg. Baseline infection rate does not influence the ARR obtained at any specific cost of vancomycin or the cost of treating infection. CONCLUSIONS: We have derived and used a break-even equation to assess efficacy of prophylactic antibiotics during shoulder surgery. We further demonstrated the prophylactic administration of local vancomycin powder during shoulder arthroplasty to be a highly cost-effective practice.

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Objective. To project the net cumulative income break-even point between practicing pharmacists and those who enter the workforce directly after high school graduation or after obtaining a bachelor's degree. Methods. Markov modeling and break-even analysis were conducted. Estimated costs of education were used in calculating net early career earnings of high school graduates, bachelor's degree holders, pharmacists without residency training, and pharmacists with residency training. Results. Models indicate that over the first 10 years of a pharmacist's career, they accumulate net earnings of $716 345 to $1 064 840, depending on cost of obtaining the PharmD degree and career path followed. In the break-even analysis, all pharmacy career tracks surpassed net cumulative earnings of high school graduates by age 33 and bachelor's degree holders by age 34. Conclusion. Regardless of the chosen pharmacy career track and the typical cost of obtaining a PharmD degree, the model under study assumptions demonstrates that pharmacy education has a positive financial return on investment, with a projected break-even point of less than 10 years upon career entry.

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The generation of municipal solid waste is further increasing in China with urbanization and improvement of living standards. The "12th five-year plan" period (2011-2015) promotes waste-to-energy technologies for the harmless disposal and recycling of municipal solid waste. Waste-to-energy plant plays an important role for reaching China's energy conservation and emission reduction targets. Industrial policies and market prospect of waste-to-energy industry are described. Technology, cost and benefit of waste-to-energy plant are also discussed. Based on an economic analysis of a waste-to-energy project in China (Return on Investment, Net Present Value, Internal Rate of Return, and Sensitivity Analysis) the paper makes the conclusions.

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BACKGROUND: Cost containment through continuous quality improvement of medical service is required in an age of a keen competition of the medical market. Laboratory managers should examine the matters on make-or-buy decision periodically. On this occasion, a break-even point analysis can be useful as an analyzing tool. In this study, cost accounting and break-even point (BEP) analysis were performed in case that the immunoassay items showing a recent increase in order volume were to be in-house made. METHODS: Fixed and variable costs were calculated in case that alpha fetoprotein (AFP), carcinoembryonic antigen (CEA), prostate-specific antigen (PSA), ferritin, free thyroxine (fT4), triiodothyronine (T3), thyroid-stimulating hormone (TSH), CA 125, CA 19-9, and hepatitis B envelope antibody (HBeAb) were to be tested with Abbott AxSYM instrument. Break-even volume was calculated as fixed cost per year divided by purchasing cost per test minus variable cost per test and BEP ratio as total purchasing costs at break-even volume divided by total purchasing costs at actual annual volume. RESULTS: The average fixed cost per year of AFP, CEA, PSA, ferritin, fT4, T3, TSH, CA 125, CA 19- 9, and HBeAb was won 8,279,187 and average variable cost per test, won 3,786. Average break-even volume was 1,599 and average BEP ratio was 852%. Average BEP ratio without including quality costs such as calibration and quality control was 74%. CONCLUSIONS: Because the quality assurance of clinical tests cannot be waived, outsourcing all of 10 items was more adequate than in-house make at the present volume in financial aspect. BEP analysis was useful as a financial tool for make-or-buy decision, the common matter which laboratory managers meet with.

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