A Cost-Utility Analysis Comparing Oncoplastic Breast Surgery to Standard Lumpectomy in Large Breasted Women

Purpose: Ablative options, beyond mastectomy, for large breasted patients with breast cancer include oncoplastic resection via reduction pattern and standard lumpectomy. Oncoplastic resection also entails a contralateral procedure for symmetry and the potential benefit of a superior cosmetic outcome. Our aim was to examine the cost-effectiveness of this treatment strategy comparing it to standard lumpectomy in treating breast cancer patients. Methods: A literature review was performed of the probabilities and outcomes related to treatment of unilateral breast cancer via oncoplastic resection or unilateral lumpectomy. Utility score surveys were used to estimate the quality adjusted life years (QALYs) associated with a successful procedure, additional margins excision and post-operative complications. A decision analysis tree was developed to highlight the more cost-effective strategy. An Incremental Cost-Utility Ratio (ICUR) was calculated. Sensitivity analysis was performed to check the robustness of our data. Results: Oncoplastic resection was associated with fewer positive margins relative to standard lumpectomy (10.0% versus 18%). In cases with positive margins, a greater percentage of oncoplastic resection patients chose a mastectomy compared to the lumpectomy patients (72% versus 19%). Utility scores for a successful operation favored oncoplastic resection (92.6 versus 86.55), but in instances of positive margins, favored the lumpectomy patients (74.2 versus 70.2). Decision tree analysis revealed that oncoplastic resection was more cost-effective with an ICUR of $2609.66/QALY gained. Conclusion: Oncoplastic resection represents a cost-effective strategy for the large breasted patient and provides the surgical team yet another reasonable option for the appropriate patient.

Cost-Utility Analysis of Nivolumab plus Chemotherapy in the First-Line Treatment of Upper Gastrointestinal Adenocarcinoma

Objective: To evaluate the cost-utility of nivolumab plus chemotherapy compared with chemotherapy alone as the first-line treatment for advanced gastric, gastro-oesophageal junction, and esophageal adenocarcinoma in China. Methods: Based on CheckMate649, a partitioned survival model was carried out with a circulation cycle of 6 weeks to simulate the patient’s lifetime. Sensitivity analysis were adopted to verify the robustness of the results. Results: The results of the base-case analysis showed that both the total cost and utility of the nivolumab group were higher, and the ICUR value was CNY 267498.67/QALY, more than 3 times the GDP per capita of China in 2020. The results of deterministic sensitivity analysis indicated that the three most influential factors were the utility value of PFS state, the cost of nivolumab and the discount rate. The results of probabilistic sensitivity analysis were consistent with those of base-case analysis, proving that the results were robust. The scenario analysis illustrated that economical price of nivolumab was CNY 3652.71. Conclusions: Under the willing-to-pay threshold of three times the GDP per capita of China in 2020, compared with chemotherapy alone, nivolumab plus chemotherapy is not a cost-effective option in China.

Cost Utility Analysis of Dapagliflozin in Egyptian Patients with CKD from the Payer Perspective

Background: Chronic kidney disease is a serious public health issue in Egypt. An estimated 13% of individuals in Egypt are expected to have CKD, with a higher prevalence among older adults and in rural regions. The primary goal of the study was to compare the cost-utility of the standard of care alone against add-on medication, dapagliflozin, as a preventative measure against complications of CKD in cases with or without diabetes mellitus. Methods: A lifetime Markov state transition model with a 3-month cycle was employed based on the clinical evidence from the DAPA-CKD clinical trial. The model was to provide estimates of the long-term economic and health impact of managing CKD patients. Cost-effectiveness is assessed regarding the cost per quality-adjusted life year (QALY) gained. This economic evaluation study used a payer perspective. Moreover, the study evaluated the impact on the budget due to the undertaking of dapagliflozin. One-way deterministic sensitivity analyses, as well as a probabilistic sensitivity analysis, were employed. Results: During a lifetime horizon, the difference in cost between dapagliflozin and SOC was EGP -65,212 (USD 2126.89). The difference in QALY between dapagliflozin and SOC was 4.3. In CKD patients, adding dapagliflozin to ramipril generates better QALYs and lower costs than ramipril alone. Dapagliflozin improved the outcomes and generated cost savings. A deterministic one was sensitivity analysis revealed that the model is robust to changes in all variables included. Probabilistic sensitivity analysis using Monte Carlo simulation with 10,000 iterations showed that in about 82.64% of trials, dapagliflozin is cost-saving. The undertaking of dapagliflozin by any percent will have a positive impact on the budget. Conclusion: During the lifetime horizon, dapagliflozin is cost-saving;it benefits the quality of life and the total cost. The addition of dapagliflozin to SOC has a saving effect of 11.9% of the budget.

Cost-Utility Analysis of Liraglutide in Type 2 Diabetes Patients in China after Chinese Reformation of Medical Care System

Objectives: The cost-utility analysis of Liraglutide is aimed at evaluating whether Liraglutide is cost-effective or not after Chinese reformation on medical insurance. The analysis is based on the results of clinical trial conducted in Asia. Methods: We applied a Markov model to estimate the quality-adjusted life years, medical cost and incidence of diabetes-related complications for patients receiving the Liraglutide as an add-on to the metformin treatment. Baseline characteristics were taken from a China’s study while the treatment effect is from an Asian study. The related medical cost and utility score were obtained from a local study in China. Having set 30 years’ simulations, the incremental cost-effectiveness ratio was calculated comparing with glimepiride treatment. The ratio would be compared with the willingness to pay for a quality-adjusted-life-year (QALY) which is three times of the GDP per capita in Beijing. Sensitivity analysis was also performed. Result: During a period of 30 years, the base-case analysis which takes discount rate at 3% shows that Liraglutide 1.8 mg results in an average incremental cost of CNY 82,671.49, an improvement in 0.12 QALYs and a reduction of incidence of diabetes-related complications comparing to glimepiride. The associated incremental cost-effectiveness ratio is CNY 688,929.08. Conclusion: Long-term project shows that taking Liraglutide as an add-on to the metformin treatment will lead to increasing quality-adjusted life years and reduction of incidence of diabetes-related complications. When the price of Liraglutide is reduced by 43 percent in China’s yuan, Liraglutide will be cost-effective in China from the healthcare system perspective taking three times of GDP per capita as our WTP threshold.

A Building Information Modeling-Life Cycle Cost Analysis Integrated Model to Enhance Decisions Related to the Selection of Construction Methods at the Conceptual Design Stage of Buildings

Life Cycle Cost Analysis (LCCA) provides a systematic approach to assess the total cost associated with owning, operating, and maintaining assets throughout their entire life. BIM empowers architects and designers to perform real-time evaluations to explore various design options. However, when integrated with LCCA, BIM provides a comprehensive economic perspective that helps stakeholders understand the long-term financial implications of design decisions. This study presents a methodology for developing a model that seamlessly integrates BIM and LCCA during the conceptual design stage of buildings. This integration allows for a comprehensive evaluation and analysis of the design process, ensuring that the development aligns with the principles of low carbon emissions by employing modular construction, 3D concrete printing methods, and different building design alternatives. The model considers the initial construction costs in addition to all the long-term operational, maintenance, and salvage values. It combines various tools and data through different modules, including energy analysis, Life Cycle Assessment (LCA), and Life Cycle Cost Analysis (LCCA) to execute a comprehensive assessment of the financial implications of a specific design option throughout the lifecycle of building projects. The development of the said model and its implementation involves the creation of a new plug-in for the BIM tool (i.e., Autodesk Revit) to enhance its functionalities and capabilities in forecasting the life-cycle costs of buildings in addition to generating associated cash flows, creating scenarios, and sensitivity analyses in an automatic manner. This model empowers designers to evaluate and justify their initial investments while designing and selecting potential construction methods for buildings, and enabling stakeholders to make informed decisions by assessing different design alternatives based on long-term financial considerations during the early stages of design.

CGE model-based analysis of the neutralized hybrid carbon policy and its decomposed effects on economic growth,carbon reduction,and energy utilization costs

The hybrid policy is a flexible policy tool that combines features of carbon trading and carbon taxation.Its economic and environmental effects under China's background are still not studied in detail.Given the exogenous carbon reduction targets,carbon prices,and carbon tax-rates,by computable general equilibrium modeling methods and factor decomposition methods,this article investigates direct and cascaded effects of the hybrid policy on economic growth,energy utilization,and carbon emission on the national level and the sector level,with China's national input-output data-set.Stepwisely,policy scenarios with irrational estimated results are selectively excluded based on comprehensive evaluation among economic,carbon reduction and other policy targets.As a result,against national economic conditions in 2007,the hybrid policy,with a carbon reduction target of -10%,a carbon tax-rate of around $10,and a ceiling carbon price of $40,is highly recommended,because of its significant lower economic loss,lower energy utilization cost,and practical robustness against fluctuation of energy market and carbon market.Furthermore,by decomposition analysis,carbon reduction-related costs are decomposed into a direct part that includes carbon allowance price and carbon tax,and an indirect part as the energy price incremental induced by direct carbon costs.Gross carbon reduction may be decomposed into three parts such as energy intensity,economic scale,and technical progress.And,carbon taxation is the main policy tool that stimulates to improve the energy efficiency.

Feasibility Analysis and Practice Research of Resource Utilization of Waste from Planting and Breeding Industry

With the extending scale of agricultural production,the treatment and utilization of waste have become increasingly serious environmental problem.Taking city garden and Zhongnan pasture in Pujiang Town of Minhang District in Shanghai for example,according to the analysis on discharge characteristic of waste and balance of resources and energy utilization,mixed anaerobic digestion was chosen to dispose waste based on government guidance and feasibility analysis of project,and the combining disposal and resource utilization of waste were realized in two enterprises,providing reference for close cases.

Comparative analysis of perpetual pavement structures based on pavement performance and life cycle cost

Pavement performance and economic efficiency are researched on the perpetual test pavement of Yijiang-Suzhou Express Highway in Jiangsu province, China. Test sections were continuously monitored. The conditions and developing laws of deflection, rutting and cracking are compared among the perpetual pavement with the rich binder layer （RBL）, the perpetual pavement without the RBL, and the conventional semi-rigid asphalt pavement in the past eight years after opening for traffic. Economical evaluation is conducted via life cycle cost analysis （LCCA）. Based on the performance comparison and LCCA analysis, sections with the RBL have good crack resistance, but they are not very satisfactory in the aspect of permanent deformation; the conventional semi-rigid asphalt pavement is the least economic one due to requiring more frequent maintenance. Research results show that the perpetual pavement without RBL is a more appropriate structure for the test site.

Advances in microfluidic-based DNA methylation analysis

DNA methylation has been extensively investigated in recent years,not least because of its known relationship with various diseases.Progress in analytical methods can greatly increase the relevance of DNA methylation studies to both clinical medicine and scientific research.Microflu-idic chips are excellent carriers for molecular analysis,and their use can provide improvements from multiple aspects.On-chip molecular analysis has received extensive attention owing to its advantages of portability,high throughput,low cost,and high efficiency.In recent years,the use of novel microfluidic chips for DNA methylation analysis has been widely reported and has shown obvious superiority to conventional methods.In this review,wefirst focus on DNA methylation and its applications.Then,we discuss advanced microfluidic-based methods for DNA methylation analysis and describe the great progress that has been made in recent years.Finally,we summarize the advantages that microfluidic technology brings to DNA methylation analysis and describe several challenges and perspectives for on-chip DNA methylation analysis.This review should help researchers improve their understanding and make progress in developing microfluidic-based methods for DNA methylation analysis.

Cost-effectiveness analysis of treatments for metastatic castration resistant prostate cancer

Objective:Treatment options for metastatic castration resistant prostate cancer(mCRPC)have expanded rapidly in recent years.Given the significant economic burden,we sought perform a cost-effectiveness analysis(CEA)of the contemporary treatment paradigm for mCRPC.Methods:We devised a treatment protocol consisting of sipuleucel-T,enzalutamide,abiraterone,docetaxel,radium-223,and cabazitaxel.We estimated number and length of treatments for each therapy using dosing schedules or progression free survival data from published clinical trials.We estimated treatment cost using billing data and Medicare reimbursement values and performed a CEA.Our analysis assumed US$100,000 per life year saved(LYS)as the threshold societal willingness to pay.Results:Incremental cost-effectiveness ratios(ICER)for strategies incorporating sipuleucel-T that were not eliminated by extended dominance exceeded the societal threshold willingnessto-pay of US$100,000 per LYS,the lowest of which was sipuleucel-T+enzalutamide+abiraterone+docetaxel at US$207,714 per LYS.Enzalutamide+abiraterone+docetaxel exhibited the most favorable ICER among strategies without sipuleucel-T at US$165,460 per LYS.Conclusion:Based on the available survival data and current costs of treatment,all treatment strategies greatly exceed a commonly assumed societal willingness-to-pay threshold of US$100,000 per LYS.Improvements in this regard can only comewith a reduction in pricing,better tailoring of treatment or significant enhancements in survival with clinical use of treatment combinations or sequences.

Capparis spinosa L waste activated carbon as an efficient adsorbent for crystal violet toxic dye removal: Modeling, optimization by experimental design, and ecological analysis

Textile dyes are dramatic sources of pollution and non-aesthetic disturbance of aquatic life and therefore represent a potential risk of bioaccumulation that can affect living species.It is imperative to reduce or eliminate these dyes from liquid effluents with innovative biomaterials and methods.Therefore,this research aims to highlight the performance of Capparis spinosa L waste-activated carbon(CSLW-AC)adsorbent to remove crystal violet(CV)from an aqueous solution.The mechanism of CV adsorption on CSLW-AC was evaluated based on the coupling of experimental data and different characterization techniques.The efficiency of the CSLW-AC material reflected by the equilibrium adsorption capacity of CV could reach more than 195.671 mg·g^(–1) when 0.5 g·L^(–1) of CSLW-AC(Particle size≤250μm)is introduced into the CV of initial concentration of 100 mg·L^(–1) at pH 6 and temperature 65℃ and in the presence of potassium ions after 60 min of contact time according to the one parameter at a time studies.The adsorption behavior of CV on CSLW-AC was found to be consistent with the pseudo-second-order kinetic model and Frumkin's linear isothermal model.The thermodynamic aspects indicate that the process is physical,spontaneous,and endothermic.The optimization of the process by the Box Behnken design of experiments resulted in an adsorption capacity approaching 183.544 mg·g^(–1)([CV]=100 mg·L^(–1) and[CSLW-AC]=0.5 g·L^(–1) at 35 min).The results of the Lactuca sativa seeds germination in treated CV(70%),adsorbent solvent and thermal regeneration(more than 5 cycles),and process cost analysis(1.0484 USD·L^(–1))tests are encouraging and promising for future exploitations of the CSLW-AC material in different industrial fields.

Competitive analysis of price online inventory problem with cost function

In this paper,a new price is given to the online decision maker at the beginning of each day.The trader must decide how many items to purchase according to the current price.We present three variants and an online algorithm based on cost function.The competitive ratio of the online algorithm is given for each variant,which is a performance measure of an online algorithm.More importantly,we show that the online algorithm is optimal.

Cost analysis and outcomes of simple elbow dislocations

AIM: To evaluate the management, clinical outcome and cost implications of three different treatment regimes for simple elbow dislocations.METHODS: Following institutional board approval, we performed a retrospective review of all consecutive patients treated for simple elbow dislocations in a Level Ⅰ trauma centre between January 2008 and December 2010. Based on the length of elbow immobilisation(LOI), patients were divided in three groups(Group I, < 2 wk; Group Ⅱ, 2-3 wk; and Group Ⅲ, > 3 wk). Outcome was considered satisfactory when a patient could achieve a pain-free range of motion ≥ 100°(from 30° to 130°). The associated direct medical costs for the treatment of each patient were then calculated and analysed.RESULTS: We identified 80 patients who met the inclusion criteria. Due to loss to follow up, 13 patients were excluded from further analysis, leaving 67 patients for the final analysis. The mean LOI was 14 d(median 15 d; range 3-43 d) with a mean duration of hospital engagement of 67 d(median 57 d; range 10-351 d). Group Ⅲ(prolonged immobilisation) had a statistically significant worse outcome in comparison to Group Ⅰ?and Ⅱ(P = 0.04 and P = 0.01 respectively); however, there was no significant difference in the outcome between groups Ⅰ?and Ⅱ(P = 0.30). No statistically significantdifference in the direct medical costs between the groups was identified.CONCLUSION: The length of elbow immobilization doesn't influence the medical cost; however immobilisation longer than three weeks is associated with persistent stiffness and a less satisfactory clinical outcome.

Comparison of School Building Construction Costs Estimation Methods Using Regression Analysis, Neural Network, and Support Vector Machine

Accurate cost estimation at the early stage of a construction project is key factor in a project’s success. But it is difficult to quickly and accurately estimate construction costs at the planning stage, when drawings, documentation and the like are still incomplete. As such, various techniques have been applied to accurately estimate construction costs at an early stage, when project information is limited. While the various techniques have their pros and cons, there has been little effort made to determine the best technique in terms of cost estimating performance. The objective of this research is to compare the accuracy of three estimating techniques (regression analysis (RA), neural network (NN), and support vector machine techniques (SVM)) by performing estimations of construction costs. By comparing the accuracy of these techniques using historical cost data, it was found that NN model showed more accurate estimation results than the RA and SVM models. Consequently, it is determined that NN model is most suitable for estimating the cost of school building projects.

Economic Viability of Smallholder Agroforestry and Beekeeping Projects in Uluguru Mountains, Tanzania: A Cost Benefit Analysis

Agroforestry and beekeeping are widely promoted as prospective Nature- Based Income Generating Activities (NIGAs) to improve livelihoods while at the same time enhancing biodiversity conservation in degrading agro-ecologies. These activities can diversify and increase famers’ incomes and support instinctive biota and fauna resilience. However, evidence to showcase and compare their long-term benefits is scant. We use the case of Uluguru Mountains in Tanzania to evaluate and compare viability of agroforestry and beekeeping projects using the Cost Benefit Analysis (CBA) approach. The results of analysis yielded positive NPVs for both agroforestry and beekeeping projects at discount rates not higher than 8.2% and 8.5% respectively. Overall, the comparison of economic viability between agroforestry and beekeeping projects revealed that the former was relatively more profitable than the later in terms of both the NPV and Benefit Cost Ratio (BCR) criteria. However, the Internal Rate of Return (IRR) for beekeeping was slightly higher than that of agroforestry. Yet, we underscore the fact that these two projects can jointly be implemented to enhance livelihoods of farmers and support biodiversity conservation in the study area and other parts with similar agro-ecologies in developing countries. However, farmers in these agro-ecologies need to be supported by governments and non-government development partners in terms of training and inspiration to shift from orthodox farming to sustainable NIGAs.

Modeling Anthrax with Optimal Control and Cost Effectiveness Analysis

Anthrax is an infection caused by bacteria and it affects both human and animal populations. The disease can be categorized under zoonotic diseases and humans can contract infections through contact with infected animals, ingest contaminated dairy and animal products. In this paper, we developed a mathematical model for anthrax transmission dynamics in both human and animal populations with optimal control. The qualitative solution of the model behaviour was analyzed by determining Rhv, equilibrium points and sensitivity analysis. A vaccination class was incorporated into the model with waning immunity. Local and global stability of the model’s equilibria was found to be locally asymptotically stable whenever Rhv Rhv. It was revealed that reducing animal and human interaction rate, would decrease Rhv. We extended the model to optimal control in order to find the best control strategy in reducing anthrax infections. It showed that the effective strategy in combating the anthrax epidemics is vaccination of animals and prevention of humans.

Optimization of Evidence Analysis Cost Using Arbitrary Re-Sampling Techniques for Sample Influx into Forensic Science Laboratory

This study analyzes the sample influx (samples per case file) into forensic science laboratory (FSL) and the corresponding analysis costs and uses arbitrary re-sampling plans to establish the minimum cost function. The demand for forensic analysis increased for all disciplines, especially biology/DNA between 2014 and 2015. While the average distribution of case files was about 42.5%, 40.6% and 17% for the three disciplines, the distribution of samples was rather different being 12%, 82.5% and 5.5% for samples requiring forensic biology, chemistry and toxicology analysis, respectively. Results show that most of the analysis workload was on forensic chemistry analysis. The cost of analysis for case files and the corresponding sample influx varied in the ratio of 35:6:1 and 28:12:1 for forensic chemistry, biology/DNA and toxicology for year 2014 for 2015, respectively. In the two consecutive years, the cost for forensic chemistry analysis was comparatively very high, necessitating re-sampling. The time series of sample influx in all disciplines are strongly stochastic, with higher magnitude for chemistry, biology/DNA and toxicology, in this order. The PDFs of sample influx data are highly skewed to the right, especially forensic toxicology and biology/DNA with peaks at 1 and 3 samples per case file. The arbitrary re-sampling plans were best suited to forensic chemistry case files (where re-sampling conditions apply). The locus of arbitrary number of samples to take from the submitted forensic samples was used to establish the minimum and scientifically acceptable samples by applying minimization function developed in this paper. The cost minimization function was also developed based on the average cost per sample and choice of re-sampling plans depending on the range of sample influx, from which the savings were determined and maximized. Thus, the study gives a forensic scientist a business model and scientific decision making tool on minimum number of samples to analyze focusing on savings on analysis cost.

Cost analysis of childhood glaucoma surgeries using the US Medicaire allowable costs

AIM: To analyze and calculate the relative cost of various childhood glaucoma surgical interventions per mm Hg intraocular pressure(IOP) reduction($/mm Hg).METHODS: Representative index studies were reviewed to quantitate the reduction of mean IOP and glaucoma medications for each surgical intervention in childhood glaucoma. A US perspective was adopted, using Medicare allowable costs to calculate cost/mm Hg IOP reduction($/mm Hg) at 1y postoperatively.RESULTS: At 1y postoperatively, the cost/mm Hg IOP reduction was $226/mm Hg for microcatheter-assisted circumferential trabeculotomy, $284/mm Hg for cyclophotocoagulation, $288/mm Hg for conventional ab-externo trabeculotomy, $338/mm Hg for Ahmed glaucoma valve, $350/mm Hg for Baerveldt glaucoma implant, $351/mm Hg for goniotomy, and $400/mm Hg for trabeculectomy.CONCLUSION: Microcatheter-assisted circumferential trabeculotomy is the most cost-efficient surgical method to lower IOP in childhood glaucoma, while trabeculectomy is the least cost-efficient surgical method.

Priority-sequence of mineral resources' development and utilization based on grey relational analysis method

Generally, the sequence decision of the development and utilization of Chinese mineral resources is based on national and provincial overall plan of the mineral resources. Such plan usually cannot reflect the relative size of the suitability of the development and utilization of mineral resources. To solve the problem, the paper has selected the gift condition, the market condition, the technological condition,socio-economic condition and environmental condition as the starting-points to analyze the influential factors of the priority-sequence of mineral resources' development and utilization. The above 5 conditions are further specified into 9 evaluative indicators to establish an evaluation indicator system. At last,we propose a decision model of the priority sequence based on grey relational analysis method, and figure out the observation objects by the suitability index of development. Finally, the mineral resources of a certain province in China were analyzed as an example. The calculation results indicate that silver(2.0057), coal(1.9955), zinc(1.9442), cement limestone(1.9077), solvent limestone(1.5624) and other minerals in the province are suitable for development and utilization.

Association between acute peripancreatic fluid collections and early readmission in acute pancreatitis:A propensity-matched analysis

BACKGROUND Patients with acute pancreatitis(AP)frequently experience hospital readmissions,posing a significant burden to healthcare systems.Acute peripancreatic fluid collection(APFC)may negatively impact the clinical course of AP.It could worsen symptoms and potentially lead to additional complications.However,clinical evidence regarding the specific association between APFC and early readmission in AP remains scarce.Understanding the link between APFC and readmission may help improve clinical care for AP patients and reduce healthcare costs.AIM To evaluate the association between APFC and 30-day readmission in patients with AP.METHODS This retrospective cohort study is based on the Nationwide Readmission Database for 2016-2019.Patients with a primary diagnosis of AP were identified.Participants were categorized into those with and without APFC.A 1:1 propensity score matching for age,gender,and Elixhauser comorbidities was performed.The primary outcome was early readmission rates.Secondary outcomes included the incidence of inpatient complications and healthcare utilization.Unadjusted analyses used Mann-Whitney U andχ2 tests,while Cox regression models assessed 30-day readmission risks and reported them as adjusted hazard ratios(aHR).Kaplan-Meier curves and log-rank tests verified readmission risks.RESULTS A total of 673059 patients with the principal diagnosis of AP were included.Of these,5.1%had APFC on initial admission.After propensity score matching,each cohort consisted of 33914 patients.Those with APFC showed a higher incidence of inpatient complications,including septic shock(3.1%vs 1.3%,P<0.001),portal venous thrombosis(4.4%vs 0.8%,P<0.001),and mechanical ventilation(1.8%vs 0.9%,P<0.001).The length of stay(LOS)was longer for APFC patients[4(3-7)vs 3(2-5)days,P<0.001],as were hospital charges($29451 vs$24418,P<0.001).For 30-day readmissions,APFC patients had a higher rate(15.7%vs 6.5%,P<0.001)and a longer median readmission LOS(4 vs 3 days,P<0.001).The APFC group also had higher readmission charges($28282 vs$22865,P<0.001).The presence of APFC increased the risk of readmission twofold(aHR 2.52,95%confidence interval:2.40-2.65,P<0.001).The independent risk factors for 30-day readmission included female gender,Elixhauser Comorbidity Index≥3,chronic pulmonary diseases,chronic renal disease,protein-calorie malnutrition,substance use disorder,depression,portal and splenic venous thrombosis,and certain endoscopic procedures.CONCLUSION Developing APFC during index hospitalization for AP is linked to higher readmission rates,more inpatient complications,longer LOS,and increased healthcare costs.Knowing predictors of readmission can help target high-risk patients,reducing healthcare burdens.