Costing the supply chain for delivery of ACT and RDTs in the public sector in Benin and Kenya

Studies have shown that supply chain costs are a significant proportion of total programme costs. Nevertheless, the costs of delivering specific products are poorly understood and ballpark estimates are often used to inadequately plan for the budgetary implications of supply chain expenses. The purpose of this research was to estimate the country level costs of the public sector supply chain for artemisinin-based combination therapy (ACT) and rapid diagnostic tests (RDTs) from the central to the peripheral levels in Benin and Kenya.MethodsA micro-costing approach was used and primary data on the various cost components of the supply chain was collected at the central, intermediate, and facility levels between September and November 2013. Information sources included central warehouse databases, health facility records, transport schedules, and expenditure reports. Data from document reviews and semi-structured interviews were used to identify cost inputs and estimate actual costs. Sampling was purposive to isolate key variables of interest. Survey guides were developed and administered electronically. Data were extracted into Microsoft Excel®, and the supply chain cost per unit of ACT and RDT distributed by function and level of system was calculated.ResultsIn Benin, supply chain costs added USD 0.2011 to the initial acquisition cost of ACT and USD 0.3375 to RDTs (normalized to USD 1). In Kenya, they added USD 0.2443 to the acquisition cost of ACT and USD 0.1895 to RDTs (normalized to USD 1). Total supply chain costs accounted for more than 30% of the initial acquisition cost of the products in some cases and these costs were highly sensitive to product volumes. The major cost drivers were found to be labour, transport, and utilities with health facilities carrying the majority of the cost per unit of product. Accurate cost estimates are needed to ensure adequate resources are available for supply chain activities. Product volumes should be considered when costing supply chain functions rather than dollar value. Further work is needed to develop extrapolative costing models that can be applied at country level without extensive micro-costing exercises. This will allow other countries to generate more accurate estimates in the future

Risky Suppliers or Risky Supply Chains? An Empirical Analysis of Sub-Tier Supply Network Structure on Firm Performance in the High-Tech Sector

Past research in supply chain risk management has focused on the interactions between buyers and their immediate suppliers and/or assumed independence of risks imposed by these suppliers. However, supply network structure may induce inter-dependency of risks due, for example, to overlapping sub-tier suppliers. This paper empirically studies the prevalence of overlapping sub-tier suppliers and their impact on financial performance for firms in the high-tech sector. Using firm-level supplier-customer relationship data, we find that on average 20 (2.3) percent of tier-2 suppliers are shared by at least two (five) tier-1 suppliers. We also find that the risk, measured as stock return volatility, of the focal tier-0 firm is positively associated with common tier-2 supplier risk, and the association is stronger for suppliers with a higher degree of tier-2 commonality. To disentangle the impact of risky supply network structure from risky tier-2 suppliers, we define two network metrics, viz., diamond ratio and cosine commonality score. We find that a one standard deviation increase in each of these metric leads to an increase in standard deviation of 0.58 and 0.41 respectively in tier-0 firm's risk. Our results reveal substantial unmanaged supply chain risks due to overlapping sub-tier suppliers, and highlight the need for firms to increase visibility into their extended supply network.http://deepblue.lib.umich.edu/bitstream/2027.42/116385/1/1297_Wang.pd

Analysis of supply contracts with commitments and flexibility

In this article we address an important class of supply contracts called the Rolling Horizon Flexibility (RHF) contracts. Under such a contract, at the beginning of the horizon a buyer has to commit requirements for components for each period into the future. Usually, a supplier provides limited flexibility to the buyer to adjust the current order and future commitments in a rolling horizon manner. We present a general model for a buyer's procurement decision under RHF contracts. We propose two heuristics and derive a lower bound. Numerically, we demonstrate the effectiveness of the heuristics for both stationary and non-stationary demands. We show that the heuristics are easy to compute, and hence, amenable to practical implementation. We also propose two measures for the order process that allow us to (a) evaluate the effectiveness of RHF contracts in restricting the variability in the orders, and (b) measure the accuracy of advance information vis-a-vis the actual orders. Numerically we demonstrate that the order process variability decreases significantly as flexibility decreases without a dramatic increase in expected costs. Our numerical studies provide several other managerial insights for the buyer; for example, we provide insights into how much flexibility is sufficient, the value of additional flexibility, the effect of flexibility on customer satisfaction (as measured by fill rate), etc. © 2008 Wiley Periodicals, Inc. Naval Research Logistics, 2008Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/60455/1/20300_ftp.pd

Managing Business Process Flows: Prinsip-prinsip Manajemen Operasi

Buku ini menyajikan sebuah pendekatan baru untuk mempelajari konsep-konsep inti dalam operasi, yang merupakan salah satu dari tiga bidang fungsional utama dalam manajemen bisnis, selain keuangan dan pemasaran. Manajemen operasi dalam hal desain, pengendalian, dan perbaikan proses bisnis serta penggunaan pandanagn proses bisnis merupakan paradigma pemersatu untuk mempelajari operasi. Buku ini juga membahas operasi manufaktur dan jasa dalam situasi make-to-stock maupun make-to-order. Pendekatan logis dan seksama untuk membahas konsep-konsep inti manajemen operasi diuraikan dalam tiga tahap: 1. Membuat model serta memahami sebuah proses bisnis dan alirannya 2. Mempelajari hubungan sebab-akibat antara struktur proses dan alat-alat ukur kinerja operasional dan financial 3. Merumuskan implikasi bagi tindakan manajerial dengan menyaring “pengungkit-pengungkit” manajerial serta dampaknya terhadap ukuran operasional dan finansial dari kinerja proses. Buku ini merupakan bacaan wajib para manajer untuk dapat mendesain dan mengendalikan struktur proses dan penggerak proses untuk meningkatkan kinerja setiap proses bisnis yang berjalan

State of the Art MR Enterography Technique

ABSTRACT: Magnetic resonance enterography (MRE) is a well-established imaging technique that is commonly used for evaluating a variety of bowel diseases, most commonly inflammatory bowel disease which is increasing in prevalence. Inflammatory bowel disease is composed of 2 related, but distinct disease entities: Crohn disease (CD) and ulcerative colitis. In ulcerative colitis, inflammation is generally limited to the mucosa and invariably involves the rectum, and often the more proximal colon. CD is typified by transmural inflammation with skip lesions occurring anywhere from the mouth to anus, but characteristically involves the terminal ileum. The transmural involvement of CD may lead to debilitating ulceration and, ultimately, development of sinus tracts, which can be associated with abscesses and fistulae as extraenteric manifestations of the disease. Because much of the small bowel and extraenteric disease cannot be adequately assessed with conventional endoscopy, imaging plays a crucial role in initial diagnosis and follow-up. MRE does not use ionizing radiation which is important for these patients, many of which present earlier in life and may require multiple imaging examinations. In this article, we review the clinical indications, patient preparation, and optimal technique for MRE. We also discuss the role and proper selection of intravenous gadolinium-based contrast material, oral contrast material, and antiperistaltic agents, including pediatric considerations. Finally, we review the recommended and optional pulse sequence selection, including discussion of a "time-efficient" protocol, reviewing their utility, advantages, and limitations. Our hope is to aid the radiologist seeking to develop a robust MRE imaging program for the evaluation of bowel disease

An Unusual Case of Gastrointestinal Bleeding

A 10-year-old boy presented with a 3-day history of worsening abdominal pain, fever, emesis and melena. Abdominal ultrasound revealed a right upper quadrant mass that was confirmed by computed tomography angiogram (CTA), which showed an 8 cm well-defined retroperitoneal vascular mass. 123Iodine metaiodobenzylguanidine (123MIBG) scan indicated uptake only in the abdominal mass. Subsequent biopsy revealed a paraganglioma that was treated with chemotherapy. This case represents an unusual presentation of a paraganglioma associated with gastrointestinal (GI) bleeding and highlights the utility of CTA and 123MIBG in evaluation and treatment

Clinical and Economic Outcomes Associated with Cell-Based Quadrivalent Influenza Vaccine vs. Standard-Dose Egg-Based Quadrivalent Influenza Vaccines during the 2018-19 Influenza Season in the United States

Non-egg-based influenza vaccines eliminate the potential for egg-adapted mutations and potentially increase vaccine effectiveness. This retrospective study compared hospitalizations/emergency room (ER) visits and all-cause annualized healthcare costs among subjects aged 4-64 years who received cell-based quadrivalent (QIVc) or standard-dose egg-based quadrivalent (QIVe-SD) influenza vaccine during the 2018-19 influenza season. Administrative claims data (IQVIA PharMetrics(R) Plus, IQVIA, USA) were utilized to evaluate clinical and economic outcomes. Adjusted relative vaccine effectiveness (rVE) of QIVc vs. QIVe-SD among overall cohort, as well as for three subgroups (age 4-17 years, age 18-64 years, and high-risk) was evaluated using inverse probability of treatment weighting (IPTW) and Poisson regression models. Generalized estimating equation models among the propensity score matched sample were used to estimate annualized all-cause costs. A total of 669,030 recipients of QIVc and 3,062,797 of QIVe-SD were identified after IPTW adjustments. Among the overall cohort, QIVc had higher adjusted rVEs against hospitalizations/ER visits related to influenza, all-cause hospitalizations, and hospitalizations/ER visits associated with any respiratory event compared to QIVe-SD. The adjusted annualized all-cause total costs were higher for QIVe-SD compared to QIVc ((+$461); p < 0.05)

A Real-World Clinical and Economic Analysis of Cell-Derived Quadrivalent Influenza Vaccine Compared to Standard Egg-Derived Quadrivalent Influenza Vaccines During the 2019-2020 Influenza Season in the United States

BACKGROUND: Cell-derived influenza vaccines are not subject to egg-adaptive mutations that have potential to decrease vaccine effectiveness. This retrospective analysis estimated the relative vaccine effectiveness (rVE) of cell-derived quadrivalent influenza vaccine (IIV4c) compared to standard egg-derived quadrivalent influenza vaccines (IIV4e) among recipients aged 4–64 years in the United States during the 2019–2020 influenza season. METHODS: The IQVIA PharMetrics Plus administrative claims database was utilized. Study outcomes were assessed postvaccination through the end of the study period (7 March 2020). Inverse probability of treatment weighting (IPTW) was implemented to adjust for covariate imbalance. Adjusted rVE against influenza-related hospitalizations/emergency room (ER) visits and other clinical outcomes was estimated through IPTW-weighted Poisson regression models for the IIV4c and IIV4e cohorts and for the subgroup with ≥1 high-risk condition. Sensitivity analyses modifying the outcome assessment period as well as a doubly-robust analysis were also conducted. IPTW-weighted generalized linear models were used to estimate predicted annualized all-cause costs. RESULTS: The final sample comprised 1 150 134 IIV4c and 3 924 819 IIV4e recipients following IPTW adjustment. IIV4c was more effective in preventing influenza-related hospitalizations/ER visits as well as respiratory-related hospitalizations/ER visits compared to IIV4e. IIV4c was also more effective for the high-risk subgroup and across the sensitivity analyses. IIV4c was also associated with significantly lower annualized all-cause total costs compared to IIV4e (–$467), driven by lower costs for outpatient medical services and inpatient hospitalizations. CONCLUSIONS: IIV4c was significantly more effective in preventing influenza-related hospitalizations/ER visits compared to IIV4e and was associated with significantly lower all-cause costs