Annual Cost Research Articles

Extractive distillation using salt-based deep eutectic solvent as entrainer for separating acetonitrile-water mixture

Salt-based deep eutectic solvents (DESs) have been proposed in this work for the separation of the azeotrope of acetonitrile and water (H2O). The vapor–liquid equilibrium experiments indicated that (ChCl:U:CaCl2)1:2:0.36 exhibits an higher selectivity among all of the entrainers investigated and eliminates the azeotropic point of acetonitrile and water mixture. Moreover, the calculated values by NRTL model coincide well with the experimental data for the systems (acetonitrile + H2O + (ChCl:U:CaCl2)1:2:0.36). Based on the thermodynamic study, the conceptual process design was established to evaluate the competitiveness of the suggested entrainers for the separation of acetonitrile and water. It was determined that the thermodynamic efficiency (η) in the extractive distillation (ED) process utilizing the new salt-based DESs entrainers increases 60.31 % compared with the benchmark entrainer ethylene glycol (EG). Conversely, the ED process using (ChCl:U:CaCl2)1:2:0.36) entrainer can reduce the total annual cost (TAC) by about 7.81 % and the CO2 emissions (ECO2) by 14.74 %. The ED process using (ChCl:U:CaCl2)1:2:0.36) as entrainer shows the high energy efficiency, low economy cost and low CO2 emissions with a great industrial application prospect when compared to the bench marked process.

Time‐Driven Activity Based Costing of an Annual Canadian Cochlear Implant Program

AbstractObjectiveTo define the cost necessary to run an adult cochlear implant (CI) program, including assessment, subsequent implantation, and follow from the Canadian provincial government perspective.Study DesignTime‐driven activity based costing (TDABC) of a CI program.SettingAdult provincial CI referral center.MethodsClinical scenario pathways were developed and verified with stakeholders. TDABC was then applied to all steps involved in the pathway. Costing was based on all patients referred to the CI program in 2019. All costs were calculated in Canadian (and American) dollars as of 2023.ResultsThis is the first TDABC model of a CI program to the authors knowledge. In 2019, 296 referrals were placed to our CI program and 154 were surgical candidates. The calculated total annual cost for patients referred in 2019 was $4.542 million ($3.365 million USD), or $29,511 ($21,865 USD) per patient implanted. The largest cost contributors to patient cycles were surgical day costs ($23,164 [$17,185 USD] for unilateral, $43,356 [$32,165 USD] for bilateral), switch‐on day costs ($1068 [$791 USD] for unilateral, $1511 [$1120 USD] for bilateral), and audiological assessment costs ($692 [$512 USD]). The highest single cost on the pathway was due to the actual CI device when used. Across other patient steps, the highest costs were related to labor.ConclusionThis TDABC evaluation of a CI program found the annual cost required to meet all referrals was $4.542 million ($3.365 million USD), or $29,511 ($21,865 USD) per patient implanted. The highest single‐cost was associated with the CI device itself.

A novel life-cycle analysis approach using pavement performance curves with cost and performance considerations

ABSTRACT The life-cycle duration (TLC) is typically assumed constant in pavement life-cycle analysis. The added scientific value of this paper is that (TLC) is considered a variable parameter to be estimated from the performance curve using a variable terminal condition rating. A variable (TLC) requires using the equivalent annual value (EAV) instead of the net present value for cost estimation. The life-cycle performance (LCP) curve is constructed using two routine maintenance cycles separated by one major rehabilitation action. The time parameters associated with LCP curve are estimated from the inverse performance function based on the initial, present and terminal condition ratings. The equivalent annual cost and performance associated with a particular LCP curve are used to compute cost/performance (C/P) ratio for optimal maintenance and rehabilitation (M&R) plan selection. The EAV represents the costs of two routine maintenance cycles and one major rehabilitation action. Sample results obtained from three case studies have indicated the reliability of the proposed LCA approach in yielding optimal M&R plans. At the project-level, the optimal M&R plan associated with 7 m/km terminal IRI value resulted in (0.949) minimal (C/P) value. However, the optimal M&R plan with 3.25 terminal PSI yielded (1.50) minimal (C/P) value.

Thermo-kinetic synergy in separating dimethyl carbonate/methanol/water mixtures using ionic liquids-based mixed solvents

The low selectivity of traditional organic solvents and the limited mass transfer efficiency caused by the high viscosity of ionic liquids (ILs) pose challenges in separating of dimethyl carbonate (DMC)/methanol/water mixtures. Therefore, a novel mixed solvent is proposed with a mass ratio of methyl salicylate to 1-butyl-3-methylimidazolium bis(trifluoromethylsulfonyl)imide of 6:4. The synergistic effects of thermodynamic, kinetic, and economic performance using the mixed solvent are investigated. Comparisons of overall efficiency and total annual cost (TAC) for four process configurations using direct and indirect extractive distillation sequences to produce industrial and battery-grade DMC products are conducted. The results indicate that direct extractive distillation outperforms the indirect sequence, reducing TAC by 6.1–14.3 % for producing industrial-grade DMC and 6.6–15.8 % for battery-grade DMC. Additionally, using mixed solvents in direct extractive distillation is more effective than using pure solvents, enhancing mass transfer coefficients by 2.8–20.9 % for industrial-grade DMC and 1.8–17.8 % for battery-grade DMC. This approach also reduces TAC by 3.2–3.6 % for industrial-grade DMC and 4.7–5.7 % for battery-grade DMC.

Economic burden and health-related quality of life in patients with epidermolysis bullosa in Spain

Background. Epidermolysis bullosa (EB) is a rare genetic skin disorder characterized by fragility of skin with appearance of acute and chronic wounds. The aim of this study was to determine the economic burden and the health-related quality of life (HRQoL) of patients with epidermolysis bullosa (EB) in Spain from a societal perspective.Methods. We conducted a cross-sectional, retrospective study including 62 patients with EB (62% dystrophic, 9.6% junctional, 3.2% Kindler syndrome, and 26% with simplex EB). Data were collected from questionnaires completed by patients or their caregivers. The costs were estimated, including not only direct healthcare costs but also direct non-healthcare costs and productivity losses. We compared severe EB (Dystrophic, Junctional EB and Kindler syndrome) to non-severe EB (simplex EB) using as reference year 2022. HRQoL was measured by generic (EQ-5D) and specific (QoLEB) questionnaires.ResultsThe average annual cost for an EB patient was €31,352. Direct healthcare costs represented 17.2% of the total cost, direct non-healthcare costs (mainly informal care costs) 71.3% and productivity losses 11.5% of the total cost. Participants in the severe EB group had a slightly higher average cost than participants in the non-severe EB group (€31,706 vs. €30,337). Direct healthcare costs and non-healthcare costs were higher in the severe EB group (€6,205 vs. €3,024 and €23,148 vs. €20,113) while productivity losses were higher in the non-severe EB group (€7,200 vs. €2,353). The mean utility index score, where the maximum value possible is one, was 0.45 for patients with severe EB (0.76 for their caregivers) and 0.62 for those with non-severe EB (0.77 for their caregivers).Conclusions. The social economic burden of EB, resulting from the high direct non-healthcare cost of informal care, and from the loss of productivity, accentuates the importance of not restricting cost analysis to direct healthcare costs. This substantiates that EB, particularly severe EB represents a significant hidden cost that should be revealed to society and should be considered in the support programmes for people who suffer from this disease, and in the economic evaluation of new treatments.

The effectiveness of duty cycling technique on air conditioning system during break period for comfort, energy and cost savings: A real case study in health center

This paper investigates the potential of duty cycling techniques for air conditioning (AC) systems in producing energy and cost savings and the impact on the indoor thermal environment, air quality, and environmental sustainability. The real case study concentrated on energy consumption practice during the break period between 13:00 to 14:00 in a lobby area of a Health Center. Site data measurements of electrical input power, energy, indoor air temperature and humidity, and indoor carbon dioxide (CO2) concentration were conducted. Two zero-cost strategies were studied and results were compared to baseline conditions. In general, the results show that all strategies can meet the indoor thermal environment and air quality requirements, except room temperature for Strategy 2 which ranges on average between 26.71 to 26.82C. In addition to the instant payback period (0 years), the results also indicate that as compared to baseline condition, Strategies 1 and 2 led to annual energy and cost savings of around 759.2 kWh (USD 64.40) and 1250.6 kWh (USD 106.08), respectively. In terms of environmental sustainability, Strategies 1 and 2 can avoid environmental CO2 emissions by 444.13 and 731.60 kg of CO2 per year, respectively. Due to these reasons and if the sensitivity of occupant comfort to room temperature during the break period can be tolerated, it is proposed that Strategy 2 is the best option for the AC system operation during the break period. Considering other buildings also adopted the same strategy, this small action can lead to a high impact, not only on energy and cost savings but also on environmental sustainability in the future.

Cost-effectiveness of an interactive voice response system for improving retention in care and adherence to antiretroviral therapy among young adults in Uganda

BackgroundNew interventions aimed at increasing access to and adherence to antiretroviral therapy among young people living with the human immunodeficiency virus (YPLHIV) are needed. This study assessed the cost-effectiveness of the call-for-life interaction voice response tool compared to that of the standard of care (SOC) for promoting treatment adherence and retention in care among YPLHIV in Western Uganda.This cost-effectiveness study used data from a randomized controlled trial and a decision-analytic Markov model to estimate the long-term outcomes and costs of the Call for Life-Interactive Voice Response (CFL-IVR) tool and the usual care from the Ugandan public payer perspective. The model was parameterized using primary data and the literature and adopted a 1-year Markov cycle. The main outcomes were mean annual costs, disability-adjusted life-years (DALYs), and the incremental cost-effectiveness ratio (ICER) in form of cost per DALY averted. The CLF-IVR was deemed cost-effective if the ICER was between 1% and 51% of Uganda’s gross domestic product. We conducted deterministic and probabilistic sensitivity analyses to assess the effect of adjusting parameter values on cost-effectiveness estimates. All costs were reported in 2021 US dollars, and a discount rate of 3% was applied to both costs and outcomes.ResultsThe base case analysis showed that, from the Ugandan public payer perspective, the CLF-IVR led to more mean annual costs ($359 vs. $280) and averted more mean annual DALYs (15.78 vs. 11.09) than the SOC, leading to an ICER of $17 per DALY averted. The base-case results did not change significantly in the deterministic and probabilistic sensitivity analyses. The cost-effectiveness estimates were more responsive to uncertainties surrounding ART duration, viral load suppression rates, and discount rates.ConclusionThe CLF-IVR may be a cost-effective intervention for promoting treatment adherence and retention in care among YPLHIV in Uganda and other low-income settings. Once implemented, similar interventions may lead to greater returns in encouraging adherence to ART and retention in care among YPLHIV and other vulnerable groups, and eventually favorable clinical outcomes.Trial registrationNCT04718974 Registry: clinical Trials.gov https://ichgcp.net/nl/clinical-trials-registry/NCT04718974 (20 Jan 2021).

Evaluating energy efficiency and environmental sustainability in fiberglass prefabricated modular structures

Fiberglass (FG) modular buildings are gaining increasing attention in the construction industry due to their adaptability, and potential for cost and time savings. This study compares the FG modular, house-like cubicles to concrete counter parts with respect to the environmental impacts and cost. The scope of the study encompasses the production and operational phase, especially air conditioning (AC) systems in hyper-arid climates. The effectiveness of insulation, quantified through R-value calculations, is evaluated across varying insulation thicknesses using Life Cycle Assessment (LCA). The results indicate that AC energy requirements significantly contribute to the climate change impact (CCH), accounting for 77 % and 90.5 %, in concrete and FG modules respectively. FG modules exhibit significantly higher environmental impacts compared to concrete modules in agricultural land occupation (+142.7 %), terrestrial ecotoxicity (+80.6 %), and urban land occupation (+66 %). Employing Net Present Value (NPV), the annual cost for FG and concrete modules was USD 963.9 and USD 550.8 per year, respectively. Sensitivity analysis indicates that increasing insulation (+5.00 cm) in FG modules reduces that annual cost due to cooling by 16.55 %, reduces CCH by 59.47 % but increases metal depletion by 130 %. This signifies the importance of incorporating the use phase when evaluating innovative building materials and methods.

What drives the growth of an open pension fund?

Abstract This paper investigates the relationship between growth and quality of pension funds. It measures growth in terms of changes in the number of participants and cash flow transfers and appreciates the quality of the funds through the set of information on past results and costs published in the official prospectuses. The results show that growth rewards the best performing funds in the long term, while annual performance and costs have no relevance. Nevertheless, other factors, such as market power and commercial pressure, appear to be more powerful. The existence of conditions of market power capable of attracting investors beyond the actual quality of pension products is undesirable as it harms future pensioners. These results have implications for the Authority, as mandatory information should be suitable to induce investors to identify the best products and direct individual choices toward the public objective of a more efficient market.

Economic evaluation of hazardous healthcare waste treatment systems

The cost estimation and assessment of healthcare waste treatment systems (HCWTSs) for preventing financial and environmental damage are essential. This work reports economic analyses of treatment of hazardous–infectious waste based on WHO approach in HCWTSS of 43 hospitals in Tehran, Iran. The waste generation rate for total hospital waste in 43 HCWTSS was 4.42 ± 2.77 kg/active-bed/day. The mean of chemical, sharps, infectious, and general wastes in 43 HCWTSS were 13.79 ± 19.71, 30.29 ± 37.46, 336.28 ± 291.31, and 539.6 ± 383.13 kg/day, respectively. Economic analyses proved that general hospitals spent 1.63 times more than specialized hospitals on treating hazardous–infectious waste per year. The annual cost of treating each kilogram of hazardous healthcare waste in studied HCWTSS was 0.3 dollars. A range of total annual costs in 43 HCWTSS was limited to 7.9–118 thousand dollars. The results of ANOVA test demonstrated that the age and performance levels of hospitals significantly affect the annual capital and operating costs, respectively. Hence, improving recycling knowledge and increasing source-separated recycling should be considered to control the costs in HCWTSS. The results of this work have implications for the hospital managers in especially developing countries to evaluate previously unknown economic analyses and policies and take action to control wasted costs in HCWTSS.

An economic model to understand the cost-effectiveness of olanzapine orally dispersible tablets (ODT) and olanzapine film coated tablets as a group compared with other oral atypical antipsychotics for treating schizophrenia in Morocco

BackgroundAntipsychotic medications are the primary treatment for schizophrenia, with olanzapine being an effective medication for schizophrenia. The economic cost for each individual with schizophrenia is high, with antipsychotic medication being a major expense. This study aims to develop an economic decision model that compares different treatment options for schizophrenia patients, including olanzapine Orally Dispersible Tablets (ODT), olanzapine [ODT + Standard Oral Tablet (SOT)], risperidone (ODT + SOT), and aripiprazole (ODT + SOT), to determine their cost-effectiveness with an objective to optimize healthcare resource allocation in Morocco.MethodsThe study used published medical literature and a clinical expert panel to develop a decision analytic model. This model was designed to capture parameters such as adherence levels, treatment discontinuation, relapse with and without hospitalization, quality-adjusted life years (QALYs), treatment-related adverse events, healthcare resource utilization, and associated costs. The main outcomes of interest included the total annual direct cost per treatment, QALYs, and incremental cost-effectiveness ratio (ICER) per 1 QALY gained. One-way and probabilistic sensitivity analyses were employed to account for parameter uncertainty.ResultsAccording to the simulation model, the ODT and ODT + SOT as a group form of olanzapine was the most effective treatment option in terms of the lowest percentages of inpatient relapse, and patients who remained stable (11% and 79% respectively) than risperidone (19% and 62% respectively) and aripiprazole ODT (26% and 50% respectively) and ODT + SOT formulation groups. Olanzapine (ODT + SOT) therapy group was cost-effective when compared to the combined group of ODT + SOT forms of risperidone [ICER: Moroccan Dirham (MAD) 103,907], and aripiprazole (ICER: MAD 65,047). Additionally, olanzapine ODT was found to be cost-effective compared to olanzapine SOT with an ICER of MAD 3921, risperidone ODT with an ICER of MAD 1,02,298, risperidone SOT with an ICER of MAD 31,088, and aripiprazole ODT or SOT formulations. All the above ICERs fall under the willingness-to-pay threshold in Morocco of MAD 250,832.40. Sensitivity analyses confirmed the reliability of the findings.ConclusionsThe model concluded that olanzapine ODT is the most cost-effective first-line treatment option for schizophrenia in Morocco when compared to other atypical antipsychotic medications in ODT and SOT formulations.

Impact of Integrative Health and Medicine on Costs Associated with Adult Health System Beneficiaries with Musculoskeletal Conditions: A Retrospective Cohort Study.

Objective: Owing to perceived additional costs, patients may avoid integrative health and medicine (IHM) treatments, while insurers may not cover IHM. We hypothesized that adult beneficiaries of a health system's employee insurance plan with musculoskeletal (MSK) conditions receiving covered outpatient IHM would have reduced total allowed costs over the 1-year follow-up compared with matched controls, secondarily exploring medical and pharmaceutical cost subsets. Methods: We queried medical records and claims spanning 2018-2023 for beneficiaries aged 18-89 years with a new MSK episode. Patients were divided into cohorts: (1) IHM within 3 months after MSK diagnosis and (2) no IHM after initial primary care. After inflation adjustment and trimming, propensity score matching was used to balance cohorts on demographics, comorbidity, health care utilization, and prior 12-month spend. Least-squares mean total, medical, and pharmaceutical allowed costs (United States Dollar) over the 1-year follow-up were analyzed using a linear mixed model. Findings were compared with a generalized linear model without trimming. Results: There were 251 patients per matched cohort, with adequate covariate balance. There was no meaningful between-cohort difference (IHM minus No IHM) in least-squares mean total cost (+703 [95% CI: -314, 1720]). Secondary outcomes included medical cost (+878 [95% CI: 61, 1695]) and pharmaceutical cost (+6 [95% CI: -71, 83]). A generalized linear model revealed no meaningful difference in estimated mean total medical costs (-2561 [95% CI: -7346, +2224]). Conclusions: IHM use among adult health system beneficiaries with MSK conditions was not associated with meaningful differences in 1-year follow-up total health care costs compared with matched controls. Our study was underpowered for secondary outcomes, which should be interpreted with caution. Future research should include a larger sample of patients and examine longitudinal changes in patient-reported outcomes.

Ionic liquids based azeotropic separation of refrigerants R410A (R32+R125) and R508B (R23+R116) through hybrid extractive distillation

ABSTRACT The increment in GreenHouse Gases (GHGs) promotes high Global Warming Potential (GWP) due to the production and consumption of hydrofluorocarbons (HFCs) that diverts the aim toward the recycling and reclaiming of refrigerant gases. However, the presence of azeotrope in refrigerant mixtures restricts the recycling process. Therefore, in this work, the refrigerant R410A and R508B have been separated through the hybrid extractive distillation method by using [HMIM][TF2N] and [BMIM][BF4] as a solvent in ASPEN Plus. UNIFAC model has been used for the correlation of ionic liquid in ASPEN Plus. For thermodynamic properties, Cosmotherm has been used with the collaboration of TurbromoleX. The Vapor-liquid Equilibrium (VLE) data has been predicted by using the UNIFAC group contribution method. The Total Annual Cost (TAC) analysis with optimization has been performed. Besides that, the energy analysis has also been performed. In the overall separation process and (TAC) analysis, [BMIM][BF4] proves to be more efficient with high separation efficiency and minimal TAC requirements. Whereas, [HMIM][TF2N]/R508B provides less CO2 emission.

The health, climate, and equity benefits of freight truck electrification in the United States

Abstract Long-haul freight shipment in the United States relies on diesel trucks and constitutes ∼3% of U.S. greenhouse gas emissions and a significant share of local air pollution. Here, we compare the climate and air pollution-related health damages from electric versus diesel long-haul truck fleets. We use truck commodity flows to estimate tailpipe emissions from diesel trucks and regional grid emissions intensities to estimate charging emissions from electric trucks under various grid scenarios. We use a reduced complexity air quality model combined with valuation of air pollution-related premature deaths (using two hazard ratios (HRs)) and quantify the distributional health impacts in different scenarios. We find that annual health and climate costs of the current diesel fleet are $195–$249/capita compared to $174–$205/capita for a new diesel fleet, and $156–$177/capita for an electric fleet, depending on the HR. We find that freight electrification could avoid $6.2–8.5 billion in health and climate damages annually when compared to a fleet of new diesel vehicles (with even higher benefits when compared to the current diesel fleet). However, the Midwest and parts of the Gulf Coast would experience an increase in health damages due to vehicles charging using electricity from coal power plants. If old coal power plants (operating in 1980 or earlier) are replaced with zero-emission generation, electrification of all U.S. freight would result in $32.3–39.2 billion in avoided damages annually and health benefits throughout the U.S. Electrifying transport of consumer manufacturing goods (including electronics, transport equipment, and precision instruments) and food, beverage, and tobacco products would provide the largest absolute health and climate benefits, whereas mixed freight and manufacturing goods would result in the largest benefits per tonne-km. We find small variations in health damages across race and income. These results will help policymakers prioritize electrification and charging investment strategies for the freight transportation sub-sector.

Economic Evaluation of a Novel Treatment of Attention-Deficit/Hyperactivity Disorder in US Motor Vehicle Drivers

Background: Attention-deficit/hyperactivity disorder (ADHD) affects approximately 4.4% of US adults. ADHD is associated with high-risk driving behavior and costly motor vehicle accidents. DYANAVEL XR (DXR) (Tris Pharma, Inc.) is a once-daily fast-acting amphetamine developed for ADHD treatment. A randomized controlled trial showed that DXR patients were 43% less likely to crash during a driving simulation than individuals taking placebo. Study outcomes suggest a DXR crash rate similar to that of a driver without ADHD, while patients treated with the current standard of care (SOC) have a 52% higher crash risk than non-ADHD drivers. Objective: The aim was to evaluate the economic benefits attributable to improved driving abilities and avoided crashes in DXR patients compared with patients treated with the SOC or those who are untreated. Methods: A cost-impact model estimated 1-year crash-related cost outcomes for DXR-treated patients compared with SOC-treated and untreated ADHD patients. SOC was assumed to consist of a combination of short-, intermediate-, and long-acting ADHD stimulant and non-stimulant medications. DXR crash risk was assumed equivalent to the non-ADHD population risk, as supported by trial data. Crash risk for untreated and SOC-treated ADHD patients were assumed to be 99% and 52% higher than the general US population, respectively. Model outcomes included the cost impact (medication- and crash-related costs) and the number of crashes, injuries, and fatalities avoided with DXR. Results: Treatment with DXR would avoid 0.82 crashes, 0.016 injuries, and 0.036 fatalities per year compared with untreated patients, and 0.036 crashes, 0.007 injuries, and 0.0001 fatalities per year compared with SOC-treated patients. Compared with a population of 25% SOC-treated patients and 75% untreated patients, DXR use would save an average of $4581 per person per year across all age groups when priced at $80 per month, assuming all SOC-treated and untreated patients utilized DXR. When the value of quality-of-life improvement is considered, savings increase over 7-fold. Discussion: Outcomes suggest that DXR may be an economically beneficial treatment compared with SOC for ADHD patients. Conclusions: The economic model showed that DXR is cost-saving compared with no treatment and SOC by reducing the number of motor vehicle crashes in the ADHD population.

Economic Evaluation of a Novel Treatment of Attention-Deficit/Hyperactivity Disorder in US Motor Vehicle Drivers.

Background: Attention-deficit/hyperactivity disorder (ADHD) affects approximately 4.4% of US adults. ADHD is associated with high-risk driving behavior and costly motor vehicle accidents. DYANAVEL XR (DXR) (Tris Pharma, Inc.) is a once-daily fast-acting amphetamine developed for ADHD treatment. A randomized controlled trial showed that DXR patients were 43% less likely to crash during a driving simulation than individuals taking placebo. Study outcomes suggest a DXR crash rate similar to that of a driver without ADHD, while patients treated with the current standard of care (SOC) have a 52% higher crash risk than non-ADHD drivers. Objective: The aim was to evaluate the economic benefits attributable to improved driving abilities and avoided crashes in DXR patients compared with patients treated with the SOC or those who are untreated. Methods: A cost-impact model estimated 1-year crash-related cost outcomes for DXR-treated patients compared with SOC-treated and untreated ADHD patients. SOC was assumed to consist of a combination of short-, intermediate-, and long-acting ADHD stimulant and non-stimulant medications. DXR crash risk was assumed equivalent to the non-ADHD population risk, as supported by trial data. Crash risk for untreated and SOC-treated ADHD patients were assumed to be 99% and 52% higher than the general US population, respectively. Model outcomes included the cost impact (medication- and crash-related costs) and the number of crashes, injuries, and fatalities avoided with DXR. Results: Treatment with DXR would avoid 0.82 crashes, 0.016 injuries, and 0.036 fatalities per year compared with untreated patients, and 0.036 crashes, 0.007 injuries, and 0.0001 fatalities per year compared with SOC-treated patients. Compared with a population of 25% SOC-treated patients and 75% untreated patients, DXR use would save an average of 80 per month, assuming all SOC-treated and untreated patients utilized DXR. When the value of quality-of-life improvement is considered, savings increase over 7-fold. Discussion: Outcomes suggest that DXR may be an economically beneficial treatment compared with SOC for ADHD patients. Conclusions: The economic model showed that DXR is cost-saving compared with no treatment and SOC by reducing the number of motor vehicle crashes in the ADHD population.

The Economic Impact of Treatment Sequencing in Chronic Lymphocytic Leukemia in Canada Using Venetoclax plus Obinutuzumab.

Bruton tyrosine kinase inhibitors (BTKis) represent an advancement in chronic lymphocytic leukemia; however, these agents are administered continuously until disease progression or unacceptable toxicity, raising concerns about their affordability. Venetoclax in combination with obinutuzumab (VO) is a fixed-duration (12-month) treatment, approved in Canada in 2020. This study estimated the total cumulative cost of different treatment sequences and evaluated the economic impact of introducing treatment sequences with/without VO, from a Canadian health care system perspective. A 10-year partitioned survival model was developed, considering key clinical parameters and direct medical costs. Results were stratified by TP53 aberration. Treatment sequences starting with first-line (1L) VO resulted in lower 10-year cumulative costs compared to sequences starting with BTKis administered until disease progression, across both TP53 aberration subgroups. With a maximum of three lines of treatment over a 10-year period, cumulative costs were largely determined by the first two lines of treatment. When comparing sequences with the same 1L treatment, sequences with BTKis in second-line incurred greater costs compared to fixed-duration regimens. Overall, the economic impact of treating all patients with VO led to 10-year cumulative savings of CAD 169,341 and CAD 293,731 per patient, without and with TP53 aberration, respectively. These savings are mainly due to reductions in treatment costs associated with fixed treatment duration.

Design of ant colony planning algorithms for multi-stage grids of distribution networks considering network resilience

Network Destruction Resilience is the ability of a system to maintain good operation in the event of an external attack or internal failure. The resilience of distribution network is crucial to guarantee the reliability of power supply. In this paper, we design a planning algorithm considering network destructibility for the multi-stage ant colony planning problem of distribution networks. The method establishes the multi-stage network planning objective function of distribution network from the perspectives of total investment cost and annual operation cost of multi-node network frame, destruction resistance, active power and reactive network loss of distribution network, etc. Then based on the constraints of the model, the improved ant colony algorithm is used to solve the multi-stage network planning objective function of distribution network, and the results of the anti-termite colony planning of multi-stage network frame of distribution network are obtained. In order to verify the effectiveness of the algorithm, simulation experiments are carried out on real distribution network data. The results show that the proposed ant colony planning algorithm for multi-stage grid frames can effectively improve the destruction resistance of distribution networks, and reduce the total investment cost and annual operation cost of multi-stage grid frames, and reduce the network loss rate data of multi-stage grid frames of distribution networks after application. It provides an effective method for planning the distribution network.

Energy-efficient separation of a ternary azeotropic mixture via azeotropic reflux-induced sequences based on the intensified pressure-swing distillation

The recovery and separation of chloroform, acetonitrile and ethanol from waste water involving two azeotropes and a distillation boundary has emerged as a pivotal concern in the pursuit of environmental protection and resource conservation. Herein, the energy-efficient separation design of the ternary azeotropic mixture based on a triple-column pressure-swing distillation (TCPSD) process with five azeotropic reflux induced sequences is comprehensively investigated. The suitable operating pressure range of the distillation columns and the potential optimal distillation sequence is investigated based on the thermodynamic intrinsic probe. According to the optimal distillation sequence, further process intensification strategies are proposed to improve the thermodynamic efficiency encompassing the heat integration pressure-swing distillation (HI-PSD), heat pump assisted pressure-swing distillation (HP-PSD), and a combination of heat pump assisted and heat integration pressure-swing distillation (HPHI-PSD). It unveils the economic preeminence of the HI-PSD process, characterized by the lowest total annual cost (TAC) in a shorter payback period (3 to 7 years). Conversely, both the HP-PSD and HPHI-PSD processes exhibit superior environmental performance on CO2 emissions of 111.46 kg/h and 119.78 kg/h respectively, with the HP-PSD demonstrating prolonged economic viability and the HPHI-PSD showcasing heightened thermodynamic efficiency of a 65.12 % improvement. This study potentially provides a theoretical basis for devising industrial separation schemes for analogous pressure-sensitive ternary azeotropic systems.

Bevacizumab First in DRCR Protocol AC vs Real-World Physician Treatment Choice for Diabetic Macular Edema: Two-Year Cost Analysis.

Purpose: To compare the modeled costs of the Protocol AC bevacizumab-first treatment protocol (with a switch to aflibercept for sub-responders) with real-world costs for treatment-naïve patients with diabetic macular edema (DME) over a 2-year period. Methods: Published data from the Diabetic Retinopathy Clinical Research Network (DRCR) Protocol AC bevacizumab-first arm (154 eyes) were used to model 2-year treatment costs. Real-world costs were modeled using data from the Vestrum Health electronic medical records database from a 2016 to 2018 cohort of treatment-naïve eyes with DME (n = 1062) treated with antivascular endothelial growth factor monotherapy. The visual acuity (VA) before treatment in the real-world cohort was matched to Protocol AC. A secondary cost analysis further matched VA gains after treatment in the real-world cohort (n = 346) to Protocol AC. Results: In Protocol AC, the modeled 2-year DME treatment cost in the bevacizumab-first arm was $18,952, with a mean of 16.1 injections over 22.5 visits and 70% of eyes being switched to aflibercept by year 2. (Within 2 years, 57% of injections were bevacizumab and 43% were aflibercept.) Over the same period, the modeled 2-year real-world cost ($11,459) was 40% lower, with a mean of 8.6 injections over 13.8 visits (42% bevacizumab, 45% aflibercept, 13% ranibizumab). Even when matched for baseline VA and a 14-letter VA gain over 2 years, the real-world cost ($15,394) was still 19% lower than the modeled cost in the Protocol AC bevacizumab-first arm. Conclusions: The real-world cost of treating DME over 2 years was significantly lower than the Protocol AC bevacizumab-first cost. Application of Protocol AC findings into real-world utilization, as with step therapy mandates, should only be considered if the same intensive protocol could be followed. These data suggest that existing real-world costs that reflect physician choice are already significantly lower than protocol-mandated step therapy, even when controlling for similar VA outcomes.