Daily Cost Research Articles

Bi-Layer Planning of Integrated Energy System by Incorporating Power-to-Gas and Ground Source Heat Pump for Curtailed Wind Power and Economic Cost Reduction

The popularization of renewable energy is limited by wasteful problems such as curtailed wind power and high economic costs. To tackle these problems, we propose a bi-layer optimal planning model with the integration of power to gas and a ground source heat pump for the existing integrated energy system. Firstly, the inner layer optimizes the daily dispatch of the system, with the minimum daily operation cost including the penalty cost of curtailed wind power. Then, the enumeration method of outer-layer optimization determines the device capacity of various schemes. After that, optimal planning can be achieved with the minimum daily comprehensive cost. The result of this example shows that the improved system can reduce curtailed wind power and system costs, thus improving the overall economy. Finally, the influences of algorithms and gas prices on planning optimization are studied.

The Posterior Approach is Associated With Lower Total Encounter and 90-Day Costs When Compared to the Direct Anterior Approach

BackgroundThe clinical impact of the surgical approach in total hip arthroplasty (THA) has been widely reviewed. This study evaluated the total encounter and 90-day costs of THA for 2 surgical approaches (posterior [P] and direct anterior [DA]) in 1 tertiary health system. MethodsThis is a retrospective review of 2,101 THAs (1,092 P and 1,009 DA) by 4 surgeons (2 with the highest volume of DA and P, respectively) from 2017 to 2022 at 1 academic center. Demographics, comorbidities, operative time, length of hospital stay, 90-day hospital returns, and complications were compared. The total encounter cost and 90-day postoperative cost were itemized. Multivariable regression analyses evaluated associations with increased cost at each time point. ResultsThe DA cohort had a higher median encounter cost ($8,348.66 versus 7,332.42, P < .01), resulting from higher intraoperative (P < .01) and radiology (P < .01) expenses. Regression analyses demonstrated the DA was independently associated with increased encounter costs (odds ratio 1.1; 95% confidence interval 1.1 to 1.1; P < .01). There was a higher incidence of 90-day emergency department visits in the DA cohort (16 versus 12%, P = .02), with a trend toward increased readmissions. There was no difference in 90-day reoperations. Median 90-day cost was higher in the DA cohort ($126.99 versus 0.00, P < .01), and regression analyses demonstrated the DA had an association with increased 90-day cost (odds ratio 2.2; 95% confidence interval 1.5 to 3.0; P < .01). ConclusionsDespite a younger patient population, the DA was independently associated with increased encounter and 90-day costs in a single academic hospital system. This study may underestimate the cost difference, as capital costs such as specialized tables were not analyzed.

Postoperative Global Period Cost Reduction Using 3 Successive Risk-Stratified Pancreatectomy Clinical Pathways.

We hypothesized that iterative revisions of our original 2016 risk-stratified pancreatectomy clinical pathways would be associated with decreased 90-day perioperative costs. From a single-institution retrospective cohort study of consecutive patients with 3 iterations: "version 1" (V1) (October 2016 to January 2019), V2 (February 2019 to October 2020), and V3 (November 2020 to February 2022), institutional data were aggregated using revenue codes and adjusted to constant 2022-dollar value. Grand total perioperative costs (primary endpoint) were the sum of pancreatectomy, inpatient care, readmission, and 90-day global outpatient care. Proprietary hospital-based costs were converted to ratios using the mean cost of all hospital operations as the denominator. Of 814 patients, pathway V1 included 363, V2 229, and V3 222 patients. Accordion Grade 3+ complications decreased with each iteration (V1: 28.4%, V2: 22.7%, and V3: 15.3%). Median length of stay decreased (V1: 6 days, interquartile range [IQR] 5 to 8; V2: 5 [IQR 4 to 6]; and V3: 5 [IQR 4 to 6]) without an increase in readmissions. Ninety-day global perioperative costs decreased by 32% (V1 cost ratio 12.6, V2 10.9, and V3 8.6). Reduction of the index hospitalization cost was associated with the greatest savings (-31%: 9.4, 8.3, and 6.5). Outpatient care costs decreased consistently (1.58, 1.41, and 1.04). When combining readmission and all outpatient costs, total "postdischarge" costs decreased (3.17, 2.59, and 2.13). Component costs of the index hospitalization that were associated with the greatest savings were room or board costs (-55%: 1.74, 1.14, and 0.79) and pharmacy costs (-61%: 2.20, 1.61, and 0.87; all p < 0.001). Three iterative risk-stratified pancreatectomy clinical pathway refinements were associated with a 32% global period cost savings, driven by reduced index hospitalization costs. This successful learning health system model could be externally validated at other institutions performing abdominal cancer surgery.

Two-stage robust planning method for distribution network energy storage based on load forecasting

A two-stage robust planning method for energy storage in distribution networks based on load prediction is proposed to address the uncertainty of active load in energy storage planning. First, considering the uncertainty of active load, a short-term load forecasting model combining the mutual information method and BiLSTM is established based on k-means++ clustering. Second, based on the results of load forecasting, a comprehensive norm-constrained uncertainty set is constructed, and a two-stage robust model for distribution network energy storage planning is established. The first stage aims to minimize the annual investment cost of the energy storage system, while the second stage aims to minimize the daily operating cost of the distribution network. At the same time, a second-order cone relaxation transformation model with non-convex constraints is introduced to ultimately achieve the optimal economy of the distribution network in energy storage planning. Finally, the effectiveness of the proposed method and model is validated on the IEEE 33-node distribution network model using the MATLAB platform.

Hierarchical Energy Management of DC Microgrid with Photovoltaic Power Generation and Energy Storage for 5G Base Station

For 5G base stations equipped with multiple energy sources, such as energy storage systems (ESSs) and photovoltaic (PV) power generation, energy management is crucial, directly influencing the operational cost. Hence, aiming at increasing the utilization rate of PV power generation and improving the lifetime of the battery, thereby reducing the operating cost of the base station, a hierarchical energy management strategy based on the improved dung beetle optimization (IDBO) algorithm is proposed in this paper. The first control layer provides bus voltage control to each power module. In the second control layer, a dynamic balance control strategy calculates the power of the ESSs using the proportional–integral (PI) controller and distributes power based on the state of charge (SOC) and virtual resistance. The third control layer uses the IDBO algorithm to solve the DC microgrid’s optimization model in order to achieve the minimum daily operational cost goal. Simulation results demonstrate that the proposed IDBO algorithm reduces the daily cost in both scenarios by about 14.64% and 9.49% compared to the baseline method. Finally, the feasibility and effectiveness of the proposed hierarchical energy management strategy are verified through experimental results.

Elagolix Represents a Less Invasive and Cheaper Option than Injectable GnRH Antagonist for Ovulation Suppression in IVF.

The injectable GnRH antagonists have traditionally been used for ovulation suppression during controlled ovarian hyperstimulation in IVF, leading to increased painful daily injections and cost. The use of the oral GnRH antagonist elagolix for ovulation suppression in IVF has not been studied. A retrospective cohort study of patients undergoing IVF received either oral elagolix 50 mg every other day or ganirelix/cetrotide injection daily for ovulation suppression during controlled ovarian hyperstimulation. A total of 269 patients, 173 in the elagolix group and 96 in the ganirelix/cetrotide group, were included. The main outcome was the suppression of luteinizing hormone (LH) blood levels reflecting ovulation suppression. The age, body mass index, AMH levels, baseline FSH, antral follicles count, the dose of medications used, the number of days of ovarian stimulation, and peak estradiol (E2) levels were similar in both groups. When blood LH and E2 levels were measured before the intake and the day after intake of either elagolix or ganirelix/cetrotide, both groups had significant and similar drop in LH levels and increase in E2 levels. When comparing the IVF cycle outcomes in both groups, the number of oocytes retrieved, the number of mature oocytes, the fertilization rate, the blastocyst formation rate, the euploidy rate and the endometrial lining thickness at the time of the trigger were all similar. Oral GnRH antagonist, a much cheaper and less invasive medication that is used at a lower frequency, showed comparable ovulation suppression to the costly injectable GnRH antagonist. Further studies are required to evaluate the effect of oral GnRH antagonist on endometrial lining receptivity and pregnancy outcomes especially when using fresh embryo transfer IVF protocols.

Cost awareness among intensivists in their daily clinical practice: a prospective multicentre study.

Better cost-awareness is a prerogative in achieving the best benefit/risk/cost ratio in the care. We aimed to assess the cost-awareness of intensivists in their daily clinical practice and to identify factors associated with accurate estimate of cost (50-150% of the real cost). We performed a prospective observational study in seven French ICUs. We compared the estimate of intensivists of the daily costs of caring with the real costs on a given day. The estimates covered five categories (drugs, laboratory tests, imaging modalities, medical devices, and waste) whose sum represented the overall cost. Of the 234 estimates made by 65 intensivists, 70 (29.9%) were accurate. The median overall cost estimate (€330 [170; 620]) was significantly higher than the real cost (€178 [124; 239], p < 0.001). This overestimation was found in four categories, in particular for waste (€40 [15; 100] vs. €1.1 [0.6; 2.3], p < 0.001). Only the laboratory tests were underestimated (€65 [30; 120] vs. €106 [79; 138], p < 0.001). Being aware of the financial impact of prescriptions was factor associated with accurate estimate (OR: 5.05, 95%CI:1.47-17.4, p = 0.01). However, feeling able to accurately perform estimation was factor negatively associated with accurate estimate (OR: 0.11, 95%CI: 0.02-0.71, p = 0.02). French intensivists have a poor awareness of costs in their daily clinical practice. Raising awareness of the financial impact of prescriptions, and of the cost of laboratory tests and waste are the main areas for improvement that could help achieve the objective of the best care at the best cost.

Risk Factors for Readmission Following Surgical Decompression for Spinal Epidural Abscesses: An Analysis of 4595 Patients.

Retrospective cohort study. The study aimed to (1) compare baseline demographics of patients undergoing surgery for SEA who were/were not readmitted; (2) identify risk factors for 90-day readmissions; and (3) quantify 90-day episode-of-care health care costs. Spinal epidural abscess (SEA), while rare, occurring ~2.5-5.1/10,000 admissions, may lead to permanent neurologic deficits and mortality. Definitive treatment often involves surgical intervention via decompression. A search of the PearlDiver database from 2010 to 2021 for patients undergoing decompression for SEA identified 4595 patients. Cohorts were identified through the International Classification of Disease, Ninth Revision (ICD-9), ICD-10, and Current Procedural Terminology codes. Baseline demographics of patients who were/were not readmitted within 90 days following decompression were aggregated/compared, identifying factors associated with readmission. Using Bonferroni correction, a P -value<0.001 was considered statistically significant. Readmission within 90 days of surgical decompression occurred in 36.1% (1659/4595) of patients. While age/gender were not associated with readmission rate, alcohol use disorder, arrhythmia, chronic kidney disease, ischemic heart disease, and obesity were associated with readmission. Readmission risk factors included fluid/electrolyte abnormalities, obesity, paralysis, tobacco use, and pathologic weight loss ( P <0.0001). Mean same-day total costs ($17,920 vs. $8204, P <0.001) and mean 90-day costs ($46,050 vs. $15,200, P <0.001) were significantly higher in the readmission group. A substantial proportion of patients (36.1%) are readmitted within 90 days following surgical decompression for SEA. The top 5 risk factors in descending order are fluid/electrolyte abnormalities, pathologic weight loss, tobacco use, pre-existing paralysis, and obesity. This study highlights areas for perioperative medical optimization that may reduce health care utilization.

Provision of special diets to children in public nurseries and kindergartens in Kraków (Poland).

A specialized diet could be due to an allergy or other medical needs and also religious or cultural reasons. This study aimed to assess the availability and provision of special diets in kindergartens and nurseries financed by the Municipality of Kraków. This observational cross-sectional study was based on a diagnostic survey carried out using the Computer-Assisted Web Interview method and addressed to the managers of nurseries (n = 21) and kindergartens (n = 71) and, separately, to the parents of children attending these facilities (n = 1,096). Non-parametric tests were applied for an unadjusted comparison between children at nurseries and those at kindergartens. Children with particular dietary requirements received special diet meals in 95.2% of nurseries and 60.5% of kindergartens. The availability of special diets was associated with the type of facility (p = 0.001), the number of children who ate in the facility (p = 0.032), and the daily cost of meals served to children (p = 0.009). The cost of meals was higher in kindergartens that offered special diets vs. those that did not offer such diets (p < 0.001). According to parents, 96.4% of the total number of children ate meals served in the facilities. In nurseries, 16.1% of children were on a special diet (as per the doctor's recommendations in 11.7% of cases and according to parents' own choice in 4.4%). In kindergartens, a special diet was served to 12.7% of children (doctor's recommendations, 8.5%; parents' own choice, 4.2%). The most common reason for using a special diet was food allergy (8.2% of children in nurseries and 5.8% of children in kindergartens). It was reported more often by the parents of children attending nurseries than by the parents of children attending kindergartens (8.0% vs. 4.2%, p = 0.007). The requirement for a special diet was found to be associated with the age of children (p < 0.033) and the use of oral treatment for chronic disease (p < 0.001). Providing special diets for children is better in nurseries than in kindergartens. Legal regulations are urgently needed to ensure equal access to adequate nutrition for all children with special dietary needs in childcare facilities.

Cost Analysis for Robotic and Open Gastrectomy.

To determine the magnitude of the perioperative costs associated with robotic gastrectomy (RG). A robotic surgery platform has a high implementation cost and requires maintenance costs; however, whether the overall cost of RG, including all perioperative costs, is higher than conventional open gastrectomy (OG) remains unknown. Patients who underwent a major gastrectomy during February 2018 through December 2021 were retrospectively identified. We calculated the perioperative costs of RG and OG and compared them overall as well as in different phases, including intraoperative costs and 30-day postsurgery inpatient and outpatient costs. We investigated factors potentially associated with high cost and estimated the likelihood of RG to reduce overall cost under a Bayesian framework. All cost data were converted to ratios to the average cost of all operations performed at our center in year FY2021. We identified 119 patients who underwent gastrectomy. The incidence of postoperative complications (Clavien-Dindo >IIIa; RG, 10% vs OG, 13%) did not significantly differ between approaches. The median length of stay was 3 days shorter for RG versus OG (4 vs 7 days, P < 0.001). Intraoperative cost ratios were significantly higher for RG (RG, 2.6 vs OG, 1.7; P < 0.001). However, postoperative hospitalization cost ratios were significantly lower for RG (RG, 2.8 vs OG, 3.9; P < 0.001). Total perioperative cost ratios were similar between groups (RG, 6.1 vs OG, 6.4; P = 0.534). The multiple Bayesian generalized linear analysis showed RG had 76.5% posterior probability of overall perioperative cost reduction (adjusted risk ratio of 0.95; 95% credible interval, 0.85-1.07). Despite increased intraoperative costs, total perioperative costs in the RG group were similar to those in the OG group because of reduced postoperative hospitalization costs.

Load Forecasting and Operation Optimization of Ice-Storage Air Conditioners Based on Improved Deep-Belief Network

The prediction of cold load in ice-storage air conditioning systems plays a pivotal role in optimizing air conditioning operations, significantly contributing to the equilibrium of regional electricity supply and demand, mitigating power grid stress, and curtailing energy consumption in power grids. Addressing the issues of minimal correlation between input and output data and the suboptimal prediction accuracy inherent in traditional deep-belief neural-network models, this study introduces an enhanced deep-belief neural-network combination prediction model. This model is refined through an advanced genetic algorithm in conjunction with the “Statistical Products and Services Solution” version 25.0 software, aiming to augment the precision of ice-storage air conditioning load predictions. Initially, the input data undergo processing via the “Statistical Products and Services Solution” software, which facilitates the exclusion of samples exhibiting low coupling. Subsequently, the improved genetic algorithm implements adaptive adjustments to surmount the challenge of random weight parameter initialization prevalent in traditional deep-belief networks. Consequently, an optimized deep-belief neural-network load prediction model, predicated on the enhanced genetic algorithm, is established and subjected to training. Ultimately, the model undergoes simulation validation across three critical dimensions: operational performance, prediction evaluation indices, and operating costs of ice-storage air conditioners. The results indicate that, compared to existing methods for predicting the cooling load of ice-storage air conditioning, the proposed model achieves a prediction accuracy of 96.52%. It also shows an average improvement of 14.12% in computational performance and a 14.32% reduction in model energy consumption. The prediction outcomes align with the actual cooling-load variation patterns. Furthermore, the daily operational cost of ice-storage air conditioning, derived from the predicted cooling-load data, has an error margin of only 2.36%. This contributes to the optimization of ice-storage air conditioning operations.

Joint Modeling and Operational Optimization of a Reverse Osmosis-Mechanical Vapor Recompression System for Coal-Fired Power Plant Wastewater.

The operation of coal-fired power plants generates a large amount of wastewater. With the issuance of increasingly strict drainage standards, the cost of wastewater treatment is increasing, and the need to reduce the cost of wastewater treatment is becoming increasingly urgent. Thus, based on the principles of reverse osmosis (RO) and mechanical vapor recompression (MVR) in wastewater treatment, the operational optimization of an RO-MVR joint system was studied in this work with the consideration of reducing the operating costs of wastewater treatment under given operational conditions. Firstly, based on the basic principles of RO and MVR, corresponding mechanism models were established and their accuracy was verified. Then, an economic model of the RO-MVR joint system was established, with the goal of minimizing the water production unit price and daily operating costs of the joint system for optimization analysis. Finally, we analyzed the cost and water production performance of the RO-MVR joint system before and after optimization under different operating conditions. The results show that this optimization based on the RO-MVR joint system will reduce the unit price of water production to 3.16 CNY/m3, with the daily operating costs being decreased by 22% compared to before optimization. This result helps to reduce the cost of zero-discharge wastewater treatment in coal-fired power plants.

Epidemiological age-based differences in traumatic spinal cord injury patients: A multicenter study based on 13,334 inpatients

Context Compared with younger traumatic spinal cord injury (TSCI) patients, the elderly had longer delays in admission to surgery, higher proportion of incomplete injury, and longer hospital stays. However, in China, the country with the largest number of TSCI patients, there have been no large-scale reports on their age differences. Objectives To explore the age-based differences among TSCI inpatients, focusing on the demographic and clinical characteristics, treatment status, and economic burden. Methods We collected the medical records of 13,334 inpatients with TSCI in the 30 hospitals of China, from January 1, 2013 to December 31, 2018. Trends are expressed as annual percentage changes (APCs) and 95% confidence intervals (CIs). Results A total of 13,334 inpatients were included. Both the number and proportion of the elderly showed an increasing trend. The APC of the number and proportion in patients ≥85 years were 39.5% (95% CI, 14.3 to 70.3; P < 0.01) and 30.5% (95% CI, 8.6 to 56.9; P < 0.01), respectively. Younger patients were more likely to undergo decompression surgery, and older patients were more likely to receive high-dose methylprednisolone sodium succinate/methylprednisolone (MPSS/MP). Of the patients ≥85 years, none underwent decompression surgery within 8 h, and only 1.4% received a high dose of MPSS/MP within 8 h after injury. Elderly patients had lower hospitalization costs than younger. The total and daily medical costs during hospitalization of patients ≥85 years were 8.06 ± 18.80 (IQR: 5.79) and 0.61 ± 0.73 (IQR: 0.55) thousands dollars, respectively. Conclusions As the first study to focus on age differences of TSCI patients in China, this study found many differences, in demographic and clinical characteristics, treatment status, and economic costs, between older and younger TSCI patients. The number and proportion of elderly patients increased, and the rate of early surgery for elderly patients is low.

Low-Carbon Economy Optimization of Integrated Energy System Considering Electric Vehicles Charging Mode and Multi-Energy Coupling

To realize the multi-energy coupling integrated energy system to meet the multi-class load demand and achieve the goal of low-carbon economic operation, a bi-level optimal configuration method for low-carbon economic operation of multi-energy coupling integrated energy system under different charging modes of electric vehicles is proposed. Firstly, an integrated energy system including cooling-heating-power-gas coupling is established. Then, within the level of intraday scheduling, factors such as ladder carbon trading mechanisms and different charging modes of electric vehicles are considered to achieve the lowest daily scheduling cost. In the configuration planning level, based on the daily operation cost, the equipment capacity is configured with the lowest equipment investment and annual operation costs. The bi-level model is solved by CPLEX solver and the optimal configuration scheme and scheduling results are obtained by mutual iteration. Finally, the impact of different charging methods of electric vehicles on the system economy and low-carbon performance is demonstrated through simulation examples. The results show that the charging method of electric vehicles and the carbon trading mechanism in this paper can significantly reduce carbon emissions and improve the system's operating cost. The proposed configuration approach can well achieve low-carbon economic operation of the multi-energy coupling integrated energy system.

Optimizing theatre utilization for abscess drainage: going beyond priority categories.

Day-only emergency surgery for abscess drainage is poorly implemented in Australia. This study assessed the feasibility, outcomes, cost, and impact of an acute day-only surgery (ADOS) program. A retrospective pre-post implementation study of patients requiring abscess drainage in theatre was performed. Following implementation of an ADOS program for abscess management, eligible patients were discharged from the emergency department and prioritized first on the following day's emergency list. Outcomes from the first 12 months of the ADOS era were compared with those of the preceding 6 months (pre-ADOS). Primary outcome was length of hospital stay (LOS). Secondary outcomes included 30-day complications, admission costs, and impact on overall emergency theatre workflow (measured by emergency appendicectomy metrics). Overall, 266 patients during the ADOS era (including 95 eligible for the ADOS pathway) were compared with 115 patients during the pre-ADOS era. Baseline characteristics were comparable. Median LOS was shorter during the ADOS era (21.9 h (IQR 11.8-43.3) vs. 30.1 h (IQR 24.7-48.8), P < 0.001). Median LOS was 10.2 h (IQR 8.9-13.1) for patients on the ADOS pathway. There were no significant differences in 30-day complications (9.3% vs. 9.5%), emergency department re-presentations (7.4% vs. 5.1%), or abscess recurrence (5.6% vs. 5.7%). Average cost per patient was lower during the ADOS era ($4155 vs. $4916, p = 0.005). ADOS did not appear to materially impact other emergency procedures. ADOS for abscess drainage is feasible, safe, and produces cost savings, while being implemented without significant additional resources.

Stochastic Flexible Resource Operations in Coordinated Green-Seaport Energy-Logistics Systems Using Constraint Generation Approach

The increasing penetration of renewable energy sources (RESs) in modern green seaports calls for more flexible management approaches that can minimize the daily seaport operation costs and RES curtailments. This paper establishes an optimal strategy in two-time intervals for flexible operations of energy storage systems and combined electric-thermal power demands of reefer containers in the coordinated green-seaport energy-logistics systems (ELS). For the day-ahead operation, a multi-stage stochastic optimization model is established to minimize the expected ELS operation cost according to the 24-hour-ahead forecasts. Uncertainties of RES power outputs, load demands, electricity prices, and ambient temperatures are considered in the optimization of day-ahead operation. For the intra-day operation, hydrogen, battery, and thermal storage systems as well as reefer containers operations are optimized based on the short-lead-time forecasts. Numerical simulations are carried out based on the Jurong seaport operation in Singapore to verify the effectiveness of the proposed optimal operation strategy for the coordinated green-seaport ELS. Simulation results reveal that the proposed strategy can achieve the lowest operation cost and the lowest RES curtailment in a green-seaport.

Research on capacity optimization of new energy hybrid energy storage system of high-speed railway

With the fast expansion of electrified railways, the need for energy is growing. Thus, improving railway coupling and interconnection, new energy, and energy storage is critical to support low-carbon and green railway development. Therefore, this paper proposes an optimal configuration method for the access capacity of wind power generation system (WPGS), photovoltaic power system (PVPS), and hybrid energy storage system (HESS) in the traction power supply system (TPSS) of high-speed railways. Firstly, the HESS’s mathematical model is developed, then the high-speed railway TPSS’s economic optimization operating model is built, and a HESS energy management approach is presented, taking the energy management strategy parameters and model capacity configuration parameters as the optimization variables. The mixed integer linear programming approach is used to resolve the actual example with the least daily operational cost of the high-speed rail system as the optimization goal, and the optimal capacity of WPGS, PVPS, and HESS is obtained. Finally, through comparison and analysis, it is verified that the economic benefit is the highest when the distributed complementary energy system covering WPGS, PVPS, and HESS is connected to the traction substation, and 10.47% of the daily expenditure is saved.

Cost sharing for oral lenvatinib among commercially insured patients.

To use a nationwide pharmaceutical claims database to evaluate cost-sharing trends for commercially insured patients with cancer who were prescribed lenvatinib(Lenvima). IBM MarketScan databases were used to evaluate lenvatinib costs for patients with employer-based commercial insurance, and for patients 65 years and older, Medicare claims for fee-for-service plans. Patients were included if they had least 1outpatient pharmaceutical claim for lenvatinib paid on a noncapitated basis from 2015 to 2019. Median and IQR costs were estimated and inflation adjusted to 2019 US$ for 30-day supplies and reported as total, insurance liability, coordination of benefits, and out-of-pocket costs. A total of 685 patients had at least 1 pharmaceutical claim for lenvatinib, which included patients with thyroid (n = 251; 36.6%), renal cell (n = 202; 29.5%), hepatocellular (n = 160; 23.4%), and endometrial (n = 48; 7.0%) cancer. The median (IQR) number of prescriptions per patient was 3 (2-7), and the median (IQR) total days of supply was 90 (45-210) days. The median (IQR) 30-day cost of lenvatinib was $17,253 ($15,597-$18,120). Median (IQR) 30-day insurance liability was $16,847 ($15,000-$17,981). Median (IQR) 30-day coordination of benefits was $0 ($0-$0). Median (IQR) 30-day patient out-of-pocket cost was $32 ($0-$100). However, the maximum 30-day out-of-pocket cost in our patient cohort was $12,538. In this cohort, insurance was liable for the majority of total lenvatinib drug costs, and 75% of patients paid $100 or less per month out of pocket. This information can be used by care teams to counsel insured patients. Health systems and drug manufacturers must identify patients with high out-of-pocket costs and provide convenient access to financial assistance programs so that patients are not forced to forgo the benefits of these drugs due to financial barriers. Value-based payment models and drug pricing reform are also needed to address underlying drivers of high drug costs.

Heuristic control of power consumption by up to 1000 V electrical loads at mining enterprises

Purpose. To develop a method for synthesizing the structure and algorithm of the system for automated control of power consumption by up to 1000 V electrical receivers at mining enterprises with iron ore underground mining methods. This enables direct control of the load connection to the industrial power grid to ensure minimum power costs depending on its cost per day ahead. Methodology. The problem of controlling power consumption of electrical receivers at iron ore underground mines is formalized as a binary form of mixed integer programming. To solve it, a binary implementation of the heuristic genetic algorithm is used. The mathematical modeling method analyzes the impact of genetic algorithm settings, such as the number of phenotypes in the population, the number of elite phenotypes that pass unchanged to the next generation, and the method of phenotype crossover on its quality. Findings. As a result of the research, it is found that the most effective way to control the process of power consumption based on an evolutionary genetic algorithm is to use the Laplace crossover function and keep the percentage of elite phenotypes in the population at 10 %. Moreover, at the smallest population size, the best accuracy is observed when using the Laplace function, while at one- and two-point crossover functions, it worsens, but not significantly (no more than 0.2 %). However, as the number of elite phenotypes increases, the duration of the evolutionary search in the control process is reduced by almost a factor of two in the case of one- and two-point crossovers. Originality. For the first time, the structure of a heuristic system for automated control of power consumption by underground electrical receivers with a supply voltage of up to 1000 V at iron ore underground mines has been developed on the basis of an evolutionary genetic algorithm. Depending on the designed volumes of ore production and the daily power cost per day, this allows determining the optimal power load schedule of underground distribution substations in advance, which, subject to the accepted limits on hourly and daily power, minimizes the cost of purchasing power, and thus reduces the cost of the final product. Practical value. The architecture of a heuristic system for controlling power consumption by electrical receivers with a voltage of up to 1000 V based on an evolutionary genetic algorithm is developed and recommended when optimizing the power load schedule of transformer substations of mining and metallurgical enterprises, in particular, of iron ore underground mines operating in this voltage class.

Robust optimal operation scheduling method for integrated energy system considering flexible energy storage and mixed hydrogen natural gas

ABSTRACT At present, the number of electric vehicles is increasing day by day. The full integration of electric vehicles and multi-energy coupled integrated energy systems is the future development trend. This paper introduces a novel form of flexible energy storage in the integrated energy system ;(IES): electric vehicle (EV). And It proposes that mixed natural gas hydrogen be used as the primary energy source for IES, which replaces traditional natural gas. Combined with the above, the IES is scheduled to meet the system’s multi-load for heating, cooling, and electricity demands. Based on the integrated energy system’s structure and energy conversion principles, a robust two-stage optimization model for the IES is proposed to minimize the daily operation scheduling costs. The proposed model considers the uncertainty of distributed renewable generation and flexible energy storage. Uncertain adjustment parameters are introduced into the model, which can flexibly adjust the conservatism of the scheme. Using the column and constraint generation algorithm (C&CG) and the strong duality theory, the model presented in this paper is solved and the optimal scheduling scheme is obtained. The final simulation results validate the effectiveness of the model and algorithm. The addition of flexible energy storage and mixed natural gas hydrogen effectively improves the economy and flexibility of the system while reducing carbon emissions costs. Consideration of uncertainty improves system robustness and safety. In addition, sensitivity analyses of the influence of the proportion of hydrogen mixed with natural gas, the setting of uncertain adjustment parameters, electricity prices, weather, and load fluctuations on system operation. The results show that compared to existing research, electric vehicles as a flexible energy storage device and mixed natural gas hydrogen supply, increase the economic benefits of IES by 19.8% and 23%, respectively.