Commercial Perspective Research Articles

PCN50 Cost of Chronic Myeloid Leukemia Care Among Patients in Advanced Phases or on Later Lines of Therapy in Chronic Phase in the United States From a Commercial and Medicare Perspective

Tyrosine kinase inhibitors (TKIs) are standard-of-care treatment for chronic myeloid leukemia-chronic phase (CML-CP). Since many patients reach later lines due to resistance/intolerance or progress to accelerated phase/blast crisis (AP/BC), a better understanding of cost of care is needed. Adult patients with CML were identified in the IBM MarketScan (Q1/2001-Q2/2019) and SEER-Medicare (Q1/2006-Q4/2016) databases. Healthcare resource utilization (HRU: inpatient [IP] days and outpatient [OP] services) were measured among patients with (a) CML-CP on third-line therapy (CML-CP-3L), (b) CML-CP on fourth-line therapy or later (CML-CP-4L+), and (c) CML-AP/BC. Three-month incidence rates (IR) and event-level costs ($2019 USD), including 3-month terminal care and stem-cell transplant (SCT in IP settings) costs, were reported from a payer’s perspective. In commercial claims, 296 (4,620 patient-months), 83 (1,644 patient-months), and 949 (25,593 patient-months) patients were identified in CML-CP-3L, CML-CP-4L+, and CML-AP/BC, respectively. Three-month OP IR were 7.6, 8.3, and 7.0 services in CML-CP-3L, CML-CP-4L+, and CML-AP/BC, respectively, with mean costs of $597 per service. Three-month IP IR were 0.6, 0.7, and 1.4 days in CML-CP-3L, CML-CP-4L+, and CML-AP/BC, respectively, with mean costs of $5,892 per day. Mean costs were $107,013 for terminal care and $352,333 for SCT. In SEER-Medicare, 53 (738 patient-months), 12 (180 patient-months), and 222 patients (5,740 patient-months) were identified in CML-CP-3L, CML-CP-4L+, and CML-AP/BC, respectively. Three-month OP IR were 13.7, 20.0, and 13.8 services in CML-CP-3L, CML-CP-4L+, and CML-AP/BC, respectively, with mean costs of $230 per service. Three-month IP IR were 3.1, 1.5, and 3.6 days in CML-CP-3L, CML-CP-4L+, and CML-AP/BC, respectively, with mean costs of $2,945 per day. Mean costs were $54,793 for terminal care and $139,991 for SCT. Cost of CML care in the US is substantial among patients with CML who are in later lines of therapy or who progressed to AP/BC, suggesting unmet treatment needs.

Prospects of Parasailing Activities in Bangladesh: A Study on the Opportunities and Challenges

Parasailing is considered as the modern and popular part of seaside recreational activities. Bangladesh has recently added ‘Parasailing’ to her service list in Cox’s Bazaar and Himchori in 2010. The purpose of this study is to investigate the tourists’ perceptions towards parasailing activities and to analyze the opportunities and challenges of parasailing in Bangladesh. The study is based on primary as well as secondary data, and has applied descriptive research method on the basis of data collected through a questionnaire consisting of 33 questions from 52 respondents. The reason behind choosing this topic is that ‘parasailing’ has a great opportunity in the future tourism business in Bangladesh. Moreover, the aim of this study is to spread this activity in different areas of Bangladesh, like Saint Martin’s island and Patenga sea beaches, so that tourists can enjoy the taste of same. Thinking from a commercial perspective it has a great potential of increasing recreational facilities, earning a huge amount of income, and employing many people from the local community to bring a change in their lives).

Budget Impact Analysis of Vericiguat for the Treatment of Chronic Heart Failure with Reduced Ejection Fraction Following a Worsening Event.

IntroductionIn the USA, patients with chronic heart failure (HF) with reduced ejection fraction (HFrEF) following a worsening HF event (WHFE) have significantly increased healthcare resource use and medical costs. This analysis aimed to estimate the budget impact of vericiguat as an add-on therapy to guideline-directed medical therapy (GDMT) for the treatment of chronic HFrEF following a WHFE from a US commercial payer perspective.MethodsA model was developed to estimate the budget impact of adding vericiguat to the formulary by comparing a current scenario (GDMT) and a new scenario (vericiguat plus GDMT) to a hypothetical 10-million-member commercial payer over a 3-year time horizon. Epidemiology data was obtained from literature. Treatment utilization rates of GDMT and clinical inputs (HF hospitalization and cardiovascular [CV] morality) were based on the VICTORIA trial in which patients with chronic HFrEF following a WHFE were randomized to GDMT plus placebo or GDMT plus vericiguat. Costs (2020 US$) included drug acquisition, hospitalization, routine care, and mortality.ResultsApproximately 20,510 prevalent cases in year 1 and 3109 annual incident cases in subsequent years were estimated to be eligible for treatment with vericiguat. At a utilization rate of 5%, 10%, and 15% for vericiguat over years 1–3, the per member per month (PMPM) budget impact was estimated to be $0.048, $0.064, and $0.086, respectively, associated with 44, 32, and 30 fewer HF hospitalizations and 7, 12, and 18 fewer CV deaths, respectively. Reduction in HF hospitalizations and CV deaths reduced the budget impact by 14% in total over 3 years.ConclusionAdding vericiguat to commercial plan formulary was associated with limited budget impact, primarily driven by drug acquisition costs but partially offset by reduced cost of HF hospitalizations and CV deaths.Supplementary InformationThe online version contains supplementary material available at 10.1007/s12325-021-01681-2.

Changes in airport operating procedures and implications for airport strategies post-COVID-19

Covid-19 is demanding a lot of changes in the realm of our daily lives. The aviation industry is also facing unprecedented changes in the management environment. Financial tensions across the sector are rising. This study suggests that the airport strategy's direction focusing on commercial revenue management. After Covid-19, safety and hygiene will be the top priority. As a result, changes in airport operating procedures are inevitable. The most noticeable difference will be the strengthening of the verification process for passengers' health conditions. Dwell time increase can be the by-products. This study identifies a dwell time increase has a more significant impact on increasing the existing purchasers' spending than creating new buyers. Airport operators can introduce a service differentiation perspective, such as a dedicated service, to utilize the current buyers' dwell time more faithfully. Also, the rise of online channels requires airport operators to change sales strategies, reinforcing emotional promotion to stimulate impulse buyers' willingness-to-buy. Before Covid-19, there was little effort to reconcile operation policies and commercial revenue despite the growing importance of revenue management. However, now it is time to change. Pre-Covid-19, passengers were advised of using off-airport processes, such as online check-in and mobile boarding passes. Now, getting passengers to the airport quickly and securing their dwell time can be financially more beneficial. It is necessary to incorporate the commercial revenue perspective into operation policies post-Covid-19 actively. Our finding indicates that even a passenger with solid purchasing power may lose the purchasing intention when assigned to an unfavorable gate or terminal. Airport operators need a better understanding of passenger and flight characteristics when determining operation policy, such as gate allocation or membership services.

Smart Speaker Recommendations: Impact of Gender Congruence and Amount of Information on Users' Engagement and Choice.

The relevance of smart speakers is steadily increasing, allowing users perform several daily tasks. From a commercial perspective, smart speakers also provide recommendations of products and services that may influence the consumer decision-making process. However, previous studies have mainly focused on the adoption of smart speakers, but there is a lack of proper guidelines that help design the way these devices should offer their consumption recommendations. Based on a stimulus-organism-response approach, we analyze how two features of smart speakers' recommendations (the gender congruence between the customer and the speaker, and the length of the message) influence on the effectiveness of such recommendations (i.e., visiting intentions) through its impact on user engagement and attitude. Data was collected from a sample of undergrad students in Spain using an experiment design that focused on a restaurant recommendation, and analyzed using partial least squares. On the one hand, our results suggests that gender congruence generates user engagement with the smart speaker. On the other hand, message length is positively related to attitudes towards the restaurant, at a declining rate. In addition, while better attitudes lead to higher visiting intentions, the influence of engagement on visiting intentions is partially mediated via attitudes. Thus, our findings contribute to understand the antecedents of users' engagement with smart speakers, as well as its impact on the customers' willingness to follow smart speakers' recommendations, constituting a base to analyze the impact of artificial intelligence solutions aimed to smooth the transitions of a customer through the stages of purchase process.

선박건조보험약관상 조선소내 선박용 LNG 연료공급과 관련된 주요 쟁점에 대한 연구

All ships engaged on international voyages must use fuel oil on board with a sulphur content of no more than 0.50% m/m. Therefore, global shipping companies have various options such as the use of low-sulfur fuel oil, the use of mixed oil, the installation of a new scrubber, and the conversion of LNG fuel in order to cope with these regulatory measures. The policy of Global alliance, etc. are comprehensively considered to select new orders. This is because LNG fuel for ships is not the ultimate means to protect the marine environment while replacing the existing high sulfur oil, but it is evaluated as a practical alternative method. Therefore, Maritime industry is the ultimate goal to build and operate eco-friendly fuel-promoting ships such as ammonia or hydrogen, fuel cells, etc., but LNG-fueled ships must be considered as an intermediate step when considering various environments. Therefore, this study legally reviewed major issues in Institute Clauses for Builders' Risks related to LNG fuel supply for LNG fuel propulsion vessels that will emerge from a commercial perspective in the future, and derived improvements to provide basic data for activating LNG fuel supply business for ships.

Avrupa Birliği’nin Cezayir ile Ekonomik ve Siyasi İş Birliği Ne Kadar Derindir? Avrupa Antlaşmalarının Etkisi

This paper examines the background of the economic and political ties between Algeria and the European Union (EU) and the tools that the EU uses. The EU-Algeria economic and political history is quite important to analyse as it is founded on important historical and colonial aspects with France, which is one of the founder countries of the EU. Within this context, the relations of Algeria with the EU have not been easy and have even been turbulent from time to time. EU’s cooperation with Algeria are five folded: The ‘Association Agreement’, the ‘Euro-Mediterranean Partnership’, ‘EU Neighbourhood Policy’, ‘Union for the Mediterranean’ and the ‘EU-Algeria Free Trade Agreement’. This study explores the tools used by the EU to forge a deeper and wider cooperation with Algeria and assesses the bilateral trade and investment status and the current political and economic problems. Our paper explores current and new cooperation opportunities, analyses trade and investment statistics, uses literature review with primary and secondary researches. EU reports and international documents are evaluated from a commercial and political perspective. Politically, we can say that the EU is longing for more cooperation from Algeria, especially on migration and security issues. Economically, we can say that the FTA is currently benefitting more the EU than Algeria’ because Algerian foreign trade balance is in deficit, the country imports more than it exports. Regarding foreign direct investments, we find economic engagement of not only European but also American investments in Algeria, especially regarding oil and gas exploring and production activities. We finally conclude our study with the recommendation of shifting towards a wider variety of economic activities for Algeria, so that it can obtain a more sustainable and balanced economic revenues

A carbon ink for use in thin, conductive, non peelable, amphiphilic, antioxidant, and large-area current collector coating with enhanced lithium ion battery performance

We reported that a stable carbon ink composed of conductive carbon materials (graphene and super P), binder (sodium carboxymethyl cellulose (CMC)), interface active agent (sodium dodecyl sulfate (SDS)), and metal coupling agent ((3-aminopropyl)triethoxysilane (APTES)) for using in coating conducting layer on cathode/anode current collector for LIBs. Graphene materials are obtained using a low-cost graphite material (KS 6) and processing it via a wet ball-milling to exfoliate single layers into the ink. The ink can be coated on the LIB current collector in a large area by a doctor blade to form a carbon layer of about 1 μm without overflow. Carbon-coated current collectors have amphiphilic properties, not peel off under extreme physical and chemical conditions, and resist oxidation under high temperature (200 °C) processing conditions. In addition, carbon-coated current collector are superior to the batteries using bare metal foil a current collectors in the LIB performance of graphite half-cell, graphite full-cell, LiFePO4 half-cell, and silicon-carbon full-cell. These results show that the carbon-coated metal foil can reduce the interface resistance with the active material and improves the adhesion of the active materials to the current collector, avoiding peeling off during charge/discharge process, thereby improving of LIBs performance. The developed method can produce high-quality, low-cost carbon material inks on a large scale through a simple and inexpensive process, and coat them evenly and finely on current collectors, making it possible to achieve efficient industrial and commercial perspectives for next-generation LIB-based current collectors.

A Review of the EU’s Regulatory Framework for the Production of Nano-Enhanced Cosmetics

Literature has suggested metallic nanomaterials (NMs) for a multitude of applications in cosmetic products, either as active ingredients or excipients. Alike most high-paced industrial sectors, cosmetology continues to capitalize on its unique properties/functions (e.g., as UV-filters, colorants, etc.), adding value to a wide range of products. However, as a result of their nano-scale, NMs do not always conform with the handling guidelines of their bulk counterparts, nor do conventional analytical methods account for their complex physicochemical and biological interactions. Among others, metallic nanoparticles have attracted the interest of many over the years due to their unique features, but possible precautions should be considered because of their bio-persistent nature. As a result, it is prevalent to consider a nano-specific framework, to regulate the use of NMs and the production of nano-enhanced cosmetics. To address this, we provide insight into the NMs that are currently used in the EU market, with a focus on metallic NMs, while analyzing the underlying legislation and relevant Opinions of the Scientific Committee on Consumer Safety (SCCS), from a scientific and commercial perspective. Even though the current Cosmetics Regulation (EU Regulation No 1223/2009) already entails specific provisions on NMs, cosmetic products incorporating unauthorized NMs have been repeatedly commercialized in the European Union. Considering the potential risks of NMs if they are mishandled, we provide an analysis of the risk assessment, as stated in Article 16 of the Cosmetics Regulation, to serve as a guideline for the future growth of nano-enhanced products. Based on the limited integration of metallic NMs along with multiple non-metallic NPs into cosmetic products, the attention of the community is directed towards coordinating efforts on the integration of metallic NMs into cosmetics.

China’s Opening-up Strategy in the Milieu of Belt and Road Initiative (BRI)

The Chinese economy is changing its development model from invest/export-led growth to consumption/growth driven by domestic demand. In the recent domestic-oriented growth phases of China's opening-up policy, what role is expected to play? Not only is this a way to acquire foreign exchange and technology, but it is also an economic powerhouse for China that strengthens its position in global governance. General Secretary Xi Jinping's proposed the "Belt and Road" initiative in 2013, which is considered an excellent strategy for China's new round of opening-up policy. This research paper aims to bring the BRI inside China's open-up policy and focuses on its increasingly important role in controlling major global economic regimes. The study also shows the importance of establishing systems of mutual aid/funding for the countries participating in BRI. The first section of the paper looks at China's reactions to major economic regimes. Section two reflects the design and the implementation of the opening-up strategy for China from the BRI perspective. Section three of the research addresses Chinese development aid/funding in the BRI and its relation to foreign regimes. The fourth part addresses the BRI's trade relationship with the participating countries, using the gravity model from a global commercial perspective. The study concluded that cross-border financial cooperation between government and business participants is vital for the development of a successful investment and funding system for the BRI. It reiterated the importance of using foreign and regional financial centers to develop a regional structure within the BRI's investment and financing system.

Organizational climate and employee engagement: A commercial bank perspective in Southeast Nigeria

Abstract Purpose: This study aimed to ascertain the role organizational climate could play in galvanizing the employees of commercial banks in southeast Nigeria for better performance through exhibiting greater engagement to their jobs and organizations. Research methodology: Survey Research Design was employed for the study. The study population consisted of 988 employees of 50 randomly selected commercial banks in the region studied. Data were elicited through a structured questionnaire while the analysis was carried out using Simple Regression Analysis and hypothesis tested at a 5% level of significance. Results: The findings showed that there is a statistically significant relationship between Distributive Justice Climate and Job Satisfaction in Microfinance Banks in South-East Nigeria (r = .962; R-Square = .926; F = 5865.689; p-value<.05) and that there is a statistically significant relationship existing between Open Communication Climate and Positive Meaning in Microfinance Banks in South-East Nigeria (r = .982; R-Square = .965; F = 13000.304; p-value<.05). Limitations: Because of the concentration of commercial banks in Anambra state, most of the banks selected for the study through a random method were from Anambra State. This could affect the generalizability of the findings. Contribution: This study contributed to the already existing body of knowledge on Organizational Climate and Employee Engagement. The study also revealed empirical results of the relationship between the variables of the study, specifically in commercial banks in South-East Nigeria.

Cost-Effectiveness of Durvalumab After Chemoradiotherapy in Unresectable Stage III NSCLC: A US Healthcare Perspective.

Durvalumab was approved by the FDA in February 2018 for patients with unresectable stage III NSCLC that has not progressed after platinum-based concurrent chemoradiotherapy (cCRT), and this regimen is the current standard of care. The objective of this study was to examine the cost-effectiveness of durvalumab following cCRT versus cCRT alone in patients with locally advanced, unresectable stage III NSCLC. A 3-state semi-Markov model was used. Modeling was performed in a US healthcare setting from Medicare and commercial payer perspectives over a 30-year time horizon. Clinical efficacy (progression-free and post progression survival) and utility inputs were based on PACIFIC study data (ClinicalTrials.gov identifier: NCT02125461; data cutoff March 22, 2018). Overall survival extrapolation was validated using overall survival data from a later data cutoff (January 31, 2019). The main outcome was the incremental cost-effectiveness ratio (ICER) of durvalumab following cCRT versus cCRT alone, calculated as the difference in total costs between treatment strategies per quality-adjusted life-year (QALY) gained. In the base-case analysis, durvalumab following cCRT was cost-effective versus cCRT alone from Medicare and commercial insurance perspectives, with ICERs of $55,285 and $61,111, respectively, per QALY gained. Durvalumab was thus considered cost-effective at the $100,000 willingness-to-pay (WTP) threshold. Sensitivity analyses revealed the model was particularly affected by variables associated with subsequent treatment, although no tested variable increased the ICER above the WTP threshold. Scenario analyses showed the model was most sensitive to assumptions regarding time horizon, treatment effect duration, choice of fitted progression-free survival curve, subsequent immunotherapy treatment duration, and use of a partitioned survival model structure. In a US healthcare setting, durvalumab was cost-effective compared with cCRT alone, further supporting the adoption of durvalumab following cCRT as the new standard of care in patients with unresectable stage III NSCLC.

Does Biosimilar Bevacizumab Offer Affordable Treatment Options for Cancer Patients in the USA? A Budget Impact Analysis from US Commercial and Medicare Payer Perspectives.

BackgroundBevacizumab remains the most widely used and most thoroughly characterized angiogenesis inhibitor for a range of advanced cancers. Bevacizumab-bvzr (Zirabev®), a biosimilar of bevacizumab, was recently approved by the US Food and Drug Administration (FDA), which provides a less costly option. This study aimed to evaluate the financial impact of introducing bevacizumab-bvzr from US commercial and Medicare payer perspectives.MethodsA Microsoft Excel-based budget impact model was developed over a 5-year time horizon. Target population was patients to be treated with bevacizumab for FDA-approved indications. Drug costs (2020 US$) were based on average sales price and wholesale acquisition cost, accounting for payer-specific reimbursement models and provider settings. Drug dosing and duration were based on prescribing information and pivotal trial publications.ResultsIn a hypothetical 10-million-member health plan, 503 and 723 patients were estimated to be treated with bevacizumab in year 1 and year 5, respectively. Assuming an annual market shift of 1.7%, 3.6%, 6.7%, 9.4%, and 11.9% to bevacizumab-bvzr, an annual cost saving of $313,363 ($0.003 per member per month [PMPM]) was estimated for a commercial payer and $92,880 ($0.001 PMPM) for Medicare in year 1. Cumulative 5-year cost savings were $7,030,924 ($0.012 PMPM) for a commercial payer and $4,059,257 ($0.007 PMPM) for Medicare. More than half of the cost savings was attributed to patients with metastatic colorectal cancer.ConclusionsThe introduction of biosimilar bevacizumab-bvzr was estimated to provide substantial cost savings for US payers, which would allow additional patients access to bevacizumab treatment.

Age Appropriate Digital Services for Young People: Major Reforms

Young people's digital lives are bigger than they have ever been. This means that realizing young people's rights now requires a concerted focus on the digital world as well. Terms and Conditions (from Cookies Policies to Terms of Service) are an important part of young people's digital worlds because they set the “rules of engagement” between digital products and young service users. However important, these Terms and Conditions rarely recognize young people's rights, let alone uphold them. This article outlines some of the ways Terms and Conditions fail young people, and why this is problematic from moral, legal, and commercial perspectives. This suggests there is a critical need for Terms and Conditions that uphold rights, and that a Standard around Terms and Conditions may be an effective way of addressing this problem.

Option-based guarantees to accelerate urgent, high-risk vaccines: a new market-shaping approach.

Accelerating the availability of COVID-19 vaccines is critical to preventing further waves and mitigating the impact on society. However, preparations for large-scale manufacturing, such as building production facilities, are typically delayed until a vaccine is proven safe and effective. This makes sense from a commercial perspective, but incurs great costs in terms of lives lost and damage to the economy. Several policy options are available to reduce this delay, all of which involve incentives or subsidies to invest in production facilities. We review existing approaches, then propose a novel alternative using "option-based guarantees" in which the government commits to paying a proportion of the manufacturer's preparation costs should the product turn out not to be viable. Counterintuitively, this "payment for failure" is appropriate because in the case of success, a company makes a profit from the product itself, and does not need additional money from the government. While other approaches have critical roles, we argue that option-based guarantees are the most promising approach to ensuring a rapid vaccine for COVID-19. Compared to the alternative approaches, they reduce both costs to the government and risk to the companies, while maintaining an incentive to produce a high-quality product quickly and at scale.

Water footprints and water allocation in a sustainable manner

Water footprint assessment (WFA) is a rapidly expanding area of study. This Special Issue includes a collection of articles that advance the subject or demonstrate novel applications. The first seven articles are WFA studies on a regional scale, S ranging from urban to continental; the following five papers are global in scope; and the last five papers are focused on water sustainability from a commercial perspective. The collection of articles demonstrates that the historical image of a town depending on its hinterlandfor water andfood is no longer accurate: urban consumers’ water impact is worldwide. Even while water is and will remain a public resource with government playing a key role, it has become apparent that smart water administration is no longer the sole province of government. With the majority of water utilized in the production of food and other consumer products, and product supply chains becoming more complicated and global, consumers, businesses, and investors are becoming increasingly conscious of their involvement. Interest in sustainable water use is growing rapidly in both civil society and the business community, but due to companies’ lack of transparency regarding their direct and indirect water use, we still have a long way to go before we can expect them to effectively contribute to making water footprints more sustainable on a large scale.

Economic evaluation of betibeglogene autotemcel (Beti-cel) gene addition therapy in transfusion-dependent β-thalassemia

ABSTRACT Background Standard of care (SoC) for transfusion-dependent β-thalassemia (TDT) requires lifelong, regular blood transfusions as well as chelation to reduce iron accumulation. Objective This study investigates the cost-effectiveness of betibeglogene autotemcel (‘beti-cel’; LentiGlobin for β-thalassemia) one-time, gene addition therapy compared to lifelong SoC for TDT. Study design Microsimulation model simulated the lifetime course of TDT based on a causal sequence in which transfusion requirements determine tissue iron levels, which in turn determine risk of iron overload complications that increase mortality. Clinical trial data informed beti-cel clinical parameters; effects of SoC on iron levels came from real-world studies; iron overload complication rates and mortality were based on published literature. Setting USA; commercial payer perspective Participants TDT patients age 2–50 Interventions Beti-cel is compared to SoC. Main outcome measure Incremental cost-effectiveness ratio (ICER) utilizing quality-adjusted life-years (QALYs) Results The model predicts beti-cel adds 3.8 discounted life years (LYs) or 6.9 QALYs versus SoC. Discounted lifetime costs were $2.28 M for beti-cel ($572,107 if excluding beti-cel cost) and $2.04 M for SoC, with a resulting ICER of $34,833 per QALY gained. Conclusion Beti-cel is cost-effective for TDT patients compared to SoC. This is due to longer survival and cost offset of lifelong SoC.

Cost-effectiveness of topical glycopyrronium tosylate for the treatment of primary axillary hyperhidrosis

Aims Primary axillary hyperhidrosis (PAHH) is a condition characterized by excessive sweating that negatively impacts health-related quality of life, with significant psychological and social impacts. Glycopyrronium tosylate (GT) is a topical anticholinergic approved in the United States for treatment of PAHH in patients 9 years of age and older. Our objective was to assess the cost-effectiveness of GT as first-line topical therapy compared to topical aluminum chloride from a United States commercial perspective. Materials and methods A Markov model was developed consisting of four health states based on the Hyperhidrosis Disease Severity Scale (HDSS) over a time horizon of 5 years with discount rates of 3% for both costs and outcomes. Transitions between health states were driven by HDSS response, defined as an improvement of ≥2 points. Non-responders and those who discontinue could switch to later line treatments or no treatment. Health utility scores were based on HDSS scores, supported by published literature. Results Over 5 years, GT yielded 0.12 greater QALYs and 0.93 greater LYs with response compared to treatment with prescription aluminum chloride at an incremental cost of $10,584. Relative to prescription aluminum chloride, GT resulted in an incremental cost-effectiveness ratio (ICER) of $87,238 per QALY gained, $11,349 per LY with response. The ICER fell below $100,000 for 66% of probabilistic sensitivity analysis simulations and below $150,000 for 82% of simulations. Limitations This analysis represents a simplified scenario of a hypothetical PAHH patient. Due to sparse data, assumptions were required for treatment patterns, efficacy, and persistence. Conclusion Based on the analysis of incremental cost per QALY gained, GT may be cost-effective relative to prescription aluminum chloride at commonly accepted willingness to pay thresholds.

Oligosaccharides: Defense Inducers, Their Recognition in Plants, Commercial Uses and Perspectives.

Plants have innate immune systems or defense mechanisms that respond to the attack of pathogenic microorganisms. Unlike mammals, they lack mobile defense cells, so defense processes depend on autonomous cellular events with a broad repertoire of recognition to detect pathogens, which compensates for the lack of an adaptive immune system. These defense mechanisms remain inactive or latent until they are activated after exposure or contact with inducing agents, or after the application of the inductor; they remain inactive only until they are affected by a pathogen or challenged by an elicitor from the same. Resistance induction represents a focus of interest, as it promotes the activation of plant defense mechanisms, reducing the use of chemical synthesis pesticides, an alternative that has even led to the generation of new commercial products with high efficiency, stability and lower environmental impact, which increase productivity by reducing not only losses but also increasing plant growth. Considering the above, the objective of this review is to address the issue of resistance induction with a focus on the potential of the use of oligosaccharides in agriculture, how they are recognized by plants, how they can be used for commercial products and perspectives.

Option-based guarantees to accelerate urgent, high-risk vaccines: a new market-shaping approach

Accelerating the availability of COVID-19 vaccines is critical to preventing further waves and mitigating the impact on society. However, preparations for large-scale manufacturing, such as building production facilities, are typically delayed until a vaccine is proven safe and effective. This makes sense from a commercial perspective, but incurs great costs in terms of lives lost and damage to the economy. Several policy options are available to reduce this delay, all of which involve incentives or subsidies to invest in production facilities. We review existing approaches, then propose a novel alternative using “option-based guarantees” in which the government commits to paying a proportion of the manufacturer’s preparation costs should the product turn out not to be viable. Counterintuitively, this “payment for failure” is appropriate because in the case of success, a company makes a profit from the product itself, and does not need additional money from the government. While other approaches have critical roles, we argue that option-based guarantees are the most promising approach to ensuring a rapid vaccine for COVID-19. Compared to the alternative approaches, they reduce both costs to the government and risk to the companies, while maintaining an incentive to produce a high-quality product quickly and at scale.