Cost-effectiveness Perspective Research Articles

Fast optimization of the emission reduction pathways of major air pollutants in China: From the perspective of different decision preferences.

To address the concern of optimization problem of China's PM2.5 control and the limitation of computational efficiencies for traditional air quality models, we developed an integrated analysis framework to efficiently establish the identification and cost-benefit assessment of PM2.5 control pathways in China by constructing a rapid PM2.5 exposure response method based on the high-order decoupled direct method (HDDM) and coupling the sequential least square algorithm (SLSQP) and health impact assessment model. Six emission reduction scenarios with varying decision preferences were analyzed. Our study provides a methodological approach for the rapid optimization of emission pathways of major air pollutants in China with flexible options in terms of objectives and constraints, fully considering the diverse differences in environmental, health, and economic impacts among different pollution sources simultaneously. Our findings based on the multi-scenario analysis strengthen the understanding of the importance of diverse species and regions for emission reduction among various decision preferences in China, confirm the necessity of implementing differentiated control strategies for distinct pollution sources from both cost and cost-effectiveness perspectives, and indicate that accelerating PM2.5 control process in the early stage is a beneficial choice for achieving more health benefits.

Optimal Stopping Ages for Colorectal Cancer Screening

Prior studies have shown that the benefits, harms, and costs of colorectal cancer (CRC) screening at older ages are associated with a patient's sex, health, and screening history. However, these studies were hypothetical exercises and not directly informed by data on CRC risk. To identify the optimal stopping ages for CRC screening by sex, comorbidity, and screening history from a cost-effectiveness perspective. This economic evaluation first validated the MISCAN-Colon (Microsimulation Screening Analysis-Colon) model against community-based CRC incidence and mortality rates for 2 subcohorts of the PRECISE (Optimizing Colorectal Cancer Screening Precision and Outcomes in Community-Based Populations) cohort. Subsequently, different CRC screening scenarios were simulated in older individuals. Cohorts of US adults aged 76 to 90 years varied by sex and comorbidity status (none, low, moderate, or severe). Statistical and sensitivity analyses were performed from March 2023 to May 2024. CRC screening histories including fecal immunochemical test (FIT) or colonoscopy, such as a negative colonoscopy result from 10, 15, 20, 25, or 30 years before the index age; 1 to 5 negative FIT results within 5 years of the index age, with different patterns of recency; or a combination of negative colonoscopy and negative FIT results. The main outcomes included estimated lifetime clinical outcomes, incremental costs, and quality-adjusted life-years gained (QALYG) associated with 1 additional FIT or colonoscopy. Optimal stopping age for screening, defined as the oldest age for which the incremental cost-effectiveness ratio was still below the willingness-to-pay threshold of $100 000 per QALYG, was evaluated. The first of the 2 PRECISE subcohorts used in validating the simulation model included 25 974 adults (15 060 females [58.0%]; 54.7% aged 76 to 80 years) with a negative colonoscopy result 10 years before the index date. The second subcohort consisted of 118 269 adults (67 058 females [56.7%]; 90.5% aged 76 to 80 years) with a negative FIT result 1 year before the index date. Older age, male sex, higher comorbidity levels, and recent CRC screenings were associated with reduced incremental benefit and cost-effectiveness of additional screening. For the reference cohort of 76-year-old females without comorbidities and a negative colonoscopy result 10 years before the index age, 1 additional colonoscopy cost $38 226 per QALYG. For cohorts with otherwise equivalent characteristics, associated costs increased to $1 689 945 per QALYG for females at age 90 years without comorbidities and a negative colonoscopy results 10 years before the index age, $51 604 per QALYG for males at age 76 years without comorbidities and a negative colonoscopy result 10 years before the index age, and $108 480 per QALYG for females at age 76 years with severe comorbidities and a negative colonoscopy result 10 years before the index age and decreased to $16 870 per QALYG for females without comorbidities and a negative colonoscopy result 30 years before the index age. The optimal stopping ages across different cohorts ranged from younger than 76 to 86 years for colonoscopy and younger than 76 to 88 years for FIT. In this economic evaluation, age, sex, screening history, comorbidity, and future screening modality were associated with the clinical outcomes, cost-effectiveness, and optimal stopping age for CRC screening. These results can inform guideline development and patient-directed informed decision-making.

A Systematic Review of the Impact of Changes to Urban Green Spaces on Health and Education Outcomes, and a Critique of Their Applicability to Inform Economic Evaluation.

Several reviews have consolidated the evidence on the impact of living near an urban green space on improving health and education outcomes and reducing mortality. However, there is limited evidence on the effectiveness or cost-effectiveness of specific improvements to these urban green spaces, which would help decision-makers make informed decisions on how to invest in urban green spaces. Therefore, this review synthesizes the impact of more specific changes to, or investments in, urban green spaces on health and education outcomes, synthesizes the cost-effectiveness of these interventions, and critiques the applicability of the evidence for an economic evaluation. We find that interventions targeted towards improving play areas or fitness equipment tended to have mostly positive impacts on physical activity, while interventions on improving walking path, or the overall greenery showed a more mixed impact on physical activity. There were only two studies on the impact of changes to urban green spaces on mental health, with only one finding a positive association of the intervention with depression, and there were no studies measuring the impact of changes to urban green spaces and educational outcomes. From a cost-effectiveness perspective, we find that typically very small improvements are required to make the interventions a cost-effective policy choice; however, we found several limitations with using the existing evidence to estimate the cost-effectiveness of the intervention. Overall, we found that most of the evidence does suggest that improvements to urban green spaces can lead to improvements in physical activity, but further research is needed on the impact on mental health and educational outcomes. Furthermore, additional evidence with longer time horizons, multi-sectoral benefits, distributional outcomes, and more consistent outcome measures would assist in informing cost-effectiveness and may ultimately lead to improved decision-making around investments for urban green spaces in specific contexts.

Telemedicine in Diabetic Retinal Screening: Pre- and Post-COVID-19 Challenges a New Perspective

Abstract Telemedicine in ophthalmology has been around for decades and has been successful with its use in diabetic retinal screening in countries like the UK (with the introduction of the UK National Diabetic Eye Screening Programme in 2003). However, most telemedicine, in the field of diabetic retinopathy, has largely been reliant on human graders for triage purposes. With the advent of COVID-19, patients with chronic conditions, such as diabetes, were disproportionately affected. The pandemic also caused significant rise in patients on waiting lists. Before the pandemic, there have been studies illustrating the use of artificial intelligence (AI) to analyse images obtained from patients screened for monitoring of their diabetic retinopathy. The image analysis by AI and deep-learning algorithms offers insight into the future of screening in diabetes. The transition, from the use of human graders in teleophthalmology to the use of AI-based image analysis has the potential to screen a wider cohort of patients, thereby tackling waiting lists awaiting screening which has lengthened since after COVID-19. It is therefore vital to understand the role of AI in screening diabetic retinopathy patients, from a patient-acceptability, cost-effectiveness and reliability perspective as, this offers potential answers to streamline the screening process further.

Clinical strategy study on prenatal screening and diagnostic model for Down syndrome

Exploring efficient and easily implementable prenatal screening strategies aims at birth defect prevention and control. However, there have been limited economic evaluations of non-invasive prenatal screening (NIPS) strategies in China. Furthermore, these studies were predominantly confined to local or geographically proximate provinces and lacked universality and representativeness. This study assesses the health economics of current prenatal screening strategies and NIPS as first-line screening programs, analyzing their efficacy to determine an optimal strategy. From the perspective of health economics, cost-effectiveness, cost-benefit, and single-factor sensitivity were conducted for five different screening strategies using a decision tree model. Among pregnant women aged < 35 years who underwent only one screening for foetal Down syndrome (DS), the detection rate, false positive rate and positive predictive value of NIPS for foetuses with DS were superior to those of the other four serological screening methods. Although applying NIPS as first-line screening method yields the highest efficacy and benefits, it currently lacks cost-effectiveness when compared to serological screening and sequential NIPS screening strategies.

Mathematical modeling and optimizing of yard layout in automated container terminals

The yard layout significantly influences the performance of automated container terminals (ACTs), especially those employing a perpendicular stack configuration, where the yard blocks are perpendicular to the quay line. Thus, this study is dedicated to optimizing the yard layout tailored for ACTs with such configurations. First, we develop cycle time formulas for the automated stacking crane (ASC) by considering the dependency between its successive handling operations, highlighting the impact of the previous operation on the subsequent one. Further, to address the interferences between the two ASCs within a yard block, a novel hybrid simulation-analytical approach is proposed. Then, utilizing the derived ASC cycle time formulas, an analytic model is constructed based on the G1/G/1 queuing theory to optimize the yard layout design parameters (including the number of yard blocks, bays per block, and rows and tiers per bay) from the perspective of both cost-effectiveness and operational efficiency. In the numerical experiments, optimal yard layouts for two ACTs of different sizes are generated by utilizing the analytic model, and design insights are derived through the sensitivity analysis. The experiments underscore the importance of considering the dependency between successive handling operations and ASC interferences in the design of yard layouts for ACTs.

Health State Utilities and Cost-Effectiveness Economic Evaluation for Treatment of a Symptomatic Accessory Navicular.

Treatment strategies for a symptomatic accessory navicular include both operative and nonoperative approaches. The primary aim of this study is to define health utility values for 7 health states experienced by those with a symptomatic accessory navicular who undergo operative and/or nonoperative treatment. Secondarily, the study incorporates the health utility values with treatment costs, probabilities of various outcomes, and duration of health states into a cost-effectiveness model comparing the nonoperative treatment protocol at our institution vs surgical excision. Institutional review board approval was obtained to call parents of patients 10-20 years old at the time of interview who were evaluated for a symptomatic accessory navicular from February 1, 2016, to March 2, 2023, at a single institution by one of 4 pediatric orthopaedic surgeons. Participants were asked to rate 7 health states from 0 to 100, with 0 representing death (if 18 years or older) or the worst health imaginable (if under 18 years) and 100 representing perfect health. Using published values for the probabilities of various treatment outcomes, time spent in various health states, and Medicare costs from the perspective of the payor and society, a decision analysis was constructed. Health utility values for 7 health states were obtained. Operative treatment was preferred to nonoperative treatment in the base case model. Surgery was more expensive ($16 825) than nonoperative treatment ($7486). Using a willingness-to-pay threshold of <$50 000 per quality-adjusted life year (QALY), surgery was cost-effective compared to nonoperative treatment with an incremental cost-effectiveness ratio of $20 303/QALY. Sensitivity analysis revealed that the only variable that indicated a preference for nonoperative treatment is a 71% likelihood of nonoperative treatment resolving the condition. Unless a physician suspects at least a 71% chance of a symptomatic accessory navicular resolving without operative treatment, surgical excision is recommended from a cost-effectiveness perspective.

Validity of the Cost-Effectiveness of Middle Meningeal Artery Embolization Following Hematoma Evacuation for Initial Chronic Subdural Hematoma

Despite numerous articles about middle meningeal artery embolization (MMAE) highlighting its efficacy and safety for recurrent chronic subdural hematoma (CSDH), the appropriateness of adjunctive MMAE after hematoma evacuation for initial CSDH remains unclear from a cost-effectiveness perspective. Patients with CSDH were enrolled in this study and were prospectively divided into two groups: the "conventional treatment" group, which was treated with hematoma evacuation alone, and the "MMAE" group, which was treated with adjunctive MMAE after hematoma evacuation. The proportion of patients requiring retreatment, length of hospital stay, economic costs, and modified Rankin Score (mRS) were compared between the two groups. In this study, 53 cases were included, with 30 classified into the conventional treatment group and 23 classified into the MMAE group. In the conventional treatment group, the proportion of patients who required surgical retreatment was higher than that in the MMAE group (16.7% vs. 8.7%). The relative risk was 0.522 (95% confidence interval, 0.111-2.45). Although the addition of MMAE increased the cost per hospitalization by 26%, the increase in cost per patient was limited to 12% owing to the reduction in patients who relapsed and required a second hospitalization. The increase in cost was not statistically significant. The MMAE group had a significantly higher proportion of patients with favorable outcomes (mRS 0-2) (56.7% vs. 87.0%, p = 0.0328). By minimizing the increase in hospitalization days and procedure costs, MMAE following hematoma evacuation for initial CSDH could decrease the retreatment rate and balance the total medical costs associated with MMAE.

Cost-Effectiveness of Lecanemab for Individuals With Early-Stage Alzheimer Disease.

Little is known regarding the cost-effectiveness of lecanemab (Leqembi), a monoclonal antibody approved by the US Food and Drug Administration in January 2023 for the treatment of mild cognitive impairment (MCI) or mild dementia due to Alzheimer disease (AD). This study aims to quantify the cost-effectiveness of lecanemab and how it varies based on the accuracy of AD testing and individuals' APOE ε4 status. Seven alternative test-treat-target strategies defined by combinations of testing approaches (PET, CSF, or plasma assay), treatment choices (standard of care [SoC] alone or lecanemab in addition to SoC), and targeting strategies (targeting APOE ε4 noncarriers or heterozygous patients or not) were compared. A hybrid decision tree-Markov cohort model was constructed with 5 states: (1) MCI (Clinical Dementia Rating-Sum of Boxes [CDR-SB] 0-4.5); (2) mild dementia (CDR-SB 4.6-9.5); (3) moderate dementia (CDR-SB 9.6-16); (4) severe dementia (CDR-SB >16); and (5) death. Effectiveness was measured by quality-adjusted life years and costs from third-party and societal perspectives were estimated in 2022 US dollars over a lifetime horizon. Among the 7 test-treat-target strategies, SoC alone was the optimal strategy from a cost-effectiveness perspective. Neither targeted lecanemab treatment nor treatment unrestricted by APOE ε4 genotype was cost-effective vs SoC alone, regardless of the test used to diagnose patients with early-stage AD. However, CSF assay followed by targeted treatment would become cost-effective if lecanemab is priced below $5,100 per year. These results were robust to the accuracy of diagnostic testing and rates of lecanemab discontinuation and adverse events. Neither targeted lecanemab treatment nor treatment unrestricted by APOE ε4 genotype is cost-effective vs SoC alone for patients with MCI or mild dementia due to AD. Lecanemab would be cost-effective in some settings if priced below $5,100 per year.

Abstract 6298: The value of routine trastuzumab-related cardiac toxicity monitoring in gastrointestinal cancers

Abstract Background: It is a common practice to monitor trastuzumab-related cardiac toxicity (TRCT) using left ventricular ejection fraction (LVEF) in patients who receive trastuzumab-containing therapy for human epidermal growth factor receptor 2 (HER2)-positive cancers. However, this monitoring approach does not appear cost effective in patients with HER2-positive gastrointestinal (GI) cancers given poor overall survival (OS). Here, we aim to examine the incidence of clinically significant TRCT in this target population. Methods: This is a retrospective cohort study of patients with advanced HER2-positive GI cancers who received trastuzumab-containing therapies (trastuzumab +/- pertuzumab, chemotherapy +/- immunotherapy + trastuzumab, trastuzumab deruxtecan) between 2011 and 2023. HER2 status was determined by immunohistochemistry, fluorescent in situ hybridization, and/or next generation sequencing. LVEF was estimated by serial transthoracic echocardiograms (TTE). Continuous variables were summarized as median and interquartile range (IQR). Paired Wilcoxon signed rank test was used to compare serial LVEF. OS was estimated using Kaplan-Meier method. Results: A total of 243 patients were included in this study with a median age of 64 (IQR: 55-70) years. 139 (57%) patients had esophageal or GEJ adenocarcinoma; 45 (19%) patients had gastric cancer; 37 (15%) patients had colorectal cancer; and the rest had other GI cancers. Median follow-up time was 18.6 (IQR: 9.2-36) months. Median OS from cancer diagnosis and the first dose of trastuzumab-containing therapy were 24.1 (95%CI: 20.2-30.2) and 11.7 (95%CI: 10.4-15.6) months, respectively. Patients received a median of 13 cycles of trastuzumab-containing therapy for a median duration of 4.1 (IQR: 1.4-10.1) months. The median number of TTE each patient had throughout therapy was 2 (IQR: 1-4). Median baseline LVEF was 61% (IQR: 56-65%) which was significantly higher (p&amp;lt;0.001) than the median lowest LVEF of 58% (IQR: 53-62%) during therapy, but not different (p=0.14) from the most recent median LVEF of 60% (IQR: 56-64%) after discontinuation of trastuzumab. Among 176 patients with serial LVEF data, 16 (9%) had &amp;gt; 10% LVEF drop; 7 (44%) of these 16 patients had LVEF recovery. None of the cardiovascular risk factors prior to trastuzumab treatment including hypertension, diabetes, hyperlipidemia, peripheral arterial disease, coronary artery disease, and stroke were significantly associated with the development of TRCT. Conclusion: The incidence of clinically significant LVEF drop appears low in patients with advanced GI cancers as post-treatment LVEF recovery to baseline was observed at the population level. The value of using TTE to monitor TRCT in these patients with short OS should be further assessed in the perspective of cost effectiveness. Citation Format: Samual R. Kosydar, Matteo Castrichini, Mojun Zhu, Hao Xie. The value of routine trastuzumab-related cardiac toxicity monitoring in gastrointestinal cancers [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 6298.

Cost-Effectiveness of Performing Reference Ultrasonography in Patients with Deep Vein Thrombosis.

The diagnosis of recurrent ipsilateral deep vein thrombosis (DVT) with compression ultrasonography (CUS) may be hindered by residual intravascular obstruction after previous DVT. A reference CUS, an additional ultrasound performed at anticoagulant discontinuation, may improve the diagnostic work-up of suspected recurrent ipsilateral DVT by providing baseline images for future comparison. To evaluate the cost-effectiveness of routinely performing reference CUS in DVT patients. Patient-level data (n = 96) from a prospective management study (Theia study; NCT02262052) and claims data were used in a decision analytic model to compare 12 scenarios for diagnostic management of suspected recurrent ipsilateral DVT. Estimated health care costs and mortality due to misdiagnosis, recurrent venous thromboembolism, and bleeding during the first year of follow-up after presentation with suspected recurrence were compared. All six scenarios including reference CUS had higher estimated 1-year costs (€1,763-€1,913) than the six without reference CUS (€1,192-€1,474). Costs were higher because reference CUS results often remained unused, as 20% of patients (according to claims data) would return with suspected recurrent DVT. Estimated mortality was comparable in scenarios with (14.8-17.9 per 10,000 patients) and without reference CUS (14.0-18.5 per 10,000). None of the four potentially most desirable scenarios included reference CUS. One-year health care costs of diagnostic strategies for suspected recurrent ipsilateral DVT including reference CUS are higher compared to strategies without reference CUS, without mortality benefit. These results can inform policy-makers regarding use of health care resources during follow-up after DVT. From a cost-effectiveness perspective, the findings do not support the routine application of reference CUS.

Importance-based system cost management and failure risk analysis for different phases in life cycle

System life cycle can be divided into four phases: the production phase, the operation phase, maintenance phase and the end-of-life phase. Component failure leads to the different variable costs in different phases. Existing studies have investigated systems from a cost-effectiveness perspective of the operation and maintenance stage, which may not be holistic. Furthermore, the expected failure cost can be used to evaluate the failure risk. In this paper, a generalized system cost for different phases is analyzed in life cycle, then a risk optimization is studied based on an improvement importance. Firstly, a comprehensive life cycle cost model is proposed. Specifically, the operation and maintenance costs due to the different types of component failures are discussed, respectively. Besides, a specific selection method for performing end-of-life in case of component failure is given using the recovery importance. Secondly, an improvement importance is proposed to optimize system reliability under invariant resources. Thirdly, the specific process of the failure risk under limited resource using improvement importance is analyzed. Finally, the proposed methods are verified using two applications, and a discussion on unlimited resources for risk optimization is given.

Efficacy and Safety of Dapsone in Primary Immune Thrombocytopenia. Results of a Randomized, Placebo-Controlled Multicenter Trial and of a Single-Arm, Emulated Trial in the Prospective, Multicenter Carmen-France Registry

Introduction: Adults treated for immune thrombocytopenia (ITP) usually respond to 1 st-line therapy but the majority of them eventually relapse and need a second-line treatment to spare corticosteroids. Dapsone is an antibiotic drug with immunomodulatory properties that has shown some efficacy in various autoimmune diseases including ITP in several retrospective studies. The aim of this study was to assess the efficacy and the safety of dapsone given as second-line for primary ITP. Methods DAPS-ITP was a prospective multicenter randomized open-label controlled trial aimed to assess the efficacy and safety of dapsone as a second-line option in adult ITP. Adult patients with primary and newly diagnosed or persistent ITP with previous transient response to corticosteroids and/or IVIg and a platelet count ≤30x10 9/L (or &amp;lt;50x10 9/L with bleeding manifestations) were eligible. After randomization (1/1 ratio), patients received either dapsone at 100 mg/day in combination with prednisone for 3 weeks (arm A) or just the 3 weeks course of prednisone (arm B). The primary outcome was the overall response rate (R + CR) in intention to treat at week 52 in the absence of any rescue therapy after week 6 and/or any other treatment for ITP over the study period. Complete response (CR) was defined by a platelet count &amp;gt;100x 10 9/L on dapsone (arm A) or off treatment (arm B) and response (R) by a platelet count &amp;gt;30x10 9/L with a least a doubling of the baseline count. We also conducted a single-arm, emulated trial in the prospective, multicenter CARMEN-France registry to provide real world evidence about the efficacy and the safety of dapsone in ITP. The CARMEN-France is a prospective, multicenter registry of adult patients with a new diagnosis of ITP in France. We selected the patients included in the registry between 2013 and 2022 with a primary ITP, exposed to dapsone, who met the inclusion criteria of the DAPS-ITP trial. We assessed the same outcomes than in the DAPS-ITP trial. Results In total, 93 patients (51% of females, median age 51 years [range: 33-66]) were included and randomized (46 in arm A and 47 in arm B) in DAPS-ITP trial. Median platelet count at inclusion was 25x 10 9/L [17-36], median ITP duration was 0.31 years [0.18-0.90]. Forty-two (arm A) and 45 patients (arm B) were followed up to week 52. In intention to treat (see figure), the overall response-rate (ORR) was respectively 8.70% [2.78%-18.93%] (arm A) and 4.26% [0.78%-12.81%] (arm B) at week 52 (primary outcome, p value = 0.78)). At week 24, the ORR was 25% [11.06%-41.78%] in arm A and 12.77% [5.18%-23.89%] in arm B (p value = 0.57). One death (intracranial hemorrhage) occurred in arm A, none in arm B; 36/46 patients (78%) from arm A had to discontinue prematurely dapsone, mostly for inefficacy with the need of other ITP treatment (n =10/36, 27.7%) or for various safety issues (n=26/36, 72%) including anemia ± gastro-intestinal manifestations (n=6); high methemoglobinemia (n=4); toxidermia (n=3) and others miscellaneous causes (n =13). In the CARMEN registry, 127 patients were exposed to dapsone. Among them, 50 met the inclusion criteria of the DAPS-ITP trial and had a 52-week follow-up after the initiation of dapsone. Patients characteristics were similar to those included in the DAPS-ITP trial. Three patients had no platelet count measured at W52 ± 4 weeks and were withdrawn from the primary outcome assessment. Overall, 5/47 achieved R or CR at W52 without any concomitant ITP treatment, resulting in an ORR of 10.6%; 95% CI: 3.5-23.1. At W24, 9/45 patients achieved R or CR (ORR: 20.0%; 95% CI: 9.6 -34.6; 5 patients had no platelet count at W24 ± 4 weeks in the real world). Seventeen (34.0%) experienced 19 adverse drug reactions (ADRs) including 8 hemolytic anemia, 4 methemoglobinemia and 3 cutaneous rash. Twelve patients discontinued dapsone due to an ADR. Conclusion Among adult patients with primary ITP and a platelet count &amp;lt;30 x 10 9/L treated with dapsone as a second-line treatment, only a minority of patients achieved a sustained response at W52. The low rate of durable response may be at least in part due to an unexpectedly high rate of early discontinuation observed in the dapsone arm (DAPS-ITP trial) due to the occurrence of ADRs, some of which could have been easily manageable outside a clinical trial. Further studies are needed to better define who are the few patients who may still benefit from dapsone, in a cost-effectiveness perspective.

Actual Shear Rate Prediction Associated with Wall Slip Phenomenon Using Radial Basis Function Network

Wall slip can be defined as a phenomenon where the particles in a suspension moving away from the wall boundary, leaving a thin liquid-rich layer adjacent to the boundary. Such a phenomenon may induce a significant impact on rheological measurements, particularly to viscosity, shear stress, and shear rate. Suspension has wide applications such as food processing, personal care products, pharmaceuticals, paints, medicine, and agrochemical. The traditional technique for the actual shear rate prediction is challenging yet difficult and non-favourable from the perspective of time and cost-effectiveness. Therefore, development of a mathematical computational model which has the ability to perform the prediction task with an acceptable level of accuracy is highly in need. Since radial basis function network (RBFN) has the ability to perform input-output mapping in a highly accurate manner, both of the approaches are employed to generate the actual shear rate prediction model. Through the model evaluation using a series of statistical analyses, it was found that RBFN model V is the best model as it shows the highest coefficient of determination (0.9998), lowest mean squared error (0.001058) and root mean squared error (0.001447), most negative Akaike information criterion (-18426.5) and Bayesian information criterion (-18415.5), and the smallest percentage error.

The Diagnosis of Malignant Pleural Effusion Using Tumor-Marker Combinations: A Cost-Effectiveness Analysis Based on a Stacking Model.

By incorporating the cost of multiple tumor-marker tests, this work aims to comprehensively evaluate the financial burden of patients and the accuracy of machine learning models in diagnosing malignant pleural effusion (MPE) using tumor-marker combinations. Carcinoembryonic antigen (CEA), carbohydrate antigen (CA)19-9, CA125, and CA15-3 were collected from pleural effusion (PE) and peripheral blood (PB) of 319 patients with pleural effusion. A stacked ensemble (stacking) model based on five machine learning models was utilized to evaluate the diagnostic accuracy of tumor markers. We evaluated the discriminatory accuracy of various tumor-marker combinations using the area under the curve (AUC), sensitivity, and specificity. To evaluate the cost-effectiveness of different tumor-marker combinations, a comprehensive score (C-score) with a tuning parameter w was proposed. In most scenarios, the stacking model outperformed the five individual machine learning models in terms of AUC. Among the eight tumor markers, the CEA in PE (PE.CEA) showed the best AUC of 0.902. Among all tumor-marker combinations, the PE.CA19-9 + PE.CA15-3 + PE.CEA + PB.CEA combination (C9 combination) achieved the highest AUC of 0.946. When w puts more weight on the cost, the highest C-score was achieved with the single PE.CEA marker. As w puts over 0.8 weight on AUC, the C-score favored diagnostic models with more expensive tumor-marker combinations. Specifically, when w was set to 0.99, the C9 combination achieved the best C-score. The stacking diagnostic model using PE.CEA is a relatively accurate and affordable choice in diagnosing MPE for patients without medical insurance or in a low economic level. The stacking model using the combination PE.CA19-9 + PE.CA15-3 + PE.CEA + PB.CEA is the most accurate diagnostic model and the best choice for patients without an economic burden. From a cost-effectiveness perspective, the stacking diagnostic model with PE.CA19-9 + PE.CA15-3 + PE.CEA combination is particularly recommended, as it gains the best trade-off between the low cost and high effectiveness.

Hepatocellular Carcinoma Prevention in the Era of Hepatitis C Elimination.

The hepatitis C virus (HCV), a single-stranded RNA virus belonging to the Flaviviridae family, is a major cause of hepatocellular carcinoma (HCC) worldwide. Tumors caused by HCC have an increased mortality rate globally, which is more accentuated in Western countries. The carcinogenic potential of this virus is mediated through a wide range of mechanisms, spanning from the induction of chronic inflammation to oxidative stress and deregulation of cellular pathways by viral proteins. As the number of new infections continues unabated, HCC-related mortality should be prioritized through early detection, continued prevention of HCV transmission, and treatment of HCV with safe and efficacious direct antiviral agents (DAAs). People who inject drugs (PWID) are a significant reservoir of new HCV infections globally, and in order to eliminate hepatitis C as a global health threat, as set out by the World Health Organization, an integrated approach based on the optimization of care delivery and increased access to harm reduction and treatment for PWID is needed. Thanks to the development of safe and effective antiviral agents, eradication of the infection is now possible in almost all treated patients, leading to a significant reduction but not the elimination of the risk for HCC in cured patients. This is particularly relevant among aged populations who have cofactors of morbidity known to accelerate HCC progression, such as diabetes, obesity, and excessive alcohol consumption. Given the restless accumulation of individuals with cured HCV infection, the implementation of risk-stratified surveillance programs becomes impellent from a cost-effectiveness perspective, whereas the availability of a performant biomarker to predict HCC in cured patients remains an unmet clinical need.

Critiquing Sustainable Openness in Technology-Based Education from the Perspective of Cost-Effectiveness and Accessibility

Critiquing Sustainable Openness in Technology-Based Education from the Perspective of Cost-Effectiveness and Accessibility

Comprehensive Review and Analysis of Glazing Systems towards Nearly Zero-Energy Buildings: Energy Performance, Thermal Comfort, Cost-Effectiveness, and Environmental Impact Perspectives

The global interest in nearly zero-energy buildings (NZEBs) has led to their establishment as mandatory building objectives in Europe for all new constructions starting in 2021. The principles outlined in the Energy Performance of Building Directive (EPBD) emphasize the significance of reducing energy demand through various energy efficiency measures to achieve NZEB status. Among these measures, the utilization of high-performance glazing systems plays a crucial role in ensuring natural light, ventilation, favorable solar gain, aesthetics, and positive psychological effects in buildings, while maintaining high energy performance and thermal comfort without burdening the budget or harming the environment. The use of increasingly larger glazing areas makes this topic of great relevance. Nevertheless, numerous studies frequently overlook certain crucial aspects of glazing systems in their assessments. This review study aims to assess different glazing solutions based on four critical perspectives called “EThCE”: Energy performance, thermal comfort, cost-effectiveness, and environmental impact, considering their interrelationships. Furthermore, the importance of adopting a comprehensive approach for selecting the optimal glazing solution for NZEBs is discussed. Additionally, the relationship between glazing systems and climate change is taken into account. Ultimately, the authors propose a comprehensive approach, including all the influential factors, to assist designers and homeowners in making informed decisions regarding glazing system selection for new NZEBs or NZEB retrofits in different situations.

Cluster-based lateral transshipments for the Zambian health supply chain

Many low- and middle-income countries, including Zambia, suffer from unreliable distribution of health commodities leading to high variation in service levels across health facilities. Our work investigates how transshipment can improve system-wide service levels, equity across facilities, and average inventory levels. We focus on the distribution of malaria medicines in Zambia’s public pharmaceutical supply chain, which is heavily impacted by the rainy season leading to seasonality and uncertainty in demand and lead times. We use the more advanced deep reinforcement learning method Proximal Policy Optimization to develop transshipment policies and compare their performance with currently available, easy-to-use heuristics. To ensure that the model applies to settings of a realistic scale, we adopt a policy architecture that effectively decouples the policy’s complexity from the problem dimensions. We find that deep reinforcement learning is mainly useful in resource-constrained environments where system-wide inventory is scarce. When sufficient inventory is available, transshipment heuristics are more appealing from an overall cost-effectiveness perspective. Based on our numerical experiments, we formulate policy insights that can support policymakers in a humanitarian health context.

The cost-effectiveness of resilient healthcare

PurposeThe purpose of this conceptual paper is to develop a model of the hypothesized relationships between investments and outcomes of resilient health care (RHC).Design/methodology/approachBased on the extant literature, the aforementioned model is described along with proxy measures of its composing variables and a matrix for assessing the cost-effectiveness of RHC instantiations. Additional possible relationships are set out in two propositions for theory testing.FindingsThe model conveys that RHC gives rise to both desired and undesired outcomes. Investments moderate the relationships between RHC and its outcomes. Both investments and outcomes can be broadly categorized as either human or technical. Moreover, the propositions refer to what type and how much investment is necessary to perform in a resilient manner, what are the intended or desired outcomes of RHC, for how long and who is affected by these outcomes.Originality/valueThe cost-effectiveness perspective of RHC is new and the proposed model opens opportunities for empirical and theoretical research.