Increase In Cost Research Articles

Nonpharmacological intervention therapies for dementia: potential break-even intervention price and savings for selected risk factors in the European healthcare system

BackgroundNew effective treatments for dementia are lacking, and early prevention focusing on risk factors of dementia is important. Non-pharmacological intervention therapies aimed at these factors may provide a valuable tool for reducing the incidence of dementia. This study focused on the development of a mathematical model to predict the number of individuals with neurodegenerative diseases, specifically Alzheimer’s disease, Parkinson’s disease, vascular dementia, and amyotrophic lateral sclerosis. Scenarios for non-pharmacological intervention therapies based on risk factor reduction were also assessed. The estimated total costs and potential cost savings from societal were included.MethodsBased on demographic and financial data from the EU, a mathematical model was developed to predict the prevalence and resulting care costs of neurodegenerative diseases in the population. Each disease (Alzheimer’s disease, Parkinson’s disease, vascular dementia, and amyotrophic lateral sclerosis) used parameters that included prevalence, incidence, and death risk ratio, and the simulation is related to the age of the cohort and the disease stage.ResultsA replicable simulation for predicting the prevalence and resulting cost of care for neurodegenerative diseases in the population exhibited an increase in treatment costs from 267 billion EUR in 2021 to 528 billion EUR by 2050 in the EU alone. Scenarios related to the reduction of the prevalence of dementia by up to 20% per decade led to total discounted treatment cost savings of up to 558 billion EUR.ConclusionThe model indicates the magnitude of the financial burden placed on EU healthcare systems due to the growth in the population prevalence of neurodegenerative diseases in the coming decades. Lifestyle interventions based on reducing the most common risk factors could serve as a prevention strategy to reduce the incidence of dementia with substantial cost-savings potential. These findings could support the implementation of public health approaches throughout life to ultimately prevent premature mortality and promote a healthier and more active lifestyle in older individuals.

Do private rental tenants pay for energy efficiency?: The dynamics of green premiums and brown discounts

ABSTRACT The rental market, notably within the UK, is facing increased scrutiny with the tightening of regulation in relation to energy performance and the increases in energy costs and rental unaffordability. Whilst a sizeable volume of research has examined the pricing effects of EPCs and house prices, scrutiny of this relationship within the private rental sector remains more embryonic. This study, using 2,914 transactions for Northern Ireland, extends the traditional analysis beyond the conditional mean estimate by examining the quantiles of the relationship between EPCs and rental prices. The findings provide evidence of a rental premium of 0.2% for a one-point improvement in energy efficiency. In terms of EPC ratings, we find premiums for B- and C-rated dwellings of 8.2% and 2.4% and also discount effects for E, F and G-rated properties ranging between 3.9%-5.5%. The quantile findings exhibited a parabolic effect across the price distribution demonstrating the lowest and highest priced properties to comprise higher price premiums of 13% and 16% for B-rated dwellings, however more pronounced discount effects for F- and G-rated properties at the lowest and highest deciles. The findings provide evidence to help alleviate the split-incentive problem between landlords and tenants within the UK.

The Impact of CSI SEEE Carbon Neutral Index Launched on Order Aggressiveness

In the context of carbon peaking and carbon neutrality goals, in order to clarify the investment direction for investors, China Securities Index Co., Ltd. (CSI) has collaborated with the Shanghai Environmental Energy Exchange to develop the CSI SEEE Carbon Neutral Index (CSCNI), which has also played a leading role in the subsequent preparation of the Green Finance Index. The launch of this index has sparked research interest among scholars in stimulating investor order aggressiveness. This study employs event study methodology to examine the impact of the CSCNI launch on order aggressiveness. The sample companies are categorized into two groups: deep low-carbon and high-carbon reduction, with a focus on studying buy and sale order aggressiveness. The results indicate that the launch of CSCNI has mobilized order aggressiveness but has led to a negative stock price effect as investors anticipate an increase in environmental costs for the sample companies. Furthermore, we reveal that the long-term growth potential of the deep low-carbon field is more promising compared to the high-carbon reduction sector, making stocks in the deep low-carbon field more attractive. The launch of CSCNI has shown contrasting effects on the buy and sale order aggressiveness of investors, with the impact of the index announcement being more significant on the sample companies. This research provides valuable insights for evaluating the impact of green finance indices and contributes to the understanding of internal mechanisms. It provides an important reference for financial regulators to evaluate the development of the current green index. At the same time, it expands the domestic research on order aggressiveness, which studies the action mechanism of the stock price effect of the green stock index from the perspective of order aggressiveness.

Feed-In-Tariff Is Key to Japan’s Current Biomass Power’s Viability, Even with Environmental Externalities

Abstract Bioenergy is increasingly recognized as an effective tool for removing carbon dioxide from the atmosphere. However, its economic feasibility remains underexplored, particularly when accounting for environmental impacts. This study proposes a quantitative assessment framework to calculate the cost-benefit ratio of biomass power generation and to assess the sustainability of its supporting policy tools, such as feed-in-tariffs (FIT). The framework accounts for benefits through electricity generation and environmental externalities, namely emissions from feedstock production and procurement, such as the transportation of biomass materials. This allows for quantification and a detailed discussion of multiple environmental burdens of biomass energy and economic costs. As a case study, this framework was applied to a hypothetical biomass plant in Japan, which has the fifth-largest biomass market globally. We prepare several scenarios to consider diverse conditions within the Japanese biomass industry, including the types of biomass materials used (pellets vs. chips), their sources (domestic vs. international), and the biomass technologies employed. The results show that using pellets, predominantly imported, significantly increases biomass energy costs. The increase in cost is directly proportional to the quantity of utilized pellets and their transportation distances. However, pellet production location —whether in Vietnam or Canada—doesn't significantly change the overall cost calculations in our study. Our result is consistent across various biomass technologies, showing that the high selling price under the feed-in-tariff system, rather than material type, supply origin, or transportation mode, plays the most critical role in economic feasibility, even when accounting for environmental externalities. Thus, decision-makers must reevaluate the efficacy of FIT policies for wood biomass powers, where fuel costs share a substantial portion. We also discuss its synergies with local industries and trade-offs with other land-use objectives.

OPT-In; Optimized Patient Treatment Outcomes in Plaque Psoriasis: A 3-Year State-Transition Treatment-Sequencing Model in the Italian Setting.

There are several treatment options for plaque psoriasis (PsO), but uncertainty remains around the optimal sequencing of treatments. The aims of this study were to investigate how adopting a best-treatment-first treatment sequence impacts patient outcomes and healthcare systems and to quantify the cost of treatment failure to the healthcare system. A 3-year state-transition treatment-sequencing model which identifies all possible treatment sequences in PsO was adapted to the Italian healthcare setting. Treatments considered in the model are those with European Medicines Agency marketing authorization and reimbursement in Italy as of December 2022. Italian market share data (2019-2021) and list prices (2022) informed the current prescribed sequences; these sequences were compared against all possible sequences to determine opportunities for improvement. Both the national perspective in Italy as well as the local perspective from seven regions were considered. The cost of treatment failure was informed through a questionnaire circulated to Italian dermatologists. Overall, 1284 possible treatment sequences are possible when four lines of treatment are considered for patients with moderate-to-severe PsO in Italy. Within the estimated range of treatment failures across those sequences (0.97-2.56 per patient over 3 years), current prescribing behavior from the national perspective suggests patients will face 1.44 failures on average; this highlights the potential for improvement. For every treatment failure, the cost borne by the Italian National Healthcare Service (NHS) is €676.80. Overall, prescribing more optimized treatment sequences results in a 22.95% reduction in failures with a 2.27% increase in costs. The regional analyses found similar trends. Results suggest that selecting the most effective treatment sequences for incident patients provides the greatest opportunity to reduce treatment failures and maximize patient outcomes with a modest impact on costs. While regional variations exist, there is room for improvement across the board, which could translate to more efficient local healthcare systems.

SMOOTHER OR BUMPIER RIDE? A STUDY ON TAXPAYER EXPERIENCES WITH COST OF SERVICE AFTER THE GST ROLLOUT

This study explores taxpayers perceptions of the costs of service within the logistics industry after the implementation of Goods and Services Tax (GST). The study showed a significant difference in taxpayers perceptions of service costs across geographical locations and annual turnover. The researchers employed a descriptive research design to examine taxpayers perceptions of service costs post-GST implementation. Convenient random sampling was utilized to ensure a representative sample across various demographic segments. Quantitative data was collected and analyzed using statistical techniques, notably ANOVA, with SPSS software facilitating efficient analysis. While rural areas tend to perceive an increase in service costs, urban areas generally report a reduction. Factors contributing to changes in service costs were analyzed, with increased compliance costs identified as a significant driver of elevated expenses. Conversely, simplifying the input tax credit process effectively reduced service costs. The study aims to offer valuable insights into the impact of GST on the logistics sector by examining taxpayers perceptions of service costs. KEYWORDS: Goods and Services tax, taxpayer perception, cost of services, logistics industry.

The Performance of Modified Asphalt Mixtures with Different Lengths of Glass Fiber

AbstractOne practical option for modifying an asphalt mixture’s performance is to use additives. This will help the mixture perform better against the damaging effects of traffic, loads, and climatic variations. In this regard, glass fiber (GF) has drawn much interest because of its positive effect. Therefore, this paper attempts to study the effect of glass fiber length and content on the performance and strength of asphalt mixtures. It also aims to determine the optimum glass fiber content and the best glass fiber length of modified asphalt mixtures. An experimental program is carried out, which includes the Marshall test, volumetric properties, freeze-thaw splitting test, immersion Marshall test, and wheel tracking test to characterize related properties of glass fiber incorporated in asphalt mixtures. Seven different percentages (0, 0.25, 0.5, 0.75, 1, 1.25, and 1.5) of glass fiber by total weight of aggregates in three various lengths are used to design 19 asphalt mixtures. Based on the results obtained, the performance of the asphalt mixture was enhanced remarkably after adding glass fiber. The use of various lengths of glass fiber led to a better-quality asphalt mixture in terms of volumetric properties, moisture damage resistance, and permanent deformation resistance. Specifically, asphalt mixtures made with (0.5%) glass fiber illustrated the highest quality, and adding (20 mm) length of glass fiber was better than (10 mm and 30 mm) glass fiber lengths. The results also show that adding (10 mm and 30 mm) lengths of glass fiber can improve the resistance of asphalt mixtures to water damage and permanent deformation compared with the control mixture (M0). The findings indicate the applicability of 20 mm glass fiber length in asphalt mixtures to achieve better resistance against moisture and reduce the chance of irreparable permanent deformation under growing traffic loads and hot climate changes. Although the inclusion of glass fiber in asphalt mixtures led to a modest increase (6%) in overall cost, the effective improvement in performance and extension of the service life of the asphalt pavement constitute a convincing argument for this approach, making it an attractive option. Finally, it was concluded that a higher amount of glass fiber (i.e., > 0.5%) and a length greater than (20 mm) could diminish the positive effect of glass fiber to improve the properties of glass fiber asphalt mixtures.

An Optimization Strategy for Truncating Ultralong Bus Lines Integrated with Metro Networks

For most ultralong bus lines, low punctuality rates and vehicle bunching are two main challenges. One potential strategy to solve these two problems is to split an ultralong line into two or three shorter lines according to historical passenger flow patterns as well as other presetting objectives and constraints. Thus, in this paper, a multiobjective optimization model is first established in consideration of both passenger flow distribution and coline metro networks. Then, the optimal truncated stop is determined by estimating the model results generated by enumerating each potential bus stop derived from related metro stops. The nondominated sorting genetic algorithm II (NSGA-II) is applied to solve the model efficiently. A case study conducted on a real bus line associated with metro networks in Beijing, China, demonstrates the efficiency of the optimization strategy adoption in terms of operating cost and passenger travel time, even with a slight increase in passenger cost. Besides, the multivehicle type is also referred in the experiments to verify economic efficiency to reduce operational costs.

Dietary adherence among persons with type 2 diabetes: A concurrent mixed methods study.

Poor adherence to dietary recommendations among persons with type 2 diabetes (T2D) can lead to long-term complications with concomitant increases in healthcare costs and mortality rates. This study aimed to identify factors associated with dietary adherence and explore the barriers and facilitators to dietary adherence among persons with T2D. A concurrent mixed methods study was conducted in two hospitals in the Ashanti Region of Ghana. One hundred and forty-two (142) persons with T2D were consecutively sampled for the survey. Dietary adherence and diabetes-related nutritional knowledge (DRNK) were assessed using the Perceived Dietary Adherence Questionnaire (PDAQ) and an adapted form of the General Nutritional Knowledge Questionnaire (GNKQ-R) respectively. A purposive sample of fourteen participants was selected for interviews to explore the factors that influence dietary adherence. Qualitative data were analysed using NVivo version 20 software and presented as themes. Furthermore, binary logistic regression was performed using IBM SPSS version 29.0 to identify the factors associated with dietary adherence. Nearly fifty-one percent (50.7%) of the participants in this study had good dietary adherence. In multivariable logistics regression, it was found that increase in DRNK (AOR = 1.099, 95% CI: 1.001-1.206, p = 0.041) score and living in an urban area (AOR = 3.041, 95% CI: 1.007-9.179, p = 0.047) were significantly associated with good dietary adherence. Inductive thematic analysis revealed four facilitators of dietary adherence (access to information on diet, individual food preferences and eating habits, perceived benefits of dietary adherence, and presence of social support) and four barriers (inability to afford recommended diets, barriers related to foods available in the environment, conflict between dietary recommendations and individual eating habits, and barriers related to the social environment). The findings support the need for interventions including continuous dietary education tailored to individual preferences and dietary habits, expansion of poverty reduction social interventions and formulation of policies that will improve access to healthy foods in communities.

Evolutionary game and system dynamics for analysis on stakeholder strategies of regional high-speed rail project in investment decision stage

This paper studies the strategic choices under the conflict among stakeholders of regional high-speed rail project at the investment decision stage in the context of the ‘high-speed rail controversy’. This study develops a tripartite evolutionary game model among the central government, the local government and China Railway, analyzes the evolutionary stability strategy, discusses the influence of multiple factors on the choice of tripartite strategy, and further calculates and analyzes the stability of the equilibrium point in the tripartite evolutionary game system. Then the dynamic change trend of strategy choice brought by the change of each factor is investigated through system dynamics simulation. The results show that the lower the intervention cost and reward to the other two parties, and the increase of the opportunity cost of non-intervention and punishment to the other two parties, the faster the convergence of the central government's choice of intervention strategy. The increase of the rewards and punishments, and the increase of negotiation profits, non-negotiation costs, and loss of reputation for non-negotiation, and the decrease in the negotiation costs and non-negotiation profits all contribute to the shortening of the convergence time of the local government's choice of negotiation strategy. The increase of the rewards and punishments, the increase of support profits, the loss of reputation for non-support, and the decrease of the profits for non-support and the extra cost for support will promote the convergence of China Railway's choice of the support strategy. Finally, the simulation results are discussed so as to target feasible coordination strategies, which provides a theory basis for the practice of conflict coordination among stakeholders of regional high-speed rail project at the investment decision stage.

Cost-effectiveness of restorative treatments for permanent molars with severe molar incisor hypomineralization: perspectives for the Brazilian public health system.

To undertake a cost-effectiveness analysis of restorative treatments for a first permanent molar with severe molar incisor hypomineralization from the perspective of the Brazilian public system. Two models were constructed: a one-year decision tree and a ten-year Markov model, each based on a hypothetical cohort of one thousand individuals through Monte Carlo simulation. Eight restorative strategies were evaluated: high viscosity glass ionomer cement (HVGIC);encapsulated GIC; etch and rinse adhesive + composite; self-etch adhesive + composite;preformed stainless steel crown; HVGIC + etch and rinse adhesive + composite; HVGIC + self-etch adhesive + composite, and encapsulated GIC + etch and rinse adhesive + composite. Effectiveness data were sourced from the literature. Micro-costing was applied using 2022 USD market averages with a 5% variation. Incremental cost-effectiveness ratio (ICER), net monetary benefit (%NMB), and the budgetary impact were obtained. Cost-effective treatments included HVGIC (%NMB = 0%/0%), encapsulated GIC (%NMB = 19.4%/ 19.7%), and encapsulated GIC + etch and rinse adhesive + composite (%NMB = 23.4%/ 24.5%) at 1year and 10years, respectively. The benefit gain of encapsulated GIC + etch and rinse adhesive + composite in relation to encapsulated GIC was small when compared to the cost increase at 1year (gain of 3.28% and increase of USD 24.26) and 10years (gain of 4% and increase of USD 15.54). Within the horizon and perspective analyzed, the most cost-effective treatment was encapsulated GIC restoration. This study can provide information for decision-making.

247 Evaluating the use of soybean hulls on growth performance, carcass composition, and digestibility when fed to grow-finish pigs

Abstract The addition of fiber to grow-finish diets is commonly utilized in swine production formulation as energy costs increase. The objective of this study was to determine the effects of feeding soybean hulls (SBH) at increasing levels to grow-finish pigs on growth performance, carcass characteristics, and apparent total tract digestibility (ATTD) of nutrients. Utilizing 192 grower pigs [PIC 337×1050, initial body weight (BW) = 21.99 ± 2.75 kg] that were randomly assigned to split sexed pens (n = 12 pens/treatment), pens were assigned to one of four dietary treatments and fed over three feeding phases for the estimated BW ranges of 22 to 50 kg, 50 to 86 kg, and 86 to 127 kg. Diets were formulated to represent conventional corn and soybean meal diets, containing increasing levels of SBH at: 1) 0% SBH (0%); 2) 7.5% SBH (7.5%); 3) 15% SBH (15%); and 4) 22.5% SBH (22.5%). Within phase, diets had equal SID Lys:ME and energy was allowed to float. Individual BW and pen feed disappearance were collected for each phase to calculate pen average daily gain (ADG), average daily feed intake (ADFI), and feed efficiency gain to feed ratio (G:F). On d 56 of study and during phase 2, 32 gilts (n = 8) were placed into individual metabolism crates, where total urine and feces were collected for 72 h to measure ATTD of gross energy (GE), nitrogen (N), neutral detergent fiber (NDF), and acid detergent fiber (ADF), then returned to original pens. At the completion of study, carcass weight, backfat depth, and loin depth were collected. Data were analyzed with the fixed effects of dietary treatment by ANOVA, linear, and quadratic contrasts. Pen served as the experimental unit for performance and carcass characteristics and pig as the experimental unit for ATTD analyses. Overall, as SBH increased from 0% to 22.5%, ADG tended to decrease (linear P = 0.060) with no difference in ADFI (P > 0.05), resulting in an overall decrease in G:F (0.38, 0.37, 0.36, 0.35; linear P < 0.001; 0, 7.5, 15 and 22.5% SBH, respectively). Final BW tended to decrease (linear P = 0.069) and carcass weight decreased (102.9, 102.7, 99.7, and 96.5 kg, linear P < 0.001) as SBH increased in diet. Carcass fat depth (P = 0.014) and loin depth (P = 0.006) linearly decreased with increasing levels of SBH in the diet. Increasing levels of SBH from 0% to 22.5% decreased ATTD of GE and N (linear P < 0.001) and tended to increase ATTD NDF and ADF (linear P = 0.056 and P = 0.073, respectively). Altogether, these data suggest increasing dietary SBH in grow-finish pig diets decreases growth efficiency and the digestibility of GE and N. Further, feeding high inclusion rates of SBH negatively impacts carcass yield, backfat and loin depth.

A novel approach for managing change in warehouse processes via integration of business process re-engineering and interval-valued hesitant fuzzy DEMATEL

PurposeThe main purpose of this study is to present a new approach to managing process changes in uncertain conditions. The proposed approach is applied in one of the largest production companies in Turkey to manage the changes in their warehouse processes which formed after the merger.Design/methodology/approachIn the model, interval-valued hesitant fuzzy the decision-making trial and evaluation laboratory (IVHF-DEMATEL) methodology is integrated into one of the most used BPR tools, change matrix. The main focus of the proposed model is to increase both flexibility and applicability in uncertain conditions. Thus, while the change matrix enables companies to be agile and responsive to changes, IVHF-DEMATEL provides a better way to continuously evaluate and determine critical processes, and strategies to align with evolving conditions.FindingsInitial analysis revealed two major problems, the slowness of shipments caused by the increase in costs and the confusion in the organizational structure. However, the conventional methods fall short of effectively determination of critical objectives in terms of dealing with uncertainty. Therefore, a comprehensive roadmap for managing the change is developed with the integration of IVHF-DEMATEL and change matrix so that a successful transition is achieved.Originality/valueIt is believed that the study will contribute to the existing literature by providing a novel approach in which the IVHF-DEMATEL methodology is integrated into the change matrix. Also, the study provides a guideline for practical applications by presenting a step-by-step implementation of the model.

COMPARISON OF PLOT ANALYTICAL METHODS FOR DETERMINING EXCESSIVE WATER PRODUCTION MECHANISMS IN OIL WELLS

Watering of production wells is an important factor leading to a decrease in production profitability and an increase in costs. There are several main mechanisms of excess water inflow. These are a leak in the production casing; a violation of contact between the production casing and the rock; a formation of a bottom water cone; a raising the WOC surface to the perforation interval; a breakthrough through a layer with high permeability. Mechanisms can complement each other, forming a complex integrated system. To identify them, there are three groups of diagnostic methods — geophysical research, hydrodynamic well testing and plot analytical studies. Each of these fundamentally different groups can be supplemented by field research. Specifically in this work, we considered the latter. The analysis is carried out using the example of wells in one of the deposits of an oil field of the Arkhangelsk region. In which the causes of unwanted water production have already been studied by other methods and can be considered known. The studied reservoir is massive, with carbonate hydrophobic rocks and the reserves of the entire field are predominantly concentrated in it (97 %); the oil field (in terms of reserves) is small. There are no injection wells, operation is carried out in a natural elastic water drive mode. In the article, in total, three plot analytical methods are analyzed, which are among the main ones and have different application algorithms. Both the physical principles of their application and their effectiveness in relation to specific oil field are considered. These are the methods of K. Chan; L.I. Merkulova and A.A. Ginzburg; R. Novotny. The first studies the dependence of the water-oil ratio and its derivative on time (WOR and WOR’(t)), is the most widely known and has a large number of modifications (however, here they are not considered in detail). The second is based on the study of the so-called «water-cut characteristics» (representing the dependence of the accumulated oil production vs accumulated liquid production during the water period of operation). It has more restrictions, but is also more comprehensive. The third is based on a comparison of the permeability properties of reservoirs that change during operation.

Hospitalization expenses of coronary heart disease inpatients in China: evidence from two hospitals in Ningxia Hui autonomous region

AimThe increasing morbidity from coronary health disease (CHD) has imposed a significant social and economic burden in China. We analyzed the factors affecting hospitalization expenses of CHD patients.DesignFrom 2012 to 2018, data on 16,726 CHD patients were collected from the hospital information system in Ningxia Hui Autonomous Region.MethodsA multiple ordered logistic regression model was used to analyze the factors affecting hospitalization expenses.ResultsThe average hospitalization expense was RMB30998.26 ± 29890.03. Hospital materials expenses accounted for roughly 60% of total hospitalization costs. The older adult, patients who were male, in critical health status, with longer hospital stays, unemployed, using antibiotics and undergoing an operation without incision had significantly raised hospital expenses, while those with fewer complications, no operations and self-paying for health care had reduced hospitalization costs (p < 0.05). The length of hospital stay played a partial mediator role (p < 0.05).Public contributionControlling the increase of medical materials costs and preventing over-consumption of hospital services by insured patients are recommended.

The rising global economic costs of invasive Aedes mosquitoes and Aedes-borne diseases

Invasive Aedes aegypti and Aedes albopictus mosquitoes transmit viruses such as dengue, chikungunya and Zika, posing a huge public health burden as well as having a less well understood economic impact. We present a comprehensive, global-scale synthesis of studies reporting these economic costs, spanning 166 countries and territories over 45 years. The minimum cumulative reported cost estimate expressed in 2022 US$ was 94.7 billion, although this figure reflects considerable underreporting and underestimation. The analysis suggests a 14-fold increase in costs, with an average annual expenditure of US$ 3.1 billion, and a maximum of US$ 20.3 billion in 2013. Damage and losses were an order of magnitude higher than investment in management, with only a modest portion allocated to prevention. Effective control measures are urgently needed to safeguard global health and well-being, and to reduce the economic burden on human societies. This study fills a critical gap by addressing the increasing economic costs of Aedes and Aedes-borne diseases and offers insights to inform evidence-based policy.

Cost of disease progression among US patients with human epidermal growth factor receptor 2-positive metastatic breast cancer.

Aim: The objectives were to investigate the differences in per patient per month (PPPM) healthcare resource utilization (HCRU) and costs among commercially insured and Medicare Advantage patients with human epidermal growth factor receptor 2 positive (HER2+) metastatic breast cancer (mBC) who experience disease progression in 12months compared with those who don't investigate the impact of progression timing on cumulative healthcare costs. Patients & methods: This claims-based study included patients diagnosed with mBC between 1January 2013 and 30April 2020 and received HER2-targeted therapy. Patients were categorized as progressed or nonprogressed. For objective one, monthly HCRU and costs were assessed for up to two lines of therapy (LOTs). Data were summarized descriptively and compared using a generalized linear model (GLM). For objective two, patients with at least 6 months of follow-up were assessed and cumulative healthcare costs were estimated in the 3 years following the start of LOT1 or LOT2 using a GLM and Kaplan-Meier weighting. Results: Among the 4113 patients in the study sample, 3406 had at least 12 months of follow-up (or less if due to death). Compared with nonprogressed patients, progressed patients had higher mean PPPM healthcare costs (LOT1: $22,014 vs $18,372, p<0.001; LOT2: $19,643 vs $16,863, p=0.001), and HCRU, including number of emergency room visits and inpatient stays (both p<0.001) in the 12 months following LOT start. Progressed patients had higher 3-year mean cumulative healthcare costs than nonprogressed patients following LOT1 and LOT2 and this difference was greater for patients who progressed earlier. Conclusion: Disease progression was associated with significant increases in HCRU and costs. Delays in progression were associated with lower cumulative healthcare costs. Earlier use of more clinically effective treatments to delay progression may reduce the economic burden among these patients.

Feasibility of zero emission freight zones: scenario analysis and risk assessment

To further incentivize the adoption of zero-emission trucks (ZETs), Chinese cities would need more proactive policies like zero-emission freight zones (ZEFZs). However, the design of the policy should avoid the disruption of goods supply, increase of logistic costs, and ensure inclusive transition of small carriers and financial sustainability for city governments. To this end, this study employs Beijing as a case: Based on ZEFZ case studies, policy document and literature review, and data analysis of freight demand distribution and truck movements in Beijing, this study constructs four scenarios with different spatial coverages, restricted truck segments, and roll-out years of ZEFZs. The impacts of different ZEFZ scenarios on emissions reduction potentials, goods supply and vehicle fleet replacement, and public and private expenditure are evaluated. The most cost-efficient and easy-to-implement scenario is recommended as the initial phase of the ZEFZ scheme, with risk assessment and risk mitigation measures.

Aviation fuels of the future − A techno-economic assessment of distribution, fueling and utilizing electricity-based LH2, LCH4 and kerosene (SAF)

This paper investigates the techno-economic implications on air travel when fossil-based kerosene is phased out of the market, specifically focusing on the comparison between liquid hydrogen, liquid methane and renewable kerosene for ten exemplary flight routes to estimate the cost of air travel per passenger and 100 km distance travelled €2020PAX100km for every fuel type. By considering the entire supply chain, including hydrogen production from renewable sources, synthesis, oversea transport, domestic distribution, and utilization, this study addresses the overarching question of whether it is more economical to change the fuel source or the fuel itself to reduce fossil kerosene usage in the aviation industry. It is demonstrated that aircraft acquisition costs play a minor role compared to fuel supply costs and specific fuel demand. The study shows that for electricity-based fuels, liquid hydrogen is the most economic option, even with a potential energy penalty, followed by liquid methane and renewable kerosene. The results for an aircraft with a capacity 180 passengers are 3.08, 4.57 and 5.11 €PAX100km for liquid hydrogen, liquid methane and renewable kerosene, respectively. Challenges regarding storage and isolation requirements for cryogenic fuels in aviation are discussed, with assumptions made that these obstacles can be overcome to realize economic benefits. Additionally, the study suggests potential shifts in aircraft size selection by airlines to mitigate rising fuel prices in the future. The study advocates for the aviation industry's openness to new fuels like liquid hydrogen and liquid methane to alleviate the cost increase associated with phasing out fossil kerosene.

Analysis of the Effect of Time and Cost Performance Risk of Toll Road Project Based on the Principle of Project Management Body of Knowledge

Toll road facilities are needed by the community to improve economic standards with adequate mobility. Toll Road Projects often have delays in the implementation schedule which results in increased project costs. This study aims to determine the effect of the risk of increasing costs on toll road projects caused by delays in project implementation time based on PMBOK guidelines. This research is based on the object of the Japek II Selatan Package III Toll Road project and studies journal literature, surveys, and questionnaires using the SEM Smart PLS program. The effect of risk on cost performance is variable due to the lack of project land readiness. Based on project data from the contract, it was supposed to be completed in December 2020 but was pushed back to mid-2024 estimates. The effect is due to an increase in costs, with a percentage of 2%; in this study, the factor of implementing K3 Projects is in the form of work accident costs. The analysis of SEM PLS shows the effect of time and cost performance on the Planning and Implementation of land readiness indicators, unit price increase, project K3 implementation, and risk management implementation. The study concludes that the risk of increasing costs includes poor planning, which is hampered by land readiness and results in delays in implementation time and year differences that cause changes in material unit prices, resulting in an increase in project costs. Risk Management, as stated in the PMBOK guidelines on Toll Road Projects, must be implemented to reduce the impact of the risk of increasing project costs.