Indirect Costs Research Articles

Economic and financial analysis in the pea production system (Pisum sativumL.) in Nariño, Colombia

The pea production system in the Department of Nariño, Colombia, constitutes an important pillar within the life strategies of Nariño families, representing a good portion of the high Andean landscape. However, despite its importance, there remains a notable lack of information in aspects such as direct and indirect costs, profitability, and other key economic variables, for the development of this productive system and for decision making, particularly in the Nariño context. current. Therefore, the purpose of this study is to carry out a detailed economic and financial analysis, focused on the producers participating in the AGROSAVIA Social Balance project, to facilitate a deep understanding of the dynamics of this productive system. To this end, 38 semi-structured interviews were carried out with producers adopting Agrosavia Obonuco Andina and Agrosavia San Isidro varieties between the years 2019 to 2022. Producers were identified through the snowball strategy and references from key territorial actors. The analysis involved calculations of economic and financial ratios, production costs and the application of an econometric model based on the Cobb-Douglas function, using ordinary least squares to evaluate the efficiency and inefficiency of the crop. The findings reveal an annual increase in production costs of 9.5 %, a financial profitability of 35 % according to the internal rate of return (IRR), and a technical efficiency of 1.67. Factors such as seed and labour exerted a predominant influence on productivity, while aspects such as production area and age showed inefficiencies, which is why more efficient management strategies for available physical resources, more active involvement of the family and management strategies and appropriation of knowledge and technologies with an intergenerational approach.

Cost-Effectiveness of Lovotibeglogene Autotemcel (Lovo-Cel) Gene Therapy for Patients with Sickle Cell Disease and Recurrent Vaso-Occlusive Events in the United States.

Gene therapies for sickle cell disease (SCD) may offer meaningful benefits for patients and society. This study evaluated the cost-effectiveness of lovotibeglogene autotemcel (lovo-cel), a one-time gene therapy administered via autologous hematopoietic stem cell transplantation, compared with common care for patients in the United States (US) with SCD aged ≥12years with ≥4 vaso-occlusive events (VOEs) in the past 24months. We developed a patient-level simulation model accounting for lovo-cel and SCD-related events, complications, and mortality over a lifetime time horizon. The pivotal phase1/2 HGB-206 clinical trial (NCT02140554) served as the basis for lovo-cel efficacy and safety. Cost, quality-of-life, and other clinical data were sourced from HGB-206 data and the literature. Analyses were conducted from US societal and third-party payer perspectives. Uncertainty was assessed through probabilistic sensitivity analysis and extensive scenario analyses. Patients treated with lovo-cel were predicted to survive 23.84years longer on average (standard deviation [SD], 12.80) versus common care (life expectancy, 62.24 versus 38.40years), with associated discounted patient quality-adjusted life-year (QALY) gains of 10.20 (SD, 4.10) and direct costs avoided of $1,329,201 (SD, $1,346,446) per patient. Predicted societal benefits included discounted caregiver QALY losses avoided of 1.19 (SD, 1.38) and indirect costs avoided of $540,416 (SD, $262,353) per patient. Including lovo-cel costs ($3,282,009 [SD, $29,690] per patient) resulted in incremental cost-effectiveness ratios of $191,519 and $124,051 per QALY gained from third-party payer and societal perspectives, respectively. In scenario analyses, the predicted cost-effectiveness of lovo-cel also was sensitive to baseline age and VOE frequency and to the proportion of patients achieving and maintaining complete resolution of VOEs. Our analysis of lovo-cel gene therapy compared with common care for patients in the US with SCD with recurrent VOEs estimated meaningful improvements in survival, quality of life, and other clinical outcomes accompanied by increased overall costs for the health care system and for broader society. The predicted economic value of lovo-cel gene therapy was influenced by uncertainty in long-term clinical effects and by positive spillover effects on patient productivity and caregiver burden.

Pediatric tympanostomy tube assessment via deep learning

PurposeTympanostomy tube (TT) placement is the most frequently performed ambulatory surgery in children under 15. After the procedure it is recommended that patients follow up regularly for “tube checks” until TT extrusion. Such visits incur direct and indirect costs to families in the form of days off from work, copays, and travel expenses. This pilot study aims to compare the efficacy of tympanic membrane (TM) evaluation by an artificial intelligence algorithm with that of clinical staff for determining presence or absence of a tympanostomy tube within the TM. MethodsUsing a digital otoscope, we performed a prospective study in children (ages 10 months–10 years) with a history of TTs who were being seen for follow up in a pediatric otolaryngology clinic. A smartphone otoscope was used by study personnel who were not physicians to take ear exam images, then through conventional otoscopic exam, ears were assessed by a clinician for tubes being in place or tubes having extruded from the TM. We trained and tested a deep learning (artificial intelligence) algorithm to assess the images and compared that with the clinician's assessment. ResultsA total of 123 images were obtained from 28 subjects. The algorithm classified images as TM with or without tube in place. Overall classification accuracy was 97.7 %. Recall and precision were 100 % and 96 %, respectively, for TM without a tube present, and 95 % and 100 %, respectively, for TM with a tube in place. DiscussionThis is a promising deep learning algorithm for classifying ear tube presence in the TM utilizing images obtained in awake children using an over-the-counter otoscope available to the lay population. We are continuing enrollment, with the goal of building an algorithm to assess tube patency and extrusion.

Asian Advantage: Leveraging Logistics for Peak Performance in Efficiency, Effectiveness, Cost, Quality, and Differentiation

The significance of logistics administration in the contemporary, fast-paced business environment has significantly transformed the way organizations operate. This study investigates the interconnected impacts of logistics efficacy, efficiency, cost, quality, and differentiation on the performance of businesses. An in-depth analysis is employed to examine the effect of various logistics management facets on the financial and operational outcomes of a business. Efficient logistics assesses the functionality of supply chains through the optimization of resources and the refining of processes, whereas successful logistics evaluates the ability to promptly and precisely fulfill consumer demands. Through the consideration of both direct and indirect costs, logistics cost analysis assesses the financial impact of logistics operations. Logistics quality examines the reliability, security, and precision of logistical processes, whereas logistics differentiation explores the ways in which unique logistical strategies set an organization apart from its competitors. The objective of this study is to examine the intricate relationships among various performance metrics and these logistics variables. To achieve this, empirical research and statistical modeling are utilized. With the intention that they will assist managers in making more informed decisions and guide businesses toward enhancing their logistics management procedures so that they may flourish in a dynamic marketplace. In order to thrive in the contemporary global marketplace, businesses must recognize the criticality of logistics in shaping organizational results and devise strategies to capitalize on the synergies that exist between these components.

Healthcare spending versus mortality in central nervous system cancer: Has anything changed?

The financial implications of central nervous system (CNS) cancers are substantial, not only for the healthcare service and payers, but also for the patients who bear the brunt of direct, indirect, and intangible costs. This study sought to investigate the impact of healthcare spending on CNS cancer survival using recent US data. This study used public data from the Disease Expenditure Project 2016 and the Global Burden of Disease Study 2019. The primary outcome was the annual healthcare spending trend from 1996 and 2016 on CNS tumors adjusted for disease prevalence, alongside morbidity and mortality. Secondary outcomes included drivers of change in healthcare expenditures for CNS cancers. Subgroup analysis was performed stratified by age group, expenditure type, and care type provided. There was a significant increase in total healthcare spending on CNS cancers from $2.72 billion (95% CI: $2.47B to $2.97B) in 1996 to $6.85 billion (95% CI: $5.98B to $7.57B) in 2016. Despite the spending increase, the mortality rate per 100 000 people increased, with 5.30 ± 0.47 in 1996 and 7.02 ± 0.47 in 2016, with an average of 5.78 ± 0.47 deaths per 100 000 over the period. The subgroups with the highest expenditure included patients aged 45 to 64, those with private insurance, and those receiving inpatient care. This study highlights a significant rise in healthcare costs for CNS cancers without corresponding improvements in mortality rate, indicating a mismatch of healthcare spending, contemporary advances, and patient outcomes as it relates to mortality.

The local economic impacts of mega nuclear accident: A synthetic control analysis of Fukushima

The economic impacts of mega accidents are complex, and accurately quantifying these impacts poses a formidable challenge. Traditional methods often fall short in capturing the extensive consequences of such infrequent disasters, which may go beyond immediate damages to include long-term economic disruptions and indirect costs. This study sheds a light on the economic aftermath of the Fukushima nuclear disaster. Utilizing the synthetic control method (SCM), our analysis reveals a significant, albeit temporary, downturn in the economic performance of the affected region. Specifically, the prefectural per capita income of Fukushima declines by up to 14.4% in the two years following the disaster. This decrease is linked to the composition of Fukushima's GDP and a reduction in labor supply. Our findings demonstrate the effectiveness of SCM as a potent tool for performing counterfactual analyses of mega accidents, offering essential insights into their economic impacts and the pathways to recovery.

Catastrophic costs for tuberculosis patients in India: Impact of methodological choices.

As financial risk protection is one of the goals towards universal health coverage, detailed information on costs, catastrophic costs and other economic consequences related to any disease are required for designing social protection measures. End Tuberculosis (TB) Strategy set a milestone of achieving zero catastrophic cost by 2020. However, a recent literature review noted that 7%-32% TB affected households in India faced catastrophic cost. Studies included in the review were small scale cross-sectional. We followed a cohort of 1482 notified drug-susceptible TB patients from four states in India: Assam, Maharashtra, Tamil Nadu, and West Bengal to provide a comprehensive picture of economic burden associated with TB treatment. Treatment cost was calculated using World Health Organization guidelines on TB patient cost survey and both human capital and output approaches of indirect cost (time, productivity, and income loss related to an episode) calculation were used to provide the range of households currently facing catastrophic cost. Depending on choice of indirect cost calculation method, 30%-61% study participants faced catastrophic cost. For over half of them, costs became catastrophic even before starting TB treatment as there was average 7-9 weeks delay from symptom onset to treatment initiation which was double the generally accepted delay of 4 weeks. During that period, they made average 8-11 visits to different providers and spent money on consultations, drugs, tests, and travel. Following the largest cohort of drug-susceptible TB patients till date, the study concluded that a significant proportion of study participants faced catastrophic cost and the proportion was much higher when income loss was considered as indirect cost calculation method. Therefore, ensuring uninterrupted livelihood during TB treatment is an absolute necessity. Another reason of high cost was the delay in diagnosis and costs incurred during pre-diagnosis period. This delay and consequently, economic burden, can be reduced by both supply side (intense private sector engagement, rapid diagnosis) and demand side (community engagement) initiatives. Reimbursement of expenses incurred before treatment initiation could be used as short-term measure for mitigating financial hardship.

Estimating the cost due to resistance against antiretroviral therapies in individuals with HIV: Perspective of the Kingdom of Saudi Arabia

ObjectivesThe emergence of resistance to antiretroviral therapy (ART) has an impact on the cost of HIV care. This study aimed to estimate the direct and indirect costs associated with the first episode of drug resistance in individuals with HIV receiving first-line ART. MethodsWe developed a cost calculator to estimate the cost of drug resistance over a period of 12 months in the Kingdom of Saudi Arabia. The model inputs (estimated using expert opinion and publicly available sources) included costs associated with testing for resistance, adverse events of a new regimen, and indirect costs. ResultsThe direct and indirect medical expenses for the year resistance developed were 6980 Saudi Arabian riyal (SAR) and SAR 2862, respectively. The addition of the cost of new ARTs would increase the total annual costs (between SAR 5174 and SAR 34,265 per patient). One-way sensitivity analysis also reported significant impact of initial and switching therapies used after resistance develops on the total costs of resistance per year. ConclusionsThere is a significant cost burden associated with drug resistance, which emphasizes the need to select an appropriate initial ART regimen that has a strong genetic barrier and conduct pre-treatment resistance tests (if possible).

Work Productivity and Activities of Daily Living in Working Patients with Uveitis

ABSTRACT Purpose To assess self-reported impairment of work productivity and activities of daily living and the indirect costs of absenteeism in a sample of working patients with uveitis and to examine their association with sociodemographic, occupational, and clinical variables. Methods We conducted a cross-sectional, cross-association study. Participants completed the self-administered Work Productivity and Activity Impairment Questionnaire uveitis 2.0 to assess absenteeism, presenteeism, overall work impairment, and impairment in activities of daily living. Clinical data were collected from the patients’ medical records or instruments used to evaluate clinical parameters in practice. Indirect costs of absenteeism were assessed by the “lost wages method.” Two clinical groups were established for this study. Bivariate and multivariate analyses were performed to assess the associations between variables. Results The final sample comprised 60 participants. Factors significantly associated with increased overall work impairment in the multivariate linear regression analysis were active uveitis (coefficient, 31.5; 95% confidence interval [CI], 16.1 to 46.9; p < 0.001) and presence of ocular comorbidities (coefficient for absence, −16.4; 95% CI, −31.1 to −1.8; p = 0.03). Factors significantly associated with increased impairment in activities of daily living were active uveitis (coefficient, 32.1; 95% CI, 18.2 to 46.0; p < 0.001), presence of ocular comorbidities (coefficient for absence, −23.5; 95% CI, −36.1 to −11.0; p < 0.001), and absence of nonocular comorbidities (coefficient 16.1; 95% CI, 3.9 to 28.3; p = 0.01). Conclusions Active uveitis and ocular comorbidities are significantly associated with increased overall work impairment and impairment in activities of daily living in working patients with uveitis.

P058 A service evaluation of rheumatologist-led ultrasound clinics at a tertiary care centre

Abstract Background/Aims Rheumatologist-led ultrasound (USG) clinics were established at UCLH over 10 years ago with an intention to improve speed of diagnosis and/or execution of treatment plan with the benefit of clinical assessment and diagnostic imaging in one appointment. The benefits for patients may include reduced time taken from work and reduced anxiety. This project aimed to evaluate reasons for referral to this clinic, the outcome of a patient review and the impact of this service. Methods Retrospective Health-record data were collected from EPIC using Google forms for patients who had USG of their hands in the specialist clinics for 3 months (Jan - March 2022). Data included patient demographics, clinical data, USG findings, intended change or initiation of treatment, and outcome of the review. Results 54 patients had been reviewed in the three months. More than half (61%) were referred to help answer a treatment-related question and the remaining were to confirm diagnosis (39%). Most patients referred for diagnosis had their diagnosis confirmed (86%). Majority (62%) also had appropriate follow up and two were discharged; a further six had potential to be discharged at this time. Out of the 33 referred for treatment questions, there were 23(70%) patients who needed no change to their treatment; 15(65%) of these would have potentially been initiated on biologics otherwise. This resulted in potential savings of between £76,497-£107,601 per 6-month (trial of DMARD) period due to drug cost. Table 1 lists potential indirect savings. Conclusion This service evaluation found considerable direct and indirect savings that emphasises the need for such specialist service in the cost-strapped NHS. The direct cost savings relate to the drugs that were not required to be initiated, with the majority attributed to the avoidance of biologics. In addition to the indirect cost savings to the NHS , the reduction of risk to the patient of unnecessary immunosuppression remains undefined. As a result of this service evaluation, to enhance potential discharges from this clinic, referring clinicians manage patient expectations at referral and communicatepotential for discharge at referral to the scanning clinician. Disclosure A. Zmuda: None. J. Manson: None. M. Castelino: None.

The potential of global coastal flood risk reduction using various DRR measures

Abstract. Coastal flood risk is a serious global challenge facing current and future generations. Several disaster risk reduction (DRR) measures have been posited as ways to reduce the deleterious impacts of coastal flooding. On a global scale, however, efforts to model the future effects of DRR measures (beyond structural) are limited. In this paper, we use a global-scale flood risk model to estimate the risk of coastal flooding and to assess and compare the efficacy and economic performance of various DRR measures, namely dykes and coastal levees, dry-proofing of urban assets, zoning restrictions in flood-prone areas, and management of foreshore vegetation. To assess the efficacy of each DRR measure, we determine the extent to which it can limit future flood risk as a percentage of regional GDP to the same proportional value as today (a “relative risk constant” objective). To assess their economic performance, we estimate the economic benefits and costs of implementing each measure. If no DRR measures are implemented to mitigate future coastal flood risk, we estimate expected annual damages to exceed USD 1.3 trillion by 2080, directly affecting an estimated 11.5 million people on an annual basis. Low- and high-end scenarios reveal large ranges of impact uncertainty, especially in lower-income regions. On a global scale, we find the efficacy of dykes and coastal levees in achieving the relative risk constant objective to be 98 %, of dry-proofing to be 49 %, of zoning restrictions to be 11 %, and of foreshore vegetation to be 6 %. In terms of direct costs, the overall figure is largest for dry-proofing (USD 151 billion) and dykes and coastal levees (USD 86 billion), much more than those of zoning restrictions (USD 27 million) and foreshore vegetation (USD 366 million). These two more expensive DRR measures also exhibit the largest potential range of direct costs. While zoning restrictions and foreshore vegetation achieve the highest global benefit–cost ratios (BCRs), they also provide the smallest magnitude of overall benefit. We show that there are large regional patterns in both the efficacy and economic performance of modelled DRR measures that display much potential for flood risk reduction, especially in regions of the world that are projected to experience large amounts of population growth. Over 90 % of sub-national regions in the world can achieve their relative risk constant targets if at least one of the investigated DRR measures is employed. While future research could assess the indirect costs and benefits of these four and other DRR measures, as well as their subsequent hybridization, here we demonstrate to global and regional decision makers the case for investing in DRR now to mitigate future coastal flood risk.

Direct and indirect costs for patients with myeloproliferative neoplasms

Myeloproliferative neoplasms (MPNs) are associated with substantial healthcare resource use and productivity loss. This retrospective cohort analysis used disability leave and medical claims data to measure direct and indirect healthcare costs associated with MPNs. The analysis included 173 patients with myelofibrosis (MF), 4477 with polycythemia vera (PV), 6061 with essential thrombocythemia (ET), and matched controls (n = 519, n = 13,431, and n = 18,183, respectively). Total healthcare costs were significantly higher for cases versus controls in each cohort (mean cost difference: MF, $67,456; PV, $10,970; ET, $22,279). Cases were more likely than controls to take disability leave and incurred higher disability-related costs. Among subgroups with thrombotic events, direct and indirect costs were higher for cases versus controls. Thrombotic events substantially increased direct costs and disability leave for patients with PV or ET compared with the full PV or ET cohorts. These findings demonstrate increased economic burden for patients with MPNs.

Economic burden assessment for the management of asthma patients at Mexico's National Institute for Respiratory Diseases

Determinar la carga económica anual del asma, desde una perspectiva institucional y con base en la clasificación recomendada por GINA, en una cohorte retrospectiva de adultos atendidos en el Instituto Nacional de Enfermedades Respiratorias (INER) de México. Estudio observacional, longitudinal y retrospectivo, llevado a cabo a partir de la información recabada de 247 pacientes femeninas con asma. Se estimaron los costos directos anuales: visitas, pruebas de laboratorio, tratamiento farmacológico y de las crisis o exacerbaciones, para determinar la carga anual de la enfermedad desde una perspectiva institucional, y según la clasificación de la Iniciativa Global para el Asma. El costo promedio anual fue de $43,813,92, que aumentó en relación con la necesidad de aumento de dosis de corticoides inhalados y beta-agonistas de acción prolongada. El costo promedio de la consulta médica fue de $2004.57, $982.82 por gestión de crisis y $2645.95 por pruebas de laboratorio. El tratamiento farmacológico representó la principal carga económica, con un costo promedio anual de $38,180.58. Los resultados resaltan una carga económica del asma estimada en un costo anual por paciente de $43,813.92 MXN (DE=93,348.85), en el contexto del tercer nivel de atención en el sistema de salud público mexicano. La gravedad del asma, los tratamientos y los biológicos fueron los principales factores que aumentaron los costos directos de la atención.

Economic Burden of Itch-Related Sleep Loss in Moderate-to-Severe Atopic Dermatitis in the United Kingdom.

Atopic dermatitis is associated with intense itch, which has been shown to cause sleep disruption that significantly impacts the lives of patients with atopic dermatitis. Despite this, little is known about its burden to the healthcare system and society. This study aimed to quantify the economic burden of itch-related sleep loss in moderate-to-severe atopic dermatitis in the UK. A literature-based decision-analytic model was developed from a healthcare payer and societal perspective. The model quantifies the economic burden by linking the severity of itch to the number of days of sleep disruption. The model captures the direct costs of healthcare resource utilization and treatment alongside the indirect costs of productivity loss from absenteeism and presenteeism at work over a 5-year time horizon. The patient population considered was patients aged ≥ 15 years with moderate-to-severe atopic dermatitis and itch-related sleep disruption. The model estimated that itch-related sleep disruption as a result of moderate-to-severe atopic dermatitis would affect an average of 821,142 people over the time horizon (2022 to 2026). This translates into an average net economic burden of £3.8 billion (£4687 per patient), with an average of 172 million days being affected by sleep disruption per year in the UK. The greatest contributor to the annual average net economic burden was productivity loss from absenteeism and presenteeism, each accounting for 34%. The direct costs (treatment costs and healthcare resource use) accounted for 32% of the net economic burden. The results showed a high and gradually increasing economic burden over the 5-year time horizon. Sleep disruption has a high economic burden and reducing itch may provide substantial direct and indirect savings. Quantifying the economic burden of itch-related sleep loss may provide support for analyses to inform public health policies for treatment of atopic dermatitis, particularly within the moderate-to-severe level.

Value contribution of blood-based neurofilament light chain as a biomarker in multiple sclerosis using multi-criteria decision analysis.

Multiple sclerosis (MS) is a chronic autoimmune demyelinating disease that represents a leading cause of non-traumatic disability among young and middle-aged adults. MS is characterized by neurodegeneration caused by axonal injury. Current clinical and radiological markers often lack the sensitivity and specificity required to detect inflammatory activity and neurodegeneration, highlighting the need for better approaches. After neuronal injury, neurofilament light chains (NfL) are released into the cerebrospinal fluid, and eventually into blood. Thus, blood-based NfL could be used as a potential biomarker for inflammatory activity, neurodegeneration, and treatment response in MS. The objective of this study was to determine the value contribution of blood-based NfL as a biomarker in MS in Spain using the Multi-Criteria Decision Analysis (MCDA) methodology. A literature review was performed, and the results were synthesized in the evidence matrix following the criteria included in the MCDA framework. The study was conducted by a multidisciplinary group of six experts. Participants were trained in MCDA and scored the evidence matrix. Results were analyzed and discussed in a group meeting through reflective MCDA discussion methodology. MS was considered a severe condition as it is associated with significant disability. There are unmet needs in MS as a disease, but also in terms of biomarkers since no blood biomarker is available in clinical practice to determine disease activity, prognostic assessment, and response to treatment. The results of the present study suggest that quantification of blood-based NfL may represent a safe option to determine inflammation, neurodegeneration, and response to treatments in clinical practice, as well as to complement data to improve the sensitivity of the diagnosis. Participants considered that blood-based NfL could result in a lower use of expensive tests such as magnetic resonance imaging scans and could provide cost-savings by avoiding ineffective treatments. Lower indirect costs could also be expected due to a lower impact of disability consequences. Overall, blood-based NfL measurement is supported by high-quality evidence. Based on MCDA methodology and the experience of a multidisciplinary group of six stakeholders, blood-based NfL measurement might represent a high-value-option for the management of MS in Spain.

Game theoretical analysis of incumbent platform investment and the supplier entry strategies in an e-supply chain

We investigate the interaction of platform investment strategy and a supplier entry strategy in an e-supply chain with a supplier and two e-commerce platforms. In addition to selling through the incumbent platform, the supplier may enter the entrant platform. The incumbent platform may prevent this by investing in the supplier to reduce production costs (indirect investment) or investing in its value-added service to enhance its own demand (direct investment). We analyze the incumbent platform's investment strategy with and without supplier entry to the entrant platform. Without entry, the incumbent platform prefers indirect investment only when the production cost is high and the indirect investment cost is low. With entry, however, the incumbent platform prefers indirect investment when the direct investment cost is high. We also explore the effect of the incumbent platform's investment strategy on the supplier's entry strategy. Counterintuitively, we find that direct investment by the incumbent platform increases the supplier's incentive to enter the entrant platform. Under certain conditions, the incumbent platform can effectively prevent this entrance through an indirect investment strategy. Even if the supplier enters the entrant platform, it is optimal for the incumbent platform to maintain investment. Furthermore, we further extend that the two platforms have the same commission rate to the case where the two platforms have different commission rates and show that the main results still hold. We have also expanded the situation where both platforms have investments. Interestingly, we find that when the production cost is high, the supplier's entry into the entrant platform and the entrant platform's indirect investment may benefit the incumbent platform.

The indirect costs of vaccine-preventable cancer mortality in the Middle East and North Africa (MENA)

Background Infections are responsible for ∼13% of cancer cases worldwide, with human papillomavirus (HPV) and hepatitis B (HBV) among the infections associated with cancer for which vaccines are available. The aim of this study was to estimate the indirect cost of premature mortality related to cancers caused by HPV and HBV in Middle East and North Africa (MENA) countries. Methods The number of deaths and years of life lost (YLL) in 2019 from four HPV-related cancers: cervical cancer, oral cavity cancer, laryngeal cancer, and oropharynx cancer, as well as HBV-related liver cancer were sourced from the Institute for Health Metrics Evaluation (IHME) Global Burden of Disease database. HPV-attributable fractions were applied to deaths and YLL. The human capital approach was used to measure productivity loss, through value of YLL (VYLL), and estimated using gross domestic product per capita (World Bank; in USD). Seventeen countries in the MENA region were included. Four countries in the region were not included due to data availability. Results In 2019, there were 11,645 potentially vaccine-preventable cancer-related deaths across the MENA region. This resulted in an indirect cost of $1,688,821,605, with 76.1% of this accrued in the Middle East ($1,284,923,633). The number of deaths in the Middle East (5,986) were similar to Northern Africa (5,659) but YLL were higher in Northern Africa (179,425) compared to the Middle East (169,207). The highest indirect cost per death occurred in Qatar ($1,378,991), compared to $14,962 in Sudan. Oral cavity cancer had the highest VYLL per death ($186,084). Conclusions There is a high burden of premature mortality and indirect costs of potentially vaccine-preventable cancer-related deaths in the MENA region. Improved vaccination program implementation, increased vaccine coverage of HPV and HBV vaccinations, and continued prioritization of public health measures, such as screening, could effectively reduce premature mortality and associated costs.

Burden and indirect cost of vaccine-preventable cancer mortality in Europe

Background The economic and mortality burden of cancer is high worldwide. In Europe, cancer was responsible for 1.3 million deaths in 2020 and incurred an estimated cost of €50 billion from premature mortality. Human papillomavirus (HPV) and hepatitis B virus (HBV) are among the leading causes of infection-related cancers despite the availability of effective vaccines against these infections. This analysis estimated the mortality and productivity loss of HBV- and HPV-associated cancers that could be preventable through vaccination across European regions. Materials and methods Institute for Health Metrics Evaluation (IHME) data were used to estimate mortality, years of life lost (YLL), and the value of years of life lost (VYLL) from five HBV- and HPV-related cancers (oral cavity, oropharynx, larynx, cervical, and liver cancers) across 40 European countries in 2019. Preventable deaths and YLL were estimated based on fractions attributable to infections. Data from the World Bank on GDP per capita were used to estimate the VYLL. The robustness of these results was explored with sensitivity and scenario analyses. Results In 2019, 31,906 cancer deaths resulted in an economic burden of €18,521,614,725 due to productivity losses across Europe. HPV-related cervical cancer had the highest mortality (19,473 deaths) and economic burden (€10,706,253,185). HBV-related liver cancer and HPV-related larynx, oral cavity, and oropharynx cancers also had a substantial burden, particularly in males. Eastern Europe had the highest YLL (308,179; 39%) and Western Europe was responsible for the greatest VYLL (€8,281,306,504; 45%), although the highest VYLL per death was in Northern Europe (€923,638). HPV-related oropharynx cancer had the highest VYLL per death (€656,607). Conclusion HPV- and HBV-related cancer deaths are associated with substantial mortality and productivity losses in Europe, which could be reduced by the continued prioritization and implementation of prophylactic public health measures including systematic awareness, vaccination, and screening efforts.

Scaling law method for cost estimation of Indonesia’s first HTGR (PeLUIt-40) and its implementation strategy

The Indonesian government has planned to build its first high-temperature gas reactor (HTGR), PeLUIt-40. A lack of estimates for PeLUIt-40′s costs hamper planning and implementation. Therefore, research is needed to determine the cost of PeLUIt-40 and develop an implementation strategy. Cost estimation is done using the scaling law method. The estimated cost for FOAK PeLUIt-40 is 215.83 million USD for investment, 14.20 million USD for annual O&M, 5.32 million USD for annual fuel and transportation, and 6.16 million USD for decommissioning costs. Using FOAK PeLUIt-40 for electricity generation produces an LCOE in the range of 37.82 to 11 cents USD/kWh. The LCOE value is lower than the diesel power plant's generation cost, which is 39.86 cents USD/kWh and produces an NPV of 15.94 million USD. Some implementation strategies can be made to make PeLUIt-40 more economically feasible, i.e., increasing NOAK from PeLUIt-40, providing incentives by the government, and adjusting PeLUIt-40′s technology grade. The results indicate that the strategies significantly impact the feasibility of PeLUIt-40 implementation. A sensitivity analysis was also conducted by changing the portion of indirect costs of FOAK HTGR to 77% of the direct costs and changing the discount rate from 10% to 3%. The discount rate change makes the LCOE of PeLUIt-40 range from 37.82 to 11 cents USD/kWh, NPV from 15.94 million USD to 871.45 million USD, and IRR from 10.75% to 37.87%.

Automotive Remanufacturing Capability for End of Life Vehicle (ELV) in Malaysia

The Malaysia Automotive Remanufacturing Roadmaps (MAAR) outline policies and technologies to transform the automotive used part sector into remanufacturing. Remanufacturing processes offer significant benefits, hence the need for transformation, despite the substantial availability of used automotive products. The automotive industry in Malaysia has experienced considerable growth and development, leading manufacturers to incorporate remanufacturing into their business operations. Recently, research has concentrated on end-of-life vehicle (ELV) management. Malaysia has no specific period for the end-of-life (ELV) regulation policy. It is essential to consider the proper disposal of these vehicles once they have reached the end of their useful life. The number of abandoned cars is increasing, leading to significant costs for society regarding removal and disposal expenses and other indirect costs due to environmental degradation. Addressing this issue will positively impact both the environment and the economy. This study explores how industries’ capabilities can face sustainability goals under the National Automotive Policy (NAP) 2020 and gain insights into how the remanufacturing process works. Therefore, it is imperative to establish remanufacturing as a norm within automotive practices.