Local Tariff Research Articles

PSY57 - A COMPARISON BETWEEN ON DEMAND USAGE OF RFVIIA VS PROPHYLAXIS USE OF EMICIZUMAB IN HIGH TITER INHIBITORY HEMOPHILIA A PATIENTS IN IRAN; A COST UTILITY ANALYSIS

Hemophilia A is an inherited X-linked bleeding disease with incidence of one in 5000 male birth. Treatment of Hemophilia is extremely expensive especially for high titer inhibitory patients. The current standard of care in Iran primarily involves on demand usage of BPAs like rFVIIa. This study evaluate the cost-effectiveness of Emicizumab compared with rFVIIa. A life time markov model with societal perspective run for patients with different age and different ABRs. Clinical efficacy, safety, route of administration and dosage considerations were extrapolated from literature for both Emicizumab and rFVIIa. Clinical management practice in Iran was obtained from clinician interviews and audit data from Mofid Hospital. Costs calculated based on official local tariff prices and utilities were taken from publications. Age dependent weight and adjusted life table were used. One way deterministic sensitivity analysis and budget impact analysis were performed. Life time delta cost for one patient with ABR 25 and age 12 at starting point (base case) was €-2.15 million and delta QALY was 6.85. Delta cost for patient with ABR 15 and age 12 was € -0.56 million and for ABR 14 was €-46472, for ABR 13 and below the cost was positive with a higher ICER. In patients with age 2 at start point, ABR 15, and in patients with age 20, ABR 16, resulted to delta cost of €255045 and €75707 and delta QALY of 8.6 & 6.7 respectively. The results sensitivity to each parameter change evaluated and in base case, Emicizumab remained dominant in all scenarios. The budget impact for one year use of Emicizumab for each patient with ABR 15, 20 and 25 were €-47876, €-94465 and €-128150 respectively. Emicizumab prophylaxis is a dominant choice for Iranian inhibitory hemophilia patients with ABR 16 and above with considerable cost saving.

Asymmetry in Priority Perception Form Local Community to PA – Budgeting through Citizen Participation (Municipality of Elbasan)

Abstract Considering several developments recently, especially at local self-government level, on budget design and application, we can notice that citizens have a deeply different perception on local PA performance than this last itself. Local government continuously claims their increasing performance, especially on accountability processes, even measuring it through effectiveness and efficiency of their investments as well as number and size of public services offered to the local community. Their pay-offs are not far of being glorious and making happy everybody taking notice on the presentation. While, on the other side, citizens of the same community have a far different view and estimation on this regard. They complain on communication, quality of public services, distribution quality of investments, division of local budget through sectors, till that point to refuse paying local taxes and tariffs, as well as burning career of “highly performance” local leaders (mayors) voting ‘no’ on elections not considering their ‘glorious increasing performance’ during the governmental mandate. Introducing citizen participation in a process of budget decision making in local self-government, especially during priority selection stage, as well as budgeting an important part of the local budget through common decision making – PA and community representativeness, analysing, first, the state of nature through adverse pricing or asymmetry reduction, both in their perception on prioritization, as well as estimating investments to each priority through independent estimation by each participator in a common Committee PA&citizens, Participatory Budgeting Committee, and second, presenting their project proposal, as well as defending it in front of the City Council, could produce a far better perceived performance by both sides.

Techno-economic evaluation of a community-based hybrid renewable energy system considering site-specific nature

In order to mitigate the environmental pollution and ease the energy consumption intensity, the integration of renewable energy sources (RES) and combined heating and power (CHP) system is expected to be widely applied throughout the world. This paper proposes a hybrid distributed energy resources (DER) system integrating CHP, photovoltaic (PV) and wind power, to handle the electrical and thermal load for residential buildings. The system economic, technical and environmental performance is analyzed in seven typical Chinese cities based on various evaluation indicators. Moreover, a non-renewable grid-connected energy system is assessed as a reference system. It is found that the optimized DER system not only meets load supplying, but also effectively minimizes emissions and system lifetime costs. DER systems are of great advantages over reference systems in almost all optimal evaluations, especially in Beijing, Wuhan, Shanghai and Nanjing. Sensitivity analysis indicates that the economic performance of DER system will become better with increase feed-in tariff, decrease local grid tariff and natural gas price. The impacts of subsidy coefficient and loan ratio on return on investment are more significant than other factors.

PHP94 - Budget Impact Model of Low Chloride Balanced Intravenous Solutions in Patients with Systemic Inflammatory Response Syndrome from a Hospital Perspective in Colombia

The study aimed to assess the budget impact of increasing usage of low chloride balanced solutions (BAL) for IV fluid therapy on costs of fluids and avoidance of fluid-related adverse outcomes in patients with systemic inflammatory response syndrome (SIRS) from a hospital perspective in Colombia. An Excel®-based budget impact model was adapted to assess the impact of increased usage of BAL in SIRS patients versus current IV fluid practice on the costs of IV fluids and fluid-related complications in a hypothetical hospital with 300 beds and 47 patients with SIRS per month. Two scenarios were compared, a baseline scenario which assumed 2% of patients were treated with BAL and an alternate scenario with a BAL adoption of 5% in Year 1, 8% in Year 2, 12% in Year 3, 16% in Year 4 and 20% in Year 5. Complication frequencies of SIRS were adapted from a single observational study. Cost of IV fluids and SIRS complications (length of stay, medication, procedures, professional services and diagnostic costs) were obtained from a literature search of Colombian studies, local national tariffs and expert opinion. All values were reviewed and validated by experts. With BAL adoption increasing progressively each year, a hypothetical Colombian hospital with 300 beds and 47 SIRS patients per month would produce cumulative savings of 78 million Colombian pesos (COP) in Year 1, 235 million COP by Year 2, 495 million COP by Year 3, 860 million COP by Year 4 and 1.33 billion COP by Year 5. The adoption of BAL could produce savings for a Colombian hospital due to a reduction in SIRS-related complications and their associated costs.

Wind resource assessment and economics of electric generation at four locations in Sinai Peninsula, Egypt

Abstract The most attractive source of clean energy is the wind power; it is also a potentially valuable source of sustainable energy in the world in general and in Egypt in particular. Egypt's energy resources are limited in oil and petroleum products and it has large reserves of natural gas, the current projects are very massive. Nowadays, the increase in demand of energy of the country is mainly due to rapid expansion of industrial projects and the economic growth, particularly, in Suez Canal area and Sinai Peninsula. This study presents a realistic approximation of wind as a promising renewable source for electricity production along the coastal southern regions in Sinai Peninsula. Where an integrated analysis was made of the wind characteristics plus accurate estimation of the wind power potential per month and per season at different heights 10–50 m AGL for the selected locations along Gulf of Suez and Gulf of Aqaba at northern Red Sea namely: Ras Seder, Abu Redis, El Tor and Nabq. The average wind speed was obtained annually to be 8.6, 6.3, 5.8 and 8.0 m/s at altitude 50 m, respectively. According to the applied method, accurate estimation of the wind power density was done. The results confirmed that the two sites Ras Seder and Nabq are absolutely the best, which have annually available wind energies over 314 and 249 kWh/m2 at 50 m, respectively. Consequently, they can be evaluated as an international regions for electric power generation by the inshore wind. The project of installing 580 MW class inshore wind farms at the four locations has been examined and that requires due attention from the policy makers and the foreign investors. The proposed wind projects will produce 2335 GWh of electricity per year which is more than the needs of the country. The generation cost per kWh at these locations varies from 1.84 to 4.22 US cent. This expected cost of electric generation by the wind is less than the local tariff of electricity which will be produced by other ways during the financial year 2017/2018 according to the announcement the Egyptian Ministry of Electricity. In addition, this venture will reduce domestic fossil fuel consumption in Egypt and can prevent thousands of tons of carbon emissions every year which entering into the local atmosphere.

Location-aware multi-objective optimization for energy cost management in semi-public buildings using thermal discomfort information

Owing to the large size and dynamic environment in semi-public buildings, reducing energy consumption while providing desirable comfort to users, is challenging. Setting air conditioning systems to a fixed temperature, based on user demands and limited experience, leads to steep increase in costs for building operators. Seasonal changes in local energy tariff further impact costs, eventually affecting the comfort rendered to users. Moreover, indoor environments in buildings vary over regions and a one-size-fits-all approach for cost management may no longer be applicable. In this regard, we propose an adaptive multi-objective optimization model, capable of delivering customized thermal settings in buildings based on geographical location and its influence on user preferences, government regulations and energy pricing. Energy cost is based on the non-linear relation of cost with energy consumed, which is consecutively modelled in terms of the building-specific heat load. A customizable user comfort model developed from the well-known Fanger's model, considers personal parameters of users, further adding to the adaptability of the solution. The model is envisioned to enable building operators in determining the indoor thermal setting while fixing the highest acceptable (dis)comfort level or energy cost as per the set budget.

Energy and Economic Performance of Plant-Shaded Building Façade in Hot Arid Climate

The use of vegetated walls and intensive plantation around buildings has increased in popularity in hot and arid climates, such as those in the United Arab Emirates (UAE). This is due to its contribution towards reducing the heat gain and increasing the occupants’ comfort levels in spaces. This paper examines the introduction of plant-shaded walls as passive technique to reduce heat gain in indoor spaces as a strategy to lower cooling demand in hot arid climate of Al-Ain city. Experimental work was carried out to analyze the impact of using plantation for solar control of residential building façades in extreme summer. External and internal wall surface and ambient temperatures were measured for plant-shaded and bare walls. The study concluded that shading effect of the intensive plantation can reduce peak time indoor air temperature by 12 °C and reduce the internal heat gain by 2 kWh daily in the tested space. The economic analysis reveals a payback period of 10 years considering local energy tariff excluding environmental savings.

Assessment of hydropower potential in wastewater systems and application to Switzerland

Energy recovery through local hydropower generation is a way of coping with high electricity expenditures in wastewater systems (WWS). Installing small hydropower plants within WWS is already in some countries eligible for incentive policy mechanisms to renewable energy production. Some examples exist of hydropower units operating in wastewater treatment plants, showing that there is an interest for this type of small-hydro, but there is still a lack of awareness of its potential. This study presents a methodology to assess the potential for hydropower in wastewater systems, either upstream or downstream of wastewater treatment plants (WWTP). An algorithm was developed in two phases, first to estimate the annual electricity production in selected areas based on GIS data and the inflows to each WWTP and second to carry out an economic evaluation of the feasibility of each scheme considering local investment costs and local electricity sell tariffs. The developed method was applied to the case study of Switzerland, covering more than 41'000 km2 and approximately 8 million inhabitants. Nineteen profitable sites were identified in the country with cumulated 9.3 GWh/year of potential energy production. Among these sites, six are already equipped for hydropower production representing 3.5 GWh/year and validated the proposed methodology.

Providing primary frequency control with residential scale photovoltaic-battery systems

Decentralized photovoltaic (PV) battery systems have recently received great attention from consumers around the world. PV battery systems allow consumers to reduce their dependence on the local electricity supplier at lower or equivalent costs. However, the profitability of PV battery systems depends greatly on the local meteorological conditions and the local electricity retail tariff. In central European countries, PV battery systems generate and store less electricity in winter months due to lower irradiation. The battery, in particular, can be reserved to provide ancillary services during winter months and thereby improves the overall systems economics. In this study, a large dataset consisting of individual load profiles is used to simulate a virtual power plant which provides ancillary services during battery idle times. The results show that participants with large batteries can greatly increase their overall systems economics by participating in reserve markets. However, participants with small battery capacities may not be able to recover the additional costs for communication with the virtual power plant and are thus not suitable candidates to provide grid stabilizing services (ancillary services).

PTH-153 The Impact of an Open Access, Non-Face to Face Nurse Led Inflammatory Bowel Disease Service on Service Transformation and Patient Outcomes

Introduction Inflammatory Bowel Disease (IBD) follows an unpredictable clinical course, adversely affecting quality of life for many patients. Access to specialist IBD services is necessary in addition to routine review in the outpatient setting, when patients are often stable. Accessing these services is a considerable source of frustration amongst IBD patients. Due to the complex nature of IBD management GPs now play a relatively minor role, however often become the first point of contact. It is widely acknowledged that patients value access to specialist services. IBD specialist nurses are invaluable in providing continuity of care and bridging the gap to multidisciplinary secondary care services. By providing an open access, non-face to face nurse led IBD service, we are able to use our dataset to inform and commission service transformation and improve patient outcomes. Methods Data was extracted from a comprehensive dataset of unrestricted non-face to face interactions. This was taken from consecutive patients over a 12 month period for immunosuppression monitoring and a consecutive 3 month sample for all other data. Results The total number of consecutive contacts with the service in 12 months in the year 2015 was 4358, rising from 3000 contacts in 2014. Monitoring of immunosuppressive treatment constituted the greatest workload with 1500 contacts in 12 months from 450 patients. In a 3 month period, provision of our service avoided 20 hospital admissions, 34 accident and emergency department attendances and 110 outpatient appointments. We supported patients by issuing 120 prescriptions, organising 24 procedures, 22 multidisciplinary discussions and 12 urgent surgical reviews. This was achieved via 1600 emails, 1400 telephone calls and 1000 contacts from 400 patients using the ‘Patient Knows Best’ software, in a 12 month period. Conclusion Our dataset has enabled analysis of the workflow of an open access non-face to face service. The volume of workload demonstrates that patients highly value this form of support. The flexibility of the service has diverted pressure of immunosuppressive monitoring away from busy consultant clinics. This data has helped to inform service transformation by allowing costing on new local tariffs for non-face to face appointments. Contacts are currently tariffed at £25, regardless of time invested, value added or outcome. In the past, this has been a disincentive to seeing IBD follow ups in comparison to the tariffs attracted for new patient workflow. We estimate the tariff for each contact with the non-face to face service to be £60. Disclosure of Interest None Declared

Financial Feasibility Analysis of Water Conservation Components in Mass Housing Projects: Suburban Indian Case Review

AbstractThe green building concept has recently gained momentum, and the success of green projects to a large extent depends on the lifecycle cost. Water conservation components contribute almost 12%–15% to the capital cost of a conventional residential building. This paper aims to analyze the financial feasibility of using water conservation components by evaluating their lifecycle costs and operational savings in large mass housing projects. Four components have been evaluated for a case project located in a metropolitan suburban location in India. To analyze the benefits, two different water tariffs are considered: local corporation combined with mineralized water and well water. Lifecycle cost analysis (LCCA) suggests that, excluding the rainwater harvesting component, the significant share of cost for all other components is related to maintenance, repair, and replacement activities. Results of the analysis suggest that water components do not pay a return when a local corporation water tariff is con...

Site assessment, turbine selection, and local feed-in tariffs through the wind energy index

Since wind energy is rapidly growing, new wind farms are installed worldwide and a discussion is going on concerning the optimal political framework to promote this development. In this paper, we present a wind energy index, which is supportive for wind farm planners, operators, and policy-makers. Based on long-term and low-scale reanalysis wind speed data from MERRA and true production data, it can predict the expected wind energy production for every location and turbine type. After an in-sample and out-of-sample evaluation of the index performance, it is applied to assess the wind energy potential of locations in Germany, to compare different turbine types, and to derive the required compensation in terms of locally different feed-in tariffs. We show that in many parts of South Germany, profitability of new wind farms cannot be achieved given the current legal situation.

APPLICATION OF THERMAL ENERGY STORAGE SYSTEM FOR A LOWLAND GREENHOUSE

This article presents a study to estimate the potential saving in annual operating cost of a hypothetical greenhouse used for planting strawberry, in Johor Bahru, Malaysia. The greenhouse needs to be maintained at a constant temperature of 20°C at all time. The goal of this study is to select a suitable TES system that can save the annual cost of electricity usage to meet the cooling load requirement of the greenhouse, based on a 24 hours operating duration and local electricity tariff. Comparison is made with the annual cost for running a conventional air-conditioning (AC) system to meet the cooling requirement. The cooling load requirement of the greenhouse dictates the capacity and size of the potential TES systems, which was estimated based on the highest total annual cooling load. Three TES system operating arrangements were considered in this study: TES full storage combined with AC systems, TES full storage and TES partial storage. Among these three arrangements, the TES full storage was found to have the highest an annual cost saving of about RM 58,990 compared to the cost of using the conventional AC system alone. This represents about 68 % of annual operating cost saving, which is considered very significant.

Performance Assessment of District Cooling System Coupled with Different Energy Technologies in Subtropical Area

In the subtropical urban area with a high density of buildings, district cooling system is regarded as an efficient alternative to supply cooling to a group of buildings with high efficiency and low cost. Appropriate design can render the district cooling system to achieve good performance. This paper attempts to study the performance of the district cooling system integrated with different energy technologies in a new development area. Performance of district cooling system with thermal storage system is calculated to level the energy consumption and reduce monthly bill. Results are compared with that of hydro pumped storage system and recommendations are given about the design and control the thermal storage system under current local tariff. The performance of district cooling system integrated with the combined cooling, heating and power system is also investigated to make full use of the primary energy. Performance of the system designed based on two ways are studied. Results show that the cogeneration system is beneficial for both the investors and users. Suggestions are given to help improve the performance of the district cooling system in the new development area by coupling with different energy technologies.

Local anaesthetic wound infiltration in addition to standard anaesthetic regimen in total hip and knee replacement: long-term cost-effectiveness analyses alongside the APEX randomised controlled trials.

BackgroundThe Arthroplasty Pain Experience (APEX) studies are two randomised controlled trials in primary total hip (THR) and total knee replacement (TKR) at a large UK orthopaedics centre. APEX investigated the effect of local anaesthetic wound infiltration (LAI), administered before wound closure, in addition to standard analgesia, on pain severity at 12 months. This article reports results of the within-trial economic evaluations.MethodsCost-effectiveness was assessed from the health and social care payer perspective in relation to quality adjusted life years (QALYs) and the primary clinical outcome, the WOMAC Pain score at 12-months follow-up. Resource use was collected from hospital records and patient-completed postal questionnaires, and valued using unit cost estimates from local NHS Trust finance department and national tariffs. Missing data were addressed using multiple imputation chained equations. Costs and outcomes were compared per trial arm and plotted in cost-effectiveness planes. If no arm was dominant (i.e., more effective and less expensive than the other), incremental cost-effectiveness ratios were estimated. The economic results were bootstrapped incremental net monetary benefit statistics (INMB) and cost-effectiveness acceptability curves. One-way deterministic sensitivity analyses explored any methodological uncertainty.ResultsIn both the THR and TKR trials, LAI was the dominant treatment: cost-saving and more effective than standard care, in relation to QALYs and WOMAC Pain. Using the £20,000 per QALY threshold, in THR, the INMB was £1,125 (95 % BCI, £183 to £2,067) and the probability of being cost-effective was over 98 %. In TKR, the INMB was £264 (95 % BCI, −£710 to £1,238), but there was only 62 % probability of being cost-effective. When considering an NHS perspective only, LAI was no longer dominant in THR, but still highly cost-effective, with an INMB of £961 (95 % BCI, £50 to £1,873).ConclusionsAdministering LAI is a cost-effective treatment option in THR and TKR surgeries. The evidence, because of larger QALY gain, is stronger for THR. In TKR, there is more uncertainty around the economic result, and smaller QALY gains. Results, however, point to LAI being cheaper than standard analgesia, which includes a femoral nerve block.Trial registrationISRCTN96095682, 29/04/2010.Electronic supplementary materialThe online version of this article (doi:10.1186/s12916-015-0389-1) contains supplementary material, which is available to authorized users.

The difference between energy consumption and energy cost: Modelling energy tariff structures for water resource recovery facilities

The objective of this paper is to demonstrate the importance of incorporating more realistic energy cost models (based on current energy tariff structures) into existing water resource recovery facilities (WRRFs) process models when evaluating technologies and cost-saving control strategies. In this paper, we first introduce a systematic framework to model energy usage at WRRFs and a generalized structure to describe energy tariffs including the most common billing terms. Secondly, this paper introduces a detailed energy cost model based on a Spanish energy tariff structure coupled with a WRRF process model to evaluate several control strategies and provide insights into the selection of the contracted power structure. The results for a 1-year evaluation on a 115,000 population-equivalent WRRF showed monthly cost differences ranging from 7 to 30% when comparing the detailed energy cost model to an average energy price. The evaluation of different aeration control strategies also showed that using average energy prices and neglecting energy tariff structures may lead to biased conclusions when selecting operating strategies or comparing technologies or equipment. The proposed framework demonstrated that for cost minimization, control strategies should be paired with a specific optimal contracted power. Hence, the design of operational and control strategies must take into account the local energy tariff.

PSY25 - Economic Evaluation Of Prophylactic Treatment Vs On Demand For Moderate Hemophilia A In Colombia

Hemophilia A is a genetic disease in which there is a deficiency in the level of activity of the clotting factor VIII, the moderate form is defined as a blood clotting factor level from 0.01 to 0.05 IU/ml. The aim of this analysis is to estimate the cost-effectiveness of prophylactic treatment of moderate hemophilia A compared to demand treatment in Colombia. A decision tree model was developed using a life expectancy horizon and a societal perspective; annual discount rate of 3% was applied to costs and effectiveness measures. Prophylactic treatment with recombinant factor VIII (25 IU/kg 3 times per week) was compared to on demand treatment (40 IU/kg BID for 3.5 days for each bleeding episode). The base case was simulated based on a patient of 8 years old and weight of 31kg without inhibitors. Effectiveness and probabilities of adverse events were taken from the literature. Costs (direct and indirect) were taken from local tariff manuals (SOAT and SISMED). Effectiveness measures were number of cases avoided of bleeding, hemarthrosis and arthropathies. All data were validated with a clinical expert. Univariate sensitivity analysis was done. Costs are presented in 2013 USD (exchange rate US$1 = $ 1927 COP). Over the time horizon, prophylactic treatment avoids 277 episodes of bleeding and 23 of joint damage. Total expected costs with prophylactic treatment were US$ 2.7M compared to on demand treatment US$ 2.4M. The incremental cost effectiveness ratios (ICER) for prophylactic treatment were US$ 1,056/avoided bleeding and US$12,512/avoided hemarthrosis/arthropathies. Sensitivity analysis showed the robustness of the results (average ICER US$ 1,153/avoided bleeding). From the social perspective, prophylactic treatment of moderate hemophilia A, with recombinant factor VIII would be a highly cost-effectiveness intervention with strong health benefits in number of cases of bleeding and joint damage avoided.

The Effect of Trade Liberalization on Firm Entry and Exit in Punjab, Pakistan

This study focuses on the impact of trade liberalization on firm entry and exit in Punjab’s export manufacturing sector over the decade 2001–10. As far as the province’s export industries are concerned, real exchange rate depreciation attracts new firms but also leads weaker firms to exit. A reduction in local or international tariffs, however, has no significant impact on firm entry or exit.

Electricity cost saving comparison due to tariff change and ice thermal storage (ITS) usage based on a hybrid centrifugal-ITS system for buildings: A university district cooling perspective

In this paper, the case study of a district cooling system of a university located in a South East Asia region (lat: 01°29′; long: 110°20′E) is presented. In general, the university has high peak ambient temperature of around 32–35°C coupled with high humidity of about 85% during afternoon period. The total electricity charge for the Universiti Malaysia Sarawak Campus is very high amounting to more than $314,911 per month. In this paper, a few district cooling schemes are investigated to provide “what-if analysis” and in order to minimize the overall electricity charges. Few scenarios designed for the application of centrifugal with and without ice-thermal storage (ITS) systems on the buildings were investigated. It was found that, due to the local tariff status, marginally saving can be achieved in the range of 0.08–3.13% if a new tariff is adopted; and a total of further saving of 1.26–2.43% if ITS is operated. This marginally saving is mainly due to the local tariff conditions and lower local temperature range (ΔT) which are less favorable as compared with those reported in the literature elsewhere.

Concentrating solar power plant investment and operation decisions under different price and support mechanisms

Abstract The dispatch opportunities provided by storage-enhanced Concentrating Solar Power (CSP) plants have direct implications on the investment decisions as not only nameplate capacity but also the storage capacity and the solar multiple play a crucial role for the viability of the plant investment. By integrating additional technical aspects and operation strategies, this paper extends the optimization model proposed by Madaeni et al. , How Thermal Energy Storage Enhances the Economic Viability of Concentrating Solar Power . Using a mixed integer maximization approach the paper yields both the optimal layout decision and the operation of CSP plants. Subsequently, the economic value of CSP storage is analyzed via energy modeling of a Spanish plant location under the respective wholesale market prices as well as the local feed-in tariff. The analysis shows that investment incentives for CSP plants with storage need to appropriately account for the interdependency between the price incentives and the plant operating strategy. As the resulting revenue characteristics influence the optimal size of solar field and storage differing operating strategies also give rise to differing optimal plant layouts. Most noteworthy, the current Spanish support scheme offers only limited incentives for larger thermal storage capacity.