Lower Net Cost Research Articles

Enhanced Performance and Stability of Perovskite Solar Cells Through Surface Modification with Benzocaine Hydrochloride.

Current development of inverted p-i-n perovskite solar cells (PSCs), with nickel oxide as the hole transport layer, is progressing toward lower net costs, higher efficiencies, and superior stabilities. Unfortunately, the high density of defect-based traps on the surface of perovskite films significantly limits the photoelectric conversion efficiency and operational stability of perovskite solar cells. Finding cost-effective interface modifiers is crucial for the further commercial development of p-i-n PSCs. In the present work, we report a passivation strategy using a multifunctional molecule, benzocaine hydrochloride (BHC), which is shown to reduce defect density and enhance the photovoltaic performance and stability of the resultant p-i-n PSCs. It has been revealed that BHC strongly interacts with perovskite precursor components and triggers the evolution of the perovskite absorber film morphology and enables improved surface energy level alignment, thus promoting charge carrier transport and extraction. These properties are beneficial for improving open-circuit voltage (VOC) and fill factor (FF). Our results show that the photoelectric conversion efficiency (PCE) of p-i-n PSCs with nickel oxide as the hole transport layer increased from an initial 20.0% to 22.1% after being passivated with BHC, and these passivated devices also exhibited improved stability. DFT calculations reveal the unusual ability of the BHC passivant to improve band alignment while also preventing the accumulation of holes at the interface. In this work, the advantages of BHC passivation are demonstrated by linking theoretical calculations with optical and electrical characterizations.

Employer-Sponsored Medicare Advantage Plans and the 2018 Therapy Cap Repeal: Reduced Overall Spending Does Not Constrain Out-of-Pocket Costs.

Policy impacting traditional Medicare beneficiaries may have unintended effects for privately insured patients. After the repeal of a longstanding $1500 outpatient therapy cap in 2018, we aimed to evaluate if this policy change was associated with differences in use of cost of postoperative therapy after common hand surgeries, including carpal tunnel release, trigger finger release, ganglion cyst excision, De Quervain tenosynovitis release, carpometacarpal arthroplasty, and distal radius fracture open reduction/internal fixation or percutaneous pinning. The Medicare Supplement and Coordination of Benefits files from Marketscan were used. Frequency of therapy appointments, overall costs, and out-of-pocket costs were obtained. A segmented interrupted time series with Poisson and log-transformed linear regression was performed. No significant monthly change in odds of therapy use was found in the postpolicy period for patients who underwent trigger finger release, carpal tunnel release, Ganglion cyst excision, De Quervain tenosynovitis release, carpometacarpal arthroplasty, or distal radius fracture, pinning, or open reduction/internal fixation. Overall cost decreased in the postpolicy period by 2% for comprehensive plans (95% confidence interval [CI]: -0.03 to -0.01, P < 0.001), by 7% for those with exclusive provider organizations (95% CI: -0.10 to -0.04, P < 0.001), by 1% for HMOs (95% CI: -0.01 to 0.002, P = 0.01), and by 3% for preferred provider organizations (95% CI: -0.03 to -0.02, P < 0.001). In the postpolicy period, no monthly change in out-of-pocket cost was observed for patients with comprehensive, exclusive provider organization, health maintenance organization, preferred provider organization, or point of service with capitation insurance plans. Patients with employer-sponsored Medicare Advantage plans experienced increased out-of-pocket costs for therapy despite lower net costs. These data highlight an urgent need for policy ensuring that patients benefit when overall costs of care decrease.

Strategy of geothermal energy development as a renewable energy source in West Java Indonesia

Background: Indonesia has vast renewable energy potential, including biofuels, biomass, and bioenergy from tropical biodiversity spread across the country. Hydropower and geothermal energy are the only forms of renewable energy used to generate electricity and are connected to the grid. Geothermal energy may be incorporated into the grid to create hybrid energy systems that will help to reduce the high energy demand while maintaining low energy costs and net present costs. There are now 14 biosphere reserves in Indonesia, divided into 24 units of core zones, six units of buffer zones, and 13 units of transition zones. The West Java Province has a geothermal potential of 6,101 MWe or 21% of Indonesia's total geothermal resources. Currently, the installed capacity of electricity from geothermal energy in West Java is 1075 MWe or 89% of the total national installed capacity of 1196 MWe. Method: This paper reviews West Java Province data collection from official government bureaus, state-owned businesses, and non-governmental organizations (NGO) reports on geothermal energy capacity, electricity installation, and used area of ​​geothermal power plant and will be limited to the years 2010 through 2020. The collected data will then be refined, extrapolated, and analyzed by the connected trend to aid in studying West Java geothermal growth and use SWOT method analysis. Finding: The result of this research is a strategy for optimizing the development of geothermal energy utilization. The strategies that can be developed are infrastructure improvement as an investment facilitation strategy, a strategy to leverage a costly investment and capital investment, underground mining in conservation forest areas to avoid degradation improvement and supervision of related institutions and stakeholders, implementation of environmentally sustainable development, and socializing programs and providing job opportunities for the local community. Conclusion: Indonesia has an enormous potential for renewable energy, especially geothermal, with West Java Province having the largest installed capacity. This study suggests strategies to optimize geothermal energy development, including improving infrastructure, investment facilities, underground mining, improving supervision, and sustainable development. Novelty/Originality of this study: Research on geothermal energy in West Java provides a comprehensive analysis and specific strategies to optimize the development of this energy in the area, including innovative underground mining approaches.

Abstract PO1-01-10: Comparison of the cost-effectiveness of multigene assays for HR+/HER2- node-negative early-stage breast cancer in the US

Abstract Background Traditional clinico-pathologic features, such as tumor grade and size, age, and menopausal status, may provide incomplete prognostic information, and have limited ability to predict chemotherapy benefit for patients with hormone-receptor-positive (HR+), human epidermal growth factor receptor 2-negative (HER2)-, axillary lymph node-negative (N0) early-stage breast cancer, leading to both under- and over-treatment with adjuvant chemotherapy. Multigene expression profile tests have been used in clinical practice to complement clinico-pathologic information to optimize treatment decisions. To date, the Oncotype DX Breast Recurrence ScoreÒ test is the only multigene assay with the ability to predict chemotherapy benefit validated by evidence from randomized clinical trials and supported by NCCN and ASCO guidelines. Other commercially available assays in the US include MammaPrintÒ, EndoPredictÒ and Prosigna RORÒ, which offer prognostic information beyond traditional clinico-pathologic features to improve treatment decisions. The relative cost-effectiveness of the four multigene assays compared to using clinico-pathologic risk alone to guide chemotherapy decisions was assessed from a societal perspective in the US. Methods A cost-effectiveness model built in Microsoft Excel estimated the cost-effectiveness of the Oncotype DXÒ test, MammaPrint, EndoPredict and Prosigna ROR compared to using clinical-pathological risk alone over a lifetime horizon. The model structure consisted of a decision-tree portion informed using published studies for the distribution of distant recurrence risk categories as defined by each test (low, intermediate, and high risk for the Oncotype DX test and Prosigna ROR, low and high risk for MammaPrint and EndoPredict). Decision impact studies and clinical expert opinion informed the proportion of patients allocated to adjuvant chemotherapy conditional on test result category. A Markov discrete health state model then simulated the future risk of distant recurrence, and long-term adverse effects of chemotherapy: acute myeloid leukemia (AML), and congestive heart failure (CHF), and aggregated the costs and outcomes of treatment decisions over a patient’s lifetime. The probability of distant recurrence of breast cancer conditional on test result category was derived from the most up-to-date studies assessing the performance of tests: TAILORx for the Oncotype DX test, MINDACT for MammaPrint, and TransATAC for EndoPredict and Prosigna ROR. Costs were estimated from a US societal perspective in 2020 US dollars (including Medicare healthcare costs, lost productivity and patient out-of-pocket chemotherapy costs from literature), and outcomes were expressed in terms of life-years, quality-adjusted life-years (QALYs), and net monetary benefit (NMB). The cost-effectiveness of each multigene assay compared to using clinico-pathologic risk alone was presented using the incremental cost-effectiveness ratio (ICER). Results Using the Oncotype DX test resulted in the largest lifetime cost savings (-$13,395) and generated the largest QALY gain (0.25) out of the four multigene assays included in the model, when compared to using clinico-pathologic risk alone (Table 1). All four multigene assays represented a cost-effective use of resources from a societal perspective (based on the accepted willingness-to-pay threshold of $100,000 per QALY gained), with a low net lifetime cost or net cost savings with positive QALY gain. Conclusion These results support the use of multigene assays to guide treatment decisions in node-negative HR+/HER2- early-stage breast cancer to improve treatment outcomes, and also result in substantial net cost savings from a societal perspective. The prediction of chemotherapy benefit using the Oncotype DX test resulted in substantially higher cost savings and improved breast cancer outcomes. Citation Format: Vladislav Berdunov, Gebra Cuyun Carter, Christy Russell, Sara Campbell, Jennifer Racz, Yara Abdou. Comparison of the cost-effectiveness of multigene assays for HR+/HER2- node-negative early-stage breast cancer in the US [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-01-10.

Techno-economic optimization of a photovoltaic-wind energy-based hydrogen production system: A case study of different cities of Saudi Arabia

The study employed Hybrid Optimization of Multiple Electric Renewables software and two-hybrid energy systems configurations to ascertain the most effective approach for generating hydrogen and electrical power in the designated three cities of Dammam, Jeddah and Tabuk in Saudi Arabia. To reduce emissions of greenhouse gases, improve energy security and encourage sustainable development, this study was motivated by the need to address the urgent need to switch to renewable energy sources like solar and wind based on Saudi Arabian's Vision 2030 initiative. To achieve these objectives, this research investigates the techno-economic feasibility of producing hydrogen from renewable energy sources to promote energy independence and economic growth in the region of Saudi Arabia. The novelty of the study provides a regional view of the use of renewable energy sources for hydrogen production by concentrating on several Saudi Arabian cities. It is essential for successful energy planning and policy formation to have insights suited to unique regional settings as demonstrated in this study. According to the findings of the study, the electrical and hydrogen requirements of the selected cities in Saudi Arabia can be fulfilled using renewable energy sources, as sufficient wind speed and sunlight are available to produce renewable hydrogen. The outcomes of the study demonstrated that the electricity and hydrogen generated in the city of Dammam were found to be significantly higher than in the other two cities resulting in high hydrogen production at the city of Dammam compared to the cities of Tabuk and Jeddah. The hybrid energy system in Dammam was identified as the most practical option for fulfilling Saudi Arabia's electricity and hydrogen production requirements based on the analysis and optimization, with low net present cost, levelized cost and levelized cost of hydrogen values of $235235, 0.316 $/kWh and 4.16 $/kg, respectively. The outcome of the study suggests that incorporating a renewable energy system in Dammam may diminish the country's reliance on fossil fuels and decarbonize its transportation sector. The results of this study could be employed by members of the Saudi hydrogen industry to promote increased hydrogen production and make Saudi Arabia's energy infrastructure more resilient and sustainable.

Cost and economic evidence for asset-based approaches to health improvement and their evaluation methods: a systematic review

BackgroundAsset-based approaches (ABAs) tackle health inequalities by empowering people in more disadvantaged communities, or targeted populations, to better utilise pre-existing local community-based resources. Using existing resources supports individuals to better manage their own health and its determinants, potentially at low cost. Targeting individuals disengaged with traditional service delivery methods offers further potential for meaningful cost-savings, since these people often require costly care. Thus, improving prevention, and management, of ill-health in these groups may have considerable cost implications.AimTo systematically review the extent of current cost and economic evidence on ABAs, and methods used to develop it.MethodsSearch strategy terms encompassed: i) costing; ii) intervention detail; and iii) locality. Databases searched: Medline, CENTRAL and Wed of Science. Researchers screened 9,116 articles. Risk of bias was assessed using the Critical Appraisal Skills Programme (CASP) tool. Narrative synthesis summarised findings.ResultsTwelve papers met inclusion criteria, representing eleven different ABAs. Within studies, methods varied widely, not only in design and comparators, but also in terms of included costs and outcome measures. Studies suggested economic efficiency, but lack of suitable comparators made more definitive conclusions difficult.ConclusionEconomic evidence around ABAs is limited. ABAs may be a promising way to engage underserved or minority groups, that may have lower net costs compared to alternative health and wellbeing improvement approaches. ABAs, an example of embedded services, suffer in the context of economic evaluation, which typically consider services as mutually exclusive alternatives. Economics of the surrounding services, mechanisms of information sharing, and collaboration underpin the success of assets and ABAs. The economic evidence, and evaluations in general, would benefit from increased context and detail to help ensure more nuanced and sophisticated understanding of the economics of ABAs. Further evidence is needed to reach conclusions about cost-effectiveness of ABAs.

Investigating the Possibility of Using Renewable Energies in Livestock Units in Iran (A Case Study: Fereydounshahr)

Fereydounshahr experiences growing electricity shortfalls and an overreliance on polluting diesel generators. This analysis models renewable hybrid systems to electrify a local dairy operation using HOMER Pro 3.11 software. Despite higher upfront costs, adding just 5% solar photovoltaics maintained low net present costs while increasing clean energy penetration versus diesel generators alone. Furthermore, a combined diesel-solar-wind system reduced carbon dioxide and nitrogen oxide emissions by over 1%. Although diesel generators had the shortest payback period at 48 years, the capital recovery factor for a diesel–solar combination reached 62 years. Thus, tailored hybrid renewable systems could provide an affordable, low-emissions electricity solution for the Fereydounshahr livestock facility. With suitable wind and solar resources, the right policy incentives could also unlock substantial local renewable capacity to meet rising demand and mitigate dependence on imported, climate-harming fossil fuels.

Cost-effectiveness of triplet therapies in metastatic hormone-sensitive prostate cancer used in PEACE-1 and ARASENS.

222 Background: Recent findings from the PEACE-1 and ARASENS trials have demonstrated survival benefits in men with newly diagnosed metastatic hormone-sensitive prostate cancer using different triplet therapies, including Abiraterone and Darolutamide added to Androgen Deprivation Therapy and Docetaxel. Given the rising costs of cancer care, this study aimed to assess the cost-effectiveness of these treatment regimens. Methods: Drug prices were obtained from drugs.com and assurance-maladie.ameli.fr at wholesale prices to evaluate both United States (US) and France payer perspectives. Survival and progression data were sourced from Kaplan-Meier curves of the PEACE-1 and ARASENS trials and fitted to Weibull distribution models in R. The parameters were imported into TreeAge Pro 2023 for partitioned survival analysis. Health states were classified as "Pre-Progression," "Post-Progression," and "Death," each assigned specific health utility values and costs. Outcomes including total costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs) were calculated. Uncertainty was addressed through one-way and probabilistic sensitivity analyses. The baseline willingness-to-pay (WTP) threshold was $100,000 per QALY. Euros were converted to US Dollars. Results: At the baseline WTP of 100,000, generic Abiraterone (US, France) in PEACE-1 and Darolutamide in ARASENS from the French perspective were cost-effective. Generic Abiraterone was dominant, associated with lower net costs (-1,347 to -333) and higher QALYs (0.16) and Darolutamide had an ICER of .7,001 per QALY. In contrast, other triplet therapies increased both net costs and QALYs. Abiraterone yielded ICERs of 408,074 (US) and 114,995 (France) per QALY. Darolutamide in the US had an ICER of $383,732 per QALY. On one-way sensitivity analyses, most drugs would need to be priced at less than ~4,000 a month to be cost-effective at WTP of 100,000 per QALY. On probabilistic sensitivity analyses, with WTP of 100,000 per QALY, generic Abiraterone (US) was the cost-effective drug (88% of simulations), while brand Abiraterone and Darolutamide (US) were the least cost-effective (0% of simulations). Conclusions: Cost-effectiveness of therapies in metastatic hormone-sensitive prostate cancer vary significantly based on pricing and country payer perspective. At a WTP threshold of $100,000, only generic Abiraterone (US, FRA) and Darolutamide (France) were cost-effective. [Table: see text]

Trade‐Off Theory for Dual Holders

AbstractA dual holder simultaneously owns (private) debt and equity in the same firm. Private debt has a tax advantage, a positive cashflow, which incentivizes its use. This cashflow leads to a lower net cost of debt, which again reduces default risk as well as the cost of external debt. The usual trade‐off between tax benefits and bankruptcy costs is altered. Debt priority affects both financing and default decisions. We find that an enterprise‐value maximizing firm should issue senior, external debt and junior, private debt, rather than debt with pari‐passu priority. Our analysis further highlights that tax authorities can effectively curtail the tax‐motivated use of private debt through straightforward measures.

Impact and cost-effectiveness of strategies to prevent respiratory syncytial virus (RSV) disease in Vietnam: A modelling study

BackgroundNew prevention strategies for respiratory syncytial virus (RSV) are emerging, but it is unclear if they will be cost-effective in low- and middle-income countries. We evaluated the potential impact and cost-effectiveness of two strategies to prevent RSV disease in young children in Vietnam. MethodsWe used a static cohort model with a finely disaggregated age structure (weeks of age <5 years) to calculate the RSV disease burden in Vietnam, with and without a single dose of maternal vaccine (RSVpreF, Pfizer) or of monoclonal antibody (Nirsevimab, Sanofi, Astra Zeneca). Each strategy was compared to no pharmaceutical intervention, and to each other. We assumed both strategies would be administered year round over a ten-year period. The primary outcome measure was the cost per disability-adjusted life year (DALY) averted, from a societal perspective. We ran probabilistic and deterministic uncertainty analyses. ResultsWith central input assumptions for RSVpreF vaccine ($25/dose, 69 % efficacy, 6 months protection) and Nirsevimab ($25/dose, 77 % efficacy, 5 months protection), both options had similar cost-effectiveness ($3442 versus $3367 per DALY averted) when compared separately to no pharmaceutical intervention. RSVpreF vaccine had a lower net cost than Nirsevimab (net discounted cost of $213 m versus $264 m) but prevented fewer RSV deaths (24 % versus 31 %). Our results were very sensitive to assumptions about the dose price, efficacy, and duration of protection. At $5/dose and a willingness-to-pay threshold of 0.5 times the national GDP per capita, both prevention strategies have the potential to be cost-effective. ConclusionsRSVpreF vaccine and Nirsevimab may be cost-effective in Vietnam if appropriately priced.

Impact, cost-effectiveness, and budget implications of HPV vaccination in Kenya: A modelling study

BackgroundSub-Saharan Africa has the highest rate of cervical cancer cases and deaths worldwide. Kenya introduced a quadrivalent HPV vaccine (GARDASIL, hereafter referred to as GARDASIL-4) for ten-year-old girls in late 2019 with donor support from Gavi, the Vaccine Alliance. As Kenya may soon graduate from Gavi support, it is important to evaluate the potential cost-effectiveness and budget impact of the current HPV vaccine, and potential alternatives. MethodsWe used a proportionate outcomes static cohort model to evaluate the annual budget impact and lifetime cost-effectiveness of vaccinating ten-year-old girls over the period 2020–2029. We included a catch-up campaign for girls aged 11–14 years in 2020. We estimated cervical cancer cases, deaths, disability adjusted life years (DALYs), and healthcare costs (government and societal perspective) expected to occur with and without vaccination over the lifetimes of each cohort of vaccinated girls. For each of the four products available globally (CECOLIN©, CERVARIX©, GARDASIL-4©, and GARDASIL-9 ©), we estimated the cost (2021 US$) per DALY averted compared to no vaccine and to each other. Model inputs were obtained from published sources, as well as local stakeholders. ResultsWe estimated 320,000 cases and 225,000 deaths attributed to cervical cancer over the lifetimes of the 14 evaluated birth cohorts. HPV vaccination could reduce this burden by 42–60 %. Without cross-protection, CECOLIN had the lowest net cost and most attractive cost-effectiveness. With cross-protection, CERVARIX was the most cost-effective. Under either scenario the most cost-effective vaccine had a 100 % probability of being cost-effective at a willingness-to-pay threshold of US$ 100 (5 % of Kenya’s national gross domestic product per capita) compared to no vaccination. Should Kenya reach its target of 90 % coverage and graduate from Gavi support, the undiscounted annual vaccine program cost could exceed US$ 10 million per year. For all three vaccines currently supported by Gavi, a single-dose strategy would be cost-saving compared to no vaccination. ConclusionHPV vaccination for girls is highly cost-effective in Kenya. Compared to GARDASIL-4, alternative products could provide similar or greater health benefits at lower net costs. Substantial government funding will be required to reach and sustain coverage targets as Kenya graduates from Gavi support. A single dose strategy is likely to have similar benefits for less cost.

Comprehensive Optimization-based Techno-economic Assessment of Hybrid Renewable Electricity-hydrogen Virtual Power Plants

Hydrogen is being considered as an important option to contribute to energy system decarbonization. However, currently its production from renewables is expensive compared with the methods that utilize fossil fuels. This paper proposes a comprehensive optimization-based techno-economic assessment of a hybrid renewable electricity-hydrogen virtual power plant (VPP) that boosts its business case by co-optimizing across multiple markets and contractual services to maximize its profits and eventually deliver hydrogen at a lower net cost. Additionally, multiple possible investment options are considered. Case studies of VPP placement in a renewable-rich, congested area of the Australian network and based on real market data and relevant sensitivities show that multi-market participation can significantly boost the business case for cleaner hydrogen. This highlights the importance of value stacking for driving down the cost of cleaner hydrogen. Due to the participation in multiple markets, all VPP configurations considered are found to be economically viable for a hydrogen price of 3 AUD $/kg (2.25 USD $/kg), which has been identified as a threshold value for Australia to export hydrogen at a competitive price. Additionally, if the high price volatility that has been seen in gas prices in 2022 (and by extension electricity prices) continues, the flexibility of hybrid VPPs will further improve their business cases.

Operative vs Nonoperative Management of Achilles Tendon Rupture: A Cost Analysis.

Achilles tendon rupture (ATR) is a common injury with a growing incidence rate. Treatment is either operative or nonoperative. However, evidence is lacking on the cost comparison between these modalities. The objective of this study is to investigate the cost differences between operative and nonoperative treatment of ATR using a large national database. Patients who received treatment for an ATR were abstracted from the large national commercial insurance claims database, Marketscan Commercial Claims and Encounters Database (n = 100 825) and divided into nonoperative (n = 75 731) and operative (n = 25 094) cohorts. Demographics, location, and health care charges were compared using multivariable regression analysis. Subanalysis of costs for medical services including clinic visits, imaging studies, opioid usage, and physical therapy were conducted. Patients who underwent secondary repair were excluded. Operative treatment was associated with increased net and total payments, coinsurance, copayment, deductible, coordination of benefits (COB) / savings, greater number of clinic visits, radiographs, magnetic resonance imaging (MRI) scans, and physical therapy (PT) sessions, and with higher net costs due to clinic visits, radiographs, MRIs, and PT (P < .001). Operative repair at an ambulatory surgical center was associated with a lower net and total payment, and a significantly higher deductible compared to in-hospital settings (P < .001). Both cohorts received similar numbers of opioid prescriptions during the study period. Yet, operative patients had a significantly shorter duration of opioid use. After controlling for confounders, operative repair was also independently associated with lower net costs due to opioid prescriptions. Compared with nonoperatively managed ATR, surgical repair is associated with greater costs partially because of greater utilization of clinic visits, imaging, and physical therapy sessions. However, surgical costs may be reduced when procedures are performed in ambulatory surgery centers vs hospital facilities. Nonoperative treatment is associated with higher prescription costs secondary to longer duration of opioid use. Level III, retrospective cohort study.

A 5-Year Cost-Utility Analysis Comparing Synthetic Cage vs Allograft Use in Anterior Cervical Discectomy and Fusion Surgery for Cervical Spondylotic Myelopathy.

Retrospective cost-utility analysis. To conduct a cost-analysis comparing SC versus Allo over a five-year time horizon. Synthetic cage (SC) and allograft (Allo) are two commonly used interbody choices for anterior cervical discectomy and fusion (ACDF) surgery. Previous analyses comparative analyses have reached mixed conclusions regarding their cost-effectiveness, yet recent estimates provide high-quality evidence. A decision-analysis model comparing the use of Allo versus SC was developed for a hypothetical 60-year-old patient with cervical spondylotic myelopathy (CSM) undergoing single level ACDF surgery. A comprehensive literature review was performed to estimate probabilities, costs (2020 USD) and Quality-Adjusted Life Years (QALYs) gained over a 5-year period. A probabilistic sensitivity analysis using a Monte Carlo Simulation of 1000 patients was carried out to calculate incremental cost effectiveness ratio (ICER) and net monetary benefits (INMB). One-way deterministic sensitivity analysis was performed to estimate the contribution of individual parameters to uncertainty in the model. The use of Allo was favored in 81.6% of the iterations at a societal willing-to-pay threshold (WTP) of 50,000 USD/QALY. Allo dominated (higher net QALYs and lower net costs) in 67.8% of the iterations. The INMB in the Allo group was 2,650 USD at a WTP threshold of 50,000 USD/QALY. One-way deterministic sensitivity analysis revealed that the cost of the index surgery was the only factor which significantly contributed to uncertainty. Cost-utility analysis suggests that Allograft maybe a more cost-effective option compared to synthetic cages in adult patients undergoing ACDF for CSM.

Cost optimization and optimal sizing of standalone biomass/diesel generator/wind turbine/solar microgrid system

&lt;abstract&gt; &lt;p&gt;Renewable energy has grown in popularity in recent years as a solution to combat the effects of pollution on the environment. The main purpose of this research is to design a microgrid system in Lakshadweep Island to determine the cost and dependability of a solar photovoltaic system that is combined with biomass, wind energy and diesel generator. Two types of hybrid systems like solar/biomass generator/wind turbine and Solar/diesel generator/biomass are investigated to get an optimal solution using HOMER Pro software. The hybrid microgrid system is optimized with low cost of energy (COE) and less environmental pollution. The reliability indice like unmet load is determined for each case to access the performance of the system. The influence of different Weibull shape parameter in solar/biomass generator/wind turbine hybrid system with sensitive variation of solar irradiation and wind speed are discussed. The scheduling of diesel generator in solar/diesel generator/biomass generator with various scenarios are analyzed based on minimum net present cost. The optimization results shows that the solar/diesel generator/biomass hybrid system has low net present cost of 432513 ＄ and cost of energy of 0.215 ＄/kWh as compared to solar/biomass/wind turbine for the selected site location. The proposed solar/diesel generator/biomass system produces emission of 7506 kg/yr. The emission produced in Lakshadweep Island using the proposed model is reduced since this Island currently produces electricity mainly with diesel generators. The optimal sizing of various components in microgrid system is performed to get the optimal solution.&lt;/p&gt; &lt;/abstract&gt;

Fire now, fire later: alarm-based systems for prescriptive process monitoring

Predictive process monitoring is a family of techniques to analyze events produced during the execution of a business process in order to predict the future state or the final outcome of running process instances. Existing techniques in this field are able to predict, at each step of a process instance, the likelihood that it will lead to an undesired outcome. These techniques, however, focus on generating predictions and do not prescribe when and how process workers should intervene to decrease the cost of undesired outcomes. This paper proposes a framework for prescriptive process monitoring, which extends predictive monitoring with the ability to generate alarms that trigger interventions to prevent an undesired outcome or mitigate its effect. The framework incorporates a parameterized cost model to assess the cost–benefit trade-off of generating alarms. We show how to optimize the generation of alarms given an event log of past process executions and a set of cost model parameters. The proposed approaches are empirically evaluated using a range of real-life event logs. The experimental results show that the net cost of undesired outcomes can be minimized by changing the threshold for generating alarms, as the process instance progresses. Moreover, introducing delays for triggering alarms, instead of triggering them as soon as the probability of an undesired outcome exceeds a threshold, leads to lower net costs.

A Machine Learning-Based Test for Predicting Response to Psoriasis Biologics

Objective: This study was designed to develop and prospectively validate a machine learning based algorithm that could predict patient response to the most common biologic drug classes used in the management of psoriasis patients. This type of tool would allow clinicians to have greater confidence that a given patient will respond to a specific drug class, which could lead to improved health outcomes and reduced wasted healthcare spend.&#x0D; Methods: Patients were enrolled into one of two observational studies (STAMP studies) where dermal biomarker patches (DBPs) were applied at baseline prior to drug exposure, followed by clinical evaluations at 12 weeks after exposure. PASI measurements were made at baseline and 12 weeks to evaluate clinical response to a clinical phenotype. Responders were defined as those who reached PASI75 at 12 weeks. The transcriptomes obtained from the DBPs were sequenced and analyzed to derive and/or validate classifiers for each biologic class, which were then combined to yield predictive responses for all three biologic drug classes (IL-23i, IL-17i, and TNFai).&#x0D; Results: A total of 242 psoriasis patients were enrolled in these studies, including 118 patients (49.6%) treated with IL-23i, 79 patients (33.2%) treated with IL-17i, 35 patients (14.7%) treated with TNFai, and 6 patients (2.5%) treated with IL-12/23i. The IL-23i predictive classifier was developed from the earlier enrolled patients and independently validated with the latter enrolled patients. IL-17i and TNFai predictive classifiers were developed using publicly available datasets and independently validated with patients from the STAMP studies. In the independent validation, positive predictive values for three classifiers (IL-23i, IL-17i, and TNFai) were 93.1%, 92.3% and 85.7% respectively. Over the entire cohort, 99.5% of patients were predicted to respond to at least one drug class.&#x0D; Conclusion: This study demonstrates the power of using baseline dermal biomarkers and machine learning methods as applied to the prediction of psoriasis biologic prior to drug exposure. Using this test, patients, physicians, and the health care system all can benefit in distinct ways. Precision medicine can be realized for individual patients as most will likely respond to their prescribed biologic the first time. Physicians can prescribe these drugs with increased confidence, and the healthcare system will realize lower net costs as well as greatly reduced wasted spend by significantly improving initial response rates to expensive biologic therapeutics.

A techno-economic analysis of membrane-based advanced treatment processes for the reuse of municipal wastewater

Abstract The objective of this paper is to compare, under Dutch market conditions, the energy consumption and net costs of membrane-based advanced treatment processes for three water reuse types (i.e. potable, industrial, agricultural reuse). The water source is municipal wastewater treatment plant effluent. Results indicate that the application of reverse osmosis is needed to reclaim high quality water for industrial and potable reuse but not for irrigation water which offers significant energy savings but may not lead automatically to lower net costs. While a reclamation process for industrial reuse is economically most promising, irrigation water reclamation processes are not cost effective due to low water prices. Moreover, process operational expenditures may exceed capital expenditures which is important for tender procedures. A significant cost factor is waste management that may exceed energy costs. Water recovery rates could be significantly enhanced through the integration of a softener/biostabilizer unit prior to reverse osmosis. Moreover, the energy consumption of wastewater reclamation processes could be supplied on-site with solar energy. The possibility of designing a ‘fit for multi-purpose’ reclamation process is discussed briefly. This comparative analysis allows for better informed decision making about which reuse type is preferably targeted in a municipal wastewater reuse project from a process design perspective.

Pursuing Value-Based Prices for Drugs:A Comprehensive Comparison of State Prescription Drug-Pricing Boards.

Rising prescription drug costs are consuming a growing proportion of state and private budgets. In response, lawmakers have experimented with a variety of policies to contain spending and achieve value in prescription drugs. As part of this series of reforms, some state legislatures have recently authorized prescription drug-pricing boards to address the high prices of brand-name prescription drugs and assess the value of those drugs. We identified state prescription drug-pricing boards in the United States, defined as any agency authorized by a state legislature to review specific drugs and pursue value-based drug prices. To describe the characteristics of the boards, we obtained public records of authorizing legislation, guidance documents, and board meeting minutes. We compared the boards' powers and responsibilities and analyzed completed pricing reviews. Six state drug-pricing boards in five states met our definition; their design varied substantially. Two of the boards (New York Medicaid and Massachusetts) have authority over drug rebates paid by state Medicaid programs, one (New York Drug Accountability Board) has jurisdiction over state-regulated commercial insurance, and another three (Maine, Maryland, and New Hampshire) oversee non-Medicaid, state-funded insurance. Three boards are authorized to require manufacturers to confidentially submit information related to the pricing and clinical effectiveness of reviewed drugs to inform value determinations. Only one board (New York Medicaid) had completed pricing reviews as of June 3, 2021. Boards' structure, scope, and statutory leverages to compel manufacturers to negotiate lower net costs are key factors that influence whether and to what extent boards can achieve cost savings for states. Though legal constraints may limit the effective reach of prescription drug-pricing boards, these agencies can enable states to address rising prescription drug costs, in part by virtue of their very existence. To overcome practical limitations, states seeking to implement similar policies can build on the experiences and designs of current boards.

Concentrated Solar Power and Photovoltaic Systems: A New Approach to Boost Sustainable Energy for All (Se4all) in Rwanda

The energy sector of today’s Rwanda has made a remarkable growth to some extent in recent years. Although Rwanda has natural energy resources (e.g., hydro, solar, and methane gas, etc.), the country currently has an installed electricity generation capacity of only 226.7 MW from its 45 power plants for a population of about 13 million in 2021. The current national rate of electrification in Rwanda is estimated to 54.5% (i.e.; 39.7% grid-connected and 14.8% off-grid connected systems). This clearly demonstrates that having access to electricity is still a challenge to numerous people not to mention some blackout-related problems. With the ambition of having electricity for all, concentrated solar power (CSP) and photovoltaic (PV) systems are regarded as solutions to the lack of electricity. The production of CSP has still not been seriously considered in Rwanda, even though the technology has attracted significant global attention. Heavy usage of conventional power has led to the depletion of fossil fuels. At the same time, it has highlighted its unfriendly relationship with the environment because of carbon dioxide (CO2) emission, which is a major cause of global warming. Solar power is another source of electricity that has the potential to generate electricity in Rwanda. Firstly, this paper summarizes the present status of CSP and PV systems in Rwanda. Secondly, we conducted a technoeconomic analysis for CSP and PV systems by considering their strengths, weaknesses, opportunities, and threats (SWOT). The input data of the SWOT analysis were obtained from relevant shareholders from the government, power producers, minigrid, off-grid, and private companies in Rwanda. Lastly, the technical and economical feasibilities of CSP and PV microgrid systems in off-grid areas of Rwanda were conducted using the system advisor model (SAM). The simulation results indicate that the off-grid PV microgrid system for the rural community is the most cost-effective because of its low net present cost (NPC). According to the past literature, the outcomes of this paper through the SWOT analyses and the results obtained from the SAM model, both the CSP and PV systems could undoubtedly play a vital role in Rwanda’s rural electrification. In fact, PV systems are strongly recommended in Rwanda because they are rapid and cost-effective ways to provide utility-scale electricity for off-grid modern energy services to the millions of people who lack electricity access.