Monetary Benefits Research Articles

A Feasibility Inquiry to the Sustainable Utilization of Few Invasive Flora

Objectives: The study focuses on utilising invasive flora affecting the indigenous plants and thereby bring about monetary benefits to the local people by means of handmade papers from the invasive weeds. Methods: Handmade paper from five invasive plants namely, Eichhornia crassipes, Eupatorium odorata, Combretum indicum, Lantana camara and Hyptis capitata was attempted. These plants after collection from Nilambur, Kerala were subjected to treatment with washing soda, blending, vat preparation, moulding and drying. This is followed by checking the paper quality parameters viz., Productivity, Clarity/opacity/transparency, Strength, Grammage, Paper grain, Ageing of paper and Moisture content. Findings: Out of the five invasive plants tested, the fibre yield was maximum for Eichhornia, but the productivity rate was less compared to other samples. Lantana and Hyptis yielded maximum productivity even though the fibre yield from these plants was less. The fibre uniformity of paper developed was positively detected for all the 4 plants except Eichhornia thereby proving the feasibility for paper manufacture. All sample paper allows the light; so, all are translucent in nature. Integrity of paper samples was retained in the paint test. The age test also yielded positive results. The gsm test showed lowest for Eichhornia as 98.12g/m2; Lantana 111.87g/m2; Combretum 131.87g/m2; Hyptis 163.75g/m2; Eupatorium is 255g/m2. Even though the gsm of Eichhornia is the best for paper manufacture according to gsm standards, the lack of fibre uniformity is a withdrawing feature for feasibility. The moisture content appeared high for Eichhornia and lowest for Combretum. Novelty: To date, studies on invasive plant utilisation done individually; no comparative study on productivity done. Current study can be further refined for environmental sustenance along with livelihood for local people. Keywords: Invasive Flora, Paper manufacture, Grammage test, Productivity, Ecological sustainability

Animal attack, concocted for monetary benefits: A case report.

Injuries from animal attacks usually occur when animals feel provoked, surprised or threatened. They may range from minor bruises and contusions to deep extensive injuries caused by biting, kicking or trampling, etc. The scenario differs from animal to animal and between species; by comparing the pattern of injuries it may be possible to work out the animal involved. We present a case where a story of an animal attack was conceived for monetary benefits. Determining the circumstances surrounding death may not be possible in all post-mortem cases but a medical examiner should strive to elicit as much information as possible from the dead body.

Cost-effectiveness of empagliflozin as add-on to standard of care for chronic kidney disease management in the United Kingdom

Objective The sodium-glucose co-transporter-2 inhibitor empagliflozin was approved for treatment of adults with chronic kidney disease (CKD) on the basis of its demonstrated ability to slow CKD progression and reduce the risk of cardiovascular death. This analysis was performed to assess the cost-effectiveness of empagliflozin plus standard of care (SoC) vs SoC alone in the treatment of CKD in the UK. Methods A comprehensive, patient-level CKD progression model that simulates the evolution of risk factors for disease progression based on CKD-specific equations and clinical data was used to project a broad range of CKD-related complications. Patient baseline characteristics, distribution across Kidney Disease Improving Global Outcomes (KDIGO) health states, and changes in estimated glomerular filtration rate (eGFR), urine albumin-creatinine ratio (uACR), and other parameters while on treatment were derived from the EMPA-KIDNEY trial. UK cost and utilities/disutilities were sourced from the literature. Univariate and probabilistic sensitivity analyses were conducted. Annual discounting of 3.5% was applied on costs and outcomes. Results Over a 50-year horizon, SoC resulted in per-patient costs, life years, and QALYs of £95,930, 8.55, and 6.28, respectively. Empagliflozin plus SoC resulted in an incremental gain in life years (+1.04) and QALYs (+0.84), while decreasing per-patient costs by £6,019. Empagliflozin was more effective and less costly (dominant) with a net monetary benefit of £22,849 at the willingness-to-pay threshold of £20,000. Although treatment cost was higher for empagliflozin, this was more than offset by savings in kidney replacement therapy. Empagliflozin remained highly cost-effective in patients with and without diabetes, and across scenario and sensitivity analyses. Limitations This analysis is limited by reliance on short-term clinical trial data and by uncertainties in modelling CKD progression. Conclusions Empagliflozin as an add-on to SoC for treatment of adults with CKD represents cost-effective use of UK National Health Service (NHS) resources.

The Assessment Model of Robotic Process Automation (RPA) Project Using Benefit Study and Balanced Scorecard (BSC) Approach

Assessing Robotic Process Automation (RPA) projects is challenging, especially for small and medium-sized enterprises (SMEs) with limited resources. The most common approach, cost-benefit analysis, measures the financial success of a project, but it does not capture all RPA benefits, which can lead to erroneous decisions about starting, continuing, delaying, or stopping an RPA project. This research presents a novel RPA project assessment model that combines a benefits approach with the balanced scorecard (BSC) framework. The model identifies RPA benefits from the scientific literature and classifies them into four BSC indicators: financial, business process improvement, customer satisfaction, and learning and development. SMEs can easily use the model by comparing expected and actual benefits to make quick and holistic decisions. The model's simplicity, ease of use, and ability to reveal both monetary and non-monetary RPA benefits make it a valuable tool for SMEs.

Cost Benefit Analysis of Re-Developing the Defunct Panguna Copper Deposit in Autonomous Region of Bougainville

The Autonomous Bougainville Government (ABG) has been obliged to devise socially inclusive mining legislation and policies that were realised through enactment of Mining Act (2015). It recognises community ownership of minerals found in predominantly maternal system of land ownership. The enactment of a separate mining legislation from that of Papua New Guinea (PNG) was a response to socio-political and environmental legacies associated with former Panguna mine. The cost benefit analysis (CBA) study was conducted using historical data from former Panguna mine and conceptual model of redeveloping the defunct Panguna resource. The results show redevelopment of the remaining copper resource could exceed the net benefits of the former mine. The historical and conceptual efficiency ratios (CBR) being greater than 1 depicted that monetary benefits could exceed production and opportunity costs of mining. Despite excluding social and environmental costs of mining, the positive NPV and IRR create opportunities to forge workable partnerships to enhance low-risk options to reduce net costs and maximize the benefits of mining. A major finding of the CBA study was that despite the local ownership of minerals, the mining lease permits and land access are competitive, similar to regalian ownership system. Also, the benefit redistribution structure was found to be similar to PNG’s regalian system where local ownership of minerals may not be a direct form of nationalisation.

Navigating Insurance Challenges: A Decision Tree Model for Insurance Pricing and Risk Strategy

Amid escalating natural disasters intensified by climate change, accurately assessing risks and determining insurance rates in disaster-prone areas present significant challenges to the insurance industry, impacting the underwriting decisions and strategies correspondingly. This article employs a frequency-loss degree framework to quantify meteorological disaster risk as the Annual Average Loss (AAL), which was classified into three categories (severe, moderate, and mild) further. Utilizing a Poisson Distribution to process extreme event data and integrating it with data from typical years into a comprehensive prediction model, this approach facilitates enhanced risk assessment and premium estimation. A decision tree model was further established to explore insurance institution’s underwriting decisions and risk strategies on the basis of monetary benefits and mental utility respectively, highlighted by case studies in Australia and the Philippines. The findings underscore the necessity for insurers to incorporate advanced decision-making tools taking utility factors into account, to navigate the complexities of risk and pricing in vulnerable areas efficiently. A tendency was observed among insurers to prefer conservative strategies in medium-risk areas, like the Philippines, over aggressive underwriting in high-risk zones, such as Western Australia. This suggests further research into expanding the model's applicability and delving into the evolving influence of climate change on the insurance industry.

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

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

It’s not just “who” you know, but “how” you know them: how social and commercial relationships differentially influence customer discounts

PurposeThe purpose of this study is to contribute to previous research on customer relationships by quantitatively examining differences in the monetary benefits obtained by consumers using social and commercial relationships to make purchases from small and medium-sized enterprises (SMEs).Design/methodology/approachCustomer transaction and relationship data from an SME in the USA is used to quantitatively assess the value of different marketplace relationships in an entrepreneurial context. Tobit regression is used to empirically model and test the impact of specific relationship characteristics on customer discounts.FindingsCustomers using social connections to make purchases obtain significantly larger discounts than customers using commercial connections; customers using direct connections attain significantly larger discounts than consumers using indirect connections (referrals). Interestingly, when examined by connection type, direct and indirect connections do not produce significant differences for social connections, yet they yield notable differences for commercial connections. The findings provide valuable insights to entrepreneurs for understanding and managing customer relationships.Originality/valueThis study empirically demonstrates that social relationships can be both prevalent and influential in the marketplace. The methodology used to quantitatively assess the monetary value associated with different methods of engaging with SMEs allows objective comparisons among different types of customer relationships. Quantification also allows important relationship characteristics to be empirically examined, including how the relationships compare to one another and to nonpersonal marketing activities. Ultimately, these novel contributions generate important insights to help marketers and entrepreneurs better understand customer relationships.

Cost-effectiveness analysis of mosunetuzumab for treatment of relapsed or refractory follicular lymphoma after two or more lines of systemic therapy in the United States

Aims Mosunetuzumab has received accelerated approval by the US Food and Drug Administration for adult patients with relapsed or refractory (R/R) follicular lymphoma (FL) after two or more lines of systemic therapy. We evaluated the cost-effectiveness of mosunetuzumab for the treatment of R/R FL from a US private payer perspective. Materials and methods A partitioned survival model simulated lifetime costs and outcomes of mosunetuzumab against seven comparators: axicabtagene ciloleucel (axi-cel), tisagenlecleucel (tisa-cel), tazemetostat (taz, EZH2 wild-type only), rituximab plus lenalidomide (R-Len) or bendamustine (R-Benda), obinutuzumab plus bendamustine (O-Benda), and a retrospective real-world cohort (RW) based on current patterns of care derived from US electronic health records (Flatiron Health). Efficacy data for mosunetuzumab were from the pivotal Phase II GO29781 trial (NCT02500407). Relative treatment efficacy was estimated from indirect treatment comparisons (ITCs). Costs included were related to treatment, adverse events, routine care, and terminal care. Except for drug costs (March 2023), all costs were inflated to 2022 US dollars. Costs and quality-adjusted life-years (QALYs) were used to calculate incremental cost-effectiveness ratios (ICERs). Net monetary benefit (NMB) was calculated using a willingness-to-pay (WTP) threshold of $150,000/QALY. Results Mosunetuzumab dominated taz, tisa-cel, and axi-cel with greater QALYs and lower costs. Mosunetuzumab was projected to be cost-effective against R-Benda, O-Benda, and RW with ICERs of $78,607, $42,731, and $21,434, respectively. Mosunetuzumab incurred lower costs but lower QALYs vs. R-Len. NMBs showed that mosunetuzumab was cost-effective against comparators except R-Len. Limitations Without head-to-head comparative data, the model had to rely on ITCs, some of which were affected by residual bias. Model inputs were obtained from multiple sources. Extensive sensitivity analyses assessed the importance of these uncertainties. Conclusion Mosunetuzumab is estimated to be cost-effective compared with approved regimens except R-Len for the treatment of adults with R/R FL.

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.

Estimating the Lifetime Costs and Benefits of the Incredible Years Teacher Classroom Management Intervention Using Data From 30 Months Follow-Up of the Supporting Teachers and childRen in Schools Trial

ObjectivesThe Incredible Years Teacher® Classroom Management (IY-TCM) intervention is associated with short-term improvements in mental health difficulties in young people. The aim was to estimate the long-term impact and cost-effectiveness of the IY-TCM intervention compared with no intervention. MethodsAn existing health economic model (LifeSim 1.0) was used to translate short-term changes in the Strength and Difficulties Questionnaire (SDQ), based on the Supporting Teachers and childRen in Schools cluster randomized controlled trial of the IY-TCM intervention in schools, into estimated medium- and long-term effects using multiple longitudinal data sets. LifeSim 1.0 was adapted to incorporate teacher-reported SDQ and account for individual heterogeneity. Cost-effectiveness analyses were conducted using the trial-based intervention cost with subgroup analyses on deprivation, conduct scores and parental depression in the simulated baseline population. ResultsRegression analyses show significant predictor variables for intervention effectiveness, including deprivation and baseline SDQ. LifeSim results indicate small gains in long-term outcomes, and cost-effective analyses estimated that the IY-TCM intervention could be cost-effective, but there was a large amount of uncertainty (net monetary benefit = £10, Estimated CI = −£134, £156). Benefits and certainty of cost-effectiveness were greater for some subgroups, such as those with high conduct scores at baseline (net monetary benefit = £206, Estimated CI = £26, £318). ConclusionsIY-TCM could be cost-effective, but there was a large amount of uncertainty around costs and benefits. Greater benefits for pupils with difficulties at baseline suggest that the intervention may be more cost-effective for schools in more deprived areas with high levels of conduct problems.

SUDS: New solution for urban flooding

Climate change causing extreme weather events across the world. The excising urban drainage system facing the great stress of managing heavy precipitation events and caused urban flooding. The specialists in the urban designing field are searching for more effective way of managing flooding events. Sustainable Urban Drainage System is kind of drainage system design which simulating nature rainwater managing practices. In this research, the SUDS is analyzed mainly from three aspects: Flood managing ability, economic benefits, and ecological benefits. This research reviews the existing SUDS examples and research basing on the SUDS designing strategies. Research has found that the SUDS is more than capable of managing stormwater but also can generate both monetary and indirect economic benefit. Furthermore, the nature feature of SUDS facilities can provide ecological benefits like providing habitats for animals, improving hydrological feature, and increase comfortability for residents. Thus, SUDS can be an ideal solution for the new urban drainage systems.

Genotype-driven asthma prescribing of inhaled corticosteroids and long-acting β2-agonist: A cost-effectiveness analysis.

Predicting response to inhaled corticosteroids (ICSs) + long-acting β2-agonist (LABA) by previously detecting the presence of Arg16Gly ADRB2 genotype is a strategy that could reduce and optimize the management of asthmatic patients. There is a need for economic evaluations to facilitate the implementation of such tests. This research aims to evaluate the cost-effectiveness of Arg16Gly ADRB2 screening in children with asthma in Colombia. From the perspective of a third-party payer, we conducted a cost-effectiveness analysis to determine the cost and quality-adjusted life-years (QALYs) of genotype-driven asthma prescribing based on the Arg16Gly ADRB2 genotype versus current treatment based on no genetic testing. Using four state-transition models, we estimate cost and QALYs employing micro-simulation modeling with a time horizon of 10 years and a cycle length of 1 week. Cost-effectiveness was assessed at a willingness-to-pay (WTP) value of US$5180. The mean incremental cost of strategy genetic testing versus no genetic testing is US$ -6809. The mean incremental benefit of strategy genetic testing is 16 QALYs. The incremental net monetary benefit of strategic genetic testing versus no genetic testing is US$ 88,893. Genetic testing is the strategy with the highest expected net benefit. The outcomes derived from our primary analysis remained robust when subjected to variations in all underlying assumptions and parameter values. Genetic testing of Arg16Gly ADRB2 is a cost-effective strategy to address asthma management in asthmatic children requiring ICS+LABA. This result should encourage the generation of more evidence and the incorporation of such evidence into clinical practice guidelines for pediatric asthma.

Cost-effectiveness analysis of durvalumab, tremelimumab, and etoposide-platinum in first-line treatment of extensive-stage small cell lung cancer.

Durvalumab plus etoposide-platinum (DEP) showed sustained overall survival improvements in patients with extensive-stage small-cell lung cancer (ES-SCLC) compared to etoposide-platinum (EP), but adding tremelimumab to DEP (DTEP) did not significantly improve outcomes. A third-party payer perspective is taken here to evaluate the cost-effectiveness of DTEP, DEP, and EP for ES-SCLC. The cost-effectiveness was evaluated by partitioning survival models into 3 mutually exclusive health states. In this model, clinical characteristics and outcomes were obtained from the CASPIAN. Model robustness was evaluated through 1-way deterministic and probabilistic sensitivity analyses. Outcome measurements included costs, quality-adjusted life-years (QALYs), incremental cost-effectiveness ratio, life-years, incremental net health benefit, and incremental net monetary benefit. The analysis was conducted with a 10-year lifetime horizon in a United States setting. Compared with EP, DEP, and DTEP were associated with an increment of 0.480 and 0.313 life-years, and an increment of 0.247 and 0.165 QALYs, as well as a $139,788 and $170,331 increase in cost per patient. The corresponding ICERs were $565,807/QALY and $1033,456/QALY, respectively. The incremental net health benefit and incremental net monetary benefit of DEP or DTEP were -0.685 QALYs and -$102,729, or -0.971 QALYs and -$145,608 at a willingness to pay threshold of $150,000/QALY, respectively. Compared with DTEP, DEP was dominated. DTEP and DEP were 100% unlikely to be cost-effective if the willingness to pay threshold was $150,000/QALY. DEP was cost-effective compared to EP when durvalumab was priced below $0.994/mg. Compared with EP, DEP, and DTEP were unlikely to be considered cost-effective across all subgroups. DEP and DTEP were not cost-effective options in the first-line treatment for ES-SCLC compared with EP, from the third-party payer perspective in the United States. Compared with DTEP, DEP was dominated.

An economic evaluation of eptinezumab for the preventive treatment of migraine in the UK, with consideration for natural history and work productivity

BackgroundMigraine is a highly prevalent neurological disease with a substantial societal burden due to lost productivity. From a societal perspective, we assessed the cost-effectiveness of eptinezumab for the preventive treatment of migraine.MethodsAn individual patient simulation of discrete competing events was developed to evaluate eptinezumab cost-effectiveness compared to best supportive care for adults in the United Kingdom with ≥ 4 migraine days per month and prior failure of ≥ 3 preventive migraine treatments. Individuals with sampled baseline characteristics were created to represent this population, which comprised dedicated episodic and chronic migraine subpopulations. Clinical efficacy, utility, and work productivity inputs were based on results from the DELIVER randomised controlled trial (NCT04418765). Timing of natural history events and treatment holidays—informed by the literature—were simulated to unmask any natural improvement of the disease unrelated to treatment. The primary outcomes were monthly migraine days, migraine-associated costs, quality-adjusted life years (QALYs), incremental cost-effectiveness ratio, and net monetary benefit, each evaluated over a 5-year time horizon from 2020. Secondary analyses explored a lifetime horizon and an alternative treatment stopping rule.ResultsTreatment with eptinezumab resulted in an average of 0.231 QALYs gained at a saving of £4,894 over 5 years, making eptinezumab dominant over best supportive care (i.e., better health outcomes and less costly). This result was confirmed by the probabilistic analysis and all alternative assumption scenarios under the same societal perspective. Univariate testing of inputs showed net monetary benefit was most sensitive to the number of days of productivity loss, and monthly salary.ConclusionsThis economic evaluation shows that from a societal perspective, eptinezumab is a cost-effective treatment in patients with ≥ 4 migraine days per month and for whom ≥ 3 other preventive migraine treatments have failed.Trial registrationN/A.Graphical

The cost-effectiveness of including liquid biopsy into molecular profiling strategies for newly diagnosed advanced non-squamous non-small cell lung cancer in an Asian population

ObjectivesLiquid biopsy is complementary to tissue biopsy for lung cancer profiling, yet evidence of the cost-effectiveness is limited. This could retard implementation and reimbursement in clinical practice. The aim of this study is to estimate the cost-effectiveness of profiling strategies that include liquid biopsy and to identify the optimal profiling approach for newly diagnosed advanced non-squamous non-small cell lung cancer (NSCLC) in an Asian population using Singapore as an example. Materials and methodsA decision tree and partitioned-survival model was developed from the Singapore healthcare system’s perspective to evaluate the cost-effectiveness of five molecular profiling strategies: either tissue or plasma next-generation sequencing (NGS) alone, a concurrent, and two sequential approaches. Model inputs were informed by local data or published literature. Sensitivity analyses and scenario analyses were undertaken to understand the robustness of the conclusions for decision making. The optimal strategy at different willingness-to-pay (WTP) thresholds was presented by cost-effectiveness acceptability frontier and the expected loss curve. ResultsThe sequential tissue-plasma NGS approach revealed an additional 0.0981 quality adjusted life years (QALYs) for an extra cost of S$3,074 over a 20-year time horizon compared to tissue NGS alone, resulting in an incremental cost-effectiveness ratio (ICER) of S$31,318/QALY and an incremental net monetary benefit of S$1,343 per patient. The findings were sensitive to the costs of pembrolizumab and osimertinib and the probabilities of re-biopsy after tissue NGS. Sequential plasma-tissue NGS and plasma NGS alone were more costly and less effective than alternatives. ConclusionThe sequential tissue-plasma NGS approach generated the highest net monetary benefit and was the optimal testing strategy when WTP was S$45,000/QALY. It retained superiority but understandably with a higher ICER when expensive, non-first line treatments were included. Overall, its routine clinical practice should be proactively considered for newly diagnosed advanced non-squamous NSCLC in an Asian population.

Cost/effectiveness of elivaldogene autotemcel vs. hematopoietic stem cells transplantation in patients with cerebral adrenoleukodystrophy (CALD)

Cerebral adrenoleukodystrophy (CALD) is a severe, rare neurological disease with a progressive course and poor prognosis. Allogeneic hematopoietic stem cell transplantation (HSCT) is still considered the standard of care for CALD. Elivaldogene autotemcel is a novel gene therapy for the treatment of childhood-onset CALD. Since many novel gene therapies are associated with high costs, our aim was to compare costs and effectiveness of elivaldogene autotemcel with the costs and effectiveness of allogeneic HSCT treatment of childhood-onset CALD. The analysis used an 80-year horizon and the perspective of the Serbian Republic Health Insurance Fund. Quality-adjusted life years (QALYs) gained with elivaldogene autotemcel and HSCT, as well as direct treatment costs, were our major outcomes. For the purposes of the economic analysis, we constructed and simulated a discrete-event simulation model to calculate the outcomes. We obtained the results of the model using a Monte Carlo simulation, which we conducted on 1000 virtual CALD patients. The analysis indicated that elivaldogene autotemcel was not cost-effective when compared to HSCT, and the net monetary benefit was negative. The base case incremental cost/effectiveness ratio was 259,848,512 RSD/QALY. Elivaldogene autotemcel is not more cost-effective than HSCT for the treatment of CALD from the perspective of the Serbian Republic Health Insurance Fund, according to classic pharmacoeconomic analysis and criteria. To ensure that the treatment is affordable for all patients for whom it is prescribed, a differentiated pricing strategy with lower drug prices in developing nations seems to be required.

Employees’ Motivation as A Determinant of Work Attitude and Performance in Elizade University

Employees’ motivation as a determinant of work attitude and performance of employees of Elizade University, Ilara-Mokin, Ondo State, Nigeria was examined in this study. Regardless of rank, age, job, gender, or educational background, employers have defined employee motivation as instruments and strategies used to affect the work attitude and performance of employees at various levels of the organisation. Purposive sampling technique was adopted in selecting Elizade University, Ilara-Mokin in Ondo state out of the 111 private universities in Nigeria. Self-structured questionnaire named Employees Motivation, Work Attitude and Performance (EMWAAPQ) was used for primary data collection. The collected data underwent analysis, focusing on the descriptive examination of demographic information. To test the two hypotheses formulated for this study, Pearson correlation and linear regression analyses were conducted. The scrutiny of all hypotheses adhered to a significance level of 0.05 alpha. The study revealed a positive correlation between employees’ motivation and employee attitudes within the institution (r=0.205**, n=181, p<0.05). Furthermore, this study established that both intrinsic and extrinsic motivation significantly influence employee performance (R2=0.136=13.6% of the variance). The implication is that organizations should prioritize employee well-being, with a particular emphasis on fostering motivation among staff. Therefore, to sustain and enhance productivity, the study recommends the implementation of comprehensive compensation packages, encompassing both monetary and non-monetary benefits.

The cost-effectiveness of a bimekizumab versus IL-17A inhibitors treatment-pathway in patients with active axial spondyloarthritis in Scotland

Objective To estimate the cost-effectiveness of a treatment-pathway initiated with bimekizumab, a monoclonal IgG1 antibody that selectively inhibits interleukin (IL)-17F and IL-17A, in patients with axial spondyloarthritis (axSpA) compared with IL-17Ai's, ixekizumab, and secukinumab, from the NHS Scotland perspective. Methods The axSpA treatment-pathway was modeled using a decision tree followed by a lifetime Markov model. The pathway included first- and second-line biologic disease-modifying antirheumatic drugs (bDMARD), followed by best supportive care (bDMARD, nonbiologic). Bimekizumab followed by any bDMARD (“BKZ”) was compared with IL-17Ai’s: secukinumab 150 mg followed by a blend (“SEC”) of dose up-titration to secukinumab 300 mg and any bDMARD, or ixekizumab followed by any bDMARD (“IXE”). Transition to the next therapy was triggered by Bath Ankylosing Spondylitis Disease Activity Index-50% (BASDAI50) non-response or any-cause discontinuation. A published network meta-analysis provided efficacy data. EuroQoL-5-dimensions utilities were derived by mapping from Ankylosing Spondylitis Disease Activity Score. Costs included disease management (linked to functional limitations), biologics acquisition (list prices), administration and monitoring (NHS 2021/22). Discounting was 3.5%/year. Probabilistic results from patients with non-radiographic axSpA and ankylosing spondylitis were averaged to reflect the axSpA disease spectrum. Scenario and sensitivity analyses were performed. Results The incremental cost-effectiveness ratio (ICER) of BKZ was £24,801/quality-adjusted life-year (QALY) vs. SEC (95% credible interval £24,163–£25,895). BKZ had similar costs (Δ -£385 [−£15,239–£14,468]) and QALYs (Δ 0.039 [−0.748–0.825]) to IXE, with £1,523 (£862–£2,222) net monetary benefit. Conclusions remained unchanged in most scenarios. Results’ drivers included BASDAI50 response rate and disease management cost. Limitations Results were based on list prices. Data concerning up-titration to secukinumab 300 mg was scarce. Conclusions The bimekizumab treatment-pathway represents a cost-effective option across the axSpA disease spectrum in Scotland. Bimekizumab is cost-effective compared to a secukinumab-pathway that includes dose up-titration, and has similar costs and QALYs to an ixekizumab-pathway.

A Feasibility Analysis of Energy Retrofit Initiatives Aimed at the Existing Property Assets Decarbonisation

In light of the growing demand for sustainability in the construction sector and real estate market, the European Community (EC) has recently begun incentivizing renovations of private and public European buildings. This aligns with the EC’s aim to reduce harmful emissions by 55% by 2030 compared to 1990 levels, and to achieve complete decarbonization of buildings, i.e., zero harmful emissions in this sector, by 2050. Given this framework, this study aims to verify the financial viability associated with the construction of “green” buildings, as well as the associated monetary benefits related to the efficient nature of these buildings and the resulting reduction in energy consumption. Lastly, an investigation is conducted to determine the economic feasibility of energy retrofit initiatives on existing building assets by comparing the required costs to retrofit against the potential increase in market value of a retrofitted residential unit. Along with assessing the undisputed environmental advantages for the community and all building users, this research aims to assess the financial and economic feasibility of sustainable construction initiatives, providing insight into how best to pursue the EC’s aims.