Net Savings Research Articles

Transurethral water vapor therapy for treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia: a cost-minimization and budget impact analysis from an Italian healthcare perspective.

The aim of this study was to compare the costs and budget impact of adopting water vapor thermal therapy with the Rezūm™ System, for treatment of lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) to transurethral resection of the prostate (TURP), from an Italian hospital healthcare perspective. A Markov model (4-year time horizon, 3-month cycle length), developed to support a submission to the National Institute of Health and Care Excellence (NICE) in England, was adapted to an Italian payer perspective. A cost minimization analysis was conducted, assuming equal efficacy between both therapies. Net difference in costs per patient was reported, considering procedure, adverse events and retreatment costs. Probabilistic and deterministic sensitivity analyses considered the uncertainty of the results. Population data and market share distribution assumptions were applied to a cohort of Italian patients treated in one year to report the budget and capacity impact of increased use of Rezūm. Over 4 years, the costs per patient with Rezūm were €2072 compared to €2836 with TURP, resulting in net savings of €764. Sensitivity analyses showed that this conclusion was robust. Replacing 10% of TURP procedures with Rezūm generates cost-savings of € 7,139,549 over 4 years and saves 4671 theatre hours and 26,856 bed days in one year. Replacing 30% of BPH surgical procedures with Rezūm generates cost-savings to € 21,418,647 over 4 years, saves 14,012 theatre hours and 80,567 bed-days in one year. This analysis demonstrates that Rezūm is highly likely to be cost-saving compared to TURP from an Italian hospital healthcare perspective.

The Visible Cash Effect with Prepaid Incentives: Evidence for Data Quality, Response Rates, Generalizability, and Cost

Abstract A prior study found that mailing prepaid incentives with $5 cash visible from outside the envelope increased the response rate to a mail survey by 4 percentage points compared to cash that was not externally visible. This “visible cash effect” suggests opportunities to improve survey response at little or no cost, but many unknowns remain. Among them: Does the visible cash effect generalize to different survey modes, respondent burdens, and cash amounts? Does it differ between fresh samples and reinterview samples? Does it affect data quality or survey costs? This article examines these questions using two linked studies where incentive visibility was randomized in a large probability sample for the American National Election Studies. The first study used $10 incentives with invitations to a long web questionnaire (median 71 minutes, n = 17,849). Visible cash increased response rates in a fresh sample for both screener and extended interview response (by 6.7 and 4.8 percentage points, respectively). Visible cash did not increase the response rate in a reinterview sample where the baseline reinterview response rate was very high (72 percent). The second study used $5 incentives with invitations to a mail-back paper questionnaire (n = 8,000). Visible cash increased the response rate in a sample of prior nonrespondents by 4.0 percentage points (from 31.5 to 35.5), but it did not increase the response rate in a reinterview sample where the baseline reinterview rate was very high (84 percent). In the two studies, several aspects of data quality were investigated, including speeding, non-differentiation, item nonresponse, nonserious responses, noncredible responses, sample composition, and predictive validity; no adverse effects of visible cash were detected, and sample composition improved marginally. Effects on survey costs were either negligible or resulted in net savings. Accumulated evidence now shows that visible cash can increase incentives’ effectiveness in several circumstances.

Assessing the effectiveness of energy efficiency measures in the residential sector gas consumption through dynamic treatment effects: Evidence from England and Wales

Improving energy efficiency (EE) is vital to ensure a sustainable, affordable, and secure energy system. The residential sector represents, on average, 18.6% of the total final energy consumption in the OECD countries in 2018, reaching 29.5% in the UK (IEA, 2020a). Using a staggered differences-in-differences approach with dynamic treatment effects, we analyse changes in residential gas consumption five years before and after the adoption of energy efficiency measures. The analysis includes energy efficiency interventions involving the installation of new heating-related insulation equipment—i.e., of loft insulation and cavity walls, supported by energy efficiency programmes in England and Wales between 2005 and 2017—using a panel of 55,154 households from the National Energy Efficiency Data-Framework (NEED). We control for, among other factors, energy prices and the extent to which gas consumption changes are dependent on household characteristics and variations in weather conditions. Our results indicate that the adoption of EE measures is associated with significant reductions in household residential gas consumption one year after their implementation. However, the effect does not last in the long run and energy savings disappear four years after the retrofitting of cavity wall insulation measures and after two years following the installation of loft insulation. The disappearance of energy savings in the longer run could be explained by the energy performance gap, the rebound effect and/or by concurrent residential construction projects and renovations associated with increases in energy consumption. Notably, for households in deprived areas, the installation of these efficiency measures does not deliver energy savings. These results confirm the existence of effects that reduce the energy savings from the adoption of these efficiency technologies over time and indicates that, for some groups, these net savings do not seem to materialize.

Return on Investment of the COVID-19 Vaccination Campaign in New York City

New York City, an early epicenter of the pandemic, invested heavily in its COVID-19 vaccination campaign to mitigate the burden of disease outbreaks. Understanding the return on investment (ROI) of this campaign would provide insights into vaccination programs to curb future COVID-19 outbreaks. To estimate the ROI of the New York City COVID-19 vaccination campaign by estimating the tangible direct and indirect costs from a societal perspective. This decision analytical model of disease transmission was calibrated to confirmed and probable cases of COVID-19 in New York City between December 14, 2020, and January 31, 2022. This simulation model was validated with observed patterns of reported hospitalizations and deaths during the same period. An agent-based counterfactual scenario without vaccination was simulated using the calibrated model. Costs of health care and deaths were estimated in the actual pandemic trajectory with vaccination and in the counterfactual scenario without vaccination. The savings achieved by vaccination, which were associated with fewer outpatient visits, emergency department visits, emergency medical services, hospitalizations, and intensive care unit admissions, were also estimated. The value of a statistical life (VSL) lost due to COVID-19 death and the productivity loss from illness were accounted for in calculating the ROI. During the study period, the vaccination campaign averted an estimated $27.96 (95% credible interval [CrI], $26.19-$29.84) billion in health care expenditures and 315 724 (95% CrI, 292 143-340 420) potential years of life lost, averting VSL loss of $26.27 (95% CrI, $24.39-$28.21) billion. The estimated net savings attributable to vaccination were $51.77 (95% CrI, $48.50-$55.85) billion. Every $1 invested in vaccination yielded estimated savings of $10.19 (95% CrI, $9.39-$10.87) in direct and indirect costs of health outcomes that would have been incurred without vaccination. Results of this modeling study showed an association of the New York City COVID-19 vaccination campaign with reduction in severe outcomes and avoidance of substantial economic losses. This significant ROI supports continued investment in improving vaccine uptake during the ongoing pandemic.

Estimating the Lifetime Medical Cost Burden of an Allogeneic Hematopoietic Cell Transplantation Patient and the Value of Addressing the Unmet Need

Background: Allogeneic hematopoietic cell transplantation (allo-HCT) management has evolved, with the emergence of molecular detection assays and therapies to treat post-HCT complications such as graft-versus-host disease (GVHD). However, this approach could increase the economic burden on healthcare systems by only managing complications that occur after the initial transplant. Instead, alternative therapies involving novel engineered donor allografts to replace standard allo-HCT to prevent late complications may potentially improve outcomes and address a greater unmet need. Objective: To estimate (1) the average total lifetime medical costs of an allo-HCT and (2) to estimate the net monetary savings and value associated with reducing late complications. Methods: A short-term decision tree (100-day) and a long-term semi-Markov partitioned survival model were developed that estimated the average per-patient lifetime cost and expected quality-adjusted life years (QALYs) for an allo-HCT patient from a United States healthcare system perspective. The allo-HCT patient population represented an average 53-year-old patient who was undergoing an allo-HCT to treat the three most common indications for allo-HCT: acute myeloid leukemia (AML), acute lymphoblastic leukemia (ALL), or myelodysplastic syndromes (MDS), distributed as 51%, 21%, and 28%, respectively. Key model clinical inputs included: overall survival, GVHD-free relapse-free survival (GRFS), incidence of both acute and chronic GVHD, relapse of the primary disease, and infections. Following the first 100 days, the patient cohort was assigned to 3 mutually exclusive health states in a semi-Markov partitioned survival model for the remainder of their lifetime: (1) GRFS, (2) progressed and/or GVHD, and (3) death. The projected time spent in each health state was derived from data provided by CIBMTR. Costs pertaining to allo-HCT and associated complications were obtained from the published literature based on medical claims analyses of payments (paid amounts) and were converted into costs using the American Hospital Association (AHA) commercial payment-to-cost ratio. Maintenance therapy costs for FLT3-ITD positive AML and Ph+ ALL cases were also included and were based on published literature, expert opinion, and prescribing information. The key outcomes were direct medical costs and expected QALYs. Cost results were reported as a range based on varying the percent of chronic GVHD patients that remained on treatment after two years (15% or 39%) as derived from the published literature. Scenario analyses were conducted to estimate the potential clinical and economic value that may be realized by improving GRFS outcomes. The scenario analyses to address some of the unmet need were modeled as a doubled improvement in GRFS (69% GRFS in year 1 as opposed to 34%) to estimate changes in allo-HCT-associated costs and survival. A willingness-to-pay threshold of $150,000 was used to monetize the QALYs gained as a result of improving GRFS outcomes. Results: Over a lifetime, the average per-patient medical cost of allo-HCT was estimated to range from $942,373 to $1,247,917. Of those total costs, 23% to 30% were incurred within the 1st 100 days and 42% to 56% within the 1st year. Of the medical costs estimated, the majority of the costs were for chronic GVHD treatment (37% to 53%) followed by the allo-HCT procedure (15% to 19%). Expected lifetime QALYs of an allo-HCT patient were estimated to be 4.7. In the scenario analyses, the unmet need that could be addressed by improving GRFS outcomes (via the medical cost offsets and QALYs gained) was associated with a net monetary value that ranged from $695,709 to $911,062. Of the estimated net monetary value, 85% to 88% was driven by direct medical cost savings while the remaining 12% to 15% was due to value of the gain in expected QALYs. Conclusions: The current per-patient cost of allo-HCT carries a substantial medical cost burden often exceeding $1M over the lifetime of the patient. Innovative research efforts focused on disease control and reduction or elimination of late complications altogether, particularly cGVHD, may provide the greatest value in improved patient outcomes and reduced healthcare spending. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Cost-Effectiveness Analysis of Motixafortide Versus Plerixafor in Stem Cell Mobilization for Autologous Transplantation in Patients with Multiple Myeloma

Introduction: The Phase 3 GENESIS trial (NCT03246529) compared the efficacy and safety of motixafortide and granulocyte-colony stimulating factor (M+G) to placebo + G (PBO+G) for the mobilization of hematopoietic stem cells (HSCs) prior to autologous stem cell transplantation (ASCT) in patients with multiple myeloma (MM). Compared with PBO+G, M+G significantly increased the proportion of patients who were able to successfully mobilize ≥6x106 CD34+ cells/kg for ASCT within 2 apheresis days (92.5% vs. 26.2%; p<0.0001). In a cost-effectiveness model (CEM) based on the GENESIS trial, M+G yielded additional quality-adjusted life years (QALYs) and cost savings relative to G alone from a United States (US) healthcare payer perspective (Lamotte et al. (2022) Value Health 25(7): S346). Plerixafor + G (P+G) is also used for HSC mobilization prior to ASCT in patients with MM. To date, M+G and P+G have not been directly compared in head-to-head trials; therefore, the relative efficacy and cost effectiveness of these therapies is currently unknown. Methods: The Bucher method was used to assess the relative efficacy of M+G in the GENESIS trial and P+G in the Phase 3 AMD-3102 trial (NCT00103662), with the PBO+G arms of both trials used as a common comparator. Risk ratios (RRs) were derived for binary trial endpoints (i.e., proportion with mobilization of ≥6x106 CD34+ cells/kg within 1-4 apheresis days, successful engraftment, use of rescue therapy, proportion who underwent ASCT, incidence of serious adverse events [SAEs]) and mean differences were derived for continuous trial endpoints (i.e., number of study drug doses received, frequency and amount of G doses, and number of apheresis sessions). The RRs were then used to update the CEM to compare the cost effectiveness of M+G and P+G from a US healthcare payer perspective over a lifetime horizon; model assumptions and sources for unit costs and quality of life scores were unchanged from the previously published CEM. Results: The mean age at baseline was 59-60 years in GENESIS and 58 years in AMD-3102; heterogeneity was observed for the mean time since diagnosis (6-7 vs. 11-12 months), prior radiotherapy (10%-11% vs. 27%-31%), and the ethnic and sex distribution of the PBO+G arms (White: 95% vs. 83%; males: 57% vs. 70%). Notably, prior lenalidomide use was markedly lower in AMD-3102 (<10%) than in GENESIS (70%), which likely contributed to the higher mobilization rates in the AMD-3102 PBO+G arm than in the GENESIS PBO+G arm. In the Bucher analysis, healthcare resource utilization (HRU) outcomes significantly favored M+G during primary mobilization, including less frequent administration of G (mean difference [MD]: -0.97; 95% CI -1.43, -0.50; p=0.0001), lower G doses (MD: -920 mcg; 95% CI -1,368, -471; p=0.0001), and fewer apheresis sessions (MD: -0.98; 95% CI -1.34, -0.63; p<0.0001) (Table 1). The proportion of patients with successful mobilization of ≥6x106 CD34+ cells/kg within 1 apheresis day was significantly greater with M+G (88.8%) than with P+G (54.2%; RR 2.97; 95% CI 1.08, 8.17; p=0.0341). Similar results were observed between groups for other outcomes, including ASCT rates (RR 1.06; 95% CI 0.93, 1.21; p=0.4124), engraftment durability by 100 days (RR 0.98; 95% CI 0.87, 1.11; p=0.7894), and SAE rate (RR 2.36; 95% CI 0.26, 21.05; p=0.4521); analyses were limited to publicly available data for P+G, and were not feasible for the use of rescue therapy because of insufficient sample size. In the cost-effectiveness analysis, M+G was dominant to P+G over a lifetime horizon, resulting in additional QALYs (+0.0358) and lower total costs (-$17,378 USD; Table 2) as per base case deterministic results. The key cost drivers were the probability of successful transplantation, long-term maintenance costs, and the time to engraftment in poor mobilizers. In a probabilistic sensitivity analysis, M+G was dominant in 66% of simulations and 92% cost effective at a WTP threshold of $50,000 per QALY. Conclusions: The results of this analysis show that the use of M+G was associated with significantly lower HRU relative to P+G for the mobilization of HSCs prior to ASCT in patients with MM, as well as significantly greater successful mobilization of ≥6x106 CD34+ cells/kg within 1 apheresis day. Cost-effectiveness analysis results showed that M+G was dominant to P+G, yielding additional QALYs and net cost savings over a lifetime horizon from a US healthcare payer perspective. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Optimum insulation thickness design of exterior walls and overhauling cost to enhance the energy efficiency of Albanian's buildings stock

In the present climate, thermal insulation is crucial for reducing energy consumption for heating or cooling in buildings, increasing the lifespan of structures, and building elements, and improving human comfort. The wall's composition layer has advanced regularly since the building regulations and established norms. However, calculation methods have remained quite the same, governed by Fourier's law. Therefore, to address this gap, a linearization process, and a correction factor of the optimized insulation thickness for four different insulation materials (i.e., EPS Graphite, EPS, GW, and RW) and five energy carriers (i.e., electricity, diesel, natural gas, liquefied petroleum gas, and biomass) by removing the boundaries of heating degree days by using Mathcad software is proposed. Other financial parameters (i.e., inflation rate, interest rate, lifespan, and present worth factor) and heating system features that lead to the optimized insulation thickness are considered. The RETScreen Expert model was coupled with a Mathcad script to compute a standardized corrected optimized insulation thickness (COIT) value by applying sensitivity analyses at ±35% of the most influencing parameters to calculate the total overhauling cost for different building types in Albania. A correction of the existing window's heat transfer coefficient for a different glass-to-wall ratio is proposed. Our findings suggest that the overall heat transfer value (U) should be equal to or less than 0.30 (W/m2•K), leading to a range of corrected optimized insulation thickness (COIT) from 0.03 m up to 0.11 m. Moreover, results exhibited encouraging economic and environmental values concerning the unrenovated buildings leading to annual net savings of 23.50–84.50 €/m2, CO2 reduction up to 39.10 kgCO2/m2, and a simple payback period (SPP) of 0.30 maximum up to 1.20 years. The outputs of this study can bring benefits in terms of reduced energy consumption and CO2 footprint, and the proposed COIT value can be applied not only in Albania but in other regions that exhibit similar climate conditions.

A Simplified Sine Cosine Algorithm for the Solution of Optimal Reactive Power Dispatch

In this article, a simplified sine cosine algorithm (SSCA) is applied to solve the optimal reactive power dispatch (ORPD) issues by estimating the control variables. This algorithm uses sine cosine functions and generates number of random solutions to obtain the best solution by fluctuating inwards or outwards. The SSCA is implemented in the ORPD problem to find the best control variables to achieve minimum power loss and maximum net savings. Furthermore, the efficacy of SSCA is validated with other recently used algorithms considering three case studies, i.e., IEEE-30, -57, and -118 bus test system. The results show that the SSCA approach finds more precise and superior ORPD solutions. A comparison among SSCA and other methods proves the robustness of SSCA to attain the solution with faster convergence. The statistical analysis is performed to justify the effectiveness of SSCA by yielding minimum operating cost and maximum net savings as compared to other techniques considered in this study.

A century of Azolla filiculoides biocontrol: the economic value of Stenopelmus rufinasus to Great Britain

BackgroundThe invasive aquatic fern Azolla filiculoides has been present in Great Britain (GB) since the end of the nineteenth century, while its specialist natural enemy, the weevil Stenopelmus rufinasus was first recorded nearly four decades later, in 1921. The purpose of this study was to estimate the economic value of management cost savings resulting from the presence of S. rufinasus as a biocontrol agent of A. filiculoides in GB, including the value of additional augmentative releases of the weevil made since the mid-2000s, compared with the expected costs of control in the absence of S. rufinasus.MethodsEstimated economic costs (based on the length/area of affected waterbodies, their infestation rates, and the proportion targeted for management) were calculated for three scenarios in which A. filiculoides occurs in GB: (1) without weevils; (2) with naturalised weevil populations; and (3) with naturalised weevil populations plus augmentative weevil releases.ResultsIn the absence of biocontrol, the expected average annual costs of A. filiculoides management were estimated to range from £8.4 to 16.9 million (US$9.4 to 18.9 million) (£1 = US$1.12). The impacts of naturalised S. rufinasus populations on A. filiculoides were expected to reduce management costs to £0.8 to 1.6 million (US$0.9 to 1.8 million) per year. With additional augmentative releases of the weevil, A. filiculoides management costs were estimated to be lower still, ranging from £31.5 to 45.8 thousand (US$35.3 to 51.3 thousand) per year, giving an estimated benefit to cost ratio of augmentative S. rufinasus releases of 43.7:1 to 88.4:1.ConclusionsThe unintentional introduction of the weevil S. rufinasus to GB is estimated to have resulted in millions of pounds of savings annually in management costs for A. filiculoides. Additional augmentative releases of the weevil provide further net cost savings, tackling A. filiculoides outbreaks and bolstering naturalised populations. The use of herbicides in the aquatic environment is likely greatly reduced due to A. filiculoides biocontrol. Although somewhat climate-limited at present in GB, climate change may result in even more effective biocontrol of A. filiculoides by S. rufinasus as has been observed in warmer regions such as South Africa, where the plant is no longer considered a threat since the introduction of the weevil.

Global sensitivity analysis and optimal design of heat recovery ventilation for zero emission buildings

Energy-efficient building services are necessary to realise zero-emission buildings while maintaining adequate indoor environmental quality. As the share of ventilation heating needs grow in well-insulated and airtight buildings, heat recovery in mechanical ventilation systems is increasingly common. Ventilation heat recovery is one of the most efficient and viable means to reduce ventilation heat losses and save energy. Highly efficient heat exchangers are being developed or applied to maximise the energy-saving potential of heat recovery ventilation. Nevertheless, the effects of practical operating conditions and the constraints of heat recovery – such as variations in ventilation rates, frost protection, and the prevention of an overheated air supply over a long-term period, which may significantly influence realistic recovery rates – have been less considered in efforts to maximise the energy savings. It is unclear which design parameters for heat recovery devices have the greatest effect on the annual energy savings from ventilation.This study proposes annual efficiency and annual net energy saving models for heat recovery ventilation that consider ventilation rate variations, the longitudinal heat conduction effect and operating controls. We use a global sensitivity analysis to quantify the contributions of various design input parameters to the variation in annual recovery efficiency and annual net energy savings. We identify the most influential parameters and their significant interaction effects for the annual energy performance of heat recovery ventilation. More attention should be paid to these most influential parameters during the design process. Furthermore, the optimal designs for rotary heat exchangers (as identified by a pattern-search optimisation algorithm) can improve annual net energy savings in demand-controlled ventilation by 33–48%, depending on the building areas. In combination with the reference year analysis presented in this study, heat recovery and demand-controlled ventilation can help to meet the need for highly efficient ventilation systems and zero-emission buildings.

Projecting the economic outcomes of switching patients with schizophrenia from oral atypical antipsychotics to once-monthly, once-every-3-months, and once-every-6-months paliperidone palmitate.

BACKGROUND: Among patients with schizophrenia, nonadherence to oral atypical antipsychotics (OAAs) leads to increased risk of relapses, which entails substantial economic burden. OBJECTIVE: To evaluate the impact on health care costs and relapse rates of switching patients with schizophrenia from OAAs to once-monthly paliperidone palmitate (PP1M), with subsequent transitions to once-every-3-months (PP3M) and once-every-6-months paliperidone palmitate (PP6M). METHODS: A 36-month Markov model was developed from a Medicaid payer's perspective. Two non-mutually exclusive subpopulations of adults with schizophrenia who were nonadherent to OAAs were considered: (1) recently relapsed and (2) young adults (aged 18-35). Patients were assumed nonadherent to OAAs until switching treatments, which was permissible multiple times during the 36-month period. Patients switching to PP1M could subsequently transition to PP3M and PP6M. Relapse rates were assumed consistent across treatments based on patients' adherence. Model inputs were literature based. PP6M transition rates were assumed similar to PP3M. Cost savings were reported at the plan level and per patient switched. RESULTS: In a hypothetical health plan of 1 million Medicaid beneficiaries, an estimated 10,053 adults with schizophrenia were nonadherent to OAAs, among whom 7,454 were recently relapsed and 4,002 were young adults. Switching 5% of recently relapsed adults (N = 373) from OAAs to PP1M prior to subsequent relapse resulted in 541 relapses avoided and plan-level savings of $8.2M after 3 years. Incorporating transitions to PP3M/PP6M increased net savings to $9.1M and 631 relapses were avoided. Among young adults, switching 5% (N = 200) from OAAs to PP1M saved $1.8M at the plan level with 178 relapses avoided after 3 years. Including transitions to PP3M/PP6M, 3-year plan-level savings were $2.0M with 223 relapses avoided. Per recently relapsed patient switched to PP1M, and subsequently to PP3M/PP6M, cumulative 3-year cost savings were $22,100 and $24,300, respectively. Among young adults, corresponding 3-year cost savings per patient were $8,900 and $9,800. CONCLUSIONS: Switching nonadherent patients from OAAs to PP1M results in substantial cost savings and reduces relapse rates. Incorporating transitions to PP3M/PP6M leads to incremental cost savings and additional relapses avoided. DISCLOSURES: Financial support for this research was provided by Janssen Scientific Affairs, LLC. Ms Morrison, Ms Ghelerter, Ms Vermette-Laforme, Mr Lefebvre, and Mr Pilon are employees of Analysis Group, Inc., a consulting company that has provided paid consulting services to Janssen Scientific Affairs, LLC., which funded the development and conduct of this study and manuscript. Dr Lin and Ms Benson are employees of Janssen Scientific Affairs, LLC., and stockholders of Johnson & Johnson.

Seasonality and trade in hydro-heavy electricity markets: A case study with the West Africa Power Pool (WAPP)

Hydroelectric power plants account for 25% of West Africa's total installed electricity generation capacity. In general, electricity generated by these plants is seasonal, and intra-annual fluctuationshave a considerable impact on electricity supply and cross-border electricity trade. This study soft-links a global hydrologic model to a multi-region capacity expansion and planning model for the West Africa Power Pool (WAPP) to examine the effects of seasonality in hydropower electricity generation on electricity trade as well as the economic benefits of unconstrainedcross-border electricity trade. Transitioning from a rainy to a dry season decreases hydroelectricity generation by an average of 40% in a typical year. Between 2018 and 2050, satisfying the region's electricity demand will require significant capital investment; nevertheless, extending from current bilateral electricity trade agreements to a fully competitive cross-border electricitytrade will result in net annual savings of $3 billion in 2015 dollars. To achieve year-round energy security, countries should plan to diversify their energy sources to ensure that supply reliability can be maintained in the event of lower supply during the dry season. This study represents a novel examination of seasonality impacts on hydropower modeling and may serve as a test case to inform future modeling efforts in other regions.

Economic Impact Analysis of Incorporation of Elecsys sFlt-1/PlGF Ratio Into Routine Practice for the Diagnosis and Follow-Up of Pregnant Women With Suspected Preeclampsia in Argentina

ObjectivesPreeclampsia (PE) is a hypertensive disorder of pregnancy that can cause severe complications and adverse fetal/maternal outcomes. We aimed to estimate the annual economic impact of incorporating Elecsys® sFlt-1/PlGF PE ratio, which measures soluble fms-like tyrosine kinase-1 and placental growth factor, into routine clinical practice in Argentina to aid diagnosis of PE and hemolysis, elevated liver enzymes, and low platelets syndrome from second trimester onward in pregnancies with clinical suspicion of PE. MethodsA decision tree was used to estimate annual economic impact on the Argentine health system as a whole, including relevant costs associated with diagnosis, follow-up, and treatment from initial presentation of clinically suspected PE to delivery. Annual costs of a standard-of-care scenario and a scenario including PE ratio (reference year 2021) were analyzed. ResultsThe economic model estimated that using the sFlt-1/PlGF ratio would enable the overall health system to save ∼$6987 million Argentine pesos annually (95% confidence interval $12 045-$2952 million), a 39.1% reduction in costs versus standard of care, mainly due to reduced hospitalizations of women with suspected PE. The economic impact calculation estimated net annual savings of approximately $80 504 Argentine pesos per patient with suspected PE. Based on the assumed uncertainty of the parameters, the likelihood the intervention would be cost saving was 100% for the considered scenarios. ConclusionOur analysis suggests that the implementation of the sFlt-1/PlGF ratio in women with suspected PE in Argentina will enable the health system to achieve significant savings, contributing to more efficient clinical management through the likely reduction of unnecessary hospitalizations, depending on assumptions. Results rest on the payers’ ability to recover savings generated by the intervention.

Impact of technology developments on multicriteria performances of BIPV in non-domestic buildings

Building Integrated Photovoltaic (BIPV) which can be applied to various parts of the building envelope such as walls, roofs, windows, and facades provides untapped opportunities to produce green energy even to meet total building’s energy need. Although, there are buildings with successful applications, the growth of the BIPV among both PV and building industries is inadequate due to various reasons particularly technical complexities. However, currently, many technological advancements have been emerged meeting market expectations, eliminating the current obstacles. System performances always lead to the decision of BIPV adoption are varied continuously. This paper aims to investigate the impact of technology developments on the multiple performances: economic; structural substitutable; environmental of 46 BIPV projects in non-domestic buildings in western countries using levelised cost of energy, net present value, material offset and greenhouse gas emission savings. Sensitivity analysis identifies generate four scenarios i) capital cost, 2) electricity conversion efficiency, 3) share of grid supply and 4) lifetime. The results revealed that capital cost has substantial influence than others to uplift the performances. It is significant to optimise the share of grid supply and onsite consumption for favourable performances. The outcome empowers stakeholders to explore the significance of technology deployment.

Health and Economic Evaluation of Vaccination Against Pertussis in China: A 40-Year Analysis

ObjectivesThis study aimed to evaluate the health and economic impact of diphtheria, tetanus, whole-cell pertussis vaccine (DTwP) and diphtheria-tetanus-acellular pertussis vaccine (DTaP) vaccination on pertussis prevention and control in China during the 40 years from 1978 to 2017. MethodsWe conducted cost-benefit analyses with a decision tree model populated with historical vaccination coverage levels and pertussis incidence and mortality data from before 1978 and during 1978 to 2017. We modeled 40 birth cohorts from birth until death. Costs and benefits were estimated from direct cost and societal perspectives (direct and indirect costs). Costs and benefits were adjusted to 2017 US dollars (USD), and future values were discounted at a 3% annual rate. We calculated net benefit values (net savings) and benefit-cost ratios of pertussis vaccination of children younger than 5 years. We conducted sensitivity analyses by varying key parameters within plausible ranges. ResultsWithout DTwP and DTaP vaccination, there would be an estimated 115.76 million pertussis cases and 426 650 pertussis deaths in the 40 cohorts. With DTwP/DTaP vaccination, pertussis cases and deaths were decreased by an estimated 92.57% and 97.43%, saving 46 987.81 million USD in direct costs and 82 013.37 million USD from societal perspective. Pertussis vaccination program costs were 2168.76 million USD and 3961.28 million USD from direct cost and societal perspectives. Benefit-cost ratios were 21.67:1 from the direct cost perspective and 20.70:1 from the societal perspective. Sensitivity analyses showed the results to be robust. ConclusionsOver the lifetime of 40 birth cohorts, China’s immunization program is preventing 93% of pertussis cases and 97% of pertussis deaths, resulting in substantial savings to the healthcare system and society.

Life Cycle Analysis of Thin-Film Photovoltaic Thermal Systems for Different Tropical Regions

Different energy solutions are required to satisfy the energy demand of the world’s ever-growing population. Photovoltaic Thermal systems (PVT) could propose resolutions to tackle real-time issues regarding power generation. Life Cycle Analysis (LCA) is performed to compare the environmental impact and measure the energy across different PVT modules consisting of a-Si, CdTe, and CIS thin-film solar cells. The authors performed LCA to calculate the energy payback time (EPBT) and life-cycle CO2 emissions of residential rooftop and open-field PVT systems. The primary energy needed to produce thin-film PVT modules of 1 m2 cell area was considered in the present life cycle analysis studies operated using water as the working fluid. The annual net electrical energy savings at various Indian weather conditions, such as New Delhi, Jodhpur, and Ladakh, have been calculated. For the thin-film PVT systems, the calculated values of annual energy yield for three locations with average solar radiation levels and peak sun hours in the range of 600–1000 W/m2 and 6–8 h were reported. Results show that the CO2 emissions for rooftop installation of CdTe and CIS are around 200 and 156 kg/annually, which is lower than the open field installation of the same, where CO2 emissions were found to be 295 and 250 kg/year.

Life-cycle cost analysis of an innovative marine dual-fuel engine under uncertainties

As innovative technologies are being deployed to accelerate shipping decarbonization in response to air emission regulations, there is considerable concern about the cost effectiveness of such technologies from a life-cycle perspective. This study conducts a life-cycle cost analysis (LCCA) on an innovative marine dual-fuel engine under uncertainties, comparing the total life-cycle cost performance of such an engine with that of a conventional diesel engine. By proposing several economic Key Performance Indicators (KPIs) such as the Net Present Cost (NPC), the Net Saving (NS) and the Saving-to-Investment Ratio (SIR), the findings indicate that the dual-fuel engine is more cost-effective than the diesel engine under a given fuel price scenario. The uncertainties are meticulously treated by using scenario sensitivity analyses and a Monte Carlo simulation. The scenario sensitivity analyses reveal that the cost effectiveness of the dual-fuel engine is sensitive to the high gas price scenarios. It is uncovered from the Monte Carlo simulation that there is an adequate degree of confidence when opting for the dual-fuel engine. Furthermore, fuel prices are found to be the most influential cost driver. Different foreseeable carbon pricing scenarios are also simulated to show that the dual-fuel engine is still the most favorable option. Regardless of fuel prices and carbon pricing scenarios, the dual-fuel engine provides a considerable environmental benefit with a CO2 emission reduction potential of 33%. The findings of this study are of interest within the field of shipping investment appraisals and relevant to decision-makers (i.e. ship-owners and investors).

Benefits of an Electric Road System for Battery Electric Vehicles

Electric road systems (ERS)—infrastructure that allows for charging while driving—are currently considered in Sweden for electrifying long-haul trucking. The technology can also charge battery electric passenger vehicles (BEVs). This study utilizes real-world car movement data in Sweden and detailed spatial analysis to explore to what extent ERS could displace stationary charging if it is available for BEVs and the expected benefits. We find that ERS utilization and the minimum battery ranges depend more on visited locations and home locations and less on the annual travel distances of car users. The median battery ranges required by rural residents are 15–18% greater than for urban residents. Our scenarios suggest that a mix of ERS and home-charging would achieve the most significant benefits. ERS with home charging reduces the required battery range by 62–71% in the main scenarios, and the net savings from smaller BEV batteries exceed the cost of ERS. Eliminating all stationary charging is feasible for many but not all vehicles. Utilizing ERS could also significantly reduce peak BEV charging by distributing charging throughout the day. We also find that there is a considerable difference between the maximum possible and minimum needed charging on ERS, which can significantly influence ERS revenues. Future studies can expand to include other modes (e.g., trucks) to provide more holistic assessments of economic benefits and charging needs.

Health and Economic Impact of the United States Varicella Vaccination Program, 1996-2020.

The aim of this study was to evaluate the health and economic impact of the varicella vaccination program on varicella disease in the United States (US), 1996-2020. Analysis was conducted using the Centers for Disease Control and Prevention or published annual population-based varicella incidence, and varicella-associated hospitalization, outpatient visit, and mortality rates in the US population aged 0-49 years during 1996-2020 (range, 199.5-214.2 million persons) compared to before vaccination (1990-1994). Disease costs were estimated using the societal perspective. Vaccination program costs included costs of vaccine, administration, postvaccination adverse events, and travel and work time lost to obtain vaccination. All costs were adjusted to 2020 US dollars using a 3% annual discount rate. The main outcome measures were the number of varicella-associated cases, hospitalizations, hospitalization days, and premature deaths prevented; life-years saved; and net societal savings from the US varicella vaccination program. Among US persons aged 0-49 years, during 1996-2020, it is estimated that more than 91 million varicella cases, 238 000 hospitalizations, 1.1 million hospitalization days, and almost 2000 deaths were prevented and 118 000 life-years were saved by the varicella vaccination program, at net societal savings of $23.4 billion. Varicella vaccination has resulted in substantial disease prevention and societal savings for the US over 25 years of program implementation.

Potential energy savings benefits and limitations of radiative cooling coatings for U.S. residential buildings

Radiative coatings are a promising strategy to implement passive cooling that provides an eco-friendly pathway to achieve energy efficiency in buildings. This study investigates the benefits and limitations of implementing radiative coatings on the building envelope, particularly the roof, of residential buildings in the United States. The analysis compares the performance of an ideal radiative coating with broadband surface properties to a realistic radiative coating with diffuse and semitransparent properties. To enhance the net energy efficiency of buildings, we carried out a comprehensive parametric analysis comprising key radiation surface properties to maximize cooling energy savings while minimizing heating energy penalties. A countrywide assessment for 68 locations across the United States showed that net energy savings are a strong function of the climatic and atmospheric conditions. Broadly, southern locations showed high overall energy savings whereas northern locations exhibited high overall energy penalties. Locations in International Energy Conservation Code (IECC) climate zones 1A, 2A, and 2B showed a net annual energy savings above 5%, whereas locations in IECC climate zones 5B, 6B, and 7 showed a net annual energy penalty greater than 3%. The hot and dry climate of Phoenix, Arizona, showed the highest overall energy savings of 426 kWh (6.2%). Additionally, the mathematical correlation reveals that the net energy savings of a location is positive only when its average cooling degree days is greater than 5.5 or its average heating degree days is less than 10.