Probabilistic Analysis Research Articles

The interconnected nature of multiple threats is impacting freshwater biodiversity.

Freshwater biodiversity is in crisis across the globe: the significant extraction, modification and pollution of freshwater resources puts these communities and systems at great risk. Here, using probabilistic network analysis and International Union for the Conservation of Nature threat data, we show that globally and across all taxonomic groups and geographical regions, threats to freshwater species are interconnected and do not occur in isolation. However, we also find that species in higher risk categories are more acutely threatened by single, dominant threats as compared with species at lower risk of global extinction. Determining when and which species are threatened by isolated threats or a suite of co-occurring threats provides crucial insights for the design of effective freshwater conservation strategies.

Probability Stability Evaluation of Coral Reef Limestone Reef Slopes Under Earthquake

With the rapid development of island construction and the frequent occurrence of natural disasters, the stability of coral reef slopes is attracting increasing attention. This study aims to assess the dynamic stability and instability risks of coral reef slopes under different earthquake intensities. Geological data were integrated, and the Newmark method and finite element analysis were employed for probabilistic stability assessment and permanent displacement evaluation, leading to the development of a validated model for slope stability assessment. The study explored the effects of varying earthquake intensities on slope stability. Results indicate that the stratified structure significantly influences stability. Reef limestone slopes exhibited higher stability, whereas multi-layered slopes, due to looseness, were less stable. Both slope types remained stable under static conditions. Earthquake intensity substantially impacted stability, with multi-layered slopes showing instability probabilities of 48% and 100% under peak ground accelerations (PGA) of 0.3 g and 0.4 g. Under extreme seismic conditions, the permanent displacement of multi-layered coral reef slopes significantly increased. This study aims to fill the gap in previous research by incorporating the random distribution of stratigraphic parameters, conducting probabilistic stability analysis based on the random distribution of geological parameters, and thereby providing references for island reef engineering construction.

24-week, all-oral regimens for pulmonary rifampicin-resistant tuberculosis in TB-PRACTECAL trial sites: an economic evaluation.

New 6-month rifampicin-resistant tuberculosis treatment regimens containing bedaquiline, pretomanid, and linezolid (BPaL) with or without moxifloxacin or clofazimine, could improve treatment efficacy, safety, and tolerability, and free up resources within the health system. Following a change to WHO rifampicin-resistant tuberculosis treatment guidelines, countries are facing difficult decisions about when and how to incorporate new drug regimens into national guidelines. We aimed to assess the probability of BPaL-based regimens being cost-saving using data collected in the TB-PRACTECAL trial. This economic evaluation using a cost-utility analysis was embedded in five TB-PRACTECAL trial sites in Belarus, Uzbekistan, and South Africa. Between Nov 19, 2020, and Sept 27, 2022, we collected detailed primary unit cost data in six hospitals and four ambulatory health facilities and collected data on patient-incurred costs from 73 trial participants. The primary efficacy endpoint of the main trial, a composite of unfavourable outcomes (death, disease recurrence, treatment failure, early discontinuation of therapy, withdrawal, or loss to follow-up) and clinically important safety outcomes by 72 weeks of follow-up were incorporated into the analysis. Societal perspective cost data and effect outcome data were input into a Markov model to estimate the cost per disability-adjusted life-year (DALY) averted by BPaL-based regimens compared with the standard of care over a 20-year time horizon. We conducted a range of univariate and probabilistic sensitivity analyses to test our findings. BPaL-based regimens averted a mean of 1·28 DALYs and saved a mean of US$14 868 (SD 291) per person from the provider perspective compared with standard-of-care regimens over 20 years. Patient-incurred costs were reduced by a mean of $172 (SD 0·84) in BPaL-based regimen groups compared with standard of care. The main cost drivers for both providers and patients were inpatient bed-days; the duration of the inpatient period varied across countries. Varying a range of model parameters affected the degree of cost savings but did not change the finding that BPaL-based regimens are cost-saving compared with standard of care. This trial-based evidence adds to consistent indications from modelling studies that BPaL-based regimens are cost-saving for both the patient and health system. Urgent implementation of BPaL-based regimens in countries with a high burden of tuberculosis could improve treatment of rifampicin-resistant tuberculosis, reduce pill burden, and free up desperately needed resources within the health system. Médecins Sans Frontières.

Analysis of Suicide-related Tweets During the COVID-19 Pandemic

Background: The COVID-19 virus started in 2019 and badly affected the different sectors of many countries around the world. Based on this, financial difficulties, loss of loved ones, sudden anger, relationships, family disputes, and psychological distress increased, and individuals were stalled from carrying out their lifestyle in a normal way, and some individuals were even motivated to commit suicide. Objective: It is important to reduce the number of suicides and identify the reasons for this situation. Through this research, the focus is on identifying the main topics discussed relevant to suicides during the COVID-19 pandemic. Methods: Individuals use Twitter, a social media platform, to share their ideas freely and publically. We collected 9750 primary data through Twitter API (Application Programming Interface). After preprocessing and feature extraction by TF-IDF (Term Frequency-Inverse Document Frequency), we applied the LDA (Latent Dirichlet Allocation) and Probabilistic Latent Semantic Analysis (PLSA) topic modeling algorithms to identify topics. Results: Based on the LDA results, we extracted ten different topics under the three themes, such as the impact of COVID-19, human feelings, getting support, and having awareness. Intertopic Distance Map, Most Salient Terms, and Word Clouds Visualization are used to check the results. The coherence score and perplexing value are used to measure how interpretable the extracted topics are to humans. PLSA also extracted 25 topics with their probabilities, and Kullback–Leibler (KL) divergence was used to check the results. Conclusion: We were able to gain insight into human emotions and the main motivations behind suicide attempts using the topics we extracted. Expert feedback proved that LDA results were better than PLSA. Based on that, we found the main impact of COVID-19 on human lives, how human feelings were changed positively and negatively during that period, what supporting and awareness methods people used, and what they preferred. The required measures can then be taken by those responsible authorities and individuals to prevent, reduce, and get ready for this kind of suicidal incident in the future.

Developing a spring-based shear connector finite element model for probabilistic analysis of composite beams with deconstructable connectors under connection and material uncertainties

Developing a spring-based shear connector finite element model for probabilistic analysis of composite beams with deconstructable connectors under connection and material uncertainties

Cost-utility analysis of ropeginterferon alfa-2b to manage low-risk patients with polycythemia vera as compared to phlebotomy only in the Austrian healthcare system.

Treatment of polycythemia vera (PV) aims to maintain hematocrit on target to reduce risk of thrombotic complications, while preventing disease progression to myelofibrosis (MF) and acute myeloid leukemia (AML). This analysis evaluated cost-effectiveness of adding ropeginterferon alfa-2b (ropegIFNα) to phlebotomy in patients with low-risk PV (those younger than 60 years without prior thrombosis), compared to phlebotomy alone. We combined a 12-month decision tree with a semi-Markov cohort model comparing ropegIFNα to the standard treatment from the Austrian healthcare system perspective over 30 years. Outcomes were quality adjusted life years (QALYs), costs, and incremental cost-utility ratio (ICUR). Model inputs were obtained from the phase 2 Low-PV study, additional published literature and from Austrian-specific cost databases. One-way and probabilistic sensitivity analyses (SA) assessed the robustness of findings. RopegIFNα led to 1,43 higher QALYs and 50.960 EUR overall higher costs compared to phlebotomy alone, with an ICUR of 35.525 EUR/QALY. Thrombosis, MF, and AML costs decreased for the ropegIFNα group by 12%, 30% and 16% respectively, due to the delayed complications onset and disease progression. In the one-way SA, ropegIFNα costs and discount rates had the greatest impact on results. The probabilistic SA showed a 100% probability of cost-effectiveness at willingness-to-pay threshold aligned to the Austrian GDP per capita. RopegIFNα is a cost-effective treatment option for patients with low-risk PV. These findings suggest that early treatment with ropegIFNα could ensure optimal resource allocation by preventing costly thrombotic events and progression to MF whilst increasing patient quality of life.

Probabilistic damage analysis of rebar corrosion in recycled aggregate concrete using sideband intensity-based nonlinear ultrasonic technique

Probabilistic damage analysis of rebar corrosion in recycled aggregate concrete using sideband intensity-based nonlinear ultrasonic technique

Probabilistic slope stability analysis on marine clay seabed considering spatial variability of soil parameters

Probabilistic slope stability analysis on marine clay seabed considering spatial variability of soil parameters

Quantum Computing: Revolutionizing Advanced Risk Management Systems

This article examines how quantum computing revolutionizes sophisticated risk management systems in several industries, focusing on cybersecurity and financial services. It looks at how quantum computing technology transforms conventional risk assessment methods, fraud prevention, and security architecture by utilizing quantum bits and the concepts of superposition and entanglement. The creation of quantum-resistant cryptographic algorithms, the application of quantum-enhanced probabilistic analysis for financial risk management, and the obstacles to the broad adoption of quantum computing are all examined in this article. The article illustrates the substantial potential of quantum computing in enhancing risk management frameworks while stressing the factors that must be considered for successful adoption by examining current market trends, technological advancements, and industry applications. The convergence of quantum computing with other cutting-edge technologies like blockchain and artificial intelligence for improved risk management capabilities is also examined, as are the broader ramifications for industries other than finance, such as healthcare, manufacturing, and telecommunications.

Enhanced Bayesian model for multienvironmental selection of winter hybrids maize: assessing grain yield using ‘ProbBreed’

BackgroundCrossover interactions stemming from phenotypic plasticity complicate selection decisions when evaluating hybrid maize with superior grain yield and consistent performance. Consequently, a two-year, region-wide investigation of 45 hybrids maize across Nepal was performed with the aim of disclosing both site and wide adapted hybrids. Utilizing an innovative “ProbBreed” package, based on Bayesian probability analysis of randomized complete block designs with three replicated trials at each station, this study substantively streamlines hybrids maize selection.ResultsThis finding revealed substantial genetic, environmental, and interactive influences on grain yield (p < 0.05). Among the hybrids, DKC9149 (8.8 tons/ha) emerged as the elite with probability coefficient of (0.39), followed by NK6607(0.35 & 8.6 tons/ha). Joint probability analysis identified RMH1899 super (0.23 & 8.3 tons/ha), followed by RMH 666 (0.15 & 8.4 tons/ha) and Uttam 121 (0.11 & 8.6 tons/ha), all of which accounted for overall environmental conditions. Additionally, over the years, DKC 9149, NK 6607(0.18 & 8.6 tons/ha), GK 3254(0.18 & 8.5 tons/ha), Shann 111(0.12 & 8.4 tons/ha), Sweety 1(0.13 & 8.4 tons/ha), and ADV 756(0.10 & 8.2 tons/ha) consistently demonstrated superior performance and stability. Delving with site specific recommendations include Nepalgunj: RMH 9999(8.5 tons/ha), NK 6607(8.6 tons/ha); Parwanipur: DKC 9149, MM 2033(8.5 tons/ha); Rampur: ADV 756, DKC 9149, MM 2929(8.6 tons/ha); and Tarahara: GK 3254(8.5 tons/ha), NK 6607(8.6 tons/ha), Uttam 121.ConclusionThus, Selected hybrids are predicted to outperform within the recommended domain. Over and above, integrating genomic information into Bayesian models expected to enhance prediction accuracy and expedite breeding progress.

Modelling the cost effectiveness and budget impact of uterine botulinum toxin injections versus conventional treatment in severe dysmenorrhoea: A French Perspective.

To assess the cost-effectiveness sand the budgetary impact of the combination of botulinum toxin (BT) + conventional treatment (CT) (hormonal treatments + analgesics) compared with CT alone in patients suffering from severe dysmenorrhoea, using a Markov model. A Markov model was developed to estimate, from the perspective of French Health Insurance (HI), the cost effectiveness and the budgetary impact of BT+CT compared with CT alone. The main health states in the model were based on Visual Analogue Scale (VAS) scores and expert opinion. All model parameters were derived from a cohort of patients treated for 12 months at the Centre de Recherche de la Santé et de la Femme (CRSF) for severe dysmenorrhoea in 2021. A Cost-Utility Analysis (CUA) was carried out to assess the quality of life of patients, crucial in this context, in which the direct healthcare costs were considered in and Budget Impact Analysis (BIA). The main decision-making criteria were the Incremental Cost-Utility Ratio (ICUR) for the CUA and the net impact for the BIA. Deterministic and probabilistic univariate sensitivity analyses were performed to assess the robustness of our results. Over the 1-year time horizon (main analysis), the costs and quality-adjusted life year (QALY) of BT+CT versus CT alone were equal to €1895.65 vs €3055.20 and 2.03 QALYs vs 1.23 QALYs, respectively. Consequently, the ICUR equalled -€1651.5/QALY, which shows that, although the initial costs of BT are higher than those of CT, the reduced follow-up costs associated with the long-term efficacy of BT make it the most effective and economically dominant option at 1, 5 and 10 years. Sensitivity analyses show that 100% of Monte Carlo iterations are below the willingness-to-pay threshold of €30,0001/QALY, making BT+CT an efficient strategy that could be adopted and reimbursed. In the absence of a reference treatment for the management of severe dysmenorrhoea, BT+CT offering an improvement in quality of life, as well as a reduction in follow-up costs. It is therefore the most cost-effective strategy over 10 years.

P-28. A Clinical and Economic Comparison of Non-Egg Influenza Vaccines in Adults 18-64 Years in the U.S

Abstract Background Influenza vaccination with non-egg-based vaccines had improved the antibody response to circulating flu viruses over that of traditional egg-based vaccines, which are the most common flu vaccines worldwide. Two non-egg-based flu vaccines— the cell-based flu vaccine (QIVc) and the recombinant flu vaccine (QIVr) —were introduced in the United States during the 2013-14 flu season. The objective of this analysis was to determine the cost-effectiveness of QIVc compared to QIVr administered to people between 18-64 years of age from U.S. commercial and societal perspectives.Table 1.Summary of Health and Economic Outcomes from the Commercial Perspective (Season 2018-19 – Vaccine Effectiveness) Methods A compartmental dynamic transmission model, calibrated to match infection data from the U.S., was used to estimate the clinical and economic impact of vaccination over one influenza season. Epidemiological data and vaccination coverage rate were obtained from CDC official databases. Vaccine effectiveness data against outpatient visits and hospitalizations, were obtained from published U.S. observational studies including outpatient and hospital setting outcomes (2018/19 and 2019/20 seasons). Associated direct medical costs, health state utilities and disutilities, and productivity loss costs were obtained from recent economic literature. Deterministic and probabilistic sensitivity analysis were conducted. Results From the U.S. commercial perspective of an equal number of vaccinated adults in both groups, QIVc compared to QIVr showed fewer outpatient visits (585,936) and emergency department visits (12,492), and a comparable number of hospitalizations (503) (see Table). QIVc compared to QIVr resulted in a higher overall number of quality-adjusted life years (QALYs) gained (2,546) and a reduction in total associated costs by US$2.9B. Cost savings were driven mainly by the lower 2023/24 acquisition costs, for QIVc vs QIVr (≈-50%). All sensitivity analyses produced similar results, confirming the robustness of the model. Results were consistent from the societal perspective. Conclusion The cell-based vaccine was cost saving compared to the recombinant vaccine for subjects 18-64 years in the U.S. and achieved comparable health outcomes results at a significant reduction in cost. Disclosures Myron J. Levin, MD, CSL Seqirus USA: Advisor/Consultant|Curevo: Advisory Board|GSK: Grant/Research Support|GSK: Advisory Board|Moderna: Advisory Board|Pfizer: Advisory Board Neda Al Rawashdh, n/a, CSL Seqirus USA: Advisor/Consultant Liliane Mofor, n/a, CSL Seqirus USA: Stocks/Bonds (Private Company) Pablo Anaya, n/a, CSL Seqirus USA: Advisor/Consultant Richard M. Zur, n/a, CSL Seqirus USA: Advisor/Consultant Emily B. Kahn, n/a, CSL Seqirus USA: Advisor/Consultant Daniel Yu, n/a, CSL Seqirus Australia: Stocks/Bonds (Private Company) Joaquin F. Mould-Quevedo, PhD, CSL Seqirus USA: Stocks/Bonds (Private Company)

Defects in the Metal of Welded Joints of Collectors to Steam Generators in Nuclear Power Plants

This article presents a study of the metal of coolant collectors' welded joints to steam generators in nuclear power plants. During the operation of nuclear power plants of the VVER-1000 type, metal defects were found in the collectors' welds to the steam generator body. The general cause for the defects' occurrence and development is the combination of: 1) the influencing stresses, and 2) the corrosively aggressive working environment. The specific manifestation and development of defects differs across different NPPs. This study focuses on examining the on-site working conditions. It describes observations on the occurrence and development of defects in the metal of the welded joints and possible facility degradation scenarios. The resulting data come from actual observations spanning a 30-year-period. This information is important for the safe operation of steam generators in NPPs. The data can be used for probabilistic safety analyses at NPPs as well as for NPP lifetime extension.

Cost-effectiveness analysis for implementation of smoking cessation strategies at primary health care settings in Tamil Nadu.

Smoking is a major public health concern in Tamil Nadu, as it is in many parts of the world. It is a leading cause of preventable diseases and deaths, with a significant economic burden on healthcare systems and society as a whole. Recognizing the need to address this issue, the implementation of smoking cessation strategies at primary health care (PHC) settings has gained attention. Conducting a cost-effectiveness analysis in this context can help policymakers and healthcare providers make informed decisions about the allocation of resources for such interventions. To compare the cost-effectiveness of the smoking cessation of proposed strategies (PSs), PS1: enhanced counselling (EC) + nicotine replacement therapy (NRT) + bupropion tablet; PS2: behavioural intervention (BI) + NRT + promotion of bupropion sustained release (SR); PS3: EC + NRT + promotion of bupropion SR with the current strategy (BI +NRT+ Bupropion) in a population of smokers aged ≥15 years attending the PHC in Tamil Nadu. In this hypothetical cohort of 100,000 individuals using the decision tree analysis, a cost-effectiveness assessment was conducted for both proposed and existing strategies. The results were evaluated in terms of incremental cost-effectiveness ratios (ICERs) per person quitting smoking. To assess the robustness of the findings, one-way sensitivity analysis and probabilistic sensitivity analysis were performed which aims to explore and address the uncertainties associated with the outcomes. The cost of the current strategy (CS) was higher (₹359 or $4.28 million) when compared with PS1 (₹327 or $3.90 million) and PS3 (₹327 or $3.90 million) strategies. The PS2 with BI + bupropion SR + NRT was found to be more cost (₹2,720,571 or $ 32,414.76) as compared to current strategy. ICER values indicates that compared to the current strategy, the PS1 and PS3 were found to be cost-saving, whereas the PS2 was found to be cost-effective. The cost-effectiveness acceptability curve demonstrated that the PS1 and PS3 indicates 100% probability of the intervention being cost-saving. After excluding dominated interventions (PS2 and CS), the remaining strategies (PS1 and PS3) were compared. The PS3, with an incremental cost of ₹462,497 ($5,510) for 131 additional quitters, resulted in an ICER of ₹3,531 ($42) per quitter, making it a cost-effective option compared to PS1. Our study findings indicate that the need for healthcare providers and policymakers to implement PS3 with EC, NRT, Bupropion SR, as which was found to be cost-saving compared to current practices.

368. Impact of Social Determinants of Health (SDOH) on Outcomes of OPAT (Outpatient Parenteral Antimicrobial Therapy)

Abstract Background Complex infections may warrant extended antibiotics traditionally reserved for inpatient settings. OPAT is safe and cost effective, allowing return to regular activities and decreased risk of hospitalization. Understanding of SDOH-sensitive risk parameters and impact on adverse events is needed to guide safety and adherence interventions.Figure 1.Most Common OPAT Antibiotics and Indications in Study Cohort Methods Records of patients treated 7/15-10/31/2023 by URMC OPAT program, exclusive of concurrent Transitions of Care Program, were retrospectively reviewed for race, social vulnerability index, insurance type, substance use, needs insecurity, household composition, and outcomes such as OPAT-related orders errors, intravascular device (IVAD) complications, emergency utilization, organ system adverse events, and clinical outcome. A composite Undesirable OPAT Outcome was derived. The impact of SDOH was assessed by chi-square, univariate and multivariate logistic regression using R v4.3 3, rstatix v0.7.2, and sjPlotv2.8.15.Table 1.Proportion and Rates of Errors, Complications, and OPAT Treatment Outcomes in Study Cohort Results Total 116 patients received 3573 OPAT days for varying indications (Fig 1). High rates of discharge order errors, ED utilization, IVAD complications, adverse events, and composite Undesirable Outcomes were noted (Table 1). Those with public insurance (OR=13.6, CI: 1.95-322) or who used cannabis (OR=5.23 CI: 1.1- 27.2) were more likely to incur a laboratory order error on discharge. Patients of color were more likely to experience IVAD complications (OR=3.61, CI: 1.1-12.6) and multiple organ system adverse events (OR= 6.55, CI: 1.45-34.9). High-risk tobacco use was associated with shortened OPAT duration due to adverse event (OR=28.47, CI: 1.72-1299) (Fig 2). OPAT patients with public insurance were least likely to follow up with the ID clinic (OR=7.65, CI: 1.27-152). Time to ID follow-up correlated with multiple SDOH parameters, with publicly insured and persons of color experiencing significantly longer time to follow-up appointments (Fig 3). Incurring a non-IVAD adverse event correlated to composite undesirable outcome in multivariate analysis.Figure 2.Odds Ratios in Univariate Analysis of OPAT Complications Based on Social Determinants of Health Conclusion Social determinants may be predictors in OPAT-related unwanted events. A dedicated focus of evaluating SDOH as contributing drivers of adverse OPAT outcomes may assist creating interventions to support marginalized patient groups.Figure 3:Time-to-event probability analysis for timing of post-discharge ID clinic follow up among OPAT patients by Insurance Type (3A), Race (3B), and All Patients (3C) Disclosures All Authors: No reported disclosures

Probabilistic parametric analysis of capacity, fragility and expected seismic damage of framed reinforced concrete buildings

Abstract 1160 framed reinforced concrete buildings, holding 3–13 stories, have been modelled in a probabilistic way. Capacity spectra have been calculated and characterized by means of 5 parameters: initial stiffness, ultimate capacity (Sdu, Sau), μ and σ. μ is related to ductility, and σ controls the way the building strength degrades. A strong correlation among these five parameters has been found. Moreover, the also high correlation between the initial stiffness and the number of stories allows to define median and percentile capacity spectra starting from the number of stories. Afterwards, for each number of stories, a fragility analysis is performed for the median capacity spectrum. The Barcelona city, in Spain, is used to depict the expected physical damage for a probabilistic and a deterministic seismic hazard scenario. Two procedures, based on the bilinear form of the capacity spectrum and on the Park and Ang damage index, are used to define damage states thresholds. The probabilistic scenario is more damaging than the deterministic one is and, damage states thresholds based on the capacity spectrum lead to more damages than the ones based on the Park and Ang damage index. Mean damage states close to 2.0 are obtained, being 25% and 6% the probabilities of Severe, and Complete, damage states, which would have significant impact on the number of homeless people and victims. Maps of expected damages depict the physical seismic risk of the probabilistic scenario. These scenarios are very useful for emergency planning and for earthquake protection.

A Probabilistic Framework for Evaluating Efficiency Gains in Vogel's Approximation Method

Transportation involves various uncertainties in determining the most efficient method for transporting goods. When a company has supply and destination points, or a supplier has specific demands, achieving an optimized balance becomes crucial. This task becomes more challenging when there is an imbalance between demand and supply, requiring an effective method to measure and address uncertainty. Probability theory provides a reliable framework for quantifying these uncertainties. Basic feasible solutions to transportation problems can be obtained using methods such as the North-West Corner Method, Least Cost Method, Row (Column) Minima Method, or Vogel’s Approximation Method. Among these, Vogel’s Approximation Method is widely recognized for its effectiveness in yielding superior results. This paper proposes a novel approach that integrates probability analysis into transportation problems, emphasizing the derivation of the probability distribution function (PDF) for Vogel's Approximation Method. The derived results not only enhance understanding but also offer valuable insights to improve decision-making processes within the transportation domain.

Cost-effectiveness and budget impact of covering Burkitt lymphoma in children under Ghana’s National Health Insurance Scheme

BackgroundChildhood cancer is not a high priority in health care financing for many countries, including in Ghana. Delayed care seeking and treatment abandonment, often due to the financial burden of care seeking to families, are common reasons for a relatively low overall survival (OS) in low-and middle-income countries. In this study, we analyzed the cost-effectiveness of extending health insurance coverage to children with Burkitt lymphoma (BL) in Ghana.MethodsWe developed a Markov model in Microsoft Excel to estimate the costs and effects of BL treatment when National Health Insurance Scheme (NHIS) was provided compared to the status quo where NHIS does not cover care for childhood cancer. The analysis was undertaken from the societal and health system (payer) perspective. Both costs (measured in $) and effects, measured using disability adjusted life years (DALYs), were discounted at a rate of 3%. The time horizon was a lifetime. Probabilistic sensitivity analysis was done to assess uncertainty in the measurement of the incremental cost-effectiveness ratio (ICER). A budget impact analysis was undertaken from the perspective of the NHIS.ResultsIn the base-case analysis, the intervention (NHIS reimbursed treatment) was less costly than current practice ($8,302 vs $9,558). The intervention was also more effective with less DALYs per patient than the standard of care (17.6 vs 23.33). The ICER was -$219 per DALY averted from societal perspective and $113 per DALY averted from health system perspective. The probabilistic sensitivity analysis showed that the intervention is likely to be both less costly and more effective than current practice in 100% of the 1,000 simulations undertaken.ConclusionProviding health insurance coverage to children with BL is potentially cost-effective. The effectiveness and cost-savings relating to this strategy is driven by its positive impact on treatment initiation and retention. Based on this evidence, there has been a policy change where Ghana’s NHIS has prioritized financing for cancer treatment in children.

Probabilistic stability assessment of slope considering soft soil and silty clay foundations

Although deterministic analysis can provide initial insights into slope stability, there is no way to reflect the true distribution of soil properties within a slope. To further investigate the effects of the spatial variability of soil properties on the stability and failure mechanism of slope under different foundation types, this study develops a framework combining simple limit equilibrium method (LEM), Monte Carlo Simulation (MCS), and random field to incorporate these factors into slope probabilistic stability analysis. The slope models of two typical foundations (e.g., soft soil and silty clay foundations) are used to illustrate the proposed methodology. The results show that the shape of critical failure slip surface in slope with a soft foundation is deep and passes through the soft soil layer, indicating that the slope with a soft foundation has a variable failure mechanism. Due to the presence of soft soil foundation, the correlation between different critical failure slip surfaces is low and deterministic analysis may significantly overestimate slope stability. When performing a probabilistic stability analysis of the slope under the silty clay foundation, it is noted that the shape of critical failure slip surface is relatively shallow and the correlation between different critical failure slip surfaces is high. The degree of slope stability overestimation caused by deterministic analysis is significantly reduced. Note that when the factor of safety is used to evaluate slope stability, deterministic analysis can only evaluate slope stability more reasonably when the correlation of failure slip surface is high, while probabilistic method can evaluate slope stability more comprehensively and reasonably. The sensitivity analysis results show that the sensitivity of internal friction angle to slope stability is much higher than that of cohesive under different scales of fluctuation, coefficients of variation, and cross correlation coefficients.

Therapeutic drug monitoring versus Bayesian AUC-based dosing for vancomycin in routine practice: a cost-benefit analysis.

AUC-based dosing with validated Bayesian software is recommended as a good approach to guide bedside vancomycin dosing. To compare treatment and vancomycin-associated acute kidney injury (AKI) costs between Bayesian AUC-based dosing and conventional therapeutic drug monitoring (TDM) using steady-state plasma concentrations of vancomycin administered as continuous infusion in hospitalized non-critically ill patients with severe Gram-positive infection. A cost-benefit analysis presented as a return on investment (ROI) analysis from a hospital perspective was conducted using a decision tree model (TDM versus AUC-based dosing) to simulate treatment cost (personnel, serum sampling and drug cost), vancomycin-associated AKI risk and cost up to 14 days. ROI was calculated against AUC-based software cost. One-way and probabilistic sensitivity analyses (respectively OWSA and PSA) were performed to check for robustness. In base case, an overall cost per patient of €621.0 with TDM and €543.6 with AUC-based dosing resulted in a treatment saving of €77.4 per patient when applying AUC-based dosing. This saving against the software cost (€26.9/patient) generated an ROI per patient of €1.9 per invested € in software [€1.9 (95% CI 1.6-2.2) in PSA]. Enrolling 900 AUC-based dosed patients annually translated to a net saving of €45 469. Software break-even was reached after 313 patients. In OWSA, a higher AKI risk with TDM strongly contributed to a positive ROI. AUC-based dosing appeared a cost-saving strategy compared with conventional TDM when applying base-case settings of vancomycin-associated AKI risk, treatment and AKI costs.