Productivity-related Costs Research Articles

Enhancing Economic Development through Inventory Management Optimization in Agro-based Industries in Bihar: A Comparative Study of EOQ and EPQ Models

Inventory management is crucial for optimizing operational efficiency and cost-effectiveness in agro-based industries, particularly in regions like Bihar,known for their agricultural resources. This study compares the effectiveness of two inventory management models, the Economic Order Quantity (EOQ) and Economic Production Quantity (EPQ), in addressing the unique challenges faced by Bihar's agro-based industries. Data from Taruwar Agro Industries Private Limited in Ashiyana, Patna, use to calculate EOQ and EPQ values for three product categories: Tomato Chili, Peri Peri, and Punjabi Tadka. The study employs relevant formulas to compute optimal order quantities and total inventory costs, assuming constant demand, quality, price, holding costs, and ordering costs. Both the EOQ and EPQ models offered viable approaches to inventory optimization. EOQ focused on minimizing holding and ordering costs, while EPQ integrated production-related costs to optimize production flow. The study underscored the importance of aligning inventory management strategies with operational capabilities, market demand, and financial objectives. This study contributes to advancing theoretical understanding and practical applications of inventory management in agro-based economies like Bihar. Recommendations for empirical validation, contextual adaptation, technology integration, and long-term impact assessment are provided to enhance inventory management practices. Integration of the BCG matrix into decision-making processes offers a comprehensive approach to prioritizing inventory management strategies and guiding strategic implications.

Productivity outcomes from chronic pain management interventions in the working age population; a systematic review.

Productivity loss because of chronic pain in the working age population is a widespread concern internationally. Interventions for chronic pain in working age adults might be expected to achieve enhanced productivity in terms of reduced costs of workers' compensation insurance, reduced disability support, and improved rates of return to work for injured workers. This would require the use of measures of productivity in the evaluation of chronic pain management interventions. The aim of this review was to identify and interpret the productivity outcomes of randomised controlled trials reported by studies that conducted economic evaluations (eg, cost-effectiveness and cost-utility) of chronic pain management interventions in the working age population published from database inception to March 2023. Econlit, Embase, and Pubmed electronic databases were searched, yielding 12 studies that met the selection criteria. All 12 studies used absenteeism to measure productivity, translating return to work measures into indirect costs. Only one study included return to work as a primary outcome. Ten studies found no statistically significant improvements in productivity-related costs. Despite evidence for reduced pain-related disability after pain management interventions, this review suggests that the use of measures for assessing productivity gains is lacking. Including such measures would greatly assist administrators and payers when considering the broader societal benefits of such interventions.

SELECTING SUSTAINABILITY KEY PERFORMANCE INDICATORS FOR SMART LOGISTICS ASSESSMENT

The application of smart technologies and applications is becoming increasingly common in the logistics processes of companies and supply chains. However, standard logistics indicators are still used to evaluate their performance, which contradicts the sustainable development strategy of many industrial enterprises and their supply chains. Thus, the article aims to design a methodology for selecting sustainability key performance indicators (SKPIs) suitable for assessing smart logistics and its technologies and applications. The research relies on cluster analysis of the SKPIs recommended in the relevant literature, frequency analysis of indicators used in practice and their comparison. The cluster analysis showed that the primary attention in the references is given to sustainability’s economic and environmental dimensions. Most frequently, the authors highlighted the importance of the following indicators: production-related costs and investments, planning performance and quality, customer satisfaction, energy efficiency, waste intensity and treatment, emissions, and resource efficiency. On the contrary, the frequency analysis corroborated that leading industrial enterprises paid more-or-less balanced attention to all areas of sustainability, but at the company level. The article’s primary result constitutes a methodology comprising six steps, respecting the results of the analyses carried out: (1) Sustainability objectives definition; (2) Establishing SKPIs cluster pool; (3) Definition of criteria for selecting SKPIs clusters; (4) Selection of SKPIs clusters; (5) Definition of SKPIs and their parameters; and (6) Development of SKPIs hierarchical structure.

KONFEKSİYON ÜRETİMİNDE İŞGÜCÜ VERİMLİLİK ANALİZİNİN PANTOLON DİKİM HATTINDA UYGULANMASI

In order not to lose their market share in global markets where borders have disappeared, to gain competitive advantage, and to increase their profitability, businesses have increased their work on efficiency values to use their scarce resources effectively. Considering that global economies, of which importance is frequently mentioned today, are composed of national economies, and national economies are constituted by the economies of enterprises operating in that nation, it becomes evident how important they are. Improving the economies of businesses operating in countries is possible by minimizing unnecessary activities in production activities with various efficiency studies and reducing production-related costs. In this study, the workforce efficiency in a clothing company manufacturing trousers was analyzed. In this context, data was collected from the sewing line of a garment company operating on trouser production in Izmir, and the data obtained was evaluated with the labor productivity model with rates from Kurosawa's productivity models. As a result of this research, it has been determined that the losses expected to be eliminated entirely after getting used to the production of the relevant product are still visible and even more than they should be.

Microstructure and flexural performances of glass fibers reinforced phosphate sludge based geopolymers at elevated temperatures

The focus of this study is the development of innovative and sustainable geopolymer composites with improved elevated temperatures performances. To minimize production related costs and support a circular economy model, phosphate sludge and MK are chosen as precursors for alkaline activation, and glass fibers as reinforcement material. The geopolymer composites were prepared by incorporating glass fibers in a geopolymer matrix based on a mixture of metakaolin and PS in a ratio of 50% and with amounts ranging from 0.25% to 1% of fibers. The developed composites were assessed in terms of physical characteristics, microstructural properties and flexural strength prior to and after introduction to higher temperatures. The findings demonstrated that PS based geopolymer matrix flexural strength decreased in the region of temperature between 25 and 600 °C, but increased progressively at higher temperatures, achieving a gain of 3.2% at 1000 °C. The same trend was followed after glass fiber incorporation, leading to a more significant gain of about 16.5% with a 1% fiber content up to 1000 °C. This behavior was assigned to the decomposition of carbonate content of PS at 600 °C as well as to the crystallization of the geopolymer matrix at higher temperatures.

Servitization as an alternative business model and its implications on product durability, profitability & environmental impact

Servitization is the activity of selling the services provided by the product rather than the product itself. It is a business model that might be environmentally superior to conventional selling. Servitization promises accessibility to the product’s functionality, pooling of consumer use, and potentially products of better design. However, it can also inflate consumption and result in a bigger environmental impact overall. In this paper, we compare servitization with traditional selling for a monopolist durable goods manufacturer from both an economic and environmental perspective. In this comparison, we define the durability of a product as the use capacity; that is, how many usages it can endure before reaching end of life. We study the firm’s durability decision, followed by the price/fee decision, and the consequent usage in the market under each model. We find that servitization produces durability levels that are robust to customer heterogeneity, and higher than selling. Overall, environmental superiority of servitization hinges on product related costs, customer heterogeneity, and market composition. It is, however, robust to varying environmental factors in the use and manufacturing phases. When we compare environmental preferability with the economic incentives of the firm, we observe that they are not always aligned.

Cost-Effectiveness of a Serum Biomarker Test for Risk-Stratified Liver Ultrasound Screening for Hepatocellular Carcinoma

ObjectivesRisk-stratified ultrasound screening for hepatocellular carcinoma (HCC), informed by a serum biomarker test, enables resources to be targeted to patients at the highest risk of developing cancer. We aimed to investigate the cost-effectiveness of risk-stratified screening for HCC in the Australian healthcare system. MethodsA Markov cohort model was constructed to test 3 scenarios for patients with compensated cirrhosis: (1) risk-stratified screening for high-risk patients, (2) all-inclusive screening, and (3) no formal screening. Probabilistic sensitivity analyses were undertaken to determine the impact of uncertainty. Scenario analyses were used to assess cost-effectiveness in Australia’s Aboriginal and Torres Strait Islander peoples and to determine the impact of including productivity-related costs of mortality. ResultsBoth risk-stratified screening and all-inclusive screening programs were cost-effective compared with no formal screening, with incremental cost-effectiveness ratios of A$39 045 and A$23 090 per quality-adjusted life-year (QALY), respectively. All-inclusive screening had an incremental cost-effectiveness ratio of A$4453 compared with risk-stratified screening and had the highest probability of being cost-effective at a willingness-to-pay (WTP) threshold of A$50 000 per QALY. Risk-stratified screening had the highest likelihood of cost-effectiveness when the WTP was between A$25 000 and A$35 000 per QALY. Cost-effectiveness results were further strengthened when applied to an Aboriginal and Torres Strait Islander cohort and when productivity costs were included. ConclusionsCirrhosis population-wide screening for HCC is likely to be cost-effective in Australia. Risk-stratified screening using a serum biomarker test may be cost-effective at lower WTP thresholds.

PIN25 A Systematic Review of the Use of Productivity Loss/GAIN in Cost-Effectiveness Analyses for Vaccines

Cost-effectiveness is one factor that is sometimes considered when deciding whether or not to recommend a vaccine for coverage and/or inclusion in immunization programs. Vaccines are associated with a range of cost implications including direct healthcare costs and indirect costs such as productivity gains and losses. This review describes the use of productivity-related costs in cost-effectiveness analyses (CEA) and cost-utility analyses (CUA) for vaccines. A systematic literature review was conducted based on a search of Medline, Embase, and Cochrane Library and a bibliography search to identify CEAs and CUAs for vaccines and vaccine programs that included productivity-related costs. A description of the studies included in terms of their country of origin, disease targeted, study design, analysis perspective, and more is provided. Moreover, the kind of productivity-related cost elements, their calculation approach, and the impact of their inclusion on cost-effectiveness outcomes are summarized. Eighty-eight studies were identified that evaluated the cost-effectiveness of vaccines and included costs associated with productivity. The specific productivity cost elements included were reported for 71 studies (81%) with absenteeism being the most widely included productivity cost element. Caregiver absenteeism was the only productivity cost element included for 39 studies (44%) and 18 studies (20%) included only patient absenteeism as a productivity cost element. Although the specific elements included were not always reported, 76 studies (86%) reported the impact of including productivity losses and gains on the ICER, with a majority of those studies reporting a more favorable cost-effectiveness based on their inclusion. Inclusion of productivity-related costs such as costs associated with absenteeism and premature mortality for CEA and CUA of vaccines resulted in more favorable cost-effectiveness – i.e. a lower ICER – based on the studies reviewed. However, the specific cost elements included tend to differ depending on the target disease and/or population.

Effects of Improved Cassava Varieties on Farmers’ Income in Northern Agro-ecological Zone, Uganda

This paper examines the extent to which improved cassava varieties contribute to improvement in income of smallholder farmers in the Northern agro-ecological zone of Uganda. In order to achieve the objective, data was collected from PRELNOR supported farmers’ fields, other farmers’ fields and baseline cassava fields. Consequently, descriptive statistics, gross margin and stochastic frontier analysis were adopted during analysis. Results from the analysis revealed that higher yields per hectare were registered within PRELNOR supported farmers’ fields and yield from NAROCAS1 surpassed all the varieties (37.3 tons per hectare). Location specific results revealed that Gulu had better yields (34.5 tons per hectare) while Kitgum registered the lowest average (24.1 tons per hectare). Gross margin indicated that every Shilling invested in improved variety earned profit 1.3 to 1.8 times above the local variety and each shillings invested in PRELNOR supported fields generated 5.6 times above the baseline fields. The parameter estimate for profit function revealed that planting material, other production related costs, NAROCAS1, NASE14 and NASE19 were positively correlated with profit but labour and baseline field had negative correlations. Conversely, profit efficiency grew by 40% under improved varieties against local varieties. This study suggests that the difference in yields and profit between locations was caused by biophysical characteristic; disease tolerant varieties can tremendously improve profitability and income; meanwhile the profit gaps were partly attributed to inefficiency. This study recommends fast tracking adoption of pest and disease tolerant varieties and integrated research and development approach throughout the cassava value chain.

Agricultural Land Suitability Assessment Using Satellite Remote Sensing-Derived Soil-Vegetation Indices

Satellite remote sensing technologies have a high potential in applications for evaluating land conditions and can facilitate optimized planning for agricultural sectors. However, misinformed land selection decisions limit crop yields and increase production-related costs to farmers. Therefore, the purpose of this research was to develop a land suitability assessment system using satellite remote sensing-derived soil-vegetation indicators. A multicriteria decision analysis was conducted by integrating weighted linear combinations and fuzzy multicriteria analyses in a GIS platform for suitability assessment using the following eight criteria: elevation, slope, and LST vegetation indices (SAVI, ARVI, SARVI, MSAVI, and OSAVI). The relative priorities of the indicators were identified using a fuzzy expert system. Furthermore, the results of the land suitability assessment were evaluated by ground truthed yield data. In addition, a yield estimation method was developed using indices representing influential factors. The analysis utilizing equal weights showed that 43% of the land (1832 km2) was highly suitable, 41% of the land (1747 km2) was moderately suitable, and 10% of the land (426 km2) was marginally suitable for improved yield productions. Alternatively, expert knowledge was also considered, along with references, when using the fuzzy membership function; as a result, 48% of the land (2045 km2) was identified as being highly suitable; 39% of the land (2045 km2) was identified as being moderately suitable, and 7% of the land (298 km2) was identified as being marginally suitable. Additionally, 6% (256 km2) of the land was described as not suitable by both methods. Moreover, the yield estimation using SAVI (R2 = 77.3%), ARVI (R2 = 68.9%), SARVI (R2 = 71.1%), MSAVI (R2 = 74.5%) and OSAVI (R2 = 81.2%) showed a good predictive ability. Furthermore, the combined model using these five indices reported the highest accuracy (R2 = 0.839); this model was then applied to develop yield prediction maps for the corresponding years (2017–2020). This research suggests that satellite remote sensing methods in GIS platforms are an effective and convenient way for agricultural land-use planners and land policy makers to select suitable cultivable land areas with potential for increased agricultural production.

Strategic bidding via the interplay of minimum income condition orders in day-ahead power exchanges

In this paper we study the so-called minimum income condition order, which is used in some day-ahead electricity power exchanges to represent the production-related costs of generating units. This order belongs to the family of complex orders, which imply non-convexities in the market clearing problem. We demonstrate via simple numerical examples that if more of such bids are present in the market, their interplay may open the possibility of strategic bidding. More precisely, we show that by the manipulation of bid parameters, a strategic player may increase its own profit and potentially induce the deactivation of an other minimum income condition order, which would be accepted under truthful bidding. Furthermore, we show that if we modify the objective function used in the market clearing according to principles suggested in the literature, it is possible to prevent the possibility of such strategic bidding, but the modification raises other issues.

A hybrid genetic algorithm for a multilevel assembly replenishment planning problem with stochastic lead times

This paper on replenishment planning for multi-level assembly systems with several components at each level deals with the problem of calculating planned lead-times when the real lead-times for all components are assumed to be stochastic. This problem is already treated in the literature by using a recursive procedure and a Branch and Bound algorithm. Here, in order to decrease the computation time, a novel generalized probabilistic model based on an iterative approach is developed. The proposed model calculates the expected total cost, which is composed of the inventory holding cost for components and the backlogging and inventory holding costs for the finished product. An iterative approach and a hybrid genetic algorithm are introduced to determine the planned order release dates for components at the last level of the bill of materials that minimizes the expected total cost. Experimental results show that the proposed optimization algorithm efficiently finds good-quality approximate solutions regardless of the type of assembly system, the number of components at the last level and the variability of the finished product-related costs.

Incremental costs of COPD exacerbations in GOLD stage 2+ COPD in ever-smokers of a general population

ObjectivesTo estimate treatment- and productivity-related costs associated with COPD in two different samples, and to analyse the association between the costs and moderate and severe exacerbations. MethodsWe performed a baseline visit and four telephone-interviews during a one-year follow-up of 81 COPD cases and 132 controls recruited from a population-based sample, and of 205 hospital-recruited COPD patients. COPD was defined by post-bronchodilator spirometry. Total costs consisted of treatment related costs and costs of productivity losses. Exacerbation-related costs were estimated by multivariate median regression. ResultsThe average annual disease-related costs for a COPD patient from the hospital sample was nearly twice as high as for a COPD case from the population sample (€26,518 vs €15,021), and nearly four times as high as for a control subject (€6740). For both sampling sources, the average annual costs of productivity losses were substantially higher than the treatment related costs (€17,014 vs €9,504, €11,192 vs €3,829, and €4494 vs €2,246, for the hospital COPD patients, the population-based COPD cases, and the controls, respectively). Severe exacerbations were an important cost driver for the treatment related costs in both COPD groups. Moderate exacerbations explained all the costs of productivity losses in the population-based COPD cases, but did not affect the costs of productivity losses in the hospital-recruited COPD patients. ConclusionWe found that there were significant incremental costs associated with COPD, and the treatment related costs were significantly affected by exacerbations. The costs of productivity losses substantially exceeded the treatment related costs in both sampling sources.

Servitization as An Alternative Business Model and Its Implications on Product Durability, Profitability & Environmental Impact

Servitization is the activity of selling the services provided by the product rather than the product itself. It is a business model that might be environmentally superior to conventional selling. Servitization promises accessibility to the product's functionality, pooling of consumer use, and potentially products of better design. However, it can also inflate consumption and result in a bigger environmental impact overall. In this paper, we compare servitization with traditional selling for a monopolist durable goods manufacturer from both an economic and environmental perspective. In this comparison, we define the durability of a product as the use capacity; that is, how many usages it can endure before reaching end of life. We study the firm's durability decision, followed by the price/fee decision, and the consequent usage in the market under each model. We find that servitization produces durability levels that are robust to customer heterogeneity, and higher than selling. Overall, environmental superiority of servitization hinges on product related costs, customer heterogeneity, and market composition. It is, however, robust to varying environmental factors in the use and manufacturing phases. When we compare environmental preferability with the economic incentives of the firm, we observe that they are not always aligned.

Land suitability assessments for yield prediction of cassava using geospatial fuzzy expert systems and remote sensing

Cassava has the potential to be a promising crop that can adapt to changing climatic conditions in Indonesia due to its low water requirement and drought tolerance. However, inappropriate land selection decisions limit cassava yields and increase production-related costs to farmers. As a root crop, yield prediction using vegetation indices and biophysical properties is essential to maximize the yield of cassava before harvesting. Therefore, the purpose of this research was to develop a yield prediction model based on suitable areas that assess with land suitability analysis (LSA). For LSA, the priority indicators were identified using a fuzzy expert system combined with a multicriteria decision method including ecological categories. Furthermore, the yield prediction method was developed using satellite remote sensing datasets. In this analysis, Sentinel-2 datasets were collected and analyzed in SNAP® and ArcGIS® environments. The multisource database of ecological criteria for cassava production was built using the fuzzy membership function. The results showed that 42.17% of the land area was highly suitable for cassava production. Then, in the highly suitable area, the yield prediction model was developed using the vegetation indices based on Sentinel-2 datasets with 10 m resolution for the accuracy assessment. The vegetation indices were used to predict cassava growth, biophysical condition, and phenology over the growing seasons. The NDVI, SAVI, IRECI, LAI, and fAPAR were used to develop the model for predicting cassava growth. The generated models were validated using regression analysis between observed and predicted yield. As the vegetation indices, NDVI showed higher accuracy in the yield prediction model (R2 = 0.62) compared to SAVI and IRECI. Meanwhile, LAI had a higher prediction accuracy (R2 = 0.70) than other biophysical properties, fAPAR. The combined model using NDVI, SAVI, IRECI, LAI, and fAPAR reported the highest accuracy (R2 = 0.77). The ground truth data were used for the evaluation of satellite remote sensing data in the comparison between the observed and predicted yields. This developed integrated model could be implemented for the management of land allocation and yield assessment in cassava production to ensure regional food security in Indonesia.

An optimization model for aggregate production planning and control: a genetic algorithm approach

In this paper, an optimization model for aggregate planning of multi-product and multi-period production system has been formulated. Due to the involvement of too many stakeholders as well as uncertainties, the aggregate production planning sometimes becomes extremely complex in dealing with all relevant cost criteria. Most of the existing approaches have focused on minimizing only production related costs, consequently ignored other cost factors, for instance, supply chain related costs. However, these types of other cost factors are greatly affected by aggregate production planning and its mismanagement often results in increased overall costs of the business enterprises. Therefore, the proposed model has attempted to incorporate all the relevant cost factors into the optimization model which are directly or indirectly affected by the aggregate production planning. In addition, the considered supply chain related costs have been segregated into two major categories. While the raw material purchasing, ordering, and inventory costs have been grouped into an upstream category, finished goods inventory, and delivery costs in the downstream category. The most notable differences with the other existing models of aggregate production planning are in the consideration of the cost factors and formulation process in the mathematical model. A real-life industrial case problem is formulated and solved by using a genetic algorithm to demonstrate the applicability and feasibility of the proposed model. The results indicate that the proposed model is capable of solving any type of aggregate production planning efficiently and effectively.

796-P: A Systematic Review of Diabetes-Related Outcomes in Food Provision Studies

In 2017, U.S. diabetes direct and productivity-related costs were $327 billion and accounted for 4 million deaths, yet much of this could be prevented by adhering to dietary guidelines. The objective was to perform a systematic review of the nutritional intervention literature where meals were provided to determine their clinical and cost impact in diabetes therapy. CINAHL, Cochrane, Health Source, and MEDLINE/PubMed were searched for food-provision articles published between January 1, 2013-May 1, 2018. Two researchers independently performed critical appraisal. Of 351 articles, appraisal was completed for 33 articles (N=14,258) that consisted of diets related to low caloric/carbohydrate intake or specific nutrients. Low calorie/carbohydrate diets consistently and significantly (p<0.017) reduced weight (>5% weight loss: 97.6%-100%; body-mass index loss: 2.3-5.4 kg/m2), waist circumference reduction (4.8-12cm), and improved markers of diabetes (A1c: 0.9-1.5% reduction) in short time frames (3 weeks-1 year). Patients reported higher dietary satisfaction (up to 93%) while achieving adequacy or 100% compliance. Large-scale education-based dietary interventions have challenges with patient adherence, yet resulted in 31.4% of patients moving from diabetes to prediabetes and 16.1% from prediabetes to none in 3 months. Other large-scale non-food provision studies (N=96,553) observed when patients improved A1c control (from 13.2% >9%A1c to 9.2% >9%A1c; p=0.01), hospitalization days were reduced by 2% annually (800,000 days) and $1.8 billion saved annually in the U.S. In this systematic review, A1c was significantly reduced by 0.9-1.5% (p<0.05) within weeks to months. Providing guideline-based culinary medicine prescriptions for medically tailored, goal-based meals may reduce healthcare costs by improving patient adherence and clinical outcomes; resulting in significant cost savings to the U.S. healthcare system, in reduced hospitalizations and/or overall direct costs. Disclosure J.B. Martinez: Board Member; Self; Healthy Meals Supreme, LLC. J.A. Draime: Consultant; Self; Healthy Meals. J. Gardner: None. S.E. Berman: None. A.M.H. Chen: None. Funding Healthy Meals Supreme, LLC

Profitability on dairy farms with automatic milking systems compared to farms with conventional milking systems

The objective of this study was to explore differences in profitability between farms with automatic milking systems (AMS) and farms with conventional milking systems (CMS). To explore profitability, we analysed the gross farm income from dairy cows. Accounting and production data for over a thousand dairy farms were collected. Using kernel-matching, we made CMS farms more comparable to AMS farms. We then used ordinary least squares regression to estimate the effect of AMS relative to farm size and time passed since last investment in milking systems. The results show that farms must have 35 to 40 cows before AMS becomes more profitable than CMS. Further, any profitability gains will only be visible after a transitional period of approximately four years. Milk revenues are higher on AMS farms, and the difference increases with the size of the farm. Production-related costs are also higher on AMS farms.

Multiscale simulation approach for production systems

Planning support for industrial production systems aims at reducing production-related costs and environmental impacts while creating required products with a desired quality. However, the increasing complexity of modern products and production technology makes planning and the provision of appropriate methods and tools a challenging task. Isolated measures for improving quality, cost or eco-efficiency, often result in problem shifting causing negative effects regarding other goal criteria. For this reason, suitable methods and tools are required for the planning and evaluation of specific improvement measures and for obtaining an interdisciplinary system understanding. This paper presents an approach, which is capable of analyzing production systems considering multiple scales based on coupled simulation models. The approach enables the evaluation of interactions between product units, processes, machines, technical building services, and the building structure. The approach contains a generic framework for the simulation structure, detailed model concepts for relevant production system elements, and a definition of interfaces between models for co-simulation. A case study demonstrates an exemplary application of the simulation approach for the production of battery cells. The study shows how the simulation enables evaluating the influences of different process configurations on intermediate product characteristics as well as of different factory scenarios and seasonal effects on the energy demands. More specifically, on product and process scale, the study revealed how different process routes and process parameters in electrode production affect the characteristics of battery slurries and coated electrode foils along with production lead-times. On process chain and factory scale, the study illustrates how the energy demands of machines and building services are influenced by machine operation and outside weather conditions. Thus, the study provides insight into the capabilities of a multiscale simulation and how such simulation may be applied to evaluate different producton system configurations, operation strategies, or facility locations.

Comparing Costs and Consequences of Eltrombopag Plus IST Versus IST Alone for First-Line Treatment in Severe Aplastic Anemia: Results from a Responder Analysis

Background: Severe Aplastic Anemia (SAA) is a rare bone marrow disorder characterized by inadequate levels of peripheral, multi-lineage blood cells.Of the two available first-line treatments for SAA, allogeneic hematopoietic stem cell transplantation is limited by patient eligibility and donor availability, and immunosuppressive therapy (IST) is characterized by a significant proportion of non-responders, toxicity, and risk of transformation to diseases such as acute myelogenous leukemia. Patients who do not respond to treatments become transfusion dependent, which has a significant impact on patients' quality of life as well as healthcare costs.Eltrombopag is the only TPO-R agonist approved for the treatment of refractory SAA. In a Phase I/II clinical trial, eltrombopag, given in association with IST, showed efficacy in patients with naive-SAA, and offers a significantly improved first-line alternative to patients affected by SAA (Townsley, et al 2017). In the US healthcare environment, there is a need to compare costs and consequences to understand value.Objective: Evaluate eltrombopag as a first-line treatment versus IST alone for SAA from the American private healthcare system perspective.Methods: A responder model for newly diagnosed SAA patients was created to assess the treatment pathway and economic impact of including eltrombopag in addition to IST (antithymocyte globulin and cyclosporine A) as a first-line treatment. A simulated cohort with two treatment arms underwent 6 months of treatment with either eltrombopag in addition to IST or with IST alone and were followed for a 3-year time period. Each arm received a diagnostic test measuring response at 6 months. Patients who achieved complete or partial response in either arm received low-dose cyclosporine A as maintenance therapy for an additional 6 months of treatment. Patients who did not respond in either arm continued with eltrombopag monotherapy as a second-line therapy for an additional 6 months.First-line therapy (eltrombopag with IST, IST alone), maintenance therapy (low-dose cyclosporine A), second-line therapy (eltrombopag monotherapy), administration, routine care, mortality and adverse event costs were included in the analysis. Workplace productivity related costs were not considered. Response rates, mortality, dosing, treatment duration and adverse event rates for each arm were based on a phase I/II trial (Townsley, et al 2017). Drug costs were obtained from a large online database (REDBOOK Online). Administration costs were based on the 2017 CMS Medical Fee Schedule. Routine care rates (visits, hospitalizations, tests and transfusions) were based on published data (Peffault De Latour, et al, 2017). Routine care, mortality and adverse event costs were based on CPT codes from the American Medical Association, HCUPnet and published data (Toner, et al 2011). All cost data are reported in 2018 US dollars. See figure 1 for details.Results: In a simulated cohort with a population of one million, the annual incidence of aplastic anemia was 0.000234% and SAA accounted for 83.8% of those cases. The two treatment paths were compared for their consequences. Based on the clinical trial data, in the treatment arm with eltrombopag and IST, 94% of patients experienced treatment response relative to the IST arm where only 66% of patients experienced treatment response. Further, in the treatment arm with eltrombopag and IST, the patients experienced a reduced annual risk of mortality by 0.3% relative to the IST arm. Use of eltrombopag therapy as a first-line therapy produced a cost increase of $77,442 over 3 years. First-line drug costs accounted for an increase of $109,147, while improvements in response rates led to cost offsets for second-line drugs and produced $29,663 in savings. Adverse event, routine care and mortality costs had relatively negligible effects on either treatment arm over a 3-year time period. Sensitivity analyses confirmed the robustness of the analysis.Conclusion: When following treatment approaches specified in clinical studies, high response rates combined with reduced risk of mortality and less usage of rescue medication, and a low disease incidence are likely to lead to manageable economic consequences with eltrombopag + IST therapy from the American private healthcare system perspective. In a simulated cohort with a population of one million, this was estimated to be $77,442 over 3 years. [Display omitted] DisclosuresSaid:Novartis: Employment. Cai:Novartis: Employment. Forsythe:Novartis: Consultancy. Roy:Novartis: Employment.