Scenario Analysis Research Articles

A Retrospective Budget Impact Analysis of Fidaxomicin Treatment for Clostridioides difficile Infections (CDI) in Germany.

Clostridioides difficile is the most common cause of healthcare-associated diarrhea. Research suggests that treating C. difficile infections (CDI) with fidaxomicin (FDX) is more effective than vancomycin (VAN), with potential cost savings. The objective was to calculate the budget impact of FDX treatment compared to VAN from a German payer perspective. The analysis used real-world data of patients discharged from University Hospital Cologne between Jan-01-2018 and Dec-31-2019. We identified recurrent and non-recurrent CDI cases and calculated direct treatment costs based on G-DRG flat rates. To calculate average costs per treatment and the budget impact, recurrence probabilities for VAN and FDX were taken from published evidence (28-day and 90-day scenarios). Totally, 475 cases were analyzed, thereof 421 non-recurrent, causing mean costs of €32,901 per case (95% CI: 27.752-38.050). Thirty-two patients experienced a recurrence within 28 days, yielding mean costs of €10,952 (95% CI: 5.627-16.277) for their additional hospital stay. The resulting budget impact was €1,303 (95% CI: 670 - 1.937) in favor of FDX, ranging from €148.34 to €2,190.30 in scenario analyses. The analysis indicates FDX treatment can lead to cost savings compared to VAN. Future research should focus on specific patient groups, such as refractory CDI patients.

Variability propagation in manufacturing systems: the impact of the processing time distribution

ABSTRACT In manufacturing and service systems, the negative effects of variability propagation are usually addressed through approximation models and other tools, such as simulation and optimization algorithms. This paper investigates the conditions in which these approaches are ineffective, and considering only the mean and variance of the processing time distribution is misleading. A scenario analysis deepens the impacts of considering the entire processing time distribution (beyond its mean and variance) on the inter-departure times in balanced and unpaced lines modeled through Discrete Event Simulation. The results correlate the impacts on variability propagation of approximating the processing time distribution with system characteristics such as utilization levels, line sizes, and inter-arrival and processing time variability. Production planning approaches can benefit from these results to reduce variability propagation, particularly in flexible and reconfigurable manufacturing systems, largely adopted in Industry 4.0, that can highly influence processing time distributions by varying product mix and line configuration.

The impact of different perspectives on the cost-effectiveness of remote patient monitoring for patients with heart failure in different European countries.

Heart failure (HF) is a complex clinical syndrome with high mortality and hospitalization rates. Non-invasive remote patient monitoring (RPM) interventions have the potential to prevent disease worsening. However, the long-term cost-effectiveness of RPM remains unclear. This study aimed to assess the cost-effectiveness of RPM in the Netherlands (NL), the United Kingdom (UK), and Germany (DE) highlighting the differences between cost-effectiveness from a societal and healthcare perspective. We developed a Markov model with a lifetime horizon to assess the cost-effectiveness of RPM compared with usual care. We included HF-related hospitalization and non-hospitalization costs, intervention costs, other medical costs, informal care costs, and costs of non-medical consumption. A probabilistic sensitivity analysis and scenario analyses were performed. RPM led to reductions in HF-related hospitalization costs, but total lifetime costs were higher in all three countries compared to usual care. The estimated incremental cost-effectiveness ratios (ICERs), from a societal perspective, were €27,921, €32,263, and €35,258 in NL, UK, and DE respectively. The lower ICER in the Netherlands was mainly explained by lower costs of non-medical consumption and HF-related costs outside of the hospital. ICERs, from a healthcare perspective, were €12,977, €11,432, and €11,546 in NL, the UK, and DE, respectively. The ICER was most sensitive to the effectiveness of RPM and utility values. This study demonstrates that RPM for HF can be cost-effective from both healthcare and societal perspective. Including costs of living longer, such as informal care and non-medical consumption during life years gained, increased the ICER.

Impact of Incorporating Future Mandatory Price Reductions with Generic Drug Entry on the Cost-Effectiveness of New Drugs: A Policy Simulation Study of Dupilumab in Atopic Dermatitis Treatment

The introduction of high-cost medications often poses challenges in achieving cost-effectiveness for drug insurance coverage. Incorporating future price reductions for these medications may enhance their cost-effectiveness. We examined the influence of future cost reductions mandated by the national insurer’s equal pricing for equivalent drugs (EPED) policy on the cost-effectiveness of dupilumab, a biologic drug for moderate to severe atopic dermatitis in the Korean healthcare system. We conducted a policy simulation study using semi-Markovian cost utility analysis of dupilumab in combination with supportive care (SC) versus SC alone, with and without the EPED policy adjustment. The EPED would lower dupilumab’s price to 70% following the entry of a biosimilar drug in 10.3 years. Scenario analyses quantified the impact of changing time to the EPED, chemical versus biological designation, response criteria, discount rates, and time horizons on the Incremental Cost-Effectiveness Ratio (ICER) and acceptability with and without EPED adjustment. The EPED adjustment of dupilumab’s future price significantly improved its cost-effectiveness, with a 9.7% decrease in ICER and a substantial 14.6% increase in acceptability. Assuming EPED in 5 years, the ICER fell below the predefined willingness-to-pay threshold. If dupilumab were a chemical drug, EPED adjustment demonstrated a 19.1% increase in acceptability. Incorporating future cost reductions via the EPED system in economic evaluations is crucial, especially for drugs facing imminent generic entry. This study underscores the importance of EPED adjustment in the cost-effectiveness analysis of innovative medications, especially for those nearing willingness-to-pay thresholds.

Abstract PO5-22-05: ULTRA-HYPOFRACTIONATED ADJUVANT RADIATION THERAPY FOR BREAST CANCER (UK FAST FORWARD TRIAL): A REAL LIFE SCENARIO ANALYSIS IN A DEVELOPING COUNTRY

Abstract Introduction: Selected patients showed non-inferior outcomes after conservative surgery for early breast cancer in the FAST-Forward UK (26Gy in 5 fractions) when compared to standard to date treatment. This study triggered an important change in radiation therapy routines across the world. We aimed to establish a pattern of treatment related events at a third-world country cancer center. Methods: We retrospectively analyzed all patients treated with 26Gy in 5 fractions (1 week) from January 2020 to June 2023. All data was exported and analyzed for demographics. A clinical profile was traced, dosimetric parameters and side effects assessed based on individual inquiries to each patient, per and post treatment. A strict medical record was kept in order to understand patterns of side effects and results. Results: 101 individuals were identified. Mean age was 64 years, 48 (47%) patients experienced radiation dermatitis of any grade, 33 (32%) grade 1, 9 (8%) grade 2, 6 grade 3 or 4 (5%). Patients older than 60 years showed to be a significant factor for dermatitis development (34 over a total of 48 - 70%) and 8 (53%) over 15 had grade 2 or higher dermatitis. 27 (26%) developed radiation dermatitis during sessions. 21 (20%) took 7 or less days to heal; 27 (26%) had a recovery longer than one week at an average age of 65 years - being the majority of dermatitis grade 1. Reported toxicities were sharp pain 31 (30%), burning pain 24 (23%), edema 17 (16%) and pruritus 5 (4%). At the time of this study was completed, 3 reported deaths (2%) were reported - with a 97% rate of survival. Conclusions: The fast forward trial regimen has 3 years since its publication. Our study shows that in a selected group of breast cancer patients, this novel model has shown to be a safe alternative for adjuvant radiation therapy following breast conservative surgery, results corroborating with published data. To the best of our knowledge, this is the largest single center group analyzed and published. Citation Format: Renne Bart, Daniel Przybysz, Ramon Ferrari, Leonardo Franco, Carlos Almeida, Paulo Canary. ULTRA-HYPOFRACTIONATED ADJUVANT RADIATION THERAPY FOR BREAST CANCER (UK FAST FORWARD TRIAL): A REAL LIFE SCENARIO ANALYSIS IN A DEVELOPING COUNTRY [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-22-05.

Artificial intelligence and design of experiments for resource adequacy assessment in power systems

Assessing the effects of the energy transition and liberalization of energy markets on resource adequacy is an increasingly important and demanding task. The rising complexity of energy systems requires adequate methods for energy system modeling leading to increased computational requirements. Furthermore, with complexity, uncertainty increases likewise calling for probabilistic assessments and scenario analyses. To adequately and efficiently address these various requirements, new methods from the field of data science are needed to accelerate current modeling approaches. With our systematic literature review, we want to close the gap between the three disciplines (1) resource adequacy assessments, (2) artificial intelligence (AI), and (3) design of experiments. For this, we conduct a large-scale systematic review of selected fields of application and methods and make a synthesis that relates the different disciplines to each other. Among other findings, we identify metamodeling of complex probabilistic resource adequacy assessment models using AI methods and applications of AI-based methods for forecasts of storage dispatch and (non-)availabilities as promising fields of application that have not yet been sufficiently covered. Eventually, we define a new methodological pipeline for adequately and efficiently addressing the present and upcoming challenges in the assessment of resource adequacy accounting for modeling the complexity and uncertainties of future developments.

An optimal “Trade-Online-Deliver-Offline” strategy for recycling unwanted medicines by reutilizing the existent informative pharmaceutical sales network

Circular economy and sustainable development resort to creating friendly and profitable environment of recycling unwanted goods in practice. This research aims to design a novel “Trade-Online-Deliver-Offline” (TODO) system to recycle unwanted medicines (UMs) by reutilizing the existent informative pharmaceutical sales network, which is the first dual-channel recycle system with synergies of manufacturer, chain drugstores and governments. Cross-selling effect, i.e., the additional sales from the customers who visit the drugstores for returning UMs, is also considered in this system. With a given revenue-sharing contract, a bi-level programming model is built to formulate such a recycle system, where the drugmaker is the leader and the chain drugstores are the followers within a decision mode of the Stackelberg game. Through reformulating, this complicated model is solved by developing an efficient smoothing algorithm. Scenario analysis and sensitivity analysis are employed to validate the built model and reveal valuable managerial insights. Main findings include: Compared with the existing modes, the proposed TODO mode is more efficient in terms of the recycled UM quantity and the reduced government burden; Cross-selling effects enhance the profit of drugstores without damage of customer’s surplus, but without significant impacts on the drugmaker’s profit; An increasing revenue-sharing ratio is beneficial to the drugstores in certain scenarios, but reduces the total profit of the recycle system; Resale prices of UMs and governmental tax relief policies both dominate the drugmaker’s optimal ratio of the resold and donated UMs.

Evaluation of the impact of plasma operation scenarios on the fusion reactor blanket design using an integrated numerical plasma and neutronics analysis suite

A very limited operation scenario has been used for fusion neutronics for the design of tritium breeding blankets. However, many advanced operation scenarios are under development and the impact of choosing a plasma operation scenario for fusion neutronics, which requires integration of neutronics analysis with plasma analysis, needs to be evaluated. An automated process from plasma analysis to neutronics analysis to create a viable fusion plasma neutron source was considered using a few different codes. In this work, we develop an integrated suite combining plasma modeling codes and neutronics codes. McCARD, a Monte-Carlo neutron-photon transport simulation code, is integrated into TRIASSIC, a tokamak reactor integrated automation suite for simulation and calculation, as the module for neutronics analysis of various plasma operation scenarios. McCARD integration allows TRIASSIC to perform neutronics analysis along with analytical and predictive plasma simulations. To evaluate this integrated suite, KSTAR experimental data were used to calculate the neutron flux at the first wall via TRIASSIC with the McCARD module in three different cases. First, the effect of plasma shape parameters, elongation and triangularity, on neutron flux is analyzed. Second, plasma scenario with the changes to the shape and the performance of plasma over time is studied to evaluate the time varying simulation. Third, two different plasma scenarios are compared to analyze the impact of plasma performance on neutron flux.

Consumer resistance diminishes environmental gains of dietary change

The environmental gains of dietary change are often assessed in relation to average national diets, overlooking differences in individual consumption habits and people’s willingness to change. This study combines microdata on food intake and consumer behaviour to elicit the likely environmental gains of dietary shifts. We focus on the Netherlands owing to the country’s ambition to halve its dietary footprint by 2050. Linking food recall survey data from a cross-section of the population (n = 4313), life cycle inventory analysis for 220 food products, and behavioural survey data (n = 1233), we estimate the dietary footprints of consumer groups across water, land, biodiversity and greenhouse gas (GHG). We find that meat and dairy significantly contribute to the dietary GHG footprint (59%), land footprint (54%), and biodiversity footprint (59%) of all consumer groups and that male consumers impose a 30%–32% greater burden than women across these impact areas. Our scenario analysis reveals that simply replacing cow milk with soy milk could reduce the GHG, land and biodiversity footprints by ≈8% if widely adopted by the Dutch adult population. These footprints could be further reduced to ≈20% with full adoption of the EAT-Lancet diet but with a significantly increased blue water footprint. However, when incorporating gender- and age-specific willingness to reduce meat and dairy consumption, the environmental gains resulting from partial adoption of the No-Milk diet and EAT diet diminish to a mere ≈0.8% and ≈4.5%, respectively. Consequently, consumer motivation alone is insufficient to realise the significant environmental gains often promised by dietary change. Yet, substituting high-impact food products offers a near-term opportunity to accelerate a rapid sustainable dietary transition. Future studies on sustainable dietary transition must incorporate consumer behaviour to fully comprehend the lock-in of food consumption patterns and targeted policy action required to secure a sustainable food future.

Climate risk assessment and adaption ability in China's coastal urban agglomerations - A case study of Guangdong-Hong Kong-Macao greater bay area

As climate change intensifies, extreme weather events, especially the coastal flooding is becoming increasingly severe. Carbon emissions exacerbate climate change, leading to increased frequency and intensity of extreme precipitation, which may result in flooding. This study focuses on the Guangdong-Hong Kong-Macao Greater Bay Area (GBA), a coastal city cluster in China, and adopts the scenario analysis approach to evaluate flood risks in the different carbon mitigation scenario from the perspectives of dangerousness, and adaption ability. The result shows that the Huizhou in the east of the GBA and the Zhaoqing in the northwest have the highest level of flood disaster risk. However, the central region of the GBA (Guangzhou, Dongguan, Zhongshan, and Foshan) is very vulnerable to disaster-inducing environments and hazard-affected bodies, which means that the flooding risk and the impact of such risk in the GBA display regional differentiation characteristics and the spatial patterns of them are different. According to the carbon neutrality scenario, the flood risk in the GBA peaks in 2030, and decreases during 2030–2090. In contrast, under the uneven development and high carbon pathways, the risk peaks in 2060, and the overall risk by 2090 is roughly the same as that in 2060. In addition, the regions with the highest flood disaster risk are Guangzhou, Foshan, Dongguan and Zhongshan along the Pearl River estuary. Overall, it shows that areas with higher levels of urbanization and more developed economies will face higher flooding risks. The “dangerousness-adaption ability” structure can reflect the spatial distribution pattern of flood disaster risks, identify the priority areas for flood prevention and control, and is conducive to risk management. At the same time, the research results show that ecological protection have a positive effect on reducing flood risk. In addition, corresponding policy recommendations for pre-disaster, mid-disaster and post-disaster have been proposed, providing references for flood risk management in the GBA.

A Comprehensive Study on Post-Merger of VI and its Implications on the Telecom Industry

Abstract: This paper conducts a thorough analysis of the post-merger scenario between Vodafone India and Idea Limited, now collectively known as Vodafone Idea Limited (VIL). The study examines various financial ratios to evaluate the implications of the merger on the telecom industry. The findings suggest that despite the strategic merger, the financial performance of VIL has deteriorated, as evidenced by a decline in key financial ratios compared to the pre-merger period. This research sheds light on the challenges faced by telecom companies in mergers and acquisitions and underscores the importance of strategic planning and execution in such endeavours.

Analysis of the effects of urban micro-scale vulnerabilities on tsunami evacuation using an agent-based model – case study in the city of Iquique, Chile

Abstract. The occurrence of mega-tsunamis over the last couple of decades has greatly increased the efforts of the research community and practitioners to work hand in hand to reduce risks from these highly destructive threats. Protecting the population through evacuation is the best alternative for avoiding loss of life in the wake of the occurrence of a tsunamigenic earthquake. Therefore, guaranteeing the proper state of evacuation routes is very important to ensuring appropriate movement to the safe zones. This study carries out a detailed analysis of possible evacuation scenarios, considering the actual state of the escape routes of Iquique, a Chilean city prone to tsunamis, with a substantial number of urban micro-scale vulnerabilities, i.e., elements that obstruct or complicate pedestrian flow. The quantification of the delay in evacuation processes resulting from the presence of urban micro-vulnerabilities is carried out through micro-scale agent-based model (ABM) simulations. In addition, these results are integrated with high-resolution tsunami inundation simulations, allowing for an estimation of the potential number of people that the tsunami may reach under different scenarios by emulating the dynamics and behavior of the population and the decision-making regarding the starting time of the evacuation.

PUBLIC-PRIVATE PARTNERSHIP AS A TOOL FOR FINANCIAL SUPPORT OF THE ENERGY SECTOR IN UKRAINE: ANALYSIS, MECHANISM, FINANCIAL REPORTING

Based on the analysis of the dynamics of implementation of public-private partnership (PPP) projects in Ukraine, key problems have been identified and its priorities in financial support for the recovery of the native energy sector have been determined. It is appointed that PPP concession agreements are the main mechanisms for attracting investment in the global electric power industry. The expediency of using the concession model on BOT terms for the implementation of large projects in the energy sector is substantiated, which will contribute to the intensification of investment attraction and will allow to distribute risks between the state and business. Recommendations on the formation of an information platform for participants in the implementation of PPP projects on the basis of disclosure of information on the effectiveness of concession operations in accounting and financial statements have been developed. The tools for the formation of the financial mechanism of public-private partnership, where the priority is budget and venture financing, are substantiated. To make decisions on the implementation of PPP investment projects, an approach to assessing the financial support of project initiatives is recommended, the basis of which is the proposed criteria for compliance with financial security, the choice of funding sources, indicators of scenario analysis and efficiency. The proposed methodical approach to assessing the effectiveness of PPP allows us to assess the synergistic effect, which reflects the totality of economic, social and environmental effects. The formulated recommendations for improving the relationship between the state and business will contribute to the intensification of the attraction of private investment resources on the basis of PPPs for the restoration of the energy sector in Ukraine.

Photovoltaic and Solar-Thermal Use Case Application Comparison with Witness Simulation and DCF Analysis

In this work, we investigate a system of solar and thermal heat collectors in combination with local and electric net storage. The system is implemented in a Witness Horizon simulation model, allowing for the investigation and scenario analysis of different use cases. In a practical industrial application example use-case, using simulation and Discounted Cash Flow (DCF) analysis, the economic feasibility of the best system variant could be calculated. The developed model includes the local consumption and production profile and it was evaluated by a DCF model after the dynamic energy modelisation with the generic industrial production system simulation software WITNESS Horizon. This model can be in future further extended to generic and more complex production systems, simultaneously integrating the DCF cost evaluation analysis and following direct economic optimisation as well as integrating it with the production portfolio theory approach by integrating diversified virtual production market aspects and market goal-oriented optimisation.

A situational analysis of antibiotic prescription, dispensing practices and resistance pattern in Nepal: Are we losing the battle?

Background: Antibiotics are widely utilized to treat infections and provide preventative and therapeutic benefits in animal and human healthcare. However, because of the emergence and spread of resistance mechanisms, which cause bacteria to become less susceptible to antibiotics and other treatments and less effective, antimicrobial resistance (AMR) has grown to be one of the most significant worldwide public health concerns. Low- and middle-income countries (LMICs) such as Nepal have a high rate of infectious illnesses and antibiotic resistance, which can lead to both human and financial losses. Methods: The information for the scenario analysis was acquired through a review of published and grey literature, as well as interviews with important stakeholders from all sectors. Conclusion: Besides knowing all the challenges of antibiotic resistance, the programs assuring towards AMR is conducted in Nepal in very infrequent way. The antibiotic use should be optimize by giving various personalized treatment approaches and accurate diagnosis which plays vital roles in minimizing unnecessary antibiotic prescriptions. We can organize different awareness programs to reduce antibiotic resistance that may enhance the proper use of antibiotic with proper dose and prescription in accordance health care professionals. Interpreting all the problems, government should give more priority to antibiotic resistance and should be able to minimize the problems. If antibiotic resistance is not taken in a very serious way by all the healthcare workers like doctors, nurses, pharmacists, lab technicians, etc. then the battle we are fighting leads to be defeated and problem will never end.

Cost-Effectiveness of Lovotibeglogene Autotemcel (Lovo-Cel) Gene Therapy for Patients with Sickle Cell Disease and Recurrent Vaso-Occlusive Events in the United States.

Gene therapies for sickle cell disease (SCD) may offer meaningful benefits for patients and society. This study evaluated the cost-effectiveness of lovotibeglogene autotemcel (lovo-cel), a one-time gene therapy administered via autologous hematopoietic stem cell transplantation, compared with common care for patients in the United States (US) with SCD aged ≥12years with ≥4 vaso-occlusive events (VOEs) in the past 24months. We developed a patient-level simulation model accounting for lovo-cel and SCD-related events, complications, and mortality over a lifetime time horizon. The pivotal phase1/2 HGB-206 clinical trial (NCT02140554) served as the basis for lovo-cel efficacy and safety. Cost, quality-of-life, and other clinical data were sourced from HGB-206 data and the literature. Analyses were conducted from US societal and third-party payer perspectives. Uncertainty was assessed through probabilistic sensitivity analysis and extensive scenario analyses. Patients treated with lovo-cel were predicted to survive 23.84years longer on average (standard deviation [SD], 12.80) versus common care (life expectancy, 62.24 versus 38.40years), with associated discounted patient quality-adjusted life-year (QALY) gains of 10.20 (SD, 4.10) and direct costs avoided of $1,329,201 (SD, $1,346,446) per patient. Predicted societal benefits included discounted caregiver QALY losses avoided of 1.19 (SD, 1.38) and indirect costs avoided of $540,416 (SD, $262,353) per patient. Including lovo-cel costs ($3,282,009 [SD, $29,690] per patient) resulted in incremental cost-effectiveness ratios of $191,519 and $124,051 per QALY gained from third-party payer and societal perspectives, respectively. In scenario analyses, the predicted cost-effectiveness of lovo-cel also was sensitive to baseline age and VOE frequency and to the proportion of patients achieving and maintaining complete resolution of VOEs. Our analysis of lovo-cel gene therapy compared with common care for patients in the US with SCD with recurrent VOEs estimated meaningful improvements in survival, quality of life, and other clinical outcomes accompanied by increased overall costs for the health care system and for broader society. The predicted economic value of lovo-cel gene therapy was influenced by uncertainty in long-term clinical effects and by positive spillover effects on patient productivity and caregiver burden.

Cost-Effectiveness Analysis of Fluocinolone Acetonide Intravitreal (FAI) Implant for Chronic Noninfectious Uveitis Affecting the Posterior Segment of the Eye (NIU-PS) in China.

Chronic non-infectious uveitis affecting the posterior segment (NIU-PS), which can be recurrent and persistent for numerous years, mainly affects people of working age and significantly increases the risk of visual impairment. This study aimed to investigate the cost-effectiveness of fluocinolone acetonide intravitreal (FAI) implant in the treatment of patients with chronic NIU-PS from the Chinese healthcare perspective. A Markov model with a 2-week cycle was constructed from the perspective of the Chinese healthcare system over a lifetime time horizon. The model consists of four health states: on-treatment, treatment failure, blindness, and death. The outcomes for effectiveness were based on the Chinese real-world study (RWS). Utilities and mortality rates were derived from published literature and standard sources. Costs were determined from the MENET website, prices of medical service items at local providers, published literature, and expert surveys. Outcomes were measured in quality-adjusted life years (QALYs). Sensitivity analyses were performed to account for the impact of uncertainty. It was estimated that in the base case, the FAI implant provided 0.43 incremental QALYs compared with the limited current practice (LCP) at an additional cost of $7503.72 (¥50,575.05), resulting in an incremental cost-effectiveness ratio (ICER) of $17,373.49 (¥117,097.33) per QALY gained. Parameters related to utility emerged as the primary influencers on the outcomes. In probabilistic sensitivity analysis (PSA), considering the willingness-to-pay (WTP) threshold of $19,072 (¥128,547) and $38,145 (¥257,094), the FAI implant had 67.70% and 99.50% probability of being cost-effective, respectively. As demonstrated in the scenario analysis, if the FAI implant aligns its price reduction with the average rate from the 2023 negotiation of the National Reimbursement Drug List (NRDL), it would result in lower costs and represent an absolute advantage. The FAI implant, which can effectively reduce the recurrence rate and maintain the incremental costs within the WTP limit, is likely to be cost-effective in treating chronic NIU-PS in China.

Multi-objective optimization for low hydrogen consumption and long useful life in fuel cell emergency power supply systems

The power system using hydrogen fuel cells (FCs) as the primary energy source holds significant potential for applications in emergency fields such as post-disaster relief and outdoor power supply. The operational environment of the FC emergency power supply system (FCEPSS) is challenging, with long continuous operation time, difficulties in hydrogen supply, high maintenance costs, and, accordingly, requirements for hydrogen consumption and useful life of FCs are heightened. Hence, this paper proposes a multi-objective energy management strategy (EMS) for FCEPSS. First, the structure of FCEPSS is designed based on the demand analysis in emergency scenarios. Then, the hydrogen consumption and life degradation models of FCEPSS are established. Aiming at the multi-objective optimization problem of minimizing hydrogen consumption and life degradation value in the FCEPSS, an improved multi-objective optimization algorithm is proposed. This paper converts complex constraints into the penalty term and incorporates it as one of the objectives, constructing a three-objective optimization model. To enhance the solution of multi-objective optimization problems, an improved strategy based on relaxation-tightening and three-objective sorting is proposed. Combining the fast non-dominated sorting genetic algorithm-II and the above improved strategy, an improved multi-objective optimization algorithm (IMOOA) is constructed. In the simulation, the advantages of the proposed IMOOA algorithm are verified. In the experimental part, compared with the logical threshold strategy, the proposed strategy saves 0.60% of hydrogen consumption and reduces 5.65% of life degradation within 24 h, respectively. Finally, the superiority of the multi-objective EMS utilizing the IMOOA is demonstrated.

Cost-effectiveness analysis of 20-valent pneumococcal conjugate vaccine for routine pediatric vaccination programs in Japan

ABSTRACT Background The Japanese National Immunization Program currently includes the pediatric 13 valent pneumococcal conjugate vaccine (PCV13) to prevent pneumococcal infections. We aimed to evaluate the cost-effectiveness of 20-valent PCV (PCV20) as a pediatric vaccine versus PCV13. Methods A decision-analytic Markov model was used to estimate expected costs, quality-adjusted life-years (QALYs), and prevented cases and deaths caused by invasive pneumococcal disease, pneumonia, and acute otitis media over a ten-year time horizon from the societal and healthcare payer perspectives. Results PCV20 was dominant, i.e. less costly and more effective, over PCV13 (gained 294,599 QALYs and reduced Japanese yen [JPY] 352.6 billion [2.6 billion United States dollars, USD] from the societal perspective and JPY 178.9 billion [USD 1.4 billion] from the payer perspective). Sensitivity and scenario analyses validated the robustness of the base scenario results. When comparing PCV20 with PCV13, the threshold analysis revealed an incremental cost-effectiveness ratio that was within the threshold value (JPY 5 million/QALY) at a maximum acquisition cost of JPY 74,033 [USD 563] (societal perspective) and JPY 67,758 [USD 515] (payer perspective). Conclusions As a pediatric vaccine, PCV20 was dominant over PCV13 regardless of the study perspective.

'Don't keep me waiting': estimating the impact of reduced vein-to-vein time on lifetime US 3L+ LBCL patient outcomes

Chimeric antigen receptor (CAR) T-cell therapies have revolutionized the treatment of hematological cancers. Production requires a complex logistical process from leukapheresis to patient infusion, the vein-to-vein time (V2VT), during which a patients clinical condition may deteriorate. This study was designed to estimate the benefits of reduced V2VT for third-line+ (3L+) relapsed/refractory large B-cell lymphoma (r/r LBCL) patients treated with CAR T. A mathematical model was developed to estimate the lifetime outcomes of a hypothetical cohort of patients who had either a 'long' or 'short' V2VT. Life-years (LYs), quality-adjusted life years (QALYs), and costs were estimated. Scenario analyses were performed to assess the robustness of results to key assumptions.  The results of the model show that reducing V2VT from 54 days (tisa-cel median V2VT; JULIET) to 24 days (axi-cel median V2VT; ZUMA-1) led to a 3.2-year gain in life expectancy (4.2 vs 7.7 LYs), and 2.4 additional QALYs (3.2 vs 5.6) per patient. Furthermore, a shorter V2VT was shown to be cost-effective under conventional willingness-to-pay thresholds in the United States. Results are driven by a higher infusion rate and and a better efficacy of CAR T-cell therapy for those infused. Scenario analyses using a smaller difference in V2VT (24 vs 36 days) produced consistent results. Our study is the first to quantify lifetime V2VT-related outcomes for 3L+ r/r LBCL patients treated with CAR T utilizing currently available evidence. Shorter V2VTs led to improved outcomes, demonstrating the importance of timely infusion achievable by faster manufacturing times and optimization of hospital delivery.