Transition Costs Research Articles

Equity, climate justice and fossil fuel extraction: principles for a managed phase out

ABSTRACT Equity issues have long been debated within international climate politics, focused on fairly distributing reductions in territorial emissions and fossil fuel consumption. There is a growing recognition among scholars and policymakers that curbing fossil fuel supply (as well as demand) can be a valuable part of the climate policy toolbox; this raises the question of where and how the tool should be applied. This paper explores how to equitably manage the social dimensions of a rapid transition away from fossil fuel extraction. Fossil fuel extraction leads to benefits for some people (such as extraction workers) and harms for others (such as pollution-affected communities). A transition must respect and uphold the rights of both groups, while also staying within climate limits, as climate impacts will fall most heavily on the world’s poor. This paper begins by reviewing how extraction affects economies and communities and the different transitional challenges they face. Based on that review, it then examines three common equity approaches – economic efficiency, meeting development needs, and effort-sharing. Drawing lessons from the strengths and weaknesses of these approaches, the paper proposes five principles as a basis for equitably curbing fossil fuel extraction within climate limits: (1) Phase out global extraction at pace consistent with limiting warming to 1.5°C; (2) Enable a just transition for workers and communities; (3) Curb extraction consistent with environmental justice; (4) Reduce extraction fastest where doing so will have the least social costs; (5) Share transition costs fairly, according to ability to bear those costs. Key policy insights: Fossil fuel extraction is unlikely to be a viable path to development because the Paris Agreement goals require most fossil fuel use to be ended within a generation; Extraction should be phased out fastest in diversified, wealthier economies that can better absorb the transitional impacts; Governments of extracting countries should enact ambitious industrial policy to diversify their economies, alongside economic and employment policies to enable a just transition; The costs of a just transition should be borne by those most able to bear it: poorer countries can reasonably demand financial support.

COMPARATIVE ANALYSIS OF OPTIMIZATION METHODS BY COST (TIME) COSTS OF FULL FACTOR EXPERIMENT PLANS

Relevance. It is proposed to use methods to search for fish schools, monkey searches, jumping frogs for constructing optimal cost (time) experiment plans in the study of technological processes and systems that allow the implementation of an active experiment on them.The purpose of the work is a comparative analysis of these optimization methods for the cost (time) costs of plans for a full factorial experiment.Method. Methods are proposed for constructing the cost-effective (time-consuming) implementation of the experiment planning matrix using fish search, monkey search, jumping frogs algorithms. At the beginning, a number of factors and transition costs are entered for each level of factors. Then, taking into account the entered data, the initial planning matrix of the experiment is formed. The fish search method is based on rearranging the columns of the experiment planning matrix, based on the sum of the values (times) of transitions between the levels for each of the factors. The schools of fish are formed according to the following principle: there are fewer schools of fish where the sum of the values (times) of transition between the levels of factors is greater. Then permutations of fish schools located side by side in the experiment planning matrix are performed. When using the monkey search method, the columns of the experiment planning matrix are trees. Each tree consists of branches along which a monkey moves. There are more tree branches where there is less sum of costs (times) of transitions between levels of factors. The monkey begins its movement upward along each branch of the tree. During this, a search is performed on the branches on which the monkey is located by the minimum value of the sum of the values (times) of transitions between the levels for each of the factors. In the jumping frog method, a successful frog is determined by the least cost of transitions between levels for each of the factors. After this, permutations of frogs are performed. The frog strives for the most successful and, provided it is nearby, it remains in its current location. Then the gain is calculated compared to the initial cost (time) of the experiment.Results. Developed software that implements the proposed methods, which was used to conduct computational experiments to study the properties of these methods in the study of technological processes and systems that allow the implementation of an active experiment on them. Optimum cost plans for the implementation of the experiments were obtained, and the gains in the optimization results compared with the initial cost of the experiment were given. A comparative analysis of optimization methods for the cost (time) costs of plans for a full factorial experiment has been carried out.Conclusions. The experiments have confirmed the performance of the proposed methods and the software implementing them, and also allow us to recommend them for practical use in constructing optimal experiment planning matrices.

Microsimulation Model to Determine the Cost-Effectiveness of Treat-to-Target Strategies for Ulcerative Colitis

Little is known about the cost effectiveness of endoscopy or biomarker-based treat to target monitoring of patients with ulcerative colitis (UC). We used a microsimulation model to identify the most cost effective treat to target monitoring strategy for patients with UC staring therapy with biologics or small molecule inhibitors. We assessed symptoms (rectal bleeding) alone, a combination of symptoms and a biomarker (fecal calprotectin), and endoscopy. Transition probabilities, costs, and quality-adjusted life year (QALY) estimates were derived from published estimates. The microsimulation model tracked an individual patient's disease course and treatment exposures to modify downstream treatment effectiveness, probabilities, and disease outcomes. The primary analysis included 100,000 individuals over 5 years with a willingness to pay threshold of $100,000/QALY. Probabilistic sensitivity analyses were performed with 500 samples and 250 trials, in addition to multiple 1-, 2-, and 3-way microsimulation sensitivity analyses. A total of 32 treatment sequencing algorithms were modeled alongside 3 disease monitoring strategies within a treat to target approach for UC. Combination symptom and biomarker-based monitoring resulted in the highest QALY estimate among all the treatment sequencing algorithms. However, monitoring disease activity with symptoms alone was the most cost-effective strategy in 86% of scenarios, followed by combination symptom and biomarker monitoring in 9%, and endoscopy monitoring in 5%. Results were sensitive to treatment costs, patient willingness to consider colectomy as a treatment option, and endoscopy costs. Endoscopy-based monitoring was favored when treatment costs were high and patients were unwilling to undergo colectomy. The combination symptom and biomarker-based monitoring resulted in the highest QALY estimate. However, symptom-based monitoring is the most cost-effective approach to implementing treat to target monitoring for patients with UC receiving biologics and small molecule inhibitors.

Cost-Effectiveness of ramucirumab plus paclitaxel as a second-line therapy for advanced gastric or gastro-oesophageal cancer in China

AimThat clinical trial (RAINBOW) showed that a 7.4 months overall survival benefit with the combination therapy with ramucirumab (RAM) and paclitaxel (PAC) as second-line therapy for patients with recurrent or metastatic gastric or gastro-oesophageal junction adenocarcinoma, compared with placebo (PLA) plus paclitaxel. We performed an analysis to assess the cost-effectiveness of RAM from a Chinese perspective and recognized the range of drug costs.MethodsBy building a Markov model to estimate quality-adjusted life-years (QALYs), life-years (LYs) and lifetime costs. Transition probabilities, costs and utilities were estimated for the published literature, Chinese health care system and local price setting. We performed threshold analyses and probabilistic sensitivity analyses to evaluate the uncertainty of the model.ResultsCompared with PLA strategy, RAM strategy provided an incremental survival benefit of 1.22 LYs and 0.64 QALYs. The probabilistic sensitivity analysis showed that when RAM costs less than $151 or $753 per 4 weeks, the incremental cost-effectiveness ratio (ICER) approximated the willingness-to-pay threshold (WTP), suggesting that there was 50% likelihood that the ICER for RAM + PAC would be less than $44528.4 per QALY or $48121 per QALY, respectively.ConclusionsFor patients with advanced gastric or gastro-oesophageal junction adenocarcinoma who fail first-line chemotherapy, our results are conducive to the multilateral drug price guidance negotiations of RAM in China.

Cost-Effectiveness of Immediate Ventricular Assist Device Implantation in Children with Inotrope-Dependent Heart Failure

Ventricular assist devices (VADs) have improved wait list survival in children with end-stage heart failure. However, questions remain about the optimal timing of VAD implantation. In this cost-effectiveness analysis, we compared immediate intracorporeal continuous VAD implantation to a watchful waiting approach using continuous inotropic therapy. Using a Markov model, we simulated a cohort of pediatric patients with dilated cardiomyopathy. We used a monthly cycle and 20-year time horizon. We estimated cost and benefits (in terms of quality-adjusted life years, QALYs) from a healthcare perspective discounted at 3% per year. Transition probabilities, costs, and utility weights were taken from published and grey literature, which we supplemented with expert opinion where there were gaps. We calculated the incremental cost-effectiveness ratio (ICER) and performed one-way and probabilistic sensitivity analyses (PSA) using 10,000 Monte Carlo simulations to understand the impact of parameter uncertainty in the main findings. Cost variables were assigned gamma distributions, while transition probabilities and utilities were assigned beta distributions. In a base case analysis, the incremental costs and benefits of immediate intracorporeal continuous VAD implantation compared to medical management was $221,269 (2017 US$) and 0.21 QALYs, respectively, resulting in an ICER of $1.04 million per QALY. One-way sensitivity analysis found that the discount rate, the probability of heart transplant among patients on VAD and medical management, and the cost of VAD implantations exerted the most influence on the ICER, though varying any of the parameters to their lowest and highest values did not bring the ICER close a $100,000 per QALY willingness-to-pay (WTP) threshold. The PSA showed a 3% chance of immediate VAD implantation to be cost-effective at a WTP of $500,000 per QALY and a 36% chance at $1 million per QALY. Though VADs provide a net health benefit as a bridge to transplant, immediate implantation in children with inotrope-dependent heart failure is not likely to be a cost-effective strategy compared to medical management based on commonly used ICER thresholds. Future analyses should explore the cost-effectiveness of VAD implantation in children with other disease states, diagnoses and device types.

Cost-effectiveness analysis of gemcitabine plus cisplatin versus docetaxel, cisplatin and fluorouracil for induction chemotherapy of locoregionally advanced nasopharyngeal carcinoma.

Recently, patients who received induction chemotherapy plus concurrent chemoradiotherapy for locoregionally advanced nasopharyngeal carcinoma were found to have survival advantages compared with those receiving concurrent chemoradiotherapy alone in two large randomized trials. Based on these two trials, we present a cost-effectiveness analysis to compare gemcitabine and cisplatin (GP) versus cisplatin, fluorouracil, and docetaxel (TPF) for induction chemotherapy to treat locoregionally advanced nasopharyngeal carcinoma. We constructed a Markov model to compare the cost and effectiveness of GP versus TPF. Clinical data including the frequency of adverse events, recurrence and death obtained from two randomized phase III trials were used to calculate transition probabilities and costs. Health utilities were estimated from the literature. Incremental cost-effectiveness ratios, expressed as dollars per quality-adjusted life-year (QALY), were calculated, and incremental cost-effectiveness ratios less than $27,534.25/QALY (3×the per capita GDP of China, 2018) were considered cost-effective. One-way sensitivity and probabilistic sensitivity analyses explored the robustness of the model. Our base case model found that the total cost was $53,082.68 in the GP group and $45,482.66 in the TPF group. The QALYs were 6.82 and 4.11, respectively. The incremental cost-effectiveness ratio favoured the GP regimen, at an incremental cost of $2,804.44 per QALY. The probabilistic sensitivity analysis found that treatment with the GP regimen was cost-effective 100% of the time at a willingness-to-pay threshold of $27,534.25‬/QALY. In this model, GP was estimated to be cost-effective compared with cisplatin, fluorouracil, and docetaxel for patients with locoregionally advanced nasopharyngeal carcinoma from the payer's perspectives in the China.

Cost-Utility of Internet-Based Cognitive Behavioral Therapy in Unipolar Depression: A Markov Model Simulation.

Background and ObjectiveUnipolar depression is the most common form of depression and demand for treatment, such as psychotherapy, is high. However, waiting times for psychotherapy often considerably exceed their recommended maximum. As a potentially less costly alternative treatment, internet-based cognitive behavior therapy (ICBT) might help reduce waiting times. We therefore analyzed the cost–utility of ICBT compared to face-to-face CBT (FCBT) as an active control treatment, taking differences in waiting time into account.MethodsWe constructed a Markov model to simulate costs and health outcomes measured in quality-adjusted life years (QALYs) for ICBT and FCBT in Germany. We modeled a time horizon of 3 years using six states (remission, depressed, spontaneous remission, undergoing treatment, treatment finished, death). The societal perspective was adopted. We obtained parameters for transition probabilities, depression-specific QoL, and cost data from the literature. Deterministic and probabilistic sensitivity analyses were conducted. Within a scenario analysis, we simulated different time-to-treatment combinations. Half-cycle correction was applied.ResultsIn our simulation, ICBT generated 0.260 QALYs and saved €2536 per patient compared to FCBT. Our deterministic sensitivity analysis suggests that the base-case results were largely unaffected by parameter uncertainty and are therefore robust. Our probabilistic sensitivity analysis suggests that ICBT is highly likely to be more effective (91.5%), less costly (76.0%), and the dominant strategy (69.7%) compared to FCBT. The scenario analysis revealed that the base-case results are robust to variations in time-to-treatment differences.ConclusionICBT has a strong potential to balance demand and supply of CBT in unipolar depression by reducing therapist time per patient. It is highly likely to generate more QALYs and reduce health care expenditure. In addition, ICBT may have further positive external effects, such as freeing up capacities for the most severely depressed patients.Electronic supplementary materialThe online version of this article (10.1007/s40258-019-00551-x) contains supplementary material, which is available to authorized users.

Cost-effectiveness analysis of low-dose direct oral anticoagulant (DOAC) for the prevention of cancer-associated thrombosis in the United States.

Randomized controlled trials (RCTs) have demonstrated that low-dose direct oral anticoagulants (DOACs), including rivaroxaban and apixaban, may help reduce the incidence of cancer-associated venous thromboembolism (VTE). A cost-utility analysis was performed from the health sector perspective using a Markov state-transition model in patients with cancer who are at intermediate-to-high risk for VTE. Transition probability, relative risk, cost, and utility inputs were obtained from a meta-analysis of the RCTs and relevant epidemiology studies. Differences in cost, quality-adjusted life-years (QALYs), and the incremental cost-effectiveness ratio (ICER) per patient were calculated over a lifetime horizon. One-way, probabilistic, and scenario sensitivity analyses were conducted. In patients with cancer at intermediate-to-high risk for VTE, treatment with low-dose DOAC thromboprophylaxis for 6months, compared with placebo, was associated with 32 per 1000 fewer VTE and 11 per 1000 more major bleeding episodes over a lifetime. The incremental cost and QALY increases were $1445 and 0.12, respectively, with an ICER of $11,947 per QALY gained. Key drivers of ICER variations included the relative risks of VTE and bleeding as well as drug cost. This strategy was 94% cost effective at the threshold of $50,000 per QALY. The selection of patients with Khorana scores ≥3 yielded the greatest value, with an ICER of $5794 per QALY gained. Low-dose DOAC thromboprophylaxis for 6months appears to be cost-effective in patients with cancer who are at intermediate-to-high risk for VTE. The implementation of this strategy in patients with Khorana scores ≥3 may lead to the highest cost-benefit ratio.

The perceived financial effects of mandatory audit firm rotation

AbstractThis paper explores the perceptions of key audit industry stakeholders concerning the direct and indirect financial effects of the implementation of mandatory audit firm rotation (MAFR) in South Africa. Globally, concerns over audit quality, in response to corporate failures, have resulted in renewed debate over MAFR as a solution. The European Union and South Africa have recently ruled in its favor, while other countries have rejected it on grounds that the benefits do not exceed the costs. Using structured surveys, the informed perspectives of experienced auditors, chief financial officers, audit committee chairs, and equity fund managers are explored and contrasted. We find that considerable costs will be imposed on audit firms in the form of “setup and transition costs,” as well as costs incurred to submit and present competitive tenders to secure appointment. Although auditors will try to recoup these costs with fee increases, this will likely not be allowed by the clients, resulting in a squeeze of audit firm profits. The Big 4 firm fee premium, relative to non‐Big 4 firms, will decrease due to increased competition. From the clients' perspective, the costs will be in the form of audit inefficiency translating into staff time and disruption, caused by the incoming auditors being less familiar with the complexities of the business. We contribute to the literature detailed descriptions and estimations of the nature and extent of potential cost implications, as expressed by experienced practitioners. The findings inform audit industry regulators, standard‐setters, and practitioners to more effectively mitigate potential unintended consequences of the regulation.

Measuring the effects of structural reforms in Malta

Abstract. Structural reforms are crucial to boost an economy’s long-term growth potential, enhance its resilienceand increase its flexibility to adjust to adverse shocks. Malta has implemented a number of reforms in recent years, both to its labour and product market, which could in part explain its stellar growth performance after the crisis. Furthermore, EU membership has facilitated the inflow of foreign labour that helped to address critical labour and skill shortages. This paper quantifies the macroeconomic effects of structural reforms in labour and product markets using EAGLE, a large scale multi-country DSGE model, calibrated for the Maltese economy, as a small and open economy in a monetary union. The results show that a 10 percentage point reduction in product and labour mark-ups raises GDP by more than 5% in the long-run. The implementation of the reforms in isolation is associated with adjustment costs but the joint implementation of reforms can, to a large extent, soften the transition costs associated with the reforms. The results are robust to varying levels of mark-ups and different parameterization of the model. A key driver behind this finding is the adjustment in the labour market. This calls for policies to further reduce skill mismatches and for incentives that attract and retain more people in the labour market. Keywords. Structural reforms, Competition, DSGE models, Malta. JEL. C53, E27, F41, F47.

Identification of the Most Cost-effective Position of Vedolizumab Among the Available Biologic Drugs for the Treatment of Ulcerative Colitis.

There are limited data on the most cost-effective sequencing of biologics for ulcerative colitis [UC]. We used Markov modelling to identify the most cost-effective position for vedolizumab among biologics for steroid-dependent UC, with a base-case of a 35-year-old male. We assessed three treatment algorithms, with vedolizumab use: prior to an initial anti-tumour necrosis factor alpha [anti-TNFα] and azathioprine [Algorithm 1]; prior to a second anti-TNF and azathioprine [Algorithm 2]; and prior to colectomy [Algorithm 3]. The initial anti-TNF could be either infliximab or adalimumab. Transition probabilities, costs, and quality-adjusted life-year estimates were derived from published estimates, Medicare, and the Nationwide Inpatient Sample. Primary analyses included 100 trials of 100 000 individuals over 1 year, with a willingness-to-pay threshold of US$100,000. Multiple sensitivity analyses were conducted to assess our findings. From a population perspective, when both infliximab and adalimumab are available, vedolizumab was preferred as the first biologic if ≥14% of initial anti-TNF use was adalimumab. If infliximab is the primary biologic, vedolizumab use after infliximab [Algorithm 2] and prior to adalimumab was the most cost-effective strategy. All models were sensitive to biologic pricing. This simulation demonstrated that the most cost-effective strategy in UC depends on the proportion of patients using adalimumab as the initial anti-TNF. If adalimumab was ≥14%, vedolizumab was preferred as the first biologic. When only infliximab was available for first-line therapy, the most cost-effective position of vedolizumab was prior to cycling to adalimumab.

The Serbian pension system in transition: A silent break with Bismarck

The pension system in Serbia was set up as Bismarckian earnings related system almost one hundred years ago. At the outset of the transition process at the beginning of 21st Century, the pension system underwent bold reforms. Despite suggestions from the World Bank to adopt a three-pillar system that would involve a break with the Bismarckian heritage, reforms concentrated on parametric adjustments that strengthened the link between previous earnings and pension benefits. However, as this paper shows, the Bismarckian earnings-related system has subsequently been silently challenged. On the basis of an analysis of the current and perspective replacement rates for various earning levels and pension variation indicators, we show how the contributions/ benefit link has been undermined. These policy changes have not been defined or understood as a new strategic course of action, nor have the strategic options been debated and analysed. These silent reforms have seemed to be a ?quick and easy? solution to tackle high public expenditures and deficits without understanding their implications, and that breaking up with Bismarck implies significant transition costs.

The cost-effectiveness analysis of drug therapy versus surgery for symptomatic adenoid hypertrophy by a Markov model

PurposeAdenoid hypertrophy (AH) is common among young children. Adenoid-based surgery and drug therapy could be applied for symptomatic AH patients, yet the treatment decision is difficult to make due to the diverse cost and efficacy between these two treatments.MethodsA Markov simulation model was designed to estimate the cost-effectiveness (CE) of the adenoid-based surgery and the drug therapy for symptomatic AH patients. Transition probabilities, costs and utilities were extracted from early researches and expert opinions. Simulations using two set of parameter inputs for China and the USA were performed. Primary outcome was cost per QALY gained over a 6-year period. Deterministic and probabilistic sensitivity analyses were also conducted.ResultsThe utility for the surgery group and the drug group were 4.10 quality-adjusted life years (QALYs) and 3.58 QALYs, respectively. The cost of the surgery group was more than that of the drug group using model parameters specific to China ($1069.0 vs. $753.7) but was less for the USA ($1994.4 vs. $3977.7). Surgery was dominant over drug therapy when US specific parameters were used. Surgery group had an ICER of $604.0 per QALY when parameters specific to China was used.ConclusionSurgery is cost-effective in the simulations for both China and the USA at WTP thresholds of $9633.1 and $62,517.5, respectively.

Lessons from Germany’s hard coal mining phase-out: policies and transition from 1950 to 2018

ABSTRACT German hard coal production ended in 2018, following the termination of subsidies. This paper looks at 60 years of continuous decline of an industry that employed more than 600,000 people, through a case study comparing Germany’s two largest hard coal mining areas (Ruhr area and Saarland). Although predominantly economic drivers underlay the transitions, both provide valuable lessons for upcoming coal phase-outs induced by stricter climate policies, including beyond Germany. The analysis identifies the main qualitative and quantitative characteristics of the two regions. It then discusses policy instruments implemented to guide the transition, including measures for the conservation of coal production, regional economic reorientation, and the easing of the transition’s social impacts. The success of these policies is evaluated using economic, social, and geographical indicators that were developed within three interdisciplinary research projects running from 2016 to 2019. A key lesson from the examined case studies is the importance of combining not only policies addressing unemployment and the attraction of new energy corporations and investments, but also measures improving infrastructure, education, research facilities and soft location factors. Protecting a declining industry for decades caused increased transition costs compared to an earlier phase-out. Economic reorientation and changing regional identities have proven most difficult in the past. However, the German example illustrates that the complexity of the challenges of a transition can be mastered if city, regional, and national governments and institutions cooperate in a polycentric approach. Key policy insights A faster and more pro-active hard coal mining phase-out in Germany would have been much less expensive and paved the way for new industries A just and in-time transition needs to: be jointly managed in a polycentric approach by city, regional, national, and international governments and institutions. combine climate, energy, social, and structural policies, whilst recognizing both local specifics and global connections. consider long-term effects, external independent advice apart from the incumbent regime and beyond-border thinking, while aiming to diversify the economy and enabling broad stakeholder participation. address unemployment, the economy, and the energy system, as well as measures to improve infrastructure, universities, research facilities, and soft location factors.

Innovation, institutions and development: a critical review and grounded heterodox economic analysis of late-industrialising contexts

AbstractThis paper critically reviews dominant approaches to the economics of innovation in contemporary developing societies, namely new institutional economics (NIE) and National Innovation Systems (NIS). Both traditions explain capitalist development in late-industrialising countries using underlying assumptions and logics of advanced industrialised societies with respect to transaction costs, path dependence, the nature and structure of institutions and economic history. At their core, both approaches proffer ideal-type institutions as an essentialist route to technological and productivity improvement akin to a staged theory of development. The NIS framework became dominant in scholarly and policy circles but has neglected the implication that the concept was developed at the Organisation of Economic Cooperation and Development during the emergence of first-stage neoliberalism. NIE has become an essential analytical toolkit of mainstream economists and international organisations promoting competitiveness in developing countries. Analyses of the economic performance of developing countries have thus diverged from structural perspectives on development, attributing instead lacklustre technological deepening to certain national features, institutional gaps or linkage failures. The paper exposes narrow assumptions and illustrates that the ‘transition costs’ that arise from new socio-institutional configurations during the development process induces firms and other actors to compete for rents. Conversely, power asymmetries, historical factors and constraining forces in the global capitalist system generate unevenness in productive forces and technological progress. The paper proposes a political economy of technological change that considers the structural, technical and socio-political interdependencies and tensions that underpin transformative policies to improve technological, coordination and collective capabilities in the economic system.

Dual models and technological platforms for efficient management of water consumption

The social and environmental challenges facing the planet require changes in consumption patterns. It is common in the literature to propose growth models of growth and persuasive technology to respond to the scarcity of resources from an efficient management of demand. In this situation, the paper analyzes the facilitator and inhibitor factors (dual models) which affect the intention to use and the effective use of a platform that monitors water consumption. A focus group with 7 participants and a survey with a sample of 401 people brought to light that the intention to use efficient water consumption platforms is determined by performance expectancy, habit and facilitating conditions. In terms of inhibitors, resistance that affects the intention to use mediates the impact of sunk costs, inertia, perceived value, transition costs and uncertainty. The paper proposes some theoretical and managerial implications related to the use of efficient water consumption devices, as well as to the development of individual prosocial habits. This paper's main theoretical contribution is to raise awareness on the need to supplement traditional models from a dual perspective. Likewise, confirmation is sought on the applicability of efficient water consumption platforms in the means of monitoring consumer habits and behavioral patterns.

Optimal Control of Multi-Source Electric Vehicles in Real Time Using Advisory Dynamic Programming

This paper presents a novel method, advisory dynamic programming (AD-DP), for power management of a fuel cell hybrid vehicle (FCHEV). The presented method embraces a new understanding of vehicle states as driver-dependent and -independent states in time domain to define a suitable state space to be used for dynamic programming. Driver-dependent states are defined in terms of multiple characteristic parameters for vehicle speed and power demand, corporately. Driver-independent states are defined in terms of discrete values for supercapacitor's state of charge $SoC_{sc}$ . Transition costs between all states in the state space are calculated offline and tabulated in look-up tables for online implementation. A state predictive model is developed based on the transition statistics of driver-dependent states for a suitable number of driving cycles. Backward calculation of the total transition cost for the predicted horizon in state space is used to define optimal power split strategy for the powertrain. The formulation of optimal control problem, in terms of situation-based solutions related to vehicle states, enables a significant reduction of computational steps and hence addresses the main challenge of real-time applications. The algorithm is adapted in terms of optimization horizon and number of discrete states for DIS to suit the real-time application. Experimental application of AD-DP, using an emulation test-rig, is conducted over different driving cycles. The obtained results reveal an improvement in energy efficiency up to 29% compared to the adaptive rule-based method. The contribution of this paper can be identified as: first, development of a corporate definition for vehicle states, that can be further implemented in optimization-based power management methods. Second, the formulation of an adaptive DP that requires lower computational steps and hence suits real-time applications in hybrid electric vehicles.

PCN117 COST-UTILITY ANALYSIS OF PERTUZUMAB IN COMBINATION WITH TRASTUZUMAB AND CHEMOTHERAPY VERSUS TRASTUZUMAB AND CHEMOTHERAPY FOR THE ADJUVANT TREATMENT OF PATIENTS WITH HER2+ EARLY BREAST CANCER IN SPAIN

Pertuzumab(P), trastuzumab and chemotherapy(HT) for the adjuvant treatment of HER2+ early breast cancer(eBC) significantly improved invasive disease-free survival(iDFS) versus HT in the intention-to-treat population(ITT) and, particularly, in lymph node-positive(N+) and/or hormone receptor-negative(HR-) patients. We performed a study aimed at determining the cost-utility of PHT versus HT as adjuvant treatment in HER2+ eBC for Spain. A six-state Markov model (iDFS, local recurrence, iDFS after local recurrence, metastatic-relapse[1L], metastatic-relapse[2L], and death) was adapted considering the Spanish National Healthcare System perspective, over a lifetime horizon. APHINITY 4 year-iDFS data were fitted with a log-logistic distribution for ITT and N+ populations and with an exponential distribution for HR- patients. Transition probabilities and costs (€ 2019 and list prices of medicines considered) were obtained from national databases/ literature. Utilities were derived from the APHINITY trial. Model inputs were validated by an expert panel. A 3% annual discount rate was applied to effects and costs. Deterministic and probabilistic sensitivity analyses(SA) were performed to explore uncertainties. PHT provided 0.637 additional quality-adjusted life-years(QALYs) and €27,733 cost versus HT in the N+ subgroup (incremental cost-utility ratio[ICUR] of €43,530/QALY). In this subgroup, ICUR were between €19,000 and €27,000 when applying a 20%-30% reduction in pertuzumab and trastuzumab treatment price. In the HR- subgroup, PHT provided 0.405 QALYs and €39,159 cost (ICUR of €96,630/QALY). ICUR were between €58,000 and €71,000 when applying a 20%-30% reduction in treatment price. The ICUR of PHT versus HT was €102,581/QALY in the ITT population, and between €60,000 and €74,000 when considering a 20%-30% treatment price decrease. SA confirmed the robustness of the model. Great controversy currently surrounds cost-effectiveness thresholds. Eighteen cycles of PHT would be an efficient therapeutic alternative in HER2+ N+ eBC with a threshold of €43,530/QALY and in HR- patients with a threshold of €96,630/QALY.

A De Giorgi–Type Conjecture for Minimal Solutions to a Nonlinear Stokes Equation

We study the one‐dimensional symmetry of solutions to the nonlinear Stokes equation urn:x-wiley:00103640:media:cpa21867:cpa21867-math-0001 which are periodic in the d − 1 last variables (living on the torus 𝕋d−1) and globally minimize the corresponding energy in Ω = ℝ × 𝕋d−1, i.e., urn:x-wiley:00103640:media:cpa21867:cpa21867-math-0002 Namely, we find a class of nonlinear potentials W ≥ 0 such that any global minimizer u of E connecting two zeros of W as x1 → ± ∞ is one‐dimensional; i.e., u depends only on the x1‐variable.In particular, this class includes in dimension d = 2 the nonlinearities with w being a harmonic function or a solution to the wave equation, while in dimension d ≥ 3, this class contains a perturbation of the Ginzburg‐Landau potential as well as potentials W having d + 1 wells with prescribed transition cost between the wells. For that, we develop a theory of calibrations relying on the notion of entropy (coming from scalar conservation laws). We also study the problem of the existence of global minimizers of E for general potentials W providing in particular compactness results for uniformly finite energy maps u in Ω connecting two wells of W as x1 → ± ∞. © 2019 Wiley Periodicals, Inc.

Intersection Dilemma-Zone Protection as a Dynamic Signal-Optimization Problem with Model Predictive Control

This paper develops a signal-optimization model for dynamic intersection control and dilemma-zone protection, where the decisions of signal phase switching are optimized to minimize the system transition cost weighted by the number of vehicles trapped in the dilemma zone and the delay incurred by queued vehicles at the intersection. The proposed model is solved with a model predictive control framework, and traffic dynamics are formulated with a cell transmission model, which offers the advantage of taking real-time traffic dynamics as the control input. Case study results from comparing the proposed model with actuated and fixed-time signal control strategies demonstrate the validity and advantages of the proposed methodology.