An economic evaluation of the randomized controlled trial of topical corticosteroid and home-based narrowband ultraviolet B for active and limited vitiligo (the HI-Light Vitiligo Trial).

BACKGROUND: Economic evidence for vitiligo treatments is absent. OBJECTIVES: To determine the cost-effectiveness of (i) handheld narrowband ultraviolet B (NB-UVB) and (ii) a combination of topical corticosteroid (TCS) and NB-UVB compared with TCS alone for localized vitiligo. METHODS: Cost-effectiveness analysis alongside a pragmatic, three-arm, placebo-controlled randomized controlled trial with 9 months' treatment. In total 517 adults and children (aged ≥ 5 years) with active vitiligo affecting < 10% of skin were recruited from secondary care and the community and were randomized 1: 1: 1 to receive TCS, NB-UVB or both. Cost per successful treatment (measured on the Vitiligo Noticeability Scale) was estimated. Secondary cost-utility analyses measured quality-adjusted life-years using the EuroQol 5 Dimensions 5 Levels for those aged ≥ 11 years and the Child Health Utility 9D for those aged 5 to < 18 years. The trial was registered with number ISRCTN17160087 on 8 January 2015. RESULTS: The mean ± SD cost per participant was £775 ± 83·7 for NB-UVB, £813 ± 111.4 for combination treatment and £600 ± 96·2 for TCS. In analyses adjusted for age and target patch location, the incremental difference in cost for combination treatment compared with TCS was £211 (95% confidence interval 188-235), corresponding to a risk difference of 10·9% (number needed to treat = 9). The incremental cost was £1932 per successful treatment. The incremental difference in cost for NB-UVB compared with TCS was £173 (95% confidence interval 151-196), with a risk difference of 5·2% (number needed to treat = 19). The incremental cost was £3336 per successful treatment. CONCLUSIONS: Combination treatment, compared with TCS alone, has a lower incremental cost per additional successful treatment than NB-UVB only. Combination treatment would be considered cost-effective if decision makers are willing to pay £1932 per additional treatment success.

Management of agricultural waste for removal of heavy metals from aqueous solution: adsorption behaviors, adsorption mechanisms, environmental protection, and techno-economic analysis.

In the last decades, Egypt has been suffering from the phenomenon of black cloud resulting from burning rice husk and increasing the demand for water leading to the water crisis. An alternative, low-value and surplus agricultural byproduct (rice husk, RH) has an enormous potential for the removal of Cu(II) ions from water. The present study focuses on the chance of the use of rice husk as a bio-adsorbent without any chemical treatment instead of burning it and soiling the environment. The elemental, structural, morphological, surface functional, thermal, and textural characteristics of RH are determined by XRF, XRD, SEM, FT-IR, TGA, and BET surface area, respectively, and contributed to the understanding of the adsorption mechanism of Cu(II) ions in aqueous solution. Also, the performance analysis, adsorption mechanism, influencing factors, favorable conditions, etc. are discussed in this article. The results obtained from optimization by batch mode are achieved under the following conditions: initial concentration, 150 ppm; amount of rice husk, 1 g; average particle size, 0.25 mm; temperature, 25 °C; pH, 4; agitation rate, 180 rpm; and contact time, 60 min. RH exhibits a high degree of selectivity for Cu(II) adsorption. The adsorption isotherm is fitted well with Langmuir and Freundlich models with R 2 0.998 and 0.997, respectively. The adsorption is well governed by the pseudo-second-order kinetics. It is observed that the rate of adsorption improves with decreasing temperature, and the process is exothermic and non-spontaneous. Particular attention has being paid to factors as production processes, fixed/operational cost, production cost, and profit. The techno-economical analysis is presented in this study that provides precise demands on capital for a fixed investment, provisions for operational capital, and finally provisions for revenue. The social, economical, and environmental benefits by industrial point of view using low-cost adsorbent are also discussed.