Implementation of personalized medicine in a context of moral hazard and uncertainty about treatment efficacy.

This paper analyzes the decision of a health authority to implement personalized medicine. We consider a model in which the health authority has three possibilities. It can apply either the same treatment (a standard or a new treatment) to the whole population or implement personalized medicine, i.e., use genetic information to offer the most suitable treatment to each patient. We first characterize the drug reimbursement contract of a firm producing a new treatment with a companion genetic test when the firm can undertake an effort to improve drug quality. Then, we determine the conditions under which personalized medicine should be implemented when this effort is observable and when it is not. Finally, we show how the unobservability of effort affects the conditions under which the health authority implements personalized medicine.

Methodology for the optimal design of an integrated first and second generation ethanol production plant combined with power cogeneration.

The application of methodologies for the optimal design of integrated processes has seen increased interest in literature. This article builds on previous works and applies a systematic methodology to an integrated first and second generation ethanol production plant with power cogeneration. The methodology breaks into process simulation, heat integration, thermo-economic evaluation, exergy efficiency vs. capital costs, multi-variable, evolutionary optimization, and process selection via profitability maximization. Optimization generated Pareto solutions with exergy efficiency ranging between 39.2% and 44.4% and capital costs from 210M$ to 390M$. The Net Present Value was positive for only two scenarios and for low efficiency, low hydrolysis points. The minimum cellulosic ethanol selling price was sought to obtain a maximum NPV of zero for high efficiency, high hydrolysis alternatives. The obtained optimal configuration presented maximum exergy efficiency, hydrolyzed bagasse fraction, capital costs and ethanol production rate, and minimum cooling water consumption and power production rate.

Round-the-clock power supply and a sustainable economy via synergistic integration of solar thermal power and hydrogen processes.

We introduce a paradigm-"hydricity"-that involves the coproduction of hydrogen and electricity from solar thermal energy and their judicious use to enable a sustainable economy. We identify and implement synergistic integrations while improving each of the two individual processes. When the proposed integrated process is operated in a standalone, solely power production mode, the resulting solar water power cycle can generate electricity with unprecedented efficiencies of 40-46%. Similarly, in standalone hydrogen mode, pressurized hydrogen is produced at efficiencies approaching ∼50%. In the coproduction mode, the coproduced hydrogen is stored for uninterrupted solar power production. When sunlight is unavailable, we envision that the stored hydrogen is used in a "turbine"-based hydrogen water power (H2WP) cycle with the calculated hydrogen-to-electricity efficiency of 65-70%, which is comparable to the fuel cell efficiencies. The H2WP cycle uses much of the same equipment as the solar water power cycle, reducing capital outlays. The overall sun-to-electricity efficiency of the hydricity process, averaged over a 24-h cycle, is shown to approach ∼35%, which is nearly the efficiency attained by using the best multijunction photovoltaic cells along with batteries. In comparison, our proposed process has the following advantages: (i) It stores energy thermochemically with a two- to threefold higher density, (ii) coproduced hydrogen has alternate uses in transportation/chemical/petrochemical industries, and (iii) unlike batteries, the stored energy does not discharge over time and the storage medium does not degrade with repeated uses.

Use of the monoclonal antibody anti-HER2 trastuzumab in the treatment of metastatic breast cancer: a cost-effectiveness analysis.

BACKGROUND: This open controlled prospective study aimed at evaluating the medical and economical impact of first line chemotherapy for metastatic breast cancer (MBC). PATIENTS AND METHODS: Two groups of HER +++ MBC patients were compared: 26 were treated by a combination of trastuzumab and paclitaxel in 4 "prescriber" centers (group A) and 19 patients were treated by any chemotherapy without addition of trastuzumab, in 6 control centers (group B). The cost of chemotherapy and related hospitalizations was taken into account during the first 8 cycles. RESULTS: Forty-five patients, mean age 51 years have been included. The objective response rate was significantly higher in group A (42% vs. 6%, P = 0.036). The median overall survival was 17 months longer in the group A (29 vs. 12 months). The median progression free survival rate was 12.2 months longer in the group A (19 vs. 7 months). The 1-year survival rate was 85% in the group A and 47% in the group B. The mean overall care cost was 33.271 euro per patient in group A versus 11.191 euro per patient in group B. The additional cost per saved year of life expressed as the incremental cost-effectiveness ratio is 15.370 euro 2002. CONCLUSION: The related additional cost seems affordable for an European health care system and justifies the recommendation for its use in the subpopulation overexpressing HER2.