A cost effectiveness analysis of two treatment strategies for trigeminal neuralgia in Ontario.

Background: Trigeminal neuralgia (TN) is a debilitating disease with an annual incidence of approximately 4-27/100,000. In Ontario, over 2000 patients receive interventions for profound pain, including medical and surgical therapies. The global expected cost of these approaches is unknown. This study aims to analyze the cost-effectiveness of one surgical therapy, microvascular decompression (MVD), compared with the best medical therapy (carbamazepine) as first-line therapy. Methods: Costs were gathered from the Canadian Institute for Health Information, Ontario Drug Benefit Formulary, and Ontario Ministry of Health Schedule of Benefits for Physician Services. Academic literature was used to estimate unavailable items. A cost-benefit Markov model was created for each strategy with literature-based rates for annual cycles from years 1 to 5, followed by a linear recurrent cycle from years 6 to 10. Incremental cost-effectiveness ratios (ICERs) were calculated based on the incremental cost in 2022 Canadian Dollars (CAD) per pain-free year. Results: Base case cost per patient was $10,866 at 10 years in the "MVD first" group and $10,710 in the "carbamazepine first" group. Ten-year ICER was $1,104 for "MVD first," with strict superiority beyond this time point. One-way deterministic sensitivity analysis for multiple factors suggested the highest cost variability and ICER variability were due to surgery cost, medication failure rate, and medication cost. Conclusion: Economic benefit is established for a "MVD first" strategy in the Ontario context with strict superiority beyond the 10-year horizon. If a cost-effectiveness threshold of $50,000 per pain-controlled year is used, the benefit is established at 4 years.

Multi-objective optimization and 4E (energy, exergy, economy, environmental impact) analysis of a triple cascade refrigeration system.

The post-pandemic energy crisis and ever-increasing environmental degradation necessitate researchers to scrutinize refrigeration systems, major contributors to these issues, for minimal environmental impact and maximum performance. Thus, this study aims to comprehensively examine a triple cascade refrigeration system (TCRS) equipped with hydrocarbon refrigerants (1-butene/Heptane/m-Xylene). This system is specifically designed for ultra-low temperature applications, including vaccine storage, quick-freezing, frozen food preservation, cryogenic processes, and gas liquefaction. The investigation integrates conventional thermodynamic analysis with economic and environmental impact assessments, and finally multi-objective optimization (MOO) to ascertain optimal operating conditions for the system. The effect of (1) evaporator temperature, Tevap (2) condenser temperature, Tcond (3) Lower Temperature Circuit (LTC) condenser temperature, TLTC (4) Mid Temperature Circuit (MTC) condenser temperature, TMTC and (5) Cascade Condenser temperature difference, Δ T on three objective functions (COP, exergy efficiency, and overall plant cost) have been investigated employing a parametric analysis. Subsequently, quadratic equations for these objective functions are generated using the Box-Behnken method, and MOO utilizing the Genetic algorithm has been performed to maximize COP and exergy efficiency while minimizing the overall cost rate. The decision-making techniques TOPSIS and LINMAP are used to retrieve a unique solution from the Pareto Front, and the system performance has been assessed at the optimal point. The optimization result demonstrates that for the 10-kW capacity TCRS, COP, exergy efficiency, and total plant cost are 0.71, 0.51, and 38262.05 $/year respectively, at optimum condition (Tevap = -101.023 °C , Tcond = 36.545 °C , TLTC = - 69.047 °C and TMTC = - 34.651 °C ). Exergy analysis identifies HTC compressor (19.3 %) and throttle valve (15.5 %) as key contributors to total exergy destruction, while economic analysis underscores capital and maintenance costs (72 %) as the primary contributors to the overall cost, with evaporator (43 %) and condenser (20 %) accounting for 63 % of this cost.

Functional and financial analysis of an inclined step solar desalination using phase change nanomaterials.

Recent decades have seen a shortage of water, which has led scientists to concentrate on solar desalination technologies. The present study examines the solar water desalination system with inclined steps, while considering various phase change materials (PCMs). The findings suggest that the incorporation of PCM generally enhances the productivity of the solar desalination system. Additionally, the combination of nanoparticles has been used to PCM, which is a popular technique utilized nowadays to improve the efficiency of these systems. The current investigation involves the transient modeling of a solar water desalination system, utilizing energy conservation equations. The equations were solved using the Runge-Kutta technique of the ODE23s order. The temperatures of the salt water, the absorbent plate of the glass cover, and the PCM were calculated at each time. Without a phase changer, the rate at which fresh water is produced is around 5.15 kg/m2·h. The corresponding mass flow rates of paraffin, n-PCM I, n-PCM III, n-PCM II, and stearic acid are 22.9, 28.9, 5.9, 11.9, and 73 kg/m2·h. PCMs, with the exception of stearic acid, exhibit similar energy efficiency up to an ambient temperature of around 29°. However, at temperatures over 29°, n-PCM II outperforms other PCM.

Component innovations for lower cost mechanical vapor compression.

Despite significant capital and operating costs, mechanical vapor compression (MVC) remains the preferred technology for challenging brine concentration applications. This work seeks to assess the dependence of MVC costs on feedwater salinity and desired water recovery and to quantify the value of improved component performance or reduced component costs for reducing the levelized cost of water (LCOW) of MVC. We built a cost optimization model coupling thermophysical, heat and mass transfer, and technoeconomic models to optimize and identify low cost MVC system designs as a function of feedwater salinity and water recovery. The LCOW ranges over 3.6 to 6.1 $/m3 for seawater feed salinities of 25-150 g/kg and water recoveries of 40-80 %. We then perform sensitivity analysis on parameter inputs to isolate irreducible costs and determine high value component innovation targets. The LCOW was most sensitive to evaporator material costs and performance, including the overall heat transfer coefficient in the evaporator. Process and material innovations such as polymer-composite evaporator tubes that reduce evaporator costs by 25 % without reducing heat transfer performance by more than 10 % would result in MVC cost reductions of 8 %.

Pyrolytic urban mining of waste printed circuit boards: an enviro-economic analysis.

E-waste, a global environmental concern resulting from supply chain inefficiency, also offers the opportunity to recover valuable materials, including general and rare earth metals. Waste printed circuit boards (WPCBs) are integral components of e-waste that contains substantial amounts of precious metals, making them a valuable waste category. Pyrolysis has emerged as a promising method for material recovery from WPCBs. Hence, pyrolytic urban mining of WPCBs offers an excellent avenue for resource recovery, redirecting valuable materials back into the supply chain. Under the current study, experimental investigation has been conducted to explore the recovery of materials from WPCBs through pyrolysis followed by process simulation, economic analysis, and life cycle assessment (LCA). An Aspen Plus simulation was conducted to model the pyrolysis of WPCBs and subsequent product recovery using a non-equilibrium kinetic model, which represents a unique approach in this study. Another distinct aspect is the comprehensive assessment of environmental and economic sustainability. The economic analysis has been carried out using Aspen economic analyzer whereas the LCA of WPCB pyrolysis has been conducted using the SimaPro software. The experimental investigation reveals yield of solid residues are about 75-84 wt.%, liquid yields of 6-13 wt.%, and gas yields of 4-21 wt.%, which is in well agreement with the Aspen Plus simulation results. The economic analysis for an e-waste pyrolysis plant with an annual feed rate of 2000 t reveals that the total capital cost of a pyrolysis plant is nearly $51.3 million, whereas the total equipment cost is nearly $2.7 million and the total operating cost is nearly $25.6 million. The desired rate of return is 20% per year and the payback period is 6 years with a profitability index of 1.25. From the LCA, the major impact categories are global warming, fossil resource scarcity, ozone formation in human health, ozone formation in terrestrial ecosystems, fine particulate matter formation, and water consumption. The findings of this study can serve as a guideline for e-waste recyclers, researchers, and decision-makers in establishing circular economy.

Savings associated with surgical aortic valve replacement with a RESILIA tissue valve based on seven-year COMMENCE trial results.

BACKGROUND: Bioprostheses with RESILIA tissue demonstrate a reduction in calcification and improve health outcomes in pre-clinical and clinical studies. Prior economic analyses which relied on 5 years of evidence from the COMMENCE trial demonstrate financial savings for RESILIA tissue valves relative to mechanical valves after surgical aortic valve replacement (SAVR). Given the recent release of 7-year COMMENCE data, this economic evaluation updates the estimate for long-run savings of bioprosthetic valves with RESILIA. METHODS: Simulation models estimated disease progression across two hypothetical SAVR cohorts (tissue vs. mechanical) of 10,000 patients each in the US. The primary comparison calculated the SAVR-related expenditures associated with each valve type ($US, 2023). Health outcome probabilities were based on the COMMENCE trial though year 7 and projected for an additional 8 years based on prior studies of tissue and mechanical SAVR. Costs for key outcomes (mortality, reoperation, bleeding, thromboembolism, endocarditis) and anticoagulant monitoring were sourced from the literature. Incidence rates of health outcomes associated with mechanical valves relied on relative risks of tissue valve versus mechanical valve patients. RESULTS: Seven-year savings are $13,415 (95% CI = $10,472-$17,321) per patient when comparing RESILIA versus mechanical SAVR. Projected 15-year savings were $23,001 ($US, 2023; 95% CI = $17,802-$30,421). Most of the 15-year savings are primarily attributed to lower anti-coagulation monitoring costs ($21,073 in ACM savings over 15 years), but lower bleeding cost (savings: $2,294) and thromboembolism-related expenditures (savings: $852) also contribute. Reoperation and endocarditis expenditures were slightly larger in the RESILIA cohort. If reoperation relative risk reverts from 1.1 to 2.2 (the level in legacy tissue valves) after year 7, savings are $18,064. RESILIA SAVR also reduce costs relative to legacy tissue valves. CONCLUSION: Patients receiving RESILIA tissue valves are projected to have lower SAVR-related health expenditures relative to mechanical and legacy tissue valves.

Synergism of floated paperboard sludge cake /sewage sludge for maximizing biomethane yield and biochar recovery from digestate: A step towards circular economy.

Anaerobic digestion of floated paperboard sludge (PS) cake suffers from volatile fatty acids (VFAs) accumulation, nutrient unbalanced condition, and generation of digestate with a risk of secondary pollution. To overcome these drawbacks, sewage sludge (SS) was added to PS cake for biogas recovery improvement under a co-digestion process followed by the thermal treatment of solid fraction of digestate for biochar production. Batch experimental assays were conducted at different SS:PS mixing ratios of 70:30, 50:50, 30:70, and 20:80 (w/w), and their anaerobic co-digestion performances were compared to the mono-digestion systems at 35 ± 0.2 °C for 45 days. The highest methane yield (MY) of 241.68 ± 14.81 mL/g CODremoved was obtained at the optimum SS:PS ratio of 50:50 (w/w). This experimental condition was accompanied by protein, carbohydrate, and VFA conversion efficiencies of 47.3 ± 3.2%, 46.8 ± 3.2%, and 56.3 ± 3.8%, respectively. The synergistic effect of SS and PS cake encouraged the dominance of Bacteroidota (23.19%), Proteobacteria (49.65%), Patescibacteria (8.12%), and Acidovorax (12.60%) responsible for hydrolyzing the complex organic compounds and converting the VFAs into biomethane. Further, the solid fraction of digestate was subjected to thermal treatment at a temperature of 500 °C for 2.0 h, under an oxygen-limited condition. The obtained biochar had a yield of 0.48 g/g dry digestate, and its oxygen-to-carbon (O/C), carbon-to-nitrogen (C/N), and carbon-to-phosphorous (C/P) ratios were 0.55, 10.23, and 16.42, respectively. A combined anaerobic co-digestion/pyrolysis system (capacity 50 m3/d) was designed based on the COD mass balance experimental data and biogenic CO2 market price of 22 USD/ton. This project could earn profits from biogas (12,565 USD/yr), biochar (6641 USD/yr), carbon credit (8014 USD/yr), and COD shadow price (6932 USD/yr). The proposed project could maintain a payback period of 6.60 yr. However, further studies are required to determine the associated life cycle cost model that is useful to validate the batch experiment assumptions.

Experimental study, simulation and technical-economic feasibility of an interesterification plant for hydrocarbons synthesis by using plastics and frying oil waste.

This work presents the experimental assessment of a 20 mL batch reactor's efficacy in converting plastic and oil residues into biofuels. The reactor, designed for ease of use, is heated using a metallic system. The experiments explore plastic solubilization at various temperatures and residence times, employing a mixture of distilled water and ethylene glycol as the solvent. Initial findings reveal that plastic solubilization requires a temperature of 350 °C with an ethylene glycol mole fraction of 0.35, whereas 250 °C suffices with a mole fraction of 0.58. Additionally, the study includes a process simulation of a plant utilizing a double fluidized bed gasifier and an economic evaluation of the interesterification/pyrolysis plant. Simulation results support project feasibility, estimating a total investment cost of approximately $12.99 million and annual operating expenses of around $17.98 million, with a projected payback period of about 5 years.

Micro-Costing Analysis for the Treatment of Atrial Fibrillation: An Economic Evaluation of the First Italian Experience of Same-Day Discharge Protocol for Cryoballoon Atrial Fibrillation Ablation.

Background: Atrial fibrillation (AF) is the most common cardiac arrhythmia, and its prevalence is expected to increase further due to the aging population, increasing prevalence of risk factors, improving detection methods, and broadening of catheter ablation indications. Along with limited healthcare resources and bed availability, these reasons led to the development of a same-day discharge (SDD) protocol. The aim of this study was to evaluate the health and economic impact of a routine adoption of same-day discharge after cryoballoon AF ablation. Methods: Consecutive patients with symptomatic and drug-refractory AF scheduled for first-time AF ablation were screened, and if deemed suitable, the SDD protocol was proposed and, if accepted, enrolled in the protocol. Results: A total of 324 patients were screened, and 118 were considered eligible for the SDD pathway. Fifty-two patients accepted the SDD pathway and were included in this study. The analysis showed that the variation in resource consumption associated with cryoablation in SDD is equal to EUR 739.85/patient. The analysis showed that the main cost driver for ordinary hospitalization was represented by the hospital stay, which was calculated to be 36% of the total cost. In total, there was a cost reduction of EUR 38.472 thanks to optimized AF patient management from the standard recovery setting to SDD. Conclusions: SDD after cryoballoon ablation of AF is feasible in selected patients with a standardized protocol.

Optimizing Healthcare Expenditure for Spinal Cord Stimulation in Italy: The Value of Battery Longevity Improvement and a Direct-to-Implant Approach.

Background: Spinal cord stimulation (SCS) is a treatment for chronic intractable pain powered by an implantable pulse generator that may be rechargeable or not rechargeable (NR). It is performed in 2 stages (a trialing phase followed by permanent device implantation) and necessitates 2 hospitalizations, which may increase infection risk. Objective: This analysis explores the cost impact of improvements in battery longevity and the adoption of 1-step (direct-to-implant [DTI]) SCS implantation. Methods: Since 2019, 3 leading NR-SCS devices have been launched: Device A (2019), Device B (2020), and Device C (2021). The battery longevity of the newest Device C was estimated at comparable stimulation settings for Devices A and B. A Markov model simulated individual patient pathways across 2 scenarios: Device A vs Device C and Device B vs Device C (both with the DTI approach and 2-step approach). Costs considered were the initial device implantation procedure, device replacements, and serious adverse event (SAE) management. Italian diagnosis-related group (DRG) tariffs were applied for costs, and a 15-year time horizon was used. Results: Over 15 years, using a DTI approach, the undiscounted total costs for Device A vs Device C were €26 860 and €22 633, respectively, and €25 111 and €22 399 for Device B vs Device C, respectively. Compared with Devices A and B, Device C offered savings of €4227 and €2712, respectively; similar savings were predicted with a 2-step implant approach. Discussion: The battery longevity of NR-SCS devices directly impacts long-term costs to a payer. The longer the device lasts, the lower mean total cumulative costs the patient will have, especially with regard to device replacement costs. With novel devices and specific programming settings, the lifetime cost per patient to a payer can be decreased without compromising the patient's safety and positive clinical outcome. Conclusions: Extended SCS battery longevity can translate into tangible cost savings for payers. The DTI approach for SCS supports National Healthcare System cost efficiencies and offers the additional benefits of optimizing operating room time while having only one recovery period for the patient.

Impact and economic analysis of human T-cell lymphotropic virus type 1 (HTLV-1)-targeted antenatal screening, England and Wales, 2021.

BackgroundHuman T-cell lymphotropic virus type 1 (HTLV-1) is a neglected virus that can cause severe disease and be transmitted from mother to child through breastfeeding. Avoidance of breastfeeding prevents 80% of vertical transmission. The United Kingdom (UK) is currently assessing whether HTLV-1-targeted antenatal screening should be implemented.AimWe aimed to assess the impact and cost-effectiveness of a targeted programme to prevent HTLV-1 vertical transmission in England and Wales.MethodsWe estimated the number of pregnant women who have high risk of HTLV-1 infection based on their or their partner's country of birth. With data from 2021, we used a mathematical model to assess cost-effectiveness of HTLV-1 antenatal screening. We also estimated the annual number of infant infections and the number that could be prevented with screening and intervention.ResultsWe estimate that ca 99,000 pregnant women in England and Wales have high risk of HTLV-1 infection. In the absence of screening, 74 (range: 25-211) HTLV-1 infections in infants would be expected to occur every year in England and Wales. Implementation of targeted screening would prevent 58 (range: 19-164) infant infections annually. The intervention is effective (incremental 0.00333 quality-adjusted life years (QALY)) and cost-saving (GBP -57.56 (EUR -66.85)).ConclusionOur findings support implementation of HTLV-1 targeted antenatal screening to reduce vertical transmission from mothers to infants in the UK.

The TransFORmation of IndiGEnous PrimAry HEAlthcare Delivery (FORGE AHEAD): economic analysis.

BACKGROUND: Indigenous populations have increased risk of developing diabetes and experience poorer treatment outcomes than the general population. The FORGE AHEAD program partnered with First Nations communities across Canada to improve access to resources by developing community-driven primary healthcare models. METHODS: This was an economic assessment of FORGE AHEAD using a payer perspective. Costs of diabetes management and complications during the 18-month intervention were compared to the costs prior to intervention implementation. Cost-effectiveness of the program assessed incremental differences in cost and number of resources utilization events (pre and post). Primary outcome was all-cause hospitalizations. Secondary outcomes were specialist visits, clinic visits and community resource use. Data were obtained from a diabetes registry and published literature. Costs are expressed in 2023 Can$. RESULTS: Study population was ~ 60.5 years old; 57.2% female; median duration of diabetes of 8 years; 87.5% residing in non-isolated communities; 75% residing in communities < 5000 members. Total cost of implementation was $1,221,413.60 and cost/person $27.89. There was increase in the number and cost of hospitalizations visits from 8/$68,765.85 (pre period) to 243/$2,735,612.37. Specialist visits, clinic visits and community resource use followed this trend. CONCLUSION: Considering the low cost of intervention and increased care access, FORGE AHEAD represents a successful community-driven partnership resulting in improved access to resources.

Analysis of wind characteristics and wind energy resource assessment for Tonga using eleven methods of estimating Weibull parameters.

of wind characteristics and assessment of wind energy resource is carried out at a location in Tonga with the help of twelve months of measurements carried out at 34 m and 20 m heights above ground level. The daily, monthly and annual averages are computed. The wind shear analysis and its diurnal variation were studied and compared with the temperature variation. The turbulence levels at the two heights were estimated for the entire measurement period as well as for some typical days. For estimating the Weibull parameters, eleven methods were employed along with goodness of fit and error estimates to find the best method. The overall averaged wind speed for the entire period of study is estimated to be 4.41 m/s at 34 m above ground level. The predominant wind direction was south-east for Tonga. 'Moments' is seen to be the best method to determine accurate Weibull parameters. The average net annual energy production from one Vergnet 275 kW wind turbine is 198.57 MWh. A payback period of 8.95 years by installing five turbines near the measurement location was estimated, which is very encouraging in terms of investment. Installing wind turbines will lower the heavy reliance on the imported fossil fuels in the country and also help in achieving Sustainable Development Goal 7.

Economic and environmental performance of microalgal energy products - A case study exploring circular bioeconomy principles applied to recycled anaerobic digester waste flows.

This study quantifies the financial and environmental impacts of a microalgal bioenergy system that attempts to maximize circular flows by recovering and reusing the carbon, nutrients, and water within the system. The system produces microalgal biomass using liquid digestate of an anaerobic digester that processes 45 metric tons of food waste and generates 28.6 m3 of permeate daily in California, and three energy production scenarios from the biomass are considered: producing biodiesel, electricity, and both. In all scenarios, the resulting energy products delivered only modest reductions in environmental impacts as measured by carbon dioxide equivalent emissions. The carbon intensities (CIs) of biodiesel from this study were 91.0 gCO2e/MJ and 93.3 gCO2e/MJ, which were lower than 94.71 gCO2e/MJ of conventional petroleum diesel, and the CI of electricity from this study was 70.6 gCO2e/MJ, lower than the average electricity grid CI in California (82.92 gCO2e/MJ). The economic analysis results show that generating electricity alone can be profitable, while biodiesel produced via this system is not cost competitive with conventional diesel due to high capital expenses. Thus, generating electricity in lieu of biodiesel appears to be a better option to maximize the use of waste flows and supply lower-carbon energy.

Techno-economic assessment of biopolymer production from methane and volatile fatty acids: effect of the reactor size and biomass concentration on the poly(3-hydroxybutyrate-co-3-hydroxyvalerate) selling price.

Poly(3-hydroxybutyrate-co-3-hydroxyvalerate) is a biobased and biodegradable polymer that could efficiently replace fossil-based plastics. However, its widespread deployment is slowed down by the high production cost. In this work, the techno-economic assessment of the process for producing poly(3-hydroxybutyrate-co-3-hydroxyvalerate) from low-cost substrates, such as methane and valeric acid derived from the anaerobic digestion of organic wastes, is proposed. Several strategies for cost abatement, such as the use of a mixed consortium and a line for reagent recycling during downstream, were adopted. Different scenarios in terms of production, from 100 to 100,000 t/y, were analysed, and, for each case, the effect of the reactor volume (small, medium and large size) on the selling price was assessed. In addition, the effect of biomass concentration was also considered. Results show that the selling price of poly(3-hydroxybutyrate-co-3-hydroxyvalerate) is minimum for a production plant with 100,000 t/y capacity, accounting for 18.4 €/kg, and highly influenced by the biomass concentration since it can be reduced up to 8.6 €/kg by increasing the total suspended solids from 5 to 30 g/L, This adjustment aligns the breakeven point of PHBV with the reported average commercial price.

Photothermal CO2 Catalysis toward the Synthesis of Solar Fuel: From Material and Reactor Engineering to Techno-Economic Analysis.

Carbon dioxide (CO2), a member of greenhouse gases, contributes significantly to maintaining a tolerable environment for all living species. However, with the development of modern society and the utilization of fossil fuels, the concentration of atmospheric CO2 has increased to 400 ppm, resulting in a serious greenhouse effect. Thus, converting CO2 into valuable chemicals is highly desired, especially with renewable solar energy, which shows great potential with the manner of photothermal catalysis. In this review, recent advancements in photothermal CO2 conversion are discussed, including the design of catalysts, analysis of mechanisms, engineering of reactors, and the corresponding techno-economic analysis. A guideline for future investigation and the anthropogenic carbon cycle are provided.

Costs of hospital admissions due to COVID-19 in the federal capital of Brazil: a study based on hospital admission authorizations.

This is a cost analysis study based on hospital admissions, conducted from the perspective of the Brazilian Unified Health System (SUS), carried out in a cohort of patients hospitalized at the University Hospital of Brasília (UHB) due to Severe Acute Respiratory Infections (SARI) caused by COVID-19, from April 1, 2020, to March 31, 2022. An approach based on macro-costing was used, considering the costs per patient identified in the Hospital Admission Authorizations (HAA). Were identified 1,015 HAA from 622 patients. The total cost of hospitalizations was R$ 2,875,867.18 for 2020 and 2021. Of this total, 86.41 % referred to hospital services and 13.59 % to professional services. The highest median cost per patient identified was for May 2020 (R$ 19,677.81 IQR [3,334.81-33,041.43]), while the lowest was in January 2021 (R$ 1,698.50 IQR [1,602.70-2,224.11]). The high cost of treating patients with COVID-19 resulted in a high economic burden of SARI due to COVID-19 for UHB and, consequently, for SUS.

Clinical and economic evaluation of blood culture whole process optimisation in critically ill adult patients with positive blood cultures.

OBJECTIVES: Optimising blood culture processing is important to ensure that bloodstream infections are accurately diagnosed while minimising adverse events caused by antibiotic abuse. This study aimed to evaluate the impact of optimised blood culture processes on antibiotic use, clinical outcomes and economics in intensive care unit (ICU) patients with positive blood cultures. METHODS: From March 2020 to October 2021, this microbiology laboratory implemented a series of improvement measures, including the clinical utility of Fastidious Antimicrobial Neutralization (FAN® PLUS) bottles for the BacT/Alert Virtuo blood culture system, optimisation of bottle reception, graded reports and an upgraded laboratory information system. A total of 122 ICU patients were included in the pre-optimisation group from March 2019 to February 2020, while 179 ICU patients were included in the post-optimisation group from November 2021 to October 2022. RESULTS: Compared with the pre-optimisation group, the average reporting time of identification and antimicrobial sensitivity was reduced by 16.72 hours in the optimised group. The time from admission to targeted antibiotic therapy within 24 hours after receiving both the Gram stain report and the final report were both significantly less in the post-optimisation group compared with the pre-optimisation group. The average hospitalisation time was reduced by 6.49 days, the average antimicrobial drug cost lowered by $1720.85 and the average hospitalisation cost by $9514.17 in the post-optimisation group. CONCLUSIONS: Optimising blood culture processing was associated with a significantly increased positive detection rate, a remarkable reduction in the length of hospital stay and in hospital costs for ICU patients with bloodstream infections.

Phase separation methods for protein purification: A meta-analysis of purification performance and cost-effectiveness.

Protein purifications based on phase separations (e.g., precipitation and liquid-liquid extraction) have seen little adoption in commercial protein drug production. To identify barriers, we analyzed the purification performance and economics of 290 phase separation purifications from 168 publications. First, we found that studies using Design of Experiments for optimization achieved significantly greater mean yield and host cell protein log10 removal values than those optimizing one factor at a time (11.5% and 53% increases, respectively). Second, by modeling each reported purification at scales from 10 to 10,000 kg product/year and comparing its cost-effectiveness versus chromatography, we found that cost-effectiveness depends strongly on scale: the fraction of phase separations predicted to be cost-effective at the 10, 100, and 1000 kg/year scales was 8%, 15%, and 43%, respectively. Total cost per unit product depends inversely on input purity, with phase separation being cheaper than chromatography at the 100 kg/year scale in 100% of cases where input purity was ≤ 1%, compared to about 25% of cases in the dataset as a whole. Finally, we identified a simple factor that strongly predicts phase separation process costs: the mass ratio of reagents versus purified product (the "direct materials usage rate"), which explains up to 58% of variation in cost per unit of purified product among all 290 reports, and up to 98% of variation within particular types of phase separation.

Cost-Effectiveness of Axicabtagene Ciloleucel for Adult Patients With Relapsed or Refractory Follicular Lymphoma in the United States.

OBJECTIVES: The results of a recent single-arm trial (ZUMA-5) of axicabtagene ciloleucel (axi-cel) for relapsed/refractory (r/r) follicular lymphoma (FL) demonstrated high rates of durable response and tolerable toxicity among treated patients. To quantify the value of axi-cel compared with standard of care (SOC) to manage r/r FL patients who have had at least 2 prior lines of systemic therapy (3L+), a cost-effectiveness model was developed from a US third-party payer perspective. METHODS: A 3-state partitioned-survival cost-effectiveness model was developed with a lifetime horizon. Patient-level analyses of the 36-month ZUMA-5 (axi-cel) and SCHOLAR-5 (SOC) studies were used to extrapolate progression-free and overall survivals. After 5 years of survival, an estimated 40% of the modeled population was assumed to experience long-term remission based on literature. Results include the incremental cost-effectiveness ratio (ICER) measured as incremental cost per quality-adjusted life year (QALY) gained. One-way sensitivity analysis, probabilistic sensitivity analysis, and scenario analyses were performed. All outcomes were discounted 3% per year. RESULTS: Axi-cel led to an increase of 4.28 life-years, 3.64 QALYs, and a total cost increase of $321 192 relative to SOC, resulting in an ICER of $88 300 per QALY. Across all parameters varied in the one-way sensitivity analysis, the ICER varied between $133 030 and $67 277. In the probabilistic sensitivity analysis, axi-cel had a 99% probability of being cost-effective across 5000 iterations using a $150 000 willingness-to-pay threshold. CONCLUSIONS: Given the robustness of the model results and sensitivity analyses, axi-cel is expected to be a cost-effective treatment in 3L+ r/r FL.