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2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Matthäus Lottes ◽  
Viviane Bremer ◽  
Christof Prugger ◽  
Christian Kollan ◽  
Daniel Schmidt

Abstract Background Recent patent losses for antiretroviral drugs (ARV) have led to the debate of cost-saving through the replacement of patented drugs with generic drugs. The split of recommended single-tablet regimens (STR) into their single substance partners is one of the considerations mentioned in said debate. Particularly, generic tenofovir disoproxil/emtricitabine (TDF/FTC) is expected to hold untapped cost-saving potential, which may curb increasing overall expenditures for combined antiretroviral therapy (cART) within the statutory health insurance (SHI) of Germany. Methods Data of ARV reimbursed by the SHI were used to describe the trends of defined daily doses (DDD) as well as the revenue within the German ARV market. They were also used to determine the cost-savings of moving to generic drugs. The time period observed was between January 2017 and June 2019. The potential cost-savings were determined with following assumption in mind: the maximum possible use of generic ARV, including 1) the split of STR and replacing all substance partners with generic ones, and 2) replacing patented tenofovir alafenamide/emtricitabine (TAF/FTC) with generic TDF/FTC. Results Throughout the observation period, the DDD of generic ARV increased nearly five-fold while their revenue increased more than four-fold. Total cost-saving showed a sharp increase over the same period, with generic TDF/FTC accounting for a share of around 70%. The largest potential cost-saving could have been achieved through replacing patented TAF/FTC with generic TDF/FTC, peaking at nearly 10% of total revenue, but showing decreasing trends in general. Conclusion The progressive distribution of generic ARV ensured increasing cost-savings, but consequently curbed the potential cost-savings. Unique price reductions of generic TDF/FTC have played a pivotal role for these effects. In any case, substituting with generic ARV should not fail to adhere to the treatment guidelines and continue to consider the medical requirements for the treatment.


2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Clarisse Lobo ◽  
Patricia Moura ◽  
Delaine Fidlarczyk ◽  
Jane Duran ◽  
Roberto Barbosa ◽  
...  

Abstract Background The costs associated with the treatment of sickle cell disease (SCD) are understudied in low and middle-income countries (LMIC). We evaluated the cost of treating SCD-related acute complications and the potential cost-savings of hydroxyurea in a specialized hematology center in Brazil. Methods The costs (US dollars) of emergency department (ED) and hospitalizations from SCD-related complications between 01.01.2018 and 06.30.2018 were ascertained using absorption and micro-costing approaches. The reasons for acute hospital visits were grouped as: 1) vaso-occlusive (VOC) pain, 2) infection, 3) anemia exacerbation, and 4) chronic organ damage complications. Hydroxyurea adherence was estimated by medication possession ratio (MPR) during the study period. Results In total, 1144 patients, median age 17 years (range 0–70), 903 (78.9%) with HbSS/HbSβ0-thalassemia, 441 (38.5%) prescribed hydroxyurea, visited the ED, of whom 381 (33%) were admitted. VOC accounted for 64% of all ED visits and 60% of all admissions. Anemia exacerbation was the most expensive reason for ED visit ($321.87/visit), while chronic organ damage carried the highest admission cost ($2176.40/visit). Compared with other genotypes, individuals with HbSS/HbSβ0-thalassemia were admitted more often (79% versus 21%, p < 0.0001), and their admission costs were higher ($1677.18 versus $1224.47/visit, p = 0.0001). Antibiotics and analgesics accounted for 43% and 42% of the total ED costs, respectively, while housing accounted for 46% of the total admission costs. Costs of ED visits not resulting in admissions were lower among HbSS/HbSβ0-thalassemia individuals with hydroxyurea MPR ≥65% compared with visits by patients with MPR <65% ($98.16/visit versus $182.46/visit, p = 0.0007). No difference in admission costs were observed relative to hydroxyurea use. Discussion In a LMIC hematology-specialized center, VOCs accounted for most acute visits from patients with SCD, but costs were highest due to anemia exacerbation. Analgesics, antibiotics, and housing drove most expenses. Hydroxyurea may reduce ED costs among individuals with HbSS/HbSβ0-thalassemia but is dependent on adherence level.


2022 ◽  
Vol 3 (1) ◽  
Author(s):  
Tshepelayi Kabata ◽  
Lilyan E. Fulginiti ◽  
Richard K. Perrin

Abstract Background Most studies on the environmental impacts of agriculture have attempted to measure environmental impacts but have not assessed the ability of the sector to reduce or mitigate such impacts. Only a few studies have examined greenhouse gas emissions from the sector. This paper assesses the ability of states in the U.S. to reduce agricultural emissions of methane and nitrous oxide, two major greenhouse gases (GHGs) with important global warming potential. Methods The analysis evaluates Färe’s PAC (pollution abatement cost) for each state and year, a measure of the potential opportunity costs of subjecting the sector to GHG emissions regulation. We use both hyperbolic and directional distance functions to specify agricultural technology with good and bad outputs. Results and conclusions We find that such regulations might reduce output by an average of about 2%, although the results for individual states vary quite widely.


Author(s):  
Rizwan Javed ◽  
Lorraine Flores ◽  
Saurabh Jayant Bhave ◽  
Asheer Jawed ◽  
Deepak Kumar Mishra

AbstractBlood is a very important resource for healthcare-based services and there has been a consistently increasing demand for it in most parts of the world. Poor volunteer-based collection system, high-risk of transfusion-transmitted infections, and emergence of new pathogens as evident from the ongoing Coronavirus Disease 2019 (COVID-19) pandemic are potential challenges to the global healthcare systems. It is imperative to explore safe and reliable alternatives to red cell transfusions. Ex vivo culture of red cells (cRBCs) from different sources such as hematopoietic stem cells (HSCs), pluripotent stem cells, and immortalized progenitors (e.g., BELA-2 cells) could revolutionize transfusion medicine. cRBC could be of great diagnostic and therapeutic utility. It may provide a backup in times of acute shortages in patients with rare blood groups, and in cases with multiple antibodies or sickle cell anemia. The CRISP-Cas9 system has been used to develop personalized, multi-compatible RBCs for diagnostic reagents and patients with multiple allo-antibodies. cRBC could be practically feasible for pediatric patients, who require small quantities of red cell transfusions. cRBC produced under good manufacturing practice (GMP) conditions has been reported to survive in human blood circulation for more than 26 days. Recently, a phase I randomized controlled clinical trial called RESTORE was initiated to assess the survival and recovery of cRBCs. However, feasible technological advancement is required to produce enough cRBCs for clinical use. It is crucial to identify sustainable sources for large-scale production of clinically useful cRBCs. Although the potential cost of one unit of cRBC is extrapolated to be around US$ 8000, it is a life-saving product for patients having rare blood groups and is a “ready to use” source of phenotype-matched, homogenous young red cells in emergency situations.


Iproceedings ◽  
10.2196/35388 ◽  
2021 ◽  
Vol 6 (1) ◽  
pp. e35388
Author(s):  
Lucy Howard ◽  
O Jagun ◽  
A Hong ◽  
Z Hassan ◽  
C Wong ◽  
...  

Background The COVID-19 pandemic has broadened the scope of teledermatology services in the United Kingdom from a primarily outpatient-based triage tool to the management of inpatient referrals. In order to reduce the risk of transmission in hospital, a number of changes were implemented within our department. As part of this, our on-call referrals were transferred to a telemedicine app, which incorporates the secure transfer of user-generated patient images onto a web-based image management system providing remote access for the dermatology team. Objective This study aimed to compare how the introduction of this referral method impacted the nature and number of referrals received, the efficiency of the on-call service, and user preferences. Methods A retrospective cohort study was conducted to compare the number of referrals, time taken to review, and referral diagnoses between previous referral methods to the dermatology department (bleep, fax, email) (July and September 2019) and the new teledermatology app (July and September 2020). We also performed a survey of junior doctors, seeking their feedback and preferences pertaining to the new referral system. Results The number of referrals increased by 80%, with a 6-fold increase in lesion referrals. There is a possibility that not all referrals from 2019 were accounted for as paper documents are easily lost or discarded, highlighting another advantage of teledermatology in providing a reliable record of referrals. Dermatology referrals may have increased as the telemedicine app is more accessible to staff across sites. The telemedicine app also led to a reduction in time to review by 0.53 days, resulting in a significantly higher number of patients being given dermatology input on the day of the referral (78% vs 58%). This will have led to earlier treatment, improved patient outcomes, and shorter inpatient stays, resulting in potential cost reductions for the hospital. The survey of junior doctors showed that 81% preferred teledermatology to the previous referral methods. Conclusions The introduction of teledermatology has provided an effective and acceptable method of managing on-call dermatology referrals. Easier access to dermatology advice via teledermatology may result in higher numbers of referrals, which may warrant strict referral criteria to prevent oversubscription of the on-call service. Teledermatology ensures an accurate log of referrals, including the nature of referrals, allowing for better auditing and service improvement. Teledermatology referrals allow for advice to be provided within shorter time frames compared to previous methods. This should improve patient outcomes and reduce hospital admission stays, potentially resulting in cost savings for the hospital. Conflict of Interest None declared.


2021 ◽  
Author(s):  
Alessandro La Grotta ◽  
Róisín Louise Harris ◽  
Clive Da Costa

Abstract While Floating Offshore Wind (FOW) represents a significant opportunity to foster wind energy development and to contribute to remarkable CO2 emissions reductions, its associated operational costs are still substantially above grid parity, and significant innovation is needed. MooringSense is a research and innovation project which explores digitisation technologies to enable the implementation of risk-based integrity management strategies for mooring systems in the FOW sector with the aim to optimise Operations and Maintenance (O&M) activities, reduce costs, and increase energy production. As part of this project, a risk-based assessment methodology specific for the mooring system of Floating Offshore Wind Turbines (FOWT) has been developed; this allows the development of a risk-based Mooring Integrity Management Strategy that can result in more cost-effective inspection planning. The methodology shall utilise the information made available by numerical tools, sensors, and algorithms developed in the project to update the risk level of the mooring system and set the required plan to mitigate the risk. Leveraging the additional information from monitoring technologies and predictive capabilities to determine the mooring system condition and remaining lifetime, the strategy provides the criteria for optimal decision making with regards to selection of O&M activities. The risk-based strategy developed allows for optimal planning of inspection and maintenance activities based on dynamic risk level that is periodically updated through the interface with the Digital Twin (DT). The validation of the strategy will demonstrate potential cost saving and economic advantages, however, it is expected that the overall MooringSense approach can reduce FOW farm operational costs by 10-15% and increase operational efficiency by means of an Annual Energy Production increase by 2-3%. The MooringSense project comprises of the development and validation of innovative solutions coming from multiple disciplines such as numerical modelling, simulation, Global Navigation Satellite System (GNSS), Structural Health Monitoring (SHM), and control systems which will provide valuable input to the risk-based mooring integrity management strategy.


2021 ◽  
Author(s):  
Fahd Siddiqui ◽  
Mohammadreza Kamyab ◽  
Michael Lowder

Abstract The economic success of unconventional reservoirs relies on driving down completion costs. Manually measuring the operational efficiency for a multi-well pad can be error-prone and time-prohibitive. Complete automation of this analysis can provide an effortless real-time insight to completion engineers. This study presents a real-time method for measuring the time spent on each completion activity, thereby enabling the identification and potential cost reduction avenues. Two data acquisition boxes are utilized at the completion site to transmit both the fracturing and wireline data in real-time to a cloud server. A data processing algorithm is described to determine the start and end of these two operations for each stage of every well on the pad. The described method then determines other activity intervals (fracturing swap-over, wireline swap-over, and waiting on offset wells) based on the relationship between the fracturing and wireline segments of all the wells. The processed data results can be viewed in real-time on mobile or computers connected to the cloud. Viewing the full operational time log in real-time helps engineers analyze the whole operation and determine key performance indicators (KPIs) such as the number of fractured stages per day, pumping percentage, average fracture, and wireline swap-over durations for a given time period. In addition, the performance of the day and night crews can be evaluated. By plotting a comparison of KPIs for wireline and fracturing times, trends can be readily identified for improving operational efficiency. Practices from best-performing stages can be adopted to reduce non-pumping times. This helps operators save time and money to optimize for more efficient operations. As the number of wells increases, the complexity of manual generation of time-log increases. The presented method can handle multi-well fracturing and wireline operations without such difficulty and in real-time. A case study is also presented, where an operator in the US Permian basin used this method in real-time to view and optimize zipper operations. Analysis indicated that the time spent on the swap over activities could be reduced. This operator set a realistic goal of reducing 10 minutes per swap-over interval. Within one pad, the goal was reached utilizing this method, resulting in reducing 15 hours from the total pad time. The presented method provides an automated overview of fracturing operations. Based on the analysis, timely decisions can be made to reduce operational costs. Moreover, because this method is automated, it is not limited to single well operations but can handle multi-well pad completion designs that are commonplace in unconventionals.


2021 ◽  
Author(s):  
Erismar Rubio ◽  
Mohamed Yousef Alklih ◽  
Nagaraju Reddicharla ◽  
Abobaker Albelazi ◽  
Melike Dilsiz ◽  
...  

Abstract Automation and data-driven models have been proven to yield commercial success in several oil fields worldwide with reported technical advantages related to improved reservoir management. This paper demonstrates the implementation of an integrated workflow to enhance CO2 injection project performance in a giant onshore smart oil field in Abu Dhabi. Since commissioning, proactive evaluation of the reservoir management strategy is enabled via smart-exception-based surveillance routines that facilitate reservoir/pattern/well performance review and supporting the decision making process. Prolonging the production sustainability of each well is a key pillar of this work, which has been made more quantifiable using live-tracking of the produced CO2 content and corrosion indicators. The intensive computing technical tasks and data aggregation from different sources; such as well testing and real time production/injection measurements; are integrated in an automatic workflow in a single platform. Accordingly, real-time visualizations and dashboards are also generated automatically; to orchestrate information, models and multidisciplinary knowledge in a systematic and efficient manner; allowing engineers to focus on problematic wells and giving attention to opportunity generation in a timely manner. Complemented with numerical techniques and other decision support tools, the intelligent system data-driven model assist to obtain a reliable short-term forecast in a shorter time and help making quick decisions on day-to-day operational optimization aspects. These dashboards have allowed measuring the true well/pattern performance towards operational objectives and production targets. A complete set of KPI's has helped to identify well health-status, potential risks and thus mitigate them for short/long term recovery to obtain an optimum reservoir energy balance in daily bases. In case of unexpected well performance behaviors, the dashboards have provided data insights on the root causes of different well issues and thus remedial actions were proposed accordingly. Maintaining CO2 miscibility is also ensured by having the right pressure support around producers, taking proactive actions from continues evaluation of producer-injector connectivity/interdependency, improving injection/production schedule, validating/tuning streamline model based on surveillance insights, avoiding CO2 recycling, optimizing data acquisition plan with potential cost saving while taking preventive measures to minimize well/facility corrosion impact. In this work, best reservoir management practices have been implemented to create a value of 12% incremental oil recovery from the field. The applied methodology uses an integrated automation and data-driven modeling approach to tackle CO2 injection project management challenges in real-time.


2021 ◽  
Author(s):  
Thomas Delaplace ◽  
Morgan Gouriou ◽  
Denis Melot

Abstract This paper presents the investigations performed by TotalEnergies and Saipem on the cost effectiveness potential of internal plastic lining for corrosion protection of offshore production lines. Objective was to better understand for a complete EPCI cost comparison the various parameters that could have a significant impact on the potential savings associated with the use of plastic lining instead of CRAs (Corrosion Resistant Alloys) for very corrosive production fluids such as sour gases. An extensive cost comparison study between CRA lining and plastic lining for offshore production lines was performed considering sensitivity on several parameters: 3 pipe diameters, S-Lay, Reel-Lay and J-Lay installation, sensitivity to external thermal insulation requirements, mechanical and design requirements, to pipe length and fixed costs (technologies and vessels). A dedicated calculation tool for system design and cost assessment was built on purpose for this sensitivity study. Costs were assessed for the various cases, starting from pipe design, then assessing procurement costs, fabrication costs then installation costs with preliminary cycle time assessment. Project management and engineering costs have been considered to obtain comparative EPCI (as installed) cost assessments for the various study cases. Plastic lining appears to be a cost-effective solution installed in J-Lay or S-Lay in addition to reeling (up to 45% of potential cost savings on installed line compared to CRA lining). The main driver for the cost savings is associated to the procurement of the pipes and associated lining, including pipe manufacturing. Some smaller savings can also be obtained from the offshore cycle times in J-Lay and S-Lay as the CRA welding add a significant operation time in comparison with standard CS welds. The fixed additional costs associated to the plastic lining (specific tooling for example) can be quickly amortized after a few kilometers thanks to the material cost savings. Integrating them as a company investment allows to unlock costs savings even for shorter lines. The thermal contribution of the plastic liner is also interesting regarding the overall pipe insulation design. This study completes the works already performed by the industry on the offshore costs of plastic lining as it considers the whole EPCI CAPEX costs from the Contractor and Operator points of view and offshore experience. The study integrates the S-Lay and J-Lay installation methods (while previous studies mainly focused on Reel-Lay) and includes an extensive sensitivity study with various key parameters such as pipe sizes, pipe design requirements, material costs and offshore operation times to get a general overview of potential benefits associated with plastic linings for offshore production lines transporting corrosive fluids such as sour gases.


2021 ◽  
Author(s):  
Nichapa Akaramethakorn ◽  
Issa Mahruqi ◽  
Mohammad Aziz ◽  
Mohamed Radwan ◽  
Yahya Amri ◽  
...  

Abstract This paper is for people to realize a strategic way of continuous improvement though optimization and standardization process with a minimum of 10% target cost reduction while developing capability in the organization in the south of Oman. BN area is one of the main production areas in PDO (Petroleum Development of Oman) and is being operated under BR cluster from 1980s. Approximately eleven fields in the BN area are contributing to the success today. Continuous improvement through optimization and cost reduction has always been a top priority, where long term production and safety has been fulfilled. In 2020, this team has been put together to look into the overall cost saving potential with the clear management steering of "Do not Leave any Stone Unturned". A mixture of experience and young team members are retained to ensure capability development in the organization. One of the key items that this team looked at is to standardize of upcoming Oil Producers and Water Injectors well design. The well design in at least 7 fields in the BN area has been reviewed and realized the value and risk through competitive scoping exercise. By avoiding looking at the fields in isolation, the team has considered a similarity of well functionality and had identified where the standard well design can be applied. Minimum functional requirements lead to minimum technical specification and building into a staircase of option with clear associated risk for each option. Through the analysis, a potential optimization of an existing well design has been discovered and is currently undergone further maturation toward design endorsement. With the maturation of the uniformity of well design in the area, it is foreseeing as an opportunity to ensure improvement can be sustained in the long run. Minimum 10% saving of well cost through standardization and efficiency in project management is a target set, aiming to provide stability in planning. In addition, the team are looking into even more than 10% cost saving through innovative contracting strategy. It could potentially help to speed up the delivery of the project, accelerate production with less waiting time i.e. improve material stock management, simplify procurement process, ensure that the experience remains in the organization and will allow for replication in the future. The approach involves a combination of integrating team from subsurface, surface, wells, contract, and procurement to enhance cost saving to the company. This has proven to be effective and aligned with the company's focus to consolidate a commercial mind-set thinking in each development.


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