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2022 ◽  
Rong Chen ◽  
Dmitry Gultyaev ◽  
Johanna Lister ◽  
Rong Han ◽  
Nan Hu ◽  

Abstract Background: Long-term prophylactic therapy is considered the standard of care for hemophilia A patients. This study models the long-term clinical and cost outcomes of two factor VIII (FVIII) products using a pharmacokinetic (PK) simulation model in a Chinese population. Methods: Head-to-head PK profile data of BAY 81-8973 (KOVALTRY®) and antihemophilic factor (recombinant) plasma/albumin-free method (rAHF-PFM, ADVATE®) were applied to a two-state (alive and dead) Markov model to simulate blood FVIII concentrations at a steady state in prophylactically-treated patients with hemophilia A. Worsening of the Pettersson score was simulated and decline was associated with the probability of having orthopaedic surgery. The only difference between the compounds was FVIII concentration at a given time; each subject was treated with 25 IU/kg every 3 days. The model used a lifetime horizon, with cycle lengths of 1 year. Results: Cumulative bleeding events, joint bleeding events, and major bleeding events were reduced by 19.3%, 9.3% and 19.3%, respectively for BAY 81-8973 compared to rAHF-PFM. Hospitalizations and hospitalization days were also reduced by 19.3% for BAY 81-8973 compared to rAHF-PFM. BAY 81-8973 resulted in both cost savings and a gain in quality adjusted life years (QALYs) compared to rAHF-PFM. Conclusion: Based on modeled head-to-head comparisons, differences in PK-properties between BAY 81-8973 and rAHF-PFM result in a reduced number of bleeding events, leading to reduced costs and increased quality of life for BAY 81-8973. These results should be used to inform clinical practice in China when caring for patients with severe hemophilia A.

Agronomy ◽  
2022 ◽  
Vol 12 (1) ◽  
pp. 200
Sukanya Sereenonchai ◽  
Noppol Arunrat

The adoption of rice straw and stubble management approaches can be affected by various factors. To understand the psychological factors influencing Thai farmers’ adoption of rice straw and stubble management approaches, three integrated behavioral theories were employed: the Theory of Planned Behavior (TPB), the Value-Belief-Norm (VBN) and the Health Belief Model (HBM). Then, a practical communication framework was synthesized and proposed to promote rice straw utilization for social-ecological benefits to achieve more sustainable agricultural production. Through a questionnaire survey and in-depth interviews with 240 local farmers, a statistical analysis was performed employing cross-tab, stepwise multiple linear regression, one-way ANOVA and descriptive content analysis using QDA lite miner software. The key results clearly showed that perceived pro-environmental personal norms, perceived cues to rice straw utilization, perceived behavioral control, perceived severity of rice straw burning, perceived ascription of responsibility, and the perceived benefits of rice straw utilization were significantly negatively influenced by burning, and that there was a significantly negative difference to non-burning approaches. Meanwhile, cost savings as perceived benefits of the current option of burning showed a significantly positive difference when compared with incorporation and free-duck grazing options. In communication strategies to promote rice straw utilization for achieving sustainable agriculture, key messages should highlight the clear steps of rice straw utilization, as well as the costs and benefits of each option in terms of economic, health, environmental and social perspectives. Moreover, messages designed to promote action knowledge and self-efficacy at the group level, to promote perceived responsibility via self-awareness and self-commitment, and convenient channels of communication to the farmers can help to achieve more effective non-burning rice straw and stubble management.

2022 ◽  
Vol 22 (1) ◽  
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 9 ◽  
Robin Hofmann ◽  
Tamrat Befekadu Abebe ◽  
Johan Herlitz ◽  
Stefan K. James ◽  
David Erlinge ◽  

Background: Myocardial infarction (MI) occurs frequently and requires considerable health care resources. It is important to ensure that the treatments which are provided are both clinically effective and economically justifiable. Based on recent new evidence, routine oxygen therapy is no longer recommended in MI patients without hypoxemia. By using data from a nationwide randomized clinical trial, we estimated oxygen therapy related cost savings in this important clinical setting.Methods: The DETermination of the role of Oxygen in suspected Acute Myocardial Infarction (DETO2X-AMI) trial randomized 6,629 patients from 35 hospitals across Sweden to oxygen at 6 L/min for 6–12 h or ambient air. Costs for drug and medical supplies, and labor were calculated per patient, for the whole study population, and for the total annual care episodes for MI in Sweden (N = 16,100) with 10 million inhabitants.Results: Per patient, costs were estimated to 36 USD, summing up to a total cost of 119,832 USD for the whole study population allocated to oxygen treatment. Applied to the annual care episodes for MI in Sweden, costs sum up to between 514,060 and 604,777 USD. In the trial, 62 (2%) patients assigned to oxygen and 254 (8%) patients assigned to ambient air developed hypoxemia. A threshold analysis suggested that up to a cut-off of 624 USD spent for hypoxemia treatment related costs per patient, avoiding routine oxygen therapy remains cost saving.Conclusions: Avoiding routine oxygen therapy in patients with suspected or confirmed MI without hypoxemia at baseline saves significant expenditure for the health care system both with regards to medical and human resources.Clinical Trial, identifier: NCT01787110.

Abstract A Valid Time Shifting (VTS) method is explored for the GSI-based ensemble variational (EnVar) system modified to directly assimilate radar reflectivity at convective scales. VTS is a cost-efficient method to increase ensemble size by including subensembles before and after the central analysis time. Additionally, VTS addresses common time and phase model error uncertainties within the ensemble. VTS is examined here for assimilating radar reflectivity in a continuous hourly analysis system for a case study of 1-2 May 2019. The VTS implementation is compared against a 36-member control experiment (ENS-36), to increase ensemble size (3×36 VTS), and as a cost-savings method (3×12 VTS), with time-shifting intervals τ between 15 and 120 min. The 3×36 VTS experiments increased the ensemble spread, with largest subjective benefits in early cycle analyses during convective development. The 3×12 VTS experiments captured analysis with similar accuracy as ENS-36 by the third hourly analysis. Control forecasts launched from hourly EnVar analyses show significant skill increases in 1-h precipitation over ENS-36 out to hour 12 for 3×36 VTS experiments, subjectively attributable to more accurate placement of the convective line. For 3×12 VTS, experiments with τ ≥ 60 min met and exceeded the skill of ENS-36 out to forecast hour 15, with VTS-3×12τ90 maximizing skill. Sensitivity results demonstrate preference to τ = 30–60 min for 3x36 VTS and 60 – 120 min for 3×12 VTS. The best 3×36 VTS experiments add a computational cost of 45-67%, compared to the near tripling of costs when directly increasing ensemble size, while best 3×12 VTS experiments save about 24-41% costs over ENS-36.

N. Shylashree ◽  
M Anil Naik ◽  
A. S. Mamatha ◽  
V. Sridhar

Image processing is an important task in data processing systems for applications such as medical sectors, remote sensing, and microscopy tomography. Edge recognition is a sort of image division method that is used to simplify the image records so as to reduce the amount of data to be processed. Edges are considered the most important in image processing because they are used to characterize the boundaries of an image. The performance of the Canny edge recognition algorithm remarkably surpasses the present edge recognition technology in various computer visualization methods. The main drawback of using Canny edge boundary is that it consumes lot of period due to its complex computation. In order to tackle this problem a hybrid edge recognition method is proposed in block stage to locate edges with no loss. It employs the Sobel operator estimate method to calculate the value and direction of the gradient by substituting complex processes by hardware cost savings, traditional non-maximum suppression adaptive thresholding block organization, and conventional hysteresis thresholding. Pipeline was presented to lessen latency. The planned strategy is simulated using Xilinx ISE Design Suite14.2 running on a Xilinx Spartan-6 FPGA board. The synthesized architecture uses less hardware to detect edges and operates at maximum frequency of 935 MHz.

2022 ◽  
Vol 22 (1) ◽  
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 2 (1) ◽  
Reimbursement Team

CADTH recommends that Opsynvi should be reimbursed by public drug plans for the long-term treatment of pulmonary arterial hypertension (PAH; WHO Group 1) to reduce morbidity in patients in WHO functional class (FC) II or III whose PAH is idiopathic, heritable, or associated with connective tissue disease or congenital heart disease if certain conditions are met. Opsynvi should only be covered for patients who are currently treated simultaneously with stable doses of macitentan 10 mg and tadalafil 40 mg as separate tablets. Opsynvi should only be reimbursed if prescribed by a specialist with expertise in managing and treating patients with PAH and if the price of Opsynvi is negotiated to ensure cost savings in comparison with separate macitentan and tadalafil tablets.

Gerrit J Jordaan ◽  
Wynand J vdM Steyn

: Nanotechnology options to road surface maintenance offers several advantages compared to traditionally used materials. The small particle sizer of hydrophobic Nano-Silane modified Nano-Polymers (NSNP) enables these nanotechnology products to deeply penetrate existing road surfaces, sealing micro-cracks and render surfacings to be water-resistant for extended periods of time. In comparison, traditionally used products contain minimum partial sizes of about 1 &ndash; 5 microns, that provide a superficial protection that wears off in a relatively short period of time. These traditional products are often associated with vehicle contamination while drying and requires the re-instatement of road markings. None of these disadvantages are associated with applicable NSNP technologies that are quick drying, with no vehicle contamination risks and is equivalent to a &ldquo;clear-seal&rdquo; requiring no reinstatement of road markings. In a similar vein, pot-hole repairs can be done using applicable, easy to use, pre-packed and treated pot-hole repair kits that are water-repellent and quick-drying at a fraction of the costs of conventional cold-mix products. Resurfacing using NME binder slurries can be done labour-intensively on a pre-treated NSNP surfacing, restoring cracked surfacing and providing a water-resistant long-lasting protective layer without the removal of existing cracked areas. The implementation of nanotechnology solutions for road surface maintenance operations is directly associated with ease of use, labour-intensive operations, prevention of considerable deterioration in riding quality due to removal and manual re-instatement of cracked surfaces, time and cost savings and a reduction in the risk of water damage to the sub-structure. TRANSLATE with x English ArabicHebrewPolish BulgarianHindiPortuguese CatalanHmong DawRomanian Chinese SimplifiedHungarianRussian Chinese TraditionalIndonesianSlovak CzechItalianSlovenian DanishJapaneseSpanish DutchKlingonSwedish EnglishKoreanThai EstonianLatvianTurkish FinnishLithuanianUkrainian FrenchMalayUrdu GermanMalteseVietnamese GreekNorwegianWelsh Haitian CreolePersian TRANSLATE with COPY THE URL BELOW Back EMBED THE SNIPPET BELOW IN YOUR SITE Enable collaborative features and customize widget: Bing Webmaster Portal Back

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