Modelling spatial variation in the treatment costs of nonpoint source pollution in mountainous regions of southwest China

Non-point source(NPS) pollution is considered to be one of the main threats of the aquatic environment. Mountainous regions are particularly important water sources for urban areas. The various driving factors of NPS pollution such as terrain, precipitation, and vegetation type in mountainous regions show clear spatial heterogeneity. Consequently, the management systems required for NPS pollution in mountainous regions are complex. In this study, we developed a framework to estimate and map the treatment costs for NPS pollution in mountainous regions and applied this method in Baoxing County, a typical mountainous county in Sichuan Province of southwest China. The export levels of total nitrogen(TN) and total phosphorus(TP) in Baoxing County were estimated using the water purification model in InVEST(Itegrated Valuation of Ecosystem Services and Tradeoffs) tool. NPS pollutant treatment costs were calculated based on the level of pollutants exports, water yield, water quality targets, and treatment costs of NPS pollutants per unit mass. The results show that at the watershed level the amounts of TN and TP exported in Baoxing County were below threshold limits. However, at the sub-watershed level, TN and TP excesses of 291.64 and 2.96 tons per year were found, respectively, with mean TN and TP treatment costs of 6.58 US$/hm^2 and 0.35 US$/hm^2. Appraising pollution treatment cost intuitively reflects the overall expenditure in NPS pollution reduction from an economic perspective. This study provides a foundation for the implementation of Payment for Ecosystem Service(PES) and the prevention and control of NPS pollution.

Cost of Medical Treatment for Primary Open-Angle Glaucoma in Relation to Patients’ Income and Its Impact on the Prognosis of the Disease, in Bouaké University Hospital

Introduction: Medical treatment for POAG is continuous and lifelong treatment. The aim of this study was to evaluate the relationship between the cost of this treatment and patients’ income and the impact of this relationship on treatment compliance. Materials and Methods: Prospective cross-sectional study with a descriptive aim covering sociodemographic data, average incomes, and direct and indirect costs of treatment of 57 patients followed for POAG during the period from January 1, 2012, to December 31, 2016 (5 years). Results: The patients were aged 25 to 77 years (mean = 54.4 years) with a male predominance (sex ratio = 1.5). Retirees were the most represented (26.32%), followed by workers in the informal sector (14.04%) and housewives (12.28%). Patients who had an annual income less than or equal to 900,000 CFA francs (€1370.83) per year represented 56.14% and those who did not have health coverage represented 57.89%. The treatment was monotherapy (64.91%), dual therapy (31.58%) or triple therapy (3.05%) and the average ratio of “annual cost of treatment to annual income” was 0.56 with for maximum 2.23 and 0.02 as minimum. Patients who considered the cost of treatment unbearable for their income represented 78.95%. Conclusion: Prevention of blindness due to glaucoma requires early detection but also the establishment of health coverage mechanisms to improve compliance with medical treatment. In addition, consideration should be given to the development of glaucoma surgery in our country, the indication of which could be the first intention in certain patients, considering for those patients, the geographical and financial accessibility of medical treatment. .

Efficacy, patterns of use and cost of Pertuzumab in the treatment of HER2+ metastatic breast cancer in Singapore: The National Cancer Centre Singapore experience

BACKGROUND Pertuzumab is a humanized anti-human epidermal growth factor receptor 2(HER2)monoclonal antibody found in a Phase III clinical trial to significantly improve median survival in HER2 positive metastatic breast cancer(MBC)when used in combination with a taxane and Trastuzumab,and its clinical efficacy has transformed the therapeutic landscape of HER2-positive breast cancer.There are currently few reports on the pattern of use and value of Pertuzumab in real world settings.Our study describes the clinical efficacy and treatment costs of Pertuzumab in HER2-positive MBC treated in a tertiary cancer centre in Singapore in a predominantly Asian population.AIM To investigate the clinical efficacy and treatment costs of Pertuzumab in HER2-positive MBC in an Asian population in Singapore.METHODS A retrospective study of 304 HER2-positive MBC patients seen at National Cancer Centre Singapore between 2011-2017 was conducted.Demographic and clinical data were extracted from electronic medical records.Clinical characteristics and billing data of patients who received Pertuzumab were compared with those who did not.RESULTS Thirty-one(62.0%)of the fifty(16.4%)patients who received Pertuzumab as firstline therapy.With a median follow-up of 21.5 mo,there was a statistically significant difference in the median overall survival between Pertuzumab and non-Pertuzumab groups[51.5(95%CI:35.8–60.0)vs 32.9(95%CI:28.1–37.5)mo;P=0.0128].Two(4.88%)patients in the Pertuzumab group experienced grade 3(G3)cardiotoxicity.The median treatment cost incurred for total chemotherapy for the Pertuzumab group was 130456 Singapore Dollars compared to 34523 Singapore Dollars for the non-Pertuzumab group.The median percentage of total chemotherapy costs per patient in the Pertuzumab group spent on Pertuzumab was 50.3%.CONCLUSION This study shows that Pertuzumab use in the treatment of metastatic breast cancer is associated with a significantly better survival and a low incidence of serious cardiotoxicity.However,the proportionate cost of Pertuzumab therapy remains high and further cost-effectiveness studies should be conducted.

Differences in Treatment Patterns and Health Care Costs among Non-Hodgkin’s Lymphoma and Chronic Lymphocytic Leukemia Patients Receiving Rituximab in the Hospital Outpatient Setting versus the Office/Clinic Setting

Objective: To examine whether differences in treatment patterns and health care costs exist among chronic lymphocytic leukemia (CLL) and non-Hodgkin’s lymphoma (NHL) patients receiving rituximab in a hospital outpatient setting versus those receiving rituximab in a physician office/community clinic setting. Methods: This retrospective database study used medical and pharmacy claims (1/2007-7/2012) from a large US health plan. Patients ≥18 years with ≥2 rituximab claims and ≥2 claims for either NHL or CLL were identified. The date of the first rituximab claim were set as the index date, and differences in treatment patterns and health care costs were examined during the period following the index date. Costs were adjusted for patient characteristics using a multivariate regression model. Results: A total of 4441 patients were identified;3167 received rituximab in the office/clinic setting, and 1274 in the hospital outpatient setting. From 2007 to 2012, the percentage of patients receiving rituximab in the hospital outpatient setting increased from 22% to 39%. Patients treated in the hospital outpatient setting vs. the office/clinic setting had fewer average counts of rituximab infusions (5.60 vs. 7.49, p 0.001), higher total health care costs (cost ratio = 1.325, p 0.001), higher infusion day drug and administration costs (cost ratio = 1.509, p 0.001), and higher rates of ER visits and inpatient stays (both p 0.001). Conclusions: These findings suggest that site of care may impact treatment patterns and costs of patients receiving rituximab, and additional research is needed to better understand the reason(s) for these differences by site of service.

AIDS Treatments Efficiency Analysis Based on Cost Efficiency Data Envelopment Analysis Model

Three data envelopment analysis (DEA) models were used to analyse the relative efficiencies of four AIDS treatments in AIDS Clinical Trial Group (ACTG) Study 193A(1 309 patients in total, classified into 4 age groups). Results from the output-oriented BCC model show that Treatment 4 ( 600 mg of zidovudine plus 400 mg of didanosine plus 400 mg of nevirapine) is particularly efficient for age group 14—25, but not efficient for the older age groups; Treatment 1 (600 mg of zidovudine alternating monthly with 400 mg of didanosine)and Treatment 2 (600 mg of zidovudine plus 2.25 mg of zalcitabine) are efficient for the age groups 35—45 and 45— ; age group 25—35 does not have a particularly efficient treatment, but Treatments 1 and 2 are relatively good. The cost efficiency BCC model, which takes the treatment cost into account, gives similar results as the output-oriented model. Results from the indirect output-oriented BCC model, which allows the replacement among medicines, show that the efficiency of Treatment 2 has greatly decreased compared with that of the output-oriented model, and a set of optimal medicine amounts for different age groups is obtained.

Treatment Patterns and Healthcare Costs among U.S. Patients with Advanced Melanoma Initiating Subsequent Systemic Therapy Following Use of Ipilimumab (IPI)

As the treatment landscape for advanced melanoma continues to evolve, it is critical to focus on unmet needs and understand the cost of therapy. While Ipilimumab (IPI), an immunotherapy indicated for unresectable advanced melanoma, has been a mainstay of 1st-line treatment, there was no standard of care following progression until recently. The objective of this study was to examine real-world treatment patterns and healthcare costs following IPI use in advanced melanoma patients prior to the anti-PD-1 class approval. Adult stage III or IV melanoma patients treated with IPI were selected between April 1, 2011, and September 30, 2013, from a large U.S. commercial and Medicare claims database. Patients were evaluated for therapy after IPI, with an index date set as the first systemic therapy after IPI. Per-Patient Per-Month (PPPM) healthcare costs while on active treatment were evaluated from index until treatment discontinuation, inpatient death, end of insurance enrollment, or September 30, 2013. Of 361 eligible patients, 111 (30.7%) initiated subsequent systemic therapy (mean age, 57 years;64.9% male). The most common therapies, single-agent or combination, included vemurafenib (32.4%), paclitaxel (28.8%), temozolomide (20.7%), and carboplatin (17.1%). During a median follow-up of 130 days, mean [standard deviation] PPPM all-cause total healthcare costs were $20,383 [$18,988], of which $4800 (23.6%), $5899 (28.9%), and $9684 (47.5%) were related to melanoma drug costs, medical claims with a diagnosis of melanoma, and other (non-specified) utilization, respectively. When considering total care, the costs of U.S. patients with advanced melanoma post-IPI were substantial across all commonly used agents.

北京市综合医改前后社区卫生服务机构治疗费用的受益人群分析

背景厘清社区卫生服务机构主要服务的人群特点,对下一步社区卫生服务机构的精准改革具有十分重要的意义。目的通过分析综合改革前后北京市社区卫生服务机构治疗费用的受益人群特征,为下一步改革政策制定和调整提供精准的数据支持。方法本研究基础数据来源于2016—2019年北京市卫生总费用核算基础数据库,其他数据来源于2016—2019年《北京市卫生健康统计年鉴》《北京市卫生财务统计年报》《北京市卫生费用核算报告》等。采用多阶段分层整群抽样的方案选取社区卫生服务机构,从HIS系统纳入全年的门诊数据、住院患者的数据。采用卫生费用核算体系2011(SHA2011)核算、分析社区卫生服务机构治疗费用的受益人群状况。结果2016—2019年北京市社区卫生服务机构治疗费用从121.81亿元增长至222.45亿元,年均增长19.07%。40岁以上中老年患者治疗费用历年占比均在92%以上,60~岁、80~岁两个年龄组患者治疗费用增长较快,年均增速分别为24.08%、25.84%;治疗费用中内分泌、营养和代谢疾病,症状、体征和检验异常、循环系统疾病占比最高,内分泌、营养和代谢疾病,神经系统疾病,症状、体征和检验异常疾病治疗费用增长较快,年均增速分别为40.11%、48.40%和32.43%。结论综合改革后分级诊疗成效初显,社区医疗服务资源主要由中老年患者、内分泌、循环系统等慢性非传染性疾病患者所消耗,改革引导更多中老年和慢性病患者流向社区,社区卫生服务机构应该从服务能力、人才队伍、慢性病管理、医联体建设等多方面着手,提升其服务能力,巩固和维持改革的效果。

基于“SHA2011”的某省综合医院治疗费用分布维度分析

[目的]分析某省综合医院治疗费用分布维度,为相关政策的完善调整提供参考。[方法]以某省2018年综合医院数据为基础,应用卫生费用核算体系2011核算方法,对该省综合医院治疗费用在不同维度的分布以及分布维度、筹资方案的矩阵分析结果进行描述性分析。[结果]该省综合医院治疗费用依次来源于社会医疗保险、家庭个人卫生支出、自愿筹资。从疾病流向看,33.5%流向循环系统疾病和消化系统疾病;从年龄流向看,45.43%流向60岁及以上人群;从性别流向看,53%流向男性群体;从医疗机构级别流向看,73.8%流向省市级医疗机构。[结论]居民疾病经济负担较重,重点疾病、重点人群、高级别医院占用的治疗费用较高。

基于互联网医院建设的肿瘤患者自助开单服务探索与实践

目的:探索自助开单服务模式的设计及实施效果,为患者提供高效、便捷的就医服务,提升患者服务效率。方法:采用χ~2检验、独立样本t检验对使用自助开单服务的患者及同期使用APP自约号来院就诊的患者的性别、年龄、来源、预约挂号至就诊的等待时间进行比较;测量系统应用后为患者节省的就医成本并对患者的就医流程进行比较。结果:使用自助开单服务的患者相比自约号的患者,老年人比例提升了5.4%(P=0.02)、京外患者比例下降了3.6%(P=0.028),患者预约挂号至就诊的平均等待时间减少了51.8个小时(P<0.01),平均为每位患者节省费用1 790元/次。结论:自助开单服务系统的应用有助于优化就医流程、缩短预约挂号到就诊的等待时间,节省就医成本,促进医疗资源合理配置,提高医疗服务效率。

一锅法一次性合成片状羟基磷灰石及其对废水中铀的去除性能及机理研究

水体中存在的铀会损害人体健康,因此铀的去除是一个需要研究的课题。以低成本的CaCO_(3)和(NH_(4))_(2)HPO_(4)为原料,通过一锅法一次性合成羟基磷灰石(OP-HAP),并将其应用于去除溶液中的铀。通过单因素和正交试验探究了OP-HAP对铀的吸附性能,并利用SEM、EDS、XRD、FTIR及XPS对其进行表征。结果表明:最优条件下,OP-HAP对10 mg·L^(-1)铀的最大去除率为97%左右,拟合最大吸附量为1 584.79 mg·g^(-1);OP-HAP对铀的吸附过程符合Langmuir等温吸附模型和准二级动力学模型;热力学研究表明吸附过程是吸热且自发的;通过Zeta电位及对吸附铀前后的OP-HAP进行表征,发现吸附机理主要是静电吸附、离子交换、配合作用及溶解沉淀。OP-HAP对铀的吸附表现出较高的吸附量,是一种潜在的铀吸附材料。

河北省高速公路软基处理降本增效措施分析

河北省沿海及内陆河湖区域软基分布较广泛,软基处理规模较大、投资较高,然而,目前关于软基处理降本增效措施的研究较少。在分析河北省公路软土路基特征的基础上,结合工程经验,从技术和管理两个方面对软基处理降本增效措施进行了论述,在提升勘察设计精细化水平,科学决策严谨管理,充分发挥时间效益等方面提出了若干已得到工程实践验证的具体措施,研究成果可供同行借鉴参考。

基于New-Cost-DEA模型的污水处理企业成本效率研究

近年来,中国污水处理企业的数量迅速增加,污水处理能力不断提高,但仍存在运行效率低下的问题。本文运用New-Cost-DEA模型,构建污水处理企业运行成本效率模型,测算13座污水处理企业的运行成本效率,并对运行成本进行分解,寻找造成运行成本损失的原因。结果显示:影响污水处理企业成本效率的因素不仅和投入要素数量有关,而且与投入要素价格有关;污水处理企业的成本效率低,是由于价格因素和配置效率引起的,需要通过降低投入要素的价格和对投入要素进行优化组合来降低运行成本,提高运行效率。

烧结车间污泥罐降本增效改造的研究

山西建邦集团有限公司在生产中所使用的污泥罐混合罐方式,由污泥池+4组加热罐组成,在长期使用过程中,污泥在加热罐中沉淀,需频繁清理和更换水泵和管道,制约了正常生产。针对这一生产问题,主要研究改进污泥罐处理工艺,针对现有污泥罐形式进行改造,设计出一种新型炼铁厂用污泥混合罐结构,在保障设备运行安全的前提下,完成降本增效改造。

尼洛替尼与达沙替尼二线治疗慢性髓性白血病的成本效用分析

目的评估费城染色体阳性慢性髓性白血病慢性期(Ph+CML-CP)患者中对伊马替尼耐药或不耐受的二线尼洛替尼与达沙替尼的成本效果。方法建立状态转移马尔可夫(Markov)模型进行成本效用分析,模型包括4种健康状态:慢性期(CP),加速期(AP),急变期(BP)和死亡。尼洛替尼与达沙替尼治疗的无进展生存率,疾病进展发生率,总生存率等有关临床参数来源于既往发表的研究和专家意见,健康状态效用值来源于文献。通过Treeage软件以增量成本效果比(ICER)作为评价指标,对尼洛替尼和达沙替尼2个方案的总产出和总成本进行评价,并通过单变量、概率敏感性分析评估模型稳定性。结果与选用达沙替尼治疗相比,选用尼洛替尼治疗的ICER为182487.71元·QALY^(-1),低于3倍2021年全国人均GDP。敏感性分析显示主要的影响参数有贴现率,达沙替尼价格和尼洛替尼价格,模型结果稳定。结论选用尼洛替尼相对达沙替尼用于对伊马替尼耐药或不耐受的Ph+CML-CP患者治疗具有成本效用优势。

复合树脂多层修复技术与复合树脂直接粘接修复技术在前牙间隙美学修复中的效果对比

目的:对比分析复合树脂多层修复技术与复合树脂直接粘接修复技术在前牙间隙美学修复中的效果。方法:纳入笔者医院2020年6月-2021年6月收治的98例(共104颗患牙)前牙间隙患者作为研究对象,按照随机数表法分为A组和B组,各49例。A组患者接受复合树脂多层修复技术,B组患者接受复合树脂直接粘接修复技术。对比两组修复效果、美学效果和治疗总费用,比较两组修复前和修复30d后、6个月后的咬合力、咀嚼效率和焦虑自评量表(Self-ratinganxietyscale,SAS)、抑郁自评量表(Self-rating depression scale,SDS)评分。结果:修复30 d后,A组优秀率高于B组(P<0.05),两组良好率和不良率比较无统计学意义(P>0.05)。修复6个月后,A组优秀率和不良率均高于B组(P<0.05),两组良好率比较无统计学意义(P>0.05)。患者的咬合力在时间、交互作用上差异有统计学意义(P<0.05),在组间作用上差异无统计学意义(P>0.05)。患者的咀嚼效率在时间、组间、交互作用上差异均有统计学意义(P<0.05)。修复6个月后,两组患者咬合力和咀嚼效率均较修复30d后和修复前升高,且A组咬合力和咀嚼效率高于B组(P<0.05)。A组修复后的边缘密合性、颜色匹配性、修复体崩裂、继发龋损、形态匹配、修复体脱落和牙龈健康评分均低于B组(P<0.05)。患者的SAS评分和SDS评分在时间、组间、交互作用上有统计学意义(均P<0.05)。修复30d后和修复6个月后,两组患者SAS和SDS评分均较修复前降低,且A组低于B组(P<0.05)。A组治疗总花费高于B组(P<0.05)。结论:与复合树脂直接粘接修复技术相比,在前牙间隙美学修复中应用复合树脂多层修复技术可取得更佳的修复效果,有助于恢复患者咬合力和咀嚼功能,使患者获得良好美学效果,改善其心理状态。但治疗总花费相对较高,临床治疗需结合患者经济情况选择合适治疗方案。

某水源热泵系统优化方案分析探讨

节能环保是建筑领域相关工作者们非常关注的问题,由于水源热泵技术具备节能、环保、经济、高效等诸多优势,符合我国发展的节能环保要求,因此水源热泵技术应运而生。该技术对水资源加以利用,从而实现为建筑物提供热能、热水的目的,虽然水源热泵技术具有非常显著的优势,有一定发展前景,但是,水源热泵技术的应用过程中仍不可避免存在一些技术性问题。本文从某地表水源热泵系统的运行原理分析,提出该系统运行存在的缺陷,以及目前投入使用过程中出现的维保疑难问题,针对存在的问题提出了后续改善处理的方案建议,探讨优化方案可行性及处理成本,确定该系统目前可改进方向思路。

尾菜规模化处理系统实际运行分析

针对已运行尾菜规模化处理系统总体效益差的问题,结合运行数据对系统稳定性、处理效果和运行成本进行详细分析,总结运行期出现的问题,提出对应措施。分析结果表明:预处理系统平均日处理量为454.13 t,在运行第48~121天因进料量增大无法保证稳定的脱水效果;厌氧发酵系统平均产气量为748.8 m^(3),运行期间平均酸碱度(pH)和温度分别为6.27和24℃,罐内物料酸化是发酵系统失稳的主要原因;污水处理系统平均进水量为551.7 m^(3),出水化学需氧量(COD)质量浓度为288.38 mg/L,出水氨氮(NH3-N)质量浓度为4.60 mg/L,出水总氮(TN)质量浓度为31.55 mg/L,出水总磷(TP)质量浓度为3.61 mg/L,均达到排放标准。在实际处理效果方面,预处理系统平均脱水率39.35%,最大脱水率可达80.16%;污水处理系统平均COD去除率为98.71%,NH3-N去除率为99.71%,TP去除率为98.63%,TN去除率为98.07%。在运行成本分析中,运行费用为94.44元/t,其中运输费用最高,占运行成本的31.76%;水费、人工费和药剂费支出较高,分别占运行成本的23.78%、14.14%和16.86%;燃料费用最低,占运行成本的0.03%。原料输入不稳定、杂质去除不彻底、压榨效果不明显、发酵系统易酸化、污水处理成本高是造成系统运行效果差的重要原因。

城镇污水处理厂改造后运行费用估算模型研究

目前,全国各省市相继出台了更严格的污水排放标准,部分污水厂已开展提标改造工作。针对城镇污水处理厂提标改造增加运行费用的问题,建立了污水处理厂改造后增加日常运行费用的估算模型,并根据污水厂实例进行验证分析。研究结果表明:该模型能够很好地体现城镇污水处理厂提标改造后增加运行费用与各指标之间的数学关系,可用于城镇污水处理厂提标改造后新增运行费用的模拟预测,对现有污水处理厂的提标改造及改造后日常运行管理提供了技术支持。

一体化市政污水处理设备运行探讨

随着一体化市政污水处理设备快速地解决应急污水处理难题,其设备也得到广泛应用,以昆山市陆家镇2个站点一体化市政污水处理设备一年的运行情况为例,根据现场在线监测数据、运行药剂成本、运行能耗作为对象,探讨了一体化市政污水处理设备运行效果和影响因素,以求从项目经验中,做一些总结,发挥自身优势,克服相关困难,为后面的项目提供一些参考意见。结果表明:该项目10000 m~3/d市政污水处理量,仅3个月就完成采购施工和调试工作,同时,根据在线监测数据分析也表明,一体化市政污水处理设备出水可以稳定做到准Ⅳ类标准。由于采用工艺线路多,在人员、设施相对常规污水处理厂更少的情况下,通过精细化运行管理,在实际运行容错率上,甚至超过一些常规污水处理厂的处理效果。