Glutamatergic projection neurons generate sophisticated excitatory circuits to integrate and transmit information among different cortical areas,and between the neocortex and other regions of the brain and spinal cord...Glutamatergic projection neurons generate sophisticated excitatory circuits to integrate and transmit information among different cortical areas,and between the neocortex and other regions of the brain and spinal cord.Appropriate development of cortical projection neurons is regulated by certain essential events such as neural fate determination,proliferation,specification,differentiation,migration,survival,axonogenesis,and synaptogenesis.These processes are precisely regulated in a tempo-spatial manner by intrinsic factors,extrinsic signals,and neural activities.The generation of correct subtypes and precise connections of projection neurons is imperative not only to support the basic cortical functions(such as sensory information integration,motor coordination,and cognition)but also to prevent the onset and progression of neurodevelopmental disorders(such as intellectual disability,autism spectrum disorders,anxiety,and depression).This review mainly focuses on the recent progress of transcriptional regulations on the development and diversity of neocortical projection neurons and the clinical relevance of the failure of transcriptional modulations.展开更多
Against the backdrop of rapid development in China’s construction and infrastructure sectors,discrepancies between project budgets and actual costs have become pronounced,manifesting in project overruns and suspensio...Against the backdrop of rapid development in China’s construction and infrastructure sectors,discrepancies between project budgets and actual costs have become pronounced,manifesting in project overruns and suspensions,posing significant challenges.To address inaccuracies in investment targets and operational complexities,this study focuses on a beam-bridge construction project in a district of Shijiazhuang city as a case study.Drawing upon historical analogs,the project employs a Work Breakdown Structure(WBS)to decompose the engineering works.Building on theories of Cost Significant(CS)and Whole Life Costing(WLC),the study constructs Cost Significant Items(CSIs)and develops a CNN-BiLSTM-Attention neural network for nonlinear prediction.By identifying significant cost drivers in engineering projects,this paper presents a streamlined cost estimation method that significantly reduces computational burdens,simplifies data collection processes,and optimizes data analysis and forecasting,thereby enhancing prediction accuracy.Finally,validation with real-world cost fluctuation data demonstrates minor errors,meeting predictive requirements across project execution phases.展开更多
A two-dimensional flow numerical model of the tidal reaches, which total length is more than 700 km, is established from Datong to the Yangtze River estuary. The tidal levels, velocities, diversion ratios and dynamic ...A two-dimensional flow numerical model of the tidal reaches, which total length is more than 700 km, is established from Datong to the Yangtze River estuary. The tidal levels, velocities, diversion ratios and dynamic axes before and after the separate regulation of each reach and combined regulation of all reaches are obtained. The comparative analysis shows that the regulation project of a separate reach basically has no impact on velocity distributions and variations of diversion ratios of upper and lower reaches, the variations of dynamic axes are only within the local scope of the project. The regulation project of a separate reach also has less impact on the water level in the lower adjacent reaches, but will make the water levels in the upper reaches rise. After the implementation of the regulation projects for all reaches, the rise of water level in the upstream reaches will have a cumulative impact.展开更多
Under the background of big data,Informatization plays an important role in the development of the engineering cost industry.The rapid development of the industry and the increasing complexity of construction projects...Under the background of big data,Informatization plays an important role in the development of the engineering cost industry.The rapid development of the industry and the increasing complexity of construction projects require higher standards of informatization.The current information processing methods and models have been difficultly to meet new requirements.Based on this,this study deeply analyzes the key factors that impede the informatization of engineering cost development,and tries to find corresponding solutions through theoretical analysis and empirical research to break these constraints.This will play a guiding role in the development of informatization in China's engineering cost industry.展开更多
The important role of Three Gorges Project (TGP) in the flood management of the Yangtze River Basin is summarized.The Optimal Regulation Schemes of the Three Gorge Reservoir is briefly described.The flood regulation e...The important role of Three Gorges Project (TGP) in the flood management of the Yangtze River Basin is summarized.The Optimal Regulation Schemes of the Three Gorge Reservoir is briefly described.The flood regulation effect of TGP is analyzed.Typical issues related to reservoir operation for flood regulation are discussed and suggestions are put forward for the future work.展开更多
After the completion of design, the construction project shall begin its implementation, which should be taken effective measures to strengthen the management of project cost and properly manage the funds to achieve t...After the completion of design, the construction project shall begin its implementation, which should be taken effective measures to strengthen the management of project cost and properly manage the funds to achieve the overall goal of the construction projects. Control of the project cost in the project implementation is mainly divided into bidding, contracting, construction and settlement. The following is the analysis and discussions of the author's experiences to the control of the project cost in the project implementation and the management measures.展开更多
In recent years,China’s society and economy has been developing very rapidly,and various industries are showing a trend of vigorous development.The importance of control and management of project cost in highway proj...In recent years,China’s society and economy has been developing very rapidly,and various industries are showing a trend of vigorous development.The importance of control and management of project cost in highway project management is becoming more and more prominent.PPP model has been widely used in the control and management of highway project cost with its own unique advantages.The author analyzes the important advantages of the PPP model and the existing problems in the cost control and management of highway projects,and puts forward effective measures for the cost control and management of highway projects using the PPP model,in hope of helping with the smooth implementation of the work.展开更多
In the current economic situation, strengthening the contract management of the construction cost has a beautifully role. At the same time, according to construction project cost management, the scientific management ...In the current economic situation, strengthening the contract management of the construction cost has a beautifully role. At the same time, according to construction project cost management, the scientific management of the contract, can promote the reasonable and balanced investment cost allocation in the quality and safety and other aspects of the project, so that the construction project can obtain higher added value, and to further promote China' s economic construction and accelerate the pace of the city. This paper first briefly elaborates our construction project cost of the contract management on the present situation, and some problems are analyzed and discussed, and then puts forward some suggestions on the measures and countermeasures for cost management of construction engineering contract.展开更多
Project construction,design,management,operation,and maintenance are all undergoing digital transformations,and project cost professionals’working mode and content will change as a result.This paper reviews the exist...Project construction,design,management,operation,and maintenance are all undergoing digital transformations,and project cost professionals’working mode and content will change as a result.This paper reviews the existing challenges in traditional talent training and adjusts training ideas as well as training modes to conform to the industry’s digital transformation trend as a training base for project cost talents.展开更多
The"replacement of business tax by VAT reform"(hereby refer to as"VAT reform"for short)is a newly promulgated and implemented tax policy,and its impact on various industries in China is very differ...The"replacement of business tax by VAT reform"(hereby refer to as"VAT reform"for short)is a newly promulgated and implemented tax policy,and its impact on various industries in China is very different,and the highway project industry is no exception.The implementation of the"VAT reform"will not only have a positive impact on the cost of highway projects,but will also have some negative impacts.For this reason,highway project construction corporates must actively respond.The author explores and analyzes the positive and negative effects of the"VAT reform"on the cost of highway projects,and proposes a reform strategy for highway project cost work under the background of the"VAT reform",in hope of helping with bringing out the intrinsic value of highway project cost management work.展开更多
Resource-constrained project scheduling problem(RCPSP) is an important problem in research on project management. But there has been little attention paid to the objective of minimizing activities' cost with the re...Resource-constrained project scheduling problem(RCPSP) is an important problem in research on project management. But there has been little attention paid to the objective of minimizing activities' cost with the resource constraints that is a critical sub-problem in partner selection of construction supply chain management because the capacities of the renewable resources supplied by the partners will effect on the project scheduling. Its mathematic model is presented firstly, and analysis on the characteristic of the problem shows that the objective function is non-regular and the problem is NP-complete following which the basic idea for solution is clarified. Based on a definition of preposing activity cost matrix, a heuristic algorithm is brought forward. Analyses on the complexity of the heuristics and the result of numerical studies show that the heuristic algorithm is feasible and relatively effective.展开更多
Time-cost trade off problem (TCTP), known in the literature as project crashing problem (PCP) and project speeding up problem (PSP) is a part of project management in planning phase. In this problem, determining the o...Time-cost trade off problem (TCTP), known in the literature as project crashing problem (PCP) and project speeding up problem (PSP) is a part of project management in planning phase. In this problem, determining the optimal levels of activity durations and activity costs which satisfy the project goal(s), leads to a balance between the project completion time and the project total cost. A large amount of literature has studied this problem under various behavior of cost function. But, in all of them, influence of discount has not been in-vestigated. Hence, in this paper, TCTP would be studied considering the influence of discount on the re-source price, using genetic algorithm (GA). The performance of proposed idea has been tested on a medium scale test problem and several computational experiments have been conducted to investigate the appropriate levels of proposed GA considering accuracy and computational time.展开更多
Software cost estimation is a main concern of the software industry. However, the fact is also that in today’s scenario, software industries are more interested in other issues like new technologies in the market, sh...Software cost estimation is a main concern of the software industry. However, the fact is also that in today’s scenario, software industries are more interested in other issues like new technologies in the market, shorter development time, skill shortage etc. They are actually deviating from critical issues to routine issues. Today, people expect high quality products at very low costs and same is the goal of software engineering. An accuracy in software cost estimation has a direct impact on company’s reputation and also affects the software investment decisions. Accurate cost estimation can minimize the unnecessary costs and increase the productivity and efficiency of the company. The objective of this paper is to identify the existing methods of software cost estimation prevailing in the market and analyzing some of the important factors impacting the software cost estimation process. In order to achieve the objective, a survey was conducted to find out: ● Nature of projects that companies prefer. ● Impact of training on employees in software cost estimation. ● How many people review the estimated cost? ● How much risk buffer the company keeps for future prospects?展开更多
The process of constructing hydraulic projects on international rivers is governed by several legal regulations, among the most important of these regulations are: the Principle of no harm, and the Principle of Prior...The process of constructing hydraulic projects on international rivers is governed by several legal regulations, among the most important of these regulations are: the Principle of no harm, and the Principle of Prior Notification, protection of the river's environment and the Principle of Settling the International Disputes via Peaceful Means, which is considered one of the most important principles called for by the UN Pact, as it provides for adopting the peaceful means by the member states of the organization to settle international disputes through peaceful means, in addition to an applied study on the Nile Basin's projects.展开更多
One of the roles of nuctear regulators is to review population projections calculated by applicants for populations lying in the vicinity of nuclear power plants. This paper examines methods of calculating rates of gr...One of the roles of nuctear regulators is to review population projections calculated by applicants for populations lying in the vicinity of nuclear power plants. This paper examines methods of calculating rates of growth and thus calculating future population growth. This paper is concerned about regulators making sure that nuclear power plants are not located near densely populated centers and that population centers located near nuclear power plants do not become densely populated. In the case of El Dabaa city in the north coast of Egypt, south west of the nominated plant site, three rates of growth 1.5%, 2.5% and 3% were identified. The first is the current population growth rate of the city, the second is the average national growth rate and the third is the expected growth rate of the city when the nuclear power plant gets constructed and operated. In all three cases, this city is a population center and rules of distance from the nuclear power plant shall apply. Thus the further natural growth of this city should be controlled and directed away from the downwind of the plant.展开更多
Nowadays, construction projects became more complex, where the responsibility of construction manager is to control and plan the project resources in a professional way to handover the project in terms of time, cost, ...Nowadays, construction projects became more complex, where the responsibility of construction manager is to control and plan the project resources in a professional way to handover the project in terms of time, cost, and quality. The aim of this study is to analyze the affect of the long experience of the construction manager on project success; it aims to identify the capability skills that the construction manager should have to complete the project on time. The fmding of this study is to help in understanding the factors that influence the project success through the long experience of the construction manager.展开更多
Due to high competition of the agriculture machines sector, the auto parts suppliers are investing in research to promote the development and reduce the costs of the products, passing these results to their clients wh...Due to high competition of the agriculture machines sector, the auto parts suppliers are investing in research to promote the development and reduce the costs of the products, passing these results to their clients who are the automakers. It was identified the need to redesign the regulation sieve system harvester, which is a compound assembly in the harvester's grain cleaning system, with the objective to reduce the costs and improve the ergonomic aspect, keeping the same efficiency from the original project. The improvement was developed by studying the original design and identifying possible project fails, such as components and manufacturing process which could be eliminated. For this, it was needed to do a research about rules and project considerations that must be applied in the products development and ergonomic too, specifically about geometric forms and anthropometric measures. From the redesign of this system, it is verified that it is possible by a study to identify possible improvements, and to develop a new system by a simple project, improving the ergonomic, reducing the cost and keeping the same efficacy from the original project.展开更多
The paper analyzes the external economy of pollution, Two different cost models of enterprises are established From the point of enterprises and the government, the measures of eliminating the externalily are discusse...The paper analyzes the external economy of pollution, Two different cost models of enterprises are established From the point of enterprises and the government, the measures of eliminating the externalily are discussed, and the limits the measures are analyzed.展开更多
BACKGROUND Hepatitis C virus(HCV) is a leading cause of worldwide liver-related morbidity and mortality. The World Health Organization released an integrated strategy targeting HCV-elimination by 2030. This study aims...BACKGROUND Hepatitis C virus(HCV) is a leading cause of worldwide liver-related morbidity and mortality. The World Health Organization released an integrated strategy targeting HCV-elimination by 2030. This study aims to estimate the required interventions to achieve elimination using updated information for direct-acting antiviral(DAA) treatment coverage, to compute the total costs(including indirect/societal costs) of the strategy and to identify whether the elimination strategy is cost-effective/cost-saving in Greece.AIM To estimate the required interventions and subsequent costs to achieve HCV elimination in Greece.METHODS A previously validated mathematical model was adapted to the Greek HCVinfected population to compare the outcomes of DAA treatment without the additional implementation of awareness or screening campaigns versus an HCV elimination strategy, which includes a sufficient number of treated patients. We estimated the total costs(direct and indirect costs), the disability-adjusted life years and the incremental cost-effectiveness ratio using two different price scenarios.RESULTS Without the implementation of awareness or screening campaigns,approximately 20000 patients would be diagnosed and treated with DAAs by2030. This strategy would result in a 19.6% increase in HCV-related mortality in2030 compared to 2015. To achieve the elimination goal, 90000 patients need to be treated by 2030. Under the elimination scenario, viremic cases would decrease by78.8% in 2030 compared to 2015. The cumulative direct costs to eliminate the disease would range from 2.1-2.3 billion euros(€) by 2030, while the indirect costs would be €1.1 billion. The total elimination cost in Greece would range from €3.2-3.4 billion by 2030. The cost per averted disability-adjusted life year is estimated between €10100 and €13380, indicating that the elimination strategy is very costeffective. Furthermore, HCV elimination strategy would save €560-895 million by2035.CONCLUSION Without large screening programs, elimination of HCV cannot be achieved. The HCV elimination strategy is feasible and cost-saving despite the uncertainty of the future cost of DAAs in Greece.展开更多
基金supported by Guangdong Provincial Basic and Applied Basic Research Fund,No.2021A1515011299(to KT)。
文摘Glutamatergic projection neurons generate sophisticated excitatory circuits to integrate and transmit information among different cortical areas,and between the neocortex and other regions of the brain and spinal cord.Appropriate development of cortical projection neurons is regulated by certain essential events such as neural fate determination,proliferation,specification,differentiation,migration,survival,axonogenesis,and synaptogenesis.These processes are precisely regulated in a tempo-spatial manner by intrinsic factors,extrinsic signals,and neural activities.The generation of correct subtypes and precise connections of projection neurons is imperative not only to support the basic cortical functions(such as sensory information integration,motor coordination,and cognition)but also to prevent the onset and progression of neurodevelopmental disorders(such as intellectual disability,autism spectrum disorders,anxiety,and depression).This review mainly focuses on the recent progress of transcriptional regulations on the development and diversity of neocortical projection neurons and the clinical relevance of the failure of transcriptional modulations.
文摘Against the backdrop of rapid development in China’s construction and infrastructure sectors,discrepancies between project budgets and actual costs have become pronounced,manifesting in project overruns and suspensions,posing significant challenges.To address inaccuracies in investment targets and operational complexities,this study focuses on a beam-bridge construction project in a district of Shijiazhuang city as a case study.Drawing upon historical analogs,the project employs a Work Breakdown Structure(WBS)to decompose the engineering works.Building on theories of Cost Significant(CS)and Whole Life Costing(WLC),the study constructs Cost Significant Items(CSIs)and develops a CNN-BiLSTM-Attention neural network for nonlinear prediction.By identifying significant cost drivers in engineering projects,this paper presents a streamlined cost estimation method that significantly reduces computational burdens,simplifies data collection processes,and optimizes data analysis and forecasting,thereby enhancing prediction accuracy.Finally,validation with real-world cost fluctuation data demonstrates minor errors,meeting predictive requirements across project execution phases.
基金financially supported by the Major Project"Golden Waterway Capacity Enhancement Technology"of Ministry of Transport of China(Grant No.201132874640)
文摘A two-dimensional flow numerical model of the tidal reaches, which total length is more than 700 km, is established from Datong to the Yangtze River estuary. The tidal levels, velocities, diversion ratios and dynamic axes before and after the separate regulation of each reach and combined regulation of all reaches are obtained. The comparative analysis shows that the regulation project of a separate reach basically has no impact on velocity distributions and variations of diversion ratios of upper and lower reaches, the variations of dynamic axes are only within the local scope of the project. The regulation project of a separate reach also has less impact on the water level in the lower adjacent reaches, but will make the water levels in the upper reaches rise. After the implementation of the regulation projects for all reaches, the rise of water level in the upstream reaches will have a cumulative impact.
基金Innovation Training Project of Hunan Province(S201911532062).
文摘Under the background of big data,Informatization plays an important role in the development of the engineering cost industry.The rapid development of the industry and the increasing complexity of construction projects require higher standards of informatization.The current information processing methods and models have been difficultly to meet new requirements.Based on this,this study deeply analyzes the key factors that impede the informatization of engineering cost development,and tries to find corresponding solutions through theoretical analysis and empirical research to break these constraints.This will play a guiding role in the development of informatization in China's engineering cost industry.
文摘The important role of Three Gorges Project (TGP) in the flood management of the Yangtze River Basin is summarized.The Optimal Regulation Schemes of the Three Gorge Reservoir is briefly described.The flood regulation effect of TGP is analyzed.Typical issues related to reservoir operation for flood regulation are discussed and suggestions are put forward for the future work.
文摘After the completion of design, the construction project shall begin its implementation, which should be taken effective measures to strengthen the management of project cost and properly manage the funds to achieve the overall goal of the construction projects. Control of the project cost in the project implementation is mainly divided into bidding, contracting, construction and settlement. The following is the analysis and discussions of the author's experiences to the control of the project cost in the project implementation and the management measures.
文摘In recent years,China’s society and economy has been developing very rapidly,and various industries are showing a trend of vigorous development.The importance of control and management of project cost in highway project management is becoming more and more prominent.PPP model has been widely used in the control and management of highway project cost with its own unique advantages.The author analyzes the important advantages of the PPP model and the existing problems in the cost control and management of highway projects,and puts forward effective measures for the cost control and management of highway projects using the PPP model,in hope of helping with the smooth implementation of the work.
文摘In the current economic situation, strengthening the contract management of the construction cost has a beautifully role. At the same time, according to construction project cost management, the scientific management of the contract, can promote the reasonable and balanced investment cost allocation in the quality and safety and other aspects of the project, so that the construction project can obtain higher added value, and to further promote China' s economic construction and accelerate the pace of the city. This paper first briefly elaborates our construction project cost of the contract management on the present situation, and some problems are analyzed and discussed, and then puts forward some suggestions on the measures and countermeasures for cost management of construction engineering contract.
文摘Project construction,design,management,operation,and maintenance are all undergoing digital transformations,and project cost professionals’working mode and content will change as a result.This paper reviews the existing challenges in traditional talent training and adjusts training ideas as well as training modes to conform to the industry’s digital transformation trend as a training base for project cost talents.
文摘The"replacement of business tax by VAT reform"(hereby refer to as"VAT reform"for short)is a newly promulgated and implemented tax policy,and its impact on various industries in China is very different,and the highway project industry is no exception.The implementation of the"VAT reform"will not only have a positive impact on the cost of highway projects,but will also have some negative impacts.For this reason,highway project construction corporates must actively respond.The author explores and analyzes the positive and negative effects of the"VAT reform"on the cost of highway projects,and proposes a reform strategy for highway project cost work under the background of the"VAT reform",in hope of helping with bringing out the intrinsic value of highway project cost management work.
文摘Resource-constrained project scheduling problem(RCPSP) is an important problem in research on project management. But there has been little attention paid to the objective of minimizing activities' cost with the resource constraints that is a critical sub-problem in partner selection of construction supply chain management because the capacities of the renewable resources supplied by the partners will effect on the project scheduling. Its mathematic model is presented firstly, and analysis on the characteristic of the problem shows that the objective function is non-regular and the problem is NP-complete following which the basic idea for solution is clarified. Based on a definition of preposing activity cost matrix, a heuristic algorithm is brought forward. Analyses on the complexity of the heuristics and the result of numerical studies show that the heuristic algorithm is feasible and relatively effective.
文摘Time-cost trade off problem (TCTP), known in the literature as project crashing problem (PCP) and project speeding up problem (PSP) is a part of project management in planning phase. In this problem, determining the optimal levels of activity durations and activity costs which satisfy the project goal(s), leads to a balance between the project completion time and the project total cost. A large amount of literature has studied this problem under various behavior of cost function. But, in all of them, influence of discount has not been in-vestigated. Hence, in this paper, TCTP would be studied considering the influence of discount on the re-source price, using genetic algorithm (GA). The performance of proposed idea has been tested on a medium scale test problem and several computational experiments have been conducted to investigate the appropriate levels of proposed GA considering accuracy and computational time.
文摘Software cost estimation is a main concern of the software industry. However, the fact is also that in today’s scenario, software industries are more interested in other issues like new technologies in the market, shorter development time, skill shortage etc. They are actually deviating from critical issues to routine issues. Today, people expect high quality products at very low costs and same is the goal of software engineering. An accuracy in software cost estimation has a direct impact on company’s reputation and also affects the software investment decisions. Accurate cost estimation can minimize the unnecessary costs and increase the productivity and efficiency of the company. The objective of this paper is to identify the existing methods of software cost estimation prevailing in the market and analyzing some of the important factors impacting the software cost estimation process. In order to achieve the objective, a survey was conducted to find out: ● Nature of projects that companies prefer. ● Impact of training on employees in software cost estimation. ● How many people review the estimated cost? ● How much risk buffer the company keeps for future prospects?
文摘The process of constructing hydraulic projects on international rivers is governed by several legal regulations, among the most important of these regulations are: the Principle of no harm, and the Principle of Prior Notification, protection of the river's environment and the Principle of Settling the International Disputes via Peaceful Means, which is considered one of the most important principles called for by the UN Pact, as it provides for adopting the peaceful means by the member states of the organization to settle international disputes through peaceful means, in addition to an applied study on the Nile Basin's projects.
文摘One of the roles of nuctear regulators is to review population projections calculated by applicants for populations lying in the vicinity of nuclear power plants. This paper examines methods of calculating rates of growth and thus calculating future population growth. This paper is concerned about regulators making sure that nuclear power plants are not located near densely populated centers and that population centers located near nuclear power plants do not become densely populated. In the case of El Dabaa city in the north coast of Egypt, south west of the nominated plant site, three rates of growth 1.5%, 2.5% and 3% were identified. The first is the current population growth rate of the city, the second is the average national growth rate and the third is the expected growth rate of the city when the nuclear power plant gets constructed and operated. In all three cases, this city is a population center and rules of distance from the nuclear power plant shall apply. Thus the further natural growth of this city should be controlled and directed away from the downwind of the plant.
文摘Nowadays, construction projects became more complex, where the responsibility of construction manager is to control and plan the project resources in a professional way to handover the project in terms of time, cost, and quality. The aim of this study is to analyze the affect of the long experience of the construction manager on project success; it aims to identify the capability skills that the construction manager should have to complete the project on time. The fmding of this study is to help in understanding the factors that influence the project success through the long experience of the construction manager.
文摘Due to high competition of the agriculture machines sector, the auto parts suppliers are investing in research to promote the development and reduce the costs of the products, passing these results to their clients who are the automakers. It was identified the need to redesign the regulation sieve system harvester, which is a compound assembly in the harvester's grain cleaning system, with the objective to reduce the costs and improve the ergonomic aspect, keeping the same efficiency from the original project. The improvement was developed by studying the original design and identifying possible project fails, such as components and manufacturing process which could be eliminated. For this, it was needed to do a research about rules and project considerations that must be applied in the products development and ergonomic too, specifically about geometric forms and anthropometric measures. From the redesign of this system, it is verified that it is possible by a study to identify possible improvements, and to develop a new system by a simple project, improving the ergonomic, reducing the cost and keeping the same efficacy from the original project.
文摘The paper analyzes the external economy of pollution, Two different cost models of enterprises are established From the point of enterprises and the government, the measures of eliminating the externalily are discussed, and the limits the measures are analyzed.
基金supported by unrestricted grants from Gilead and MSD
文摘BACKGROUND Hepatitis C virus(HCV) is a leading cause of worldwide liver-related morbidity and mortality. The World Health Organization released an integrated strategy targeting HCV-elimination by 2030. This study aims to estimate the required interventions to achieve elimination using updated information for direct-acting antiviral(DAA) treatment coverage, to compute the total costs(including indirect/societal costs) of the strategy and to identify whether the elimination strategy is cost-effective/cost-saving in Greece.AIM To estimate the required interventions and subsequent costs to achieve HCV elimination in Greece.METHODS A previously validated mathematical model was adapted to the Greek HCVinfected population to compare the outcomes of DAA treatment without the additional implementation of awareness or screening campaigns versus an HCV elimination strategy, which includes a sufficient number of treated patients. We estimated the total costs(direct and indirect costs), the disability-adjusted life years and the incremental cost-effectiveness ratio using two different price scenarios.RESULTS Without the implementation of awareness or screening campaigns,approximately 20000 patients would be diagnosed and treated with DAAs by2030. This strategy would result in a 19.6% increase in HCV-related mortality in2030 compared to 2015. To achieve the elimination goal, 90000 patients need to be treated by 2030. Under the elimination scenario, viremic cases would decrease by78.8% in 2030 compared to 2015. The cumulative direct costs to eliminate the disease would range from 2.1-2.3 billion euros(€) by 2030, while the indirect costs would be €1.1 billion. The total elimination cost in Greece would range from €3.2-3.4 billion by 2030. The cost per averted disability-adjusted life year is estimated between €10100 and €13380, indicating that the elimination strategy is very costeffective. Furthermore, HCV elimination strategy would save €560-895 million by2035.CONCLUSION Without large screening programs, elimination of HCV cannot be achieved. The HCV elimination strategy is feasible and cost-saving despite the uncertainty of the future cost of DAAs in Greece.