An Updated Economic Assessment of Moxidectin Treatment Strategies for Onchocerciasis Elimination.

BACKGROUND: Concerns that annual mass administration of ivermectin, the predominant strategy for onchocerciasis control and elimination, may not lead to elimination of parasite transmission (EoT) in all endemic areas have increased interest in alternative treatment strategies. One such strategy is moxidectin. We performed an updated economic assessment of moxidectin- relative to ivermectin-based strategies. METHODS: We investigated annual and biannual community-directed treatment with ivermectin (aCDTI, bCDTI) and moxidectin (aCDTM, bCDTM) with minimal or enhanced coverage (65% or 80% of total population taking the drug, respectively) in intervention-naive areas with 30%, 50%, or 70% microfilarial baseline prevalence (representative of hypo-, meso-, and hyperendemic areas). We compared programmatic delivery costs for the number of treatments achieving 90% probability of EoT (EoT90), calculated with the individual-based stochastic transmission model EPIONCHO-IBM. We used the costs for 40 years of program delivery when EoT90 was not reached earlier. The delivery costs do not include drug costs. RESULTS: aCDTM and bCDTM achieved EoT90 with lower programmatic delivery costs than aCDTI with 1 exception: aCDTM with minimal coverage did not achieve EoT90 in hyperendemic areas within 40 years. With minimal coverage, bCDTI delivery costs as much or more than aCDTM and bCDTM. With enhanced coverage, programmatic delivery costs for aCDTM and bCDTM were lower than for aCDTI and bCDTI. CONCLUSIONS: Moxidectin-based strategies could accelerate progress toward EoT and reduce programmatic delivery costs compared with ivermectin-based strategies. The costs of moxidectin to national programs are needed to quantify whether delivery cost reductions will translate into overall program cost reduction.

Techno-economic assessment of bioleaching for metallurgical by-products.

This study focused on the economic feasibility of two potential industrial-scale bioleaching technologies for metal recovery from specific metallurgical by-products, mainly basic oxygen steelmaking dust (BOS-D) and goethite. The investigation compared two bioleaching scaling technology configurations, including an aerated bioreactor and an aerated and stirred bioreactor across different scenarios. Results indicated that bioleaching using Acidithiobacillus ferrooxidans proved financially viable for copper extraction from goethite, particularly when 5% and 10% pulp densities were used in the aerated bioreactor, and when 10% pulp density was used in the aerated and stirred bioreactor. Notably, a net present value (NPV) of $1,275,499k and an internal rate of return (IRR) of 65% for Cu recovery from goethite were achieved over 20-years after project started using the aerated and stirred bioreactor plant with a capital expenditure (CAPEX) of $119,816,550 and an operational expenditure (OPEX) of $5,896,580/year. It is expected that plant will start to make profit after one year of operation. Aerated and stirred bioreactor plant appeared more reliable alternative compared to the aerated bioreactor plant as the plant consists of 12 reactors which can allow better management and operation in small volume with multiple reactors. Despite the limitations, this techno-economic assessment emphasized the significance of selective metal recovery and plant design, and underscored the major expenses associated with the process.

Life cycle assessment and techno-economic analysis of wood-based biorefineries for cellulosic ethanol production.

Poplar is widely used in the paper industry and accompanied by abundant branches waste, which is potential feedstock for bioethanol production. Acid-chlorite pretreatment can selectively remove lignin, thereby significantly increasing enzymatic efficiency. Moreover, lignin residues valorization via gasification-syngas fermentation can achieve higher fuel yield. Herein, environmental and economic aspects were conducted to assess technological routes, which guides further process optimization. Life cycle assessment results show that wood-based biorefineries especially coupling scenarios have significant advantages in reducing global warming potential in contrast to fossil-based automotive fuels. Normalization results indicate that acidification potential surpasses other indicators as the primary impact category. In terms of economic feasibility, coupling scenarios present better investment prospects. Bioethanol yield is the most critical factor affecting market competitiveness. Minimum ethanol selling price below ethanol international market price is promising with higher-levels technology. Further work should be focused on technological breakthrough, consumable reduction or replacement.

Feasibility study and techno-economic assessment of power-to-gas (P2G) technology based on solid oxide electrolysis (SOE).

Power-to-Gas (P2G) is considered as a promising energy storage technology in a long-time horizon. The rapid growth in the share of intermittent renewables in the energy mix is driving forward research and development in large-scale energy storage. This paper presents a feasibility analysis of a power-to-gas system in terms of various operating points and capacities. The analysis was performed using a system model, which features a solid oxide electrolyzer (SOE), a CO2 separation unit, and a methanation reactor as the key components. For the purposes of the techno-economic assessment (TEA) of the system, the CAPEX/OPEX estimation was performed and the cost structure defined. The model proposed in the study enables system-level optimization, including technical and economic criteria, considering two nominal scales: 10 kW and 40 GW, which corresponds to the nominal capacity of SOE in each case. According to the study, in an SOE-based P2G system, the cost of synthetic natural gas (SNG) production will fall by 15-21% by 2030 and 29-37% by 2050. SNG production would cost 3.15-3.75 EUR2023/kgSNG in 2030 and 2.6-3.0 EUR2023/kgSNG in 2050 for systems with SOE power >10 MW. Generally, product cost reductions occur as a result of material development and large-scale production, which influences the system's CAPEX. According to the research, the technology will break even by 2050. The large-scale power-to-gas system with a total of 40 GW installed capacity delivers a product price of 2.4 EUR2023/kgSNG with the average conversion efficiency of 68%.

Techno-Economic Analysis of the Optimum Configuration for Supercritical Carbon Dioxide Cycles in Concentrating Solar Power Systems.

There is a general agreement among researchers that supercritical carbon dioxide (sCO2) cycles will be part of the next generation of thermal power plants, especially in concentrating solar power (CSP) plants. While certain studies focus on maximizing the efficiency of these cycles in the hope of achieving a reduction in electricity costs, it is important to note that this assumption does not always hold true. This work provides a comprehensive analysis of the differences between minimizing the cost and maximizing the efficiency for the most remarkable sCO2 cycles. The analysis considers the most important physical uncertainties surrounding CSP and sCO2 cycles, such as turbine inlet temperature, ambient temperature, pressure drop and turbomachinery efficiency. Moreover, the uncertainties related to cost are also analyzed, being divided into uncertainties of sCO2 component costs and uncertainties of heating costs. The CSP system with partial cooling (sometimes with reheating and sometimes without it) is the cheapest configuration in the analyzed cases. However, the differences in cost are generally below 5% (and sometimes neglectable), while the differences in efficiency are significantly larger and below 15%. Besides the much lower efficiency of systems with simple cycle, if the heating cost is low enough, their cost could be even lower than the cost of the system with partial cooling. Systems with recompression cycles could also achieve costs below systems with partial cooling if the design's ambient temperature and the pressure drop are low.

Life-cycle and economic assessments of microalgae biogas production in suspension and biofilm cultivation systems.

Biogas production via anaerobic digestion is highly attractive for microalgae. The technology of microalgae cultivation has profound impacts on biogas production system as it is the most energy-consuming process. However, a comprehensive evaluation of the environmental and economic benefits of different cultivation systems has yet to be sufficiently conducted. Here, life-cycle and economic assessments of open raceway ponds, photobioreactors and biofilm systems were investigated. Results showed greenhouse gas emissions of all systems were positive because more than two-thirds of carbon in fuel gas was lost and the fixed carbon in product gas and solid fertilizer was less than the emitted carbon during energy input. Particularly, biofilm system achieved the least greenhouse gas emissions (9.3 g CO2-eq/MJ), net energy ratio (0.7) and levelized cost of energy (0.9 $/kWh), indicating the optimum cultivation system. Open raceway ponds and photobioreactors failed to achieve positive benefits because of low harvesting efficiency and biomass concentration.

Pyrolysis of mixed engineering plastics: Economic challenges for automotive plastic waste.

Chemical recycling of complex plastic waste via pyrolysis can reduce fossil resource dependence of the plastics value chain and greenhouse gas emissions. However, economic viability is crucial for its implementation, especially considering challenging waste streams with high shares of engineering plastics that have lower pyrolysis product quality than standard thermoplastics waste. Thus, this study conducts a techno-economic assessment determining the profitability factors of pyrolysis plants for automotive plastic waste in Germany including different plant capacities and calculating cost-covering minimum sales prices for the resulting pyrolysis oil. Main findings are that due to economies of scale, the cost-covering minimum sales prices vary between 1182 €/Mg pyrolysis oil (3750 Mg input/year) and 418 €/Mg pyrolysis oil (100,000 Mg input/year). The pyrolysis technology employed must be robust and scalable to realize these economies of scale. Large plant capacities face challenges such as feedstock availability at reasonable costs, constant feedstock quality, and pyrolysis oil quality, affecting pyrolysis oil pricing. Due to the limited yield and quality of pyrolysis oil produced from these technically demanding feedstocks, policy implications are that additional revenue streams such as gate fees or subsidies that are essential to ensure a positive business case are necessary. Depending on the assessed plant capacity, additional revenues between 720 and 59 €/Mg pyrolysis oil should be realized to be competitive with the price of the reference product heavy fuel oil. Otherwise, the environmental potential of this technology cannot be exploited.

Tackling climate change through wastewater reuse in agriculture: A prioritization methodology.

Water shortages, exacerbated by climate change, are posing a major global challenge, particularly impacting the agricultural sector. A growing interest is raised towards reclaimed wastewater (RWW) as an alternative irrigation source, capable of exploiting also the nutrient content through the fertigation practice. However, a prioritization methodology for selecting the most appropriate wastewater treatment plants (WWTPs) for implementing direct RWW reuse is currently missing. Such prioritization would benefit water utilities, often managing several WWTPs, and policymakers in optimizing economic asset allocation. In this work, a prioritization framework is proposed to evaluate WWTPs' suitability for implementing direct RWW reuse considering both WWTP and surrounding territory characteristics. This procedure consists of four key steps. Firstly, a techno-economic model was developed, in which monthly mass balances on water and nutrients are solved by matching crop requirements, rainfall conditions, and effluent characteristics. Economic suitability was quantified considering economic benefits due to savings in freshwater resource, mineral fertilizers and avoided greenhouse gases emissions, but also losses in crop yield due to RWW salinity content. Secondly, a classification procedure was coded to select representative WWTPs among a set of WWTPs, based on their size, presence of nutrient removal processes, and type of crops in their surroundings. The techno-economic model was then applied to these selected WWTPs. Thirdly, input parameters' relevance in determining WWTP suitability for RWW reuse was ranked. Finally, scenario analyses were conducted to study the influence of rainfall patterns and nutrient treatment removal on the RWW reuse feasibility. The type of crops surrounding the WWTPs and RWW salinity content resulted to be crucial elements in determining WWTPs suitability for RWW reuse implementation. The proposed methodology proved to be an effective support tool for policymakers and water utilities to assess the techno-economic feasibility of direct RWW reuse, generalizing results to several combinations of WWTPs and crops.

Prefeasibility analysis of biomass gasification and electrolysis for hydrogen production.

Hydrogen is a key energy vector to accomplishing energy transition and decarbonization goals proposed in the transport and industrial sectors worldwide. In recent years, research has focused on analyzing, designing, and optimizing hydrogen production, searching to improve economic prefeasibility with minimal emissions of polluting gases. Therefore, the techno-economic analysis of hydrogen production by electrolytic and gasification processes becomes relevant since these processes could compete commercially with industrial technologies such as SMR - Steam methane reforming. This work aims to analyze hydrogen production in stand-alone processes and energy-driven biorefineries. The gasification and electrolysis technologies were evaluated experimentally, and the yields obtained were input data for scaling up the processes through simulation tools. Biomass gasification is more cost-effective than electrolytic schemes since the hydrogen production costs were 4.57 USD/kg and 8.30 USD/kg at an annual production rate of 491.6 tons and 38.96 tons, respectively. Instead, the electrolysis process feasibility is strongly influenced by the recycled water rate and the electricity cost. A sensitivity analysis was performed to evaluate the temperature, pressure, and current density variability on the hydrogen production rate. The increase in pressure and current density induces parasitic currents while the temperature increases hydrogen production. Although higher hydrogen production rates from gasification, the syngas composition decreases the possibility of being implemented in applications where purity is critical.

Integrating microalgae growth in biomethane plants: Process design, modelling, and cost evaluation.

The integration of microalgae cultivation in anaerobic digestion (AD) plants can take advantage of relevant nutrients (ammonium and ortho-phosphate) and CO2 loads. The proposed scheme of microalgae integration in existing biogas plants aims at producing approximately 250 t·y-1 of microalgal biomass, targeting the biostimulants market that is currently under rapid expansion. A full-scale biorefinery was designed to treat 50 kt·y-1 of raw liquid digestate from AD and 0.45 kt·y-1 of CO2 from biogas upgrading, and 0.40 kt·y-1 of sugar-rich solid by-products from a local confectionery industry. An innovative three-stage cultivation process was designed, modelled, and verified, including: i) microalgae inoculation in tubular PBRs to select the desired algal strains, ii) microalgae cultivation in raceway ponds under greenhouses, and iii) heterotrophic microalgae cultivation in fermenters. A detailed economic assessment of the proposed biorefinery allowed to compute a biomass production cost of 2.8 ± 0.3 €·kg DW-1, that is compatible with current downstream process costs to produce biostimulants, suggesting that the proposed nutrient recovery route is feasible from the technical and economic perspective. Based on the case study analysis, a discussion of process, bioproducts and policy barriers that currently hinder the development of microalgae-based biorefineries is presented.

[Assessment of Emission Reduction Potential of CO2 Capture, Geological Utilization, and Storage in Cement Industry of China].

The cement industry faces great pressure from the targets of carbon peak and carbon neutrality. CO2capture, geological utilization, and storage(CCUS) technology is crucial for CO2 mitigation in large-scale fossil-based industries. An integrated techno-economic assessment model of CCUS was improved here to assess the potential of CCUS retrofits in the cement industry in China, and the cost curve or supply curve of CCUS in the cement industry was obtained. The model set up ten scenarios from four aspects:source-sink matching distance, capture rate, CCUS technology, and technical level. The cement enterprise screening, site screening, techno-economic evaluation, and source-sink matching of CCUS were completed to answer some key problems in realizing low-carbon development via CCUS, such as enterprise inventory, storage site, emission reduction scale, and cost range. Under the scenario of 250 km matching distance, 85% net capture rate, CO2-enhanced water recovery technology, and current technical level, 44% of cement enterprises reduced carbon emission via CCUS, the cumulative capacity reached 625 million tons per year, and the levelized cost was 290-1838 yuan·t-1. The projects with a levelized cost of fewer than 600 yuan·t-1 accounted for 77% and could reduce CO2 emission by 564 million tons annually. The projects whose levelized cost was less than 400 yuan·t-1 could reduce CO2 by 199 million tons per year. When the coupling of CO2-enhanced oil recovery and CO2-enhanced water recovery technology was considered, the levelized cost was 27% lower. When the cement capacity was less than 530 million tons per year, the additional cost of cement production was 95-300 yuan·t-1. Under technological progress to 2030, the levelized cost will be reduced by 9%-15%. The regions with early demonstration advantages of full-chain CO2-enhanced water recovery technology were Xinjiang, Inner Mongolia, Ningxia, Henan, and Hebei. Additionally, the areas suitable for cement CCUS cluster included Ordos Basin, Junggar Basin, Bohai Bay Basin, and Songliao Basin. It is technically feasible for the cement industry to deploy full-chain CCUS projects, and low-cost projects have an early demonstration opportunity. These results can provide a quantitative reference for the low-carbon development of the cement industry and the commercial deployment of CCUS in cement production.

A clinical and economic assessment of adjuvanted trivalent versus standard egg-derived quadrivalent influenza vaccines among older adults in the United States during the 2018-19 and 2019-20 influenza seasons.

BACKGROUND: Clinical evidence supports use of enhanced influenza vaccines in older adults. Few economic outcome studies have compared adjuvanted trivalent inactivated (aIIV3) and standard egg-derived quadrivalent inactivated influenza vaccines (IIV4e). RESEARCH DESIGN AND METHODS: A retrospective cohort study was conducted leveraging deidentified US hospital data linked to claims data during the 2018-19 and 2019-20 influenza seasons. Relative vaccine effectiveness (rVE) was compared in adults aged ≥ 65 years receiving aIIV3 or IIV4e using inverse probability of treatment weighting (IPTW) and Poisson regression. An economic assessment quantified potential real-world cost savings. RESULTS: The study included 715,807 aIIV3 and 320,991 IIV4e recipients in the 2018-19 and 844,169 aIIV3 and 306,270 IIV4e recipients in the 2019-20 influenza seasons. aIIV3 was significantly more effective than IIV4e in preventing cardiorespiratory disease (2018-19 rVE = 6.2%; and 2019-20 rVE = 6.0%) and respiratory disease (2018-19 rVE = 8.9%; and 2019-20 rVE = 10.1%). During the 2018-19 influenza season cardiorespiratory hospitalization cost savings for the aIIV3 population were $392 M, and $221 M for the 2019-20 season. Respiratory hospitalization cost savings for the aIIV3 population were $145 M and $97 M, respectively. CONCLUSIONS: Our findings suggest that aIIV3 provides clinical and economic advantages versus IIV4e in the elderly.

Flu vaccines do not work as well in older adults due to the aging of their immune system. One approach to improving vaccine efficacy is the addition of a substance, or adjuvant, to the vaccine in order to boost an individual's immune response. This study evaluated an adjuvanted vaccine compared to an unadjuvanted vaccine for preventing cardiorespiratory hospitalizations and hospitalization costs. The findings demonstrated that the adjuvanted flu vaccine, compared to the unadjuvanted vaccine, prevented more hospitalizations and greatly reduced associated hospital costs.

Eco-friendly treatment of copper smelting flue dust for recovering multiple heavy metals with economic and environmental benefits.

Handling flue dust in an environmentally friendly manner has become an urgent task for pollution prevention in the copper industry. Here, driven by the low-carbon notion, we report a process that enables the selective retrieval of multiple metals (As, Cu, Pb, Zn, and Bi) from copper smelting flue dust (CSFD). This process employed low-temperature roasting to separate arsenic from heavy metals, thereby eliminating the tedious separation steps required by existing processes. Subsequently, Zn and Cu were dissolved in water, while Pb and Bi were left as a solid residue. We achieved 98.23% extraction of Cu via Zn cementation at a micro-voltage of 0.50 V. Utilizing the difference in solubility, Bi was selectively dissolved from the residue using a NaCl-HCl medium, which enabled the subsequent production of metallic Bi through electrowinning. Finally, more than 99% of Pb in the solid was reduced to elemental Pb by mechanochemical reduction. Through optimized process conditions, high-purity As2O3 (99.04%), lead ingot (99.95%), metallic copper (94.16%), and bismuth (99.20%) were obtained. Our economic assessment revealed significant advantages, demonstrating the industrial feasibility of this process. Consequently, this study presents an effective and cost-efficient system for CSFD disposal while minimizing the environmental impact and fostering a circular economy.

Multi-scale techno-economic assessment of nitrogen recovery systems for livestock operations.

Intensive livestock farming generates vast amounts of organic materials, which are an important source of nitrogen releases. These anthropogenic nitrogen releases contribute to multiple environmental problems, including eutrophication of water systems, contamination of drinking water sources, and greenhouse gas emissions. Nitrogen recovery and recycling are technically feasible, and there exists a number of processes for nitrogen recovery from livestock material in the form of different products. In this work, a multi-scale techno-economic assessment of techniques for nitrogen recovery and recycling is performed. The assessment includes a material flow analysis of each process, from material collection to final treatment, to determine nitrogen recovery efficiency, losses, and recovery cost, as well as an environmental cost-benefit analysis to compare the nitrogen recovery cost versus the economic losses derived from its uncontrolled release into the environment. The results show that transmembrane chemisorption process results in the lowest recovery cost, 3.4-10.4 USD per kilogram of nitrogen recovered in the range of studied processing scales. The recovery of nitrogen from livestock material through three technologies, i.e., transmembrane chemisorption, MAPHEX, and stripping in packed bed, reveales to be cost-effective. Since the economic losses due to the harmful effects of nitrogen into the environment are estimated at 32-35 USD per kilogram of nitrogen released, nitrogen recycling is an environmentally and economically beneficial approach to reduce nutrient pollution caused by livestock operations.

Discounting health gain: a different view.

At least since the Age of Enlightenment, good health has been a tenet for society. Healthy societies could learn better, work harder, improve their wealth, and live longer. Today societies focus on life expectancy, as we value long and healthy lives. As illustrated by the provision of COVID-19 vaccines first for the elderly, societies value life-saving actions. Paradoxically, health economic assessments conventionally devalue long-lasting health through the practice of discounting health benefits along with costs. However, health, with its intrinsic and instrumental characteristics, is not synonymous with money cash, a tradeable asset that devalues with time. If improving healthy life expectancy is a societal ambition, it seems counter-intuitive to value future health less as a result of an artificial mathematical construct when evaluating economically new medical interventions. In this paper, we investigate the application of discounting health in healthcare and consider paradoxical findings, especially in relation to disease prevention with vaccination. We argue that there is no economically sustainable argument to discount health gains, except for the benefit of the payer with a goal of spending less on life-saving products. If that is the objective for discounting health, there are other means to achieve the same goal in a more transparent and simpler way. From the long-term perspective of healthcare development, not discounting health gains would encourage research that values long-term effects. This in turn has the potential to benefit the investor, the payer, and the patient/consumer, improving the situation from multiple perspectives.

Multicriteria analysis of sewage sludge-based biodiesel production.

There is increasing attention on developing efficient processes including circular economy principles, and obtaining fuels from wastewater treatment feedstocks is among the most promising. As a wastewater treatment byproduct, sewage sludge is a source of lipids that can be converted to biodiesel in a transesterification process. Economic and environmental analysis have been applied to a 60 m3/h sewage sludge plant, exploring 32 process alternatives. Using solvent extraction from wet sewage sludge, the high cost associated with the drying step is skipped. The wet alternatives with low amounts of solvent and acid usage depicted higher performance compared to the dry ones. Incorporating additional extraction stages increases both the financial gains and environmental impacts. As a result, a multicriteria analysis is implemented to ascertain the optimum process based on different priorities. The case with 0.5:1 (v/v) of hexane to biomass ratio, 3-stage extractor, 60 min residence time and pH 4 was the optimum alternative in most criteria.

Evaluating Sustainable Development Pathways for Protein- and Peptide-Based Bioadsorbents for Phosphorus Recovery from Wastewater.

Recovering phosphate (P) from point sources such as wastewater effluent is a priority in order to alleviate the impacts of eutrophication and implement a circular economy for an increasingly limited resource. Bioadsorbents featuring P-binding proteins and peptides offer exquisite P specificity and sensitivity for achieving ultralow P concentrations, i.e., <100 µg P L-1, a discharge limit that has been implemented in at least one treatment facility in nine U.S. states. To prioritize research objectives for P recovery in wastewater treatment, we compared the financial and environmental sustainability of protein/peptide bioadsorbents to those of LayneRT anion exchange resin. The baseline scenario (reflecting lab-demonstrated performance at a full-scale implementation) had costs that were 3 orders of magnitude higher than those for typical wastewater treatment. However, scenarios exploring bioadsorbent improvements, including increasing the P-binding capacity per unit volume by using smaller P-selective peptides and nanoparticle base materials and implementing reuse, dramatically decreased median impacts to $1.06 m-3 and 0.001 kg CO2 equiv m-3; these values are in line with current wastewater treatment impacts and lower than the median LayneRT impacts of $4.04 m-3 and 0.19 kg CO2 equiv m-3. While the financial viability of capturing low P concentrations is a challenge, incorporating the externalities of environmental impacts may provide a feasible path forward to motivate ultralow P capture.

Revealing the mechanism of quartz sand seeding in accelerating phosphorus recovery from anaerobic fermentation supernatant through vivianite crystallization.

The recovery of phosphorus (P) through vivianite crystallization offers a promising approach for resource utilization in wastewater treatment plants. However, this process encounters challenges in terms of small product size and low purity. The study aimed to assess the feasibility of using quartz sand as a seed material to enhance P recovery and vivianite crystal characteristics from anaerobic fermentation supernatant. Various factors, including seed dosage, seed size, Fe/P ratio, and pH, were systematically tested in batch experiments to assess their influence. Results demonstrated that the effect of seed enhancement on vivianite crystallization was more pronounced under higher seed dosages, smaller seed sizes, and lower pH or Fe/P ratio. The addition of seeds increased P recovery by 4.43% in the actual anaerobic fermentation supernatant and also augmented the average particle size of the recovered product from 19.57 to 39.28 µm. Moreover, introducing quartz sand as a seed material effectively reduced co-precipitation, leading to a notable 12.5% increase in the purity of the recovered vivianite compared to the non-seeded process. The formation of an ion adsorption layer on the surface of quartz sand facilitated crystal attachment and growth, significantly accelerating the vivianite crystallization rate and enhancing P recovery. The economic analysis focused on chemical costs further affirmed the economic viability of using quartz sand as a seed material for P recovery through vivianite crystallization, which provides valuable insights for future research and engineering applications.

Budesonide/formoterol maintenance and reliever therapy in childhood asthma: Real-world effectiveness and economic assessment.

INTRODUCTION: The study aims to compare the real-world effectiveness and economy of the budesonide/formoterol reliever and maintenance therapy (SMART) with fixed-dose inhaled corticosteroids (ICS)/long-acting b-agonist (LABA) or ICS alone plus as-needed, short-acting ß2 agonists (SABA) in pediatric patients. METHODS: The outpatient data warehouse of a hospital in China was used. A total of 103 patients under 18 years old in the SMART group and 63 patients in the control group were included from January 1, 2020 to December 31, 2021. The effectiveness was assessed using asthma attacks and lung function at baseline, 6 months and 12 months follow-up. Cost-effectiveness analysis was performed with a three-state Markov model from the healthcare system perspective. One-way sensitivity analyses and probabilistic sensitivity analyses were performed to check the robustness of the results. RESULTS: The SMART regimen was more effective than other strategies in reducing the risk of mild and severe attacks in the real-life management of childhood asthma. Patients in both groups showed significant improvement in lung function at 6 and 12 months in contrast to baseline. Compared with other strategies, the forced expiratory volume in 1 s (FEV1 ) level in the SMART group was markedly improved at 6 months. The total cost of outpatient service using the SMART regimen was lower than that of other strategies, while the drug costs were similar in different groups. Incremental cost-effectiveness analysis results showed that using the SMART regimen reduced the total cost by approximately CNY 10,516.11 per year with a 0.12 quality-adjusted life year (QALYs) increase. Sensitive analyses supported that the SMART regimen was the dominant choice at the willingness-to-pay threshold of CNY 85,698, per capita GDP in China. CONCLUSIONS: Collectively, our findings indicate that the real-world effectiveness and economy of the SMART regimen are superior to the traditional strategies in pediatric asthma patients.