ObjectiveTo compare cost effectiveness of endovascular revascularisation (ER) and supervised exercise therapy (SET) as primary treatment for patients with intermittent claudication (IC) due to iliac artery obstruction.MethodsCost utility analysis from a restricted societal perspective and time horizon of 12 months. Patients were included in a multicentre randomised controlled trial (SUPER study, NCT01385774, NTR2648) which compared effectiveness of ER and SET. Health status and health related quality of life (HRQOL) were measured using the Euroqol 5 dimensions 3 levels (EQ5D-3L) and VascuQol-25-NL. Incremental costs were determined per allocated treatment and use of healthcare during follow up. Effectiveness of treatment was determined in quality adjusted life years (QALYs). The difference between treatment groups was calculated by an incremental cost utility ratio (ICER).ResultsSome 240 patients were included, and complete follow up was available for 206 patients (ER 111 , SET 95). The mean costs for patients allocated to ER were €4 031 and €2 179 for SET, a mean difference of €1 852 (95% bias corrected and accelerated [bca] bootstrap confidence interval 1 185 – 2 646). The difference in QALYs during follow up was 0.09 (95% bcaCI 0.04 – 0.13) in favour of ER. The ICER per QALY was €20 805 (95% bcaCI 11 053 – 45 561). The difference in VascuQol sumscore was 0.64 (95% bcaCI 0.39 – 0.91), again in favour of ER.ConclusionER as a primary treatment, results in slightly better health outcome and higher QALYs and HRQOL during 12 months of follow up. Although these differences are statistically significant, clinical relevance must be discussed due to the small differences and relatively high cost of ER as primary treatment.
MULTIFILE
Electric vehicles and renewable energy sources are collectively being developed as a synergetic implementation for smart grids. In this context, smart charging of electric vehicles and vehicle-to-grid technologies are seen as a way forward to achieve economic, technical and environmental benefits. The implementation of these technologies requires the cooperation of the end-electricity user, the electric vehicle owner, the system operator and policy makers. These stakeholders pursue different and sometime conflicting objectives. In this paper, the concept of multi-objective-techno-economic-environmental optimisation is proposed for scheduling electric vehicle charging/discharging. End user energy cost, battery degradation, grid interaction and CO2 emissions in the home micro-grid context are modelled and concurrently optimised for the first time while providing frequency regulation. The results from three case studies show that the proposed method reduces the energy cost, battery degradation, CO2 emissions and grid utilisation by 88.2%, 67%, 34% and 90% respectively, when compared to uncontrolled electric vehicle charging. Furthermore, with multiple optimal solutions, in order to achieve a 41.8% improvement in grid utilisation, the system operator needs to compensate the end electricity user and the electric vehicle owner for their incurred benefit loss of 27.34% and 9.7% respectively, to stimulate participation in energy services.
Knowledge valorisation is the transfer of knowledge from one party to another for economic benefit. The concept of valorisation is based on the underlying metaphor of KNOWLEDGE AS A THING. It is the same metaphor that makes it possible to talk about the value of knowledge. If knowledge is like a ‘thing’, then that ‘ thing’ must have a specific value. Value can be defined as the degree of usefulness or desirability of something, especially in comparison with other things, and is by definition subjective. Value is in the eye of the beholder. Any valuation method therefore needs to take into account this subjective nature by deliberately choosing the appropriate ‘standard of value’ (value to whom?) and ‘premise of value’ (value under what circumstances?). There are three ways to determine the value of something of which financial valuation is the most used. In turn financial valuation can be done using a cost approach, a market approach or an income approach. In most cases the income approach is the most appropriate. However, this approach requires a number of assumptions to be made; most of which are impossible to validate. The formulas that are used in the process can be intimidating to non-experts with the danger of disguising the inherent subjective and speculative nature of any valuation of knowledge as a ‘thing’.
