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This study estimates the maximum price at which mesenchymal stem cell (MSC) therapy is deemed cost-effective for septic shock patients and identifies parameters that are most important in making treatment decisions.
We developed a probabilistic Markov model according to the sepsis care trajectory to simulate costs and quality-adjusted life years (QALYs) of septic shock patients receiving either MSC therapy or usual care over their lifetime. We calculated the therapeutic headroom by multiplying the gains attributable to MSCs with willingness-to-pay (WTP) threshold and derived the maximum reimbursable price (MRP) from the expected net monetary benefit and savings attributable to MSCs. We performed scenario analyses to assess the impact of changes to assumptions on the study findings. A value of information analysis is performed to identify parameters with greatest impact on the uncertainty around the cost-effectiveness of MSC therapy.
At a WTP threshold of $50,000 per QALY, the therapeutic headroom and MRP of MSC therapy were $20,941 and $16,748, respectively; these estimates increased with the larger WTP values and the greater impact of MSCs on in-hospital mortality and hospital discharge rates. The parameters with greatest information value were MSC's impact on in-hospital mortality and the baseline septic shock in-hospital mortality.
At a common WTP of $50,000/QALY, MSC therapy is deemed to be economically attractive if its unit cost does not exceed $16,748. This ceiling price can be increased to $101,450 if the therapy significantly reduces both in-hospital mortality and increases hospital discharge rates.
XRF maps of a uranium ore sample have been analyzed using software that allows the graphical spatial correlations of all detected elements to be measured. The association of uranium with arsenic, nickel and cesium was explored; all showed unique finely-granular microscopic patterns that could be used to assist the recovery of uranium and rare earths.
The magnitude and distribution of elastic strain for a nickel alloy 600 (A600) sample that had been subjected to uniaxial tensile stress were measured by micro Laue diffraction (MLD) and neutron diffraction techniques. For a sample that had been dimensionally strained by 1%, both MLD and neutron diffraction data indicated that the global residual elastic strain was on the order of 10−4, however the micro-diffraction data indicated considerable grain-to-grain variability amongst individual components of the residual strain tensor. A more precise comparison was done by finding those grains in the MLD map that had appropriate <hkl> oriented in the specific directions matching those used in the neutron measurements and the strains were found to agree within the uncertainty. Large variations in strain values across the grains were noted during the MLD measurements which are reflected in the uncertainties. This is a possible explanation for the large uncertainty in the average strains measured from multiple grains during neutron diffraction.
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