Search results for: stratified shields

Authors: Sari F. Alkhatib, Chang Je Park, Gyuhong Roh, Daeseong Jo

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The iterative scheme which is used to treat buildup factors for stratified shields of three-layers or more is being investigated here using the layer-splitting technique. The second layer in a double-layer shield was split into two equivalent layers and the scheme was implemented on the new 'three-layer' shield configuration. The results of such manipulation for water-lead and water-iron shields combinations are presented here for 1 MeV photons. It was found that splitting the second layer introduces some deviation on the overall buildup factor. This expected deviation appeared to be higher in the case of low Z layer followed by high Z. However, the iterative scheme showed a great consistency and strong coherence with the introduced changes.

Keywords: build-up factor, iterative scheme, stratified shields, radiation protection

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Authors: Sari F. Alkhatib, Chang Je Park, Gyuhong Roh

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The iterative scheme which is used to treat buildup factors for stratified shields is being investigated here using the layer-splitting technique. A simple suggested formalism for the scheme based on the Kalos’ formula is introduced, based on which the implementation of the testing technique is carried out. The second layer in a double-layer shield was split into two equivalent layers and the scheme (with the suggested formalism) was implemented on the new “three-layer” shield configuration. The results of such manipulation on water-lead and water-iron shields combinations are presented here for 1 MeV photons. It was found that splitting the second layer introduces some deviation on the overall buildup factor value. This expected deviation appeared to be higher in the case of low Z layer followed by high Z. However, the overall performance of the iterative scheme showed a great consistency and strong coherence even with the introduced changes. The introduced layer-splitting testing technique shows the capability to be implemented in test the iterative scheme with a wide range of formalisms.

Keywords: buildup factor, iterative scheme, stratified shields, layer-splitting tecnique

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Authors: Mahmoud I. Syam, Kamarulzaman Ibrahim, Amer I. Al-Omari

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Stratified double extreme ranked set sampling (SDERSS) method is introduced and considered for estimating the population mean. The SDERSS is compared with the simple random sampling (SRS), stratified ranked set sampling (SRSS) and stratified simple set sampling (SSRS). It is shown that the SDERSS estimator is an unbiased of the population mean and more efficient than the estimators using SRS, SRSS and SSRS when the underlying distribution of the variable of interest is symmetric or asymmetric.

Keywords: double extreme ranked set sampling, extreme ranked set sampling, ranked set sampling, stratified double extreme ranked set sampling

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Authors: Tapas Kumar Sinha, Joseph Mathew

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At the moment earth is in grave danger due to threats of global warming. The temperature of the earth has risen by almost 20C. Glaciers in the Arctic have started to melt. It would be foolhardy to think that this is a small effect and in time it would go away. Global warming is caused by a number of factors. However, one sure and simple way to totally eliminate this problem is to put programmable shields in space. Just as an umbrella blocks sunlight, a programmable shield in space will block sun rays from reaching the earth as in a solar eclipse and cause cooling in the penumbral region just as it happens during an eclipse.

Keywords: glaciers, green house, global warming space, satellites

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Authors: Ahmed I. Raheem

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In this thesis, stratified and stratified wavy flow regimes have been investigated numerically for the oil (1.57 mPa s viscosity and 780 kg/m3 density) and water twophase flow in small and large horizontal steel pipes with a diameter between 0.0254 to 0.508 m by ANSYS Fluent software. Volume of fluid (VOF) with two phases flows using two equations family models (Realizable k-

Keywords: CFD, two-phase flow, pressure gradient, volume of fluid, large diameter, horizontal pipe, oil-water stratified and stratified wavy flow

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Authors: Mahmoud I. Syam

Abstract:

Stratified double median ranked set sampling (SDMRSS) method is suggested for estimating the population mean. The SDMRSS is compared with the simple random sampling (SRS), stratified simple random sampling (SSRS), and stratified ranked set sampling (SRSS). It is shown that SDMRSS estimator is an unbiased of the population mean and more efficient than SRS, SSRS, and SRSS. Also, by SDMRSS, we can increase the efficiency of mean estimator for specific value of the sample size. SDMRSS is applied on real life examples, and the results of the example agreed the theoretical results.

Keywords: efficiency, double ranked set sampling, median ranked set sampling, ranked set sampling, stratified

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Authors: Satish Kumar Dewangan, Santosh Kumar Senapati

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The present work focuses on the investigation of the effect of non-Newtonian behavior on the oil-water stratified flow in a horizontal channel using ANSYS Fluent. Coupled level set and volume of fluid (CLSVOF) has been used to capture the evolving interface assuming unsteady, coaxial flow with constant fluid properties. The diametric variation of oil volume fraction, mixture velocity, total pressure and pressure gradient has been studied. Non-Newtonian behavior of oil has been represented by the power law model in order to investigate the effect of flow behavior index. Stratified flow pattern tends to assume dispersed flow pattern with the change in the behavior of oil to non-Newtonian. The pressure gradient is found to be very much sensitive to the flow behavior index. The findings could be useful in designing the transportation pipe line in petroleum industries.

Keywords: oil-water stratified flow, horizontal channel, CLSVOF, non–Newtonian behaviour.

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Authors: Muqaddas Javed, Muhammad Hanif

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The generalized multivariate ratio and regression type estimators for population mean are suggested under multi-phase stratified systematic sampling (MPSSS) using multi auxiliary information. Estimators are developed under the two different situations of availability of auxiliary information. The expressions of bias and mean square error (MSE) are developed. Special cases of suggested estimators are also discussed and simulation study is conducted to observe the performance of estimators.

Keywords: generalized estimators, multi-phase sampling, stratified random sampling, systematic sampling

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Authors: Y. Madani, H. Achache, B. Boutabout

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The purpose of this paper is to analyze numerically by the three-dimensional finite element method, using ABAQUS calculation code, the mechanical behavior of a unidirectional and multidirectional delaminated stratified composite under mechanical loading in Mode II. This study consists of the determination of the energy release rate G in mode II as well as the distribution of equivalent von Mises stresses along the damaged zone by varying several parameters such as the applied load and the delamination length. It allowed us to deduce that the high energy release rate favors delamination at the free edges of a stratified plate subjected to bending.

Keywords: delamination, energy release rate, finite element method, stratified composite

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Authors: H. Achache, Y. Madani, A. Benzerdjeb

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The present study is based on the three-dimensional digital analysis by the finite elements method of the mechanical loading effect on the delamination of unidirectional and multidirectional stratified composites. The aim of this work is the determination of the release energy rate G in mode I and the Von Mises equivalent constraint distribution along the damaged area under the influence of several parameters such as the applied load and the delamination size. The results obtained in this study show that the unidirectional composite laminates have better mechanical resistance one the loading line than the multidirectional composite laminates.

Keywords: delamination, release energy rate, stratified composite, finite element method, ply

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Authors: Mohammad O. Diab, Sahera A. Saleh, Mustapha M. Dichari, Nijez Aloulou, Omar Hamoui, Feras Chehade

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This study sought to evaluate the efficiency of lead-free sterile radiation shield (Radionex) in the reduction of physician's exposure dose during interventional cardiology procedures. Cardiac catheterization procedures are often associated with high radiation doses and high levels of secondary radiation emitted by the patient's body. This study compares physician exposure dose rate during cardiac catheterization procedures done through the femoral artery with sterile radiation shielding to same procedures made without the shielding. The mean operator radiation dose rate without using the shield was found to be 18.4µSv/min compared to a mean dose rate of 5.1 µSv/min when using the shield, rendering a reduction of 72.5% of radiation received by the physician. Sterile radiation shielding is consequently an effective addition to a cardiac catheterization lab radiation protection system.

Keywords: cardiac catheterization, physician exposure dose, sterile radiation shielding, lead-free sterile radiation shields

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Authors: Zainal Abidin Akasah, Maizam Alias, Azuin Ramli

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The safety and health performances aspects of a building are the most challenging aspect of facility management. It requires a deep understanding by the building managers on the factors that contribute to health and safety performances. This study attempted to develop an explanatory architectural safety performance model for stratified low-cost housing in Malaysia. The proposed Building Safety and Health Performance (BSHP) model was tested empirically through a survey on 308 construction practitioners using Partial Least Squares (PLS) and Structural Equation Modelling (SEM) tool. Statistical analysis results supports the conclusion that architecture, building services, external environment, management approaches and maintenance management have positive influence on safety and health performance of stratified low-cost housing in Malaysia. The findings provide valuable insights for construction industry to introduce BSHP model in the future where the model could be used as a guideline for training purposes of managers and better planning and implementation of building management.

Keywords: building management, stratified low-cost housing, safety, health model

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Authors: K. A. Adeleke

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Often in epidemiological research, introducing stratified Cox model can account for the existence of interactions of some inherent factors with some major/noticeable factors. This research work aimed at modelling correlated variables in infant mortality with the existence of some inherent factors affecting the infant survival function. An alternative semiparametric Stratified Cox model is proposed with a view to take care of multilevel factors that have interactions with others. This, however, was used as a tool to model infant mortality data from Nigeria Demographic and Health Survey (NDHS) with some multilevel factors (Tetanus, Polio, and Breastfeeding) having correlation with main factors (Sex, Size, and Mode of Delivery). Asymptotic properties of the estimators are also studied via simulation. The tested model via data showed good fit and performed differently depending on the levels of the interaction of the strata variable Z*. An evidence that the baseline hazard functions and regression coefficients are not the same from stratum to stratum provides a gain in information as against the usage of Cox model. Simulation result showed that the present method produced better estimates in terms of bias, lower standard errors, and or mean square errors.

Keywords: stratified Cox, semiparametric model, infant mortality, multilevel factors, cofounding variables

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Authors: Nader Parsazadeh

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The variety of bed sediment load relationships, insufficient information and data, and the influence of river conditions make the selection of an optimum relationship for a given river extremely difficult. Hence, in order to select the best formulae, the bed load equations should be evaluated. The affecting factors need to be scrutinized, and equations should be verified. Also, re-evaluation may be needed. In this research, sediment bed load of Dez Dam at Tal-e Zang Station has been studied. After reviewing the available references, the most common formulae were selected that included Meir-Peter and Muller, using MS Excel to compute and evaluate data. Then, 52 series of already measured data at the station were re-measured, and the sediment bed load was determined. 1. The calculated bed load obtained by different equations showed a great difference with that of measured data. 2. r difference ratio from 0.5 to 2.00 was 0% for all equations except for Nilsson and Shields equations while it was 61.5 and 59.6% for Nilsson and Shields equations, respectively. 3. By reviewing results and discarding probably erroneous measured data measurements (by human or machine), one may use Nilsson Equation due to its r value higher than 1 as an effective equation for estimating bed load at Tal-e Zang Station in order to predict activities that depend upon bed sediment load estimate to be determined. Also, since only few studies have been conducted so far, these results may be of assistance to the operators and consulting companies.

Keywords: bed load, empirical relation ship, sediment, Tale Zang Station

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Authors: Nurul Bin Ibrahim

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Advancements in neural networks have offered valuable insights into Fluid Dynamics, notably in addressing turbulence-related challenges. In this research, we introduce multiple applications of models of neural networks, namely Feed-Forward and Recurrent Neural Networks, to explore the relationship between jet formations and stratified turbulence within stochastically excited Boussinesq systems. Using machine learning tools like TensorFlow and PyTorch, the study has created models that effectively mimic and show the underlying features of the complex patterns of jet formation and stratified turbulence. These models do more than just help us understand these patterns; they also offer a faster way to solve problems in stochastic systems, improving upon traditional numerical techniques to solve stochastic differential equations such as the Euler-Maruyama method. In addition, the research includes a thorough comparison with the Statistical State Dynamics (SSD) approach, which is a well-established method for studying chaotic systems. This comparison helps evaluate how well neural networks can help us understand the complex relationship between jet formations and stratified turbulence. The results of this study underscore the potential of neural networks in computational physics and fluid dynamics, opening up new possibilities for more efficient and accurate simulations in these fields.

Keywords: neural networks, machine learning, computational fluid dynamics, stochastic systems, simulation, stratified turbulence

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Authors: Yilei Song, Linlin Tian, Ning Zhao

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Turbulence energetics and structures in the wake of large-scale wind turbines under the stably-stratified atmospheric boundary layer (SABL) can be complicated due to the presence of low-level jets (LLJs), a region of higher wind speeds than the geostrophic wind speed. With a modified one-k-equation, eddy viscosity model specified for atmospheric flows as the sub-grid scale (SGS) model, a realistic atmospheric state of the stable ABL is well reproduced by large-eddy simulation (LES) techniques. Corresponding to the precursor stably stratification, the detailed wake properties of a standard 5-MW wind turbine represented as an actuator line model are provided. An engineering model is proposed for wake prediction based on the simulation statistics and gets validated. Results confirm that the proposed wake model can provide good predictions for wind turbines under the SABL.

Keywords: large-eddy simulation, stably-stratified atmospheric boundary layer, wake model, wind turbine wake

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Authors: Joshua Kim Schimpf, Kyun Doo Kim, Jaseok Heo

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In this study, the droplet behavior of under horizontal stratified flow regime for air and water flow in horizontal pipe experiments from a 0.24 m, 0.095 m, and 0.0486 m size diameter pipe are examined. The effects of gravity, pipe diameter, and turbulent diffusion on droplet deposition are considered. Models for droplet entrainment and deposition are proposed that considers developing length. Validation for experimental data dedicated from the REGARD, CEA and Williams, University of Illinois, experiment were performed using SPACE (Safety and Performance Analysis Code for Nuclear Power Plants).

Keywords: droplet, entrainment, deposition, horizontal

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Authors: A. Giniatoulline

Abstract:

A nonlinear model of the mathematical fluid dynamics which describes the motion of an incompressible viscous rotating fluid in a homogeneous gravitational field is considered. The model is a generalization of the known Navier-Stokes system with the addition of the Coriolis parameter and the equations for changeable density. An explicit algorithm for the solution is constructed, and the proof of the existence and uniqueness theorems for the strong solution of the nonlinear problem is given. For the linear case, the localization and the structure of the spectrum of inner waves are also investigated.

Keywords: Galerkin method, Navier-Stokes equations, nonlinear partial differential equations, Sobolev spaces, stratified fluid

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Authors: Sanam Haseen, Abdul Bari

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In this paper a three stage multivariate programming problem with random survey cost and variances as random variables has been formulated as a non-linear stochastic programming problem. The problem has been converted into an equivalent deterministic form using chance constraint programming and modified E-modeling. An empirical study of the problem has been done at the end of the paper using R-simulation.

Keywords: chance constraint programming, modified E-model, stochastic programming, stratified sample surveys, three stage sample surveys

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Authors: Yuan-Hao Lee, Chia-Wei Lee, Ming-Fang Lin, Tzu-Huei Wu, Chih-Hsiang Ko, Wing P. Chan

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Computed tomography (CT) scan of the head is a good method for investigating cranial lesions. However, radiation-induced oxidative stress can be accumulated in the eyes and promote carcinogenesis and cataract. In this regard, we aimed to protect the eyes with barium sulfate shield(s) during CT scans and investigate the resultant image quality and radiation dose to the eye. Patients who underwent health examinations were selectively enrolled in this study in compliance with the protocol approved by the Ethics Committee of the Joint Institutional Review Board at Taipei Medical University. Participants’ brains were scanned with a water-based marker simultaneously by a multislice CT scanner (SOMATON Definition Flash) under a fixed tube current-time setting or automatic tube current modulation (TCM). The lens dose was measured by Gafchromic films, whose dose response curve was previously fitted using thermoluminescent dosimeters, with or without barium sulfate or bismuth-antimony shield laid above. For the assessment of image quality CT images at slice planes that exhibit the interested regions on the zygomatic, orbital and nasal bones of the head phantom as well as the water-based marker were used for calculating the signal-to-noise and contrast-to-noise ratios. The application of barium sulfate and bismuth-antimony shields decreased 24% and 47% of the lens dose on average, respectively. Under topogram-based TCM, the dose saving power of bismuth-antimony shield was mitigated whereas that of barium sulfate shield was enhanced. On the other hand, the signal-to-noise and contrast-to-noise ratios of DSCT images were decreased separately by barium sulfate and bismuth-antimony shield, resulting in an overall reduction of the CNR. In contrast, the integration of topogram-based TCM elevated signal difference between the ROIs on the zygomatic bones and eyeballs while preferentially decreasing the signal-to-noise ratios upon the use of barium sulfate shield. The results of this study indicate that the balance between eye exposure and image quality can be optimized by combining eye shields with topogram-based TCM on the multislice scanner. Eye shielding could change the photon attenuation characteristics of tissues that are close to the shield. The application of both shields on eye protection hence is not recommended for seeking intraorbital lesions.

Keywords: computed tomography, barium sulfate shield, dose saving, image quality

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Authors: Zhidong Zhang, Zhi-Chao Zhang, Georgianna Duarte

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This study investigated the attention problems with the instrument of Achenbach System of Empirically Based Assessment (ASEBA). Two thousand eight hundred and ninety-four adolescents were surveyed by using a stratified sampling method. We examined the relationships between relevant background variables and attention problems. Multiple regression models were applied to analyze the data. Relevant variables such as sports activities, hobbies, age, grade and the number of close friends were included in this study as predictive variables. The analysis results indicated that educational environments and extracurricular activities are important factors which influence students’ attention problems.

Keywords: adolescents, ASEBA, attention problems, educational environments, stratified sampling

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Authors: A. Giniatoulline

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A model of the mathematical fluid dynamics which describes the motion of a three-dimensional viscous rotating fluid in a homogeneous gravitational field with the consideration of the salinity and heat transfer is considered in a vertical finite layer. The model is a generalization of the linearized Navier-Stokes system with the addition of the Coriolis parameter and the equations for changeable density, salinity, and heat transfer. An explicit solution is constructed and the proof of the existence and uniqueness theorems is given. The localization and the structure of the spectrum of inner waves is also investigated. The results may be used, in particular, for constructing stable numerical algorithms for solutions of the considered models of fluid dynamics of the Atmosphere and the Ocean.

Keywords: Fourier transform, generalized solutions, Navier-Stokes equations, stratified fluid

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Authors: David Alejandro Lazo-Vasquez, Jorge Luis Balino

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In the petroleum industry, multiphase flow occurs when oil, gas, and water are transported in the same pipe through large pipeline systems. The flow can take different patterns depending on parameters like fluid velocities, pipe diameter, pipe inclination, and fluid properties. Mainly, intermittent flow is produced by the natural propagation of short and long waves, according to the Kelvin-Helmholtz Stability Theory. To model stratified flow and the onset of intermittent flow, it is crucial to have knowledge of short and long waves behavior. The two-fluid model, frequently employed for characterizing multiphase systems, becomes ill-posed for high liquid and gas velocities and large inclination angles, for short waves can develop infinite growth rates. We are interested in focusing attention on long-wave instability, which leads to the production of roll waves that may grow and result in the transition from stratified flow to intermittent flow. In this study, global and local linear stability analyses for dynamic and kinematic stability criteria predict the regions of stability of the flow for different pipe inclinations and fluid velocities in regularized and non-regularized systems, concurrently. It was possible to distinguish when: wave growth rates are absolutely bounded (stable stratified smooth flow), waves have finite growth rates (unstable stratified wavy flow), and when the equation system becomes elliptic and hyperbolization is needed. In order to bound short wave growth rates and regularize the equation system, we incorporated some lower and higher-order terms like interfacial drag and surface tension, respectively.

Keywords: linear stability analysis, multiphase flow, onset of slugging, two-fluid model regularization

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Authors: Maria Neagu

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This paper presents the heat and mass driven natural convection succession in a Darcy thermally stratified porous medium that embeds a vertical semi-infinite impermeable wall of constant heat flux and concentration. The scale analysis of the system determines the two possible maps of the heat and mass driven natural convection sequence along the wall as a function of the process parameters. These results are verified using the finite differences method applied to the conservation equations.

Keywords: finite difference method, natural convection, porous medium, scale analysis, thermal stratification

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Authors: Kudu Dangana, Pai H. Halilu, Osesienemo R. Asiribo-Sallau, Garba Inuwa Kuta

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The study examined the determinants of household water accessibility in Southern part of Niger State, Nigeria. Data for the study was obtained from primary and secondary sources using questionnaire, interview, personal observation and documents. 1,192 questionnaires were administered; sampling techniques adopted are combination of purposive, stratified and simple random. Purposive sampling technique was used to determine sample frame; sample unit was determined using stratified sampling method and simple random technique was used in administering questionnaires. The result was analyzed within the scope of “WHO” water accessibility indicators using descriptive statistics. Major sources of water in the area are well; hand and electric pump borehole and streams. These sources account for over 90% of household’s water. Average per capita water consumption in the area is 22 liters per day, while location efficiency of facilities revealed an average of 80 people per borehole. Household water accessibility is affected mainly by the factors of distances, time spent to obtain water, low income status of the majority of respondents to access modern water infrastructure, and to a lesser extent household size. Recommendations includes, all tiers of government to intensify efforts in providing water infrastructures and existing ones through budgetary provisions, and communities should organize fund raising bazaar, so as to raise fund to improve water infrastructures in the area.

Keywords: accessibility, determined, stratified, scope

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Authors: Francesco Scarpati

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Because of their long history, ranging from ancient times to the present day, European cities feature many historical layers, whose single identities are represented by traces surviving in the urban design. However, urban transformations, in particular, the ones that have been produced by the property speculation phenomena of the 20th century, often compromised the readability of these traces, resulting in a loss of the historical identities of the single layers. The purpose of this research is, therefore, a reflection on the theme of the reenactment of the historical memory in the stratified European contexts and on how contemporary architecture can help to reveal past signs of the cities. The research work starts from an analysis of a series of emblematic examples that have already provided an original solution to the described problem, going from the architectural detail scale to the urban and landscape scale. The results of these analyses are then applied to the case study of the city of Naples, as an emblematic example of a stratified city, with an ancient Greek origin; a city where it is possible to read most of the traces of its transformations. Particular consideration is given to the trace of the medieval walls of the city, which a long time ago clearly divided the city itself from the outer fields, and that is no longer readable at the current time. Finally, solutions and methods of intervention are proposed to ensure that the trace of the walls, read as a boundary, can be revealed through the contemporary project.

Keywords: contemporary project, historic memory, historic urban contexts, medieval walls, naples, stratified cities, urban traces

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Authors: Govind Sharma, Bahni Ray

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Ubiquitous nature of particle settling is governed by the presence of the surrounding fluid medium. Thermally stratified fluid alters the settling phenomenon of particles as well as their interactions. Direct numerical simulation (DNS) is carried out with an open-source library Immersed Boundary Adaptive Mesh Refinement (IBAMR) to quantify the fundamental mechanism based on Distributed Lagrangian Multiplier (DLM). The presence of background density gradient due to thermal stratification replaces the drafting-kissing-tumbling in a homogeneous fluid to drafting-kissing-separation behavior. Simulations are performed with a varying range of particle-fluid density ratios, and it is shown that the stratification effect on particle interactions varies with density ratio. It is observed that the combined role of buoyancy and inertia govern the physical mechanism of particle-particle interaction.

Keywords: direct numerical simulation, distributed lagrangian multiplier, rigidity constraint, sedimentation, stratification

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Authors: A. Giniatoulline

Abstract:

We consider the internal oscillations of the ocean which are caused by the gravity force and the Coriolis force, for different models with changeable density, heat transfer, and salinity. Traditionally, the mathematical description of the resonance effect is related to the growing amplitude as a result of input vibrations. We offer a different approach: the study of the relation between the spectrum of the internal oscillations and the properties of the limiting amplitude of the solution for the harmonic input vibrations of the external forces. Using the results of the spectral theory of self-adjoint operators in Hilbert functional spaces, we prove that there exists an explicit relation between the localization of the frequency of the external input vibrations with respect to the essential spectrum of proper inner oscillations and the non-uniqueness of the limiting amplitude. The results may find their application in various problems concerning mathematical modeling of turbulent flows in the ocean.

Keywords: computational fluid dynamics, essential spectrum, limiting amplitude, rotating fluid, spectral theory, stratified fluid, the uniqueness of solutions of PDE equations

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Authors: Yagya Sharma, Basanta K. Rana, Arup K. Das

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Rotary entrainment is a phenomenon in which the interfaces of two immiscible fluids are subjected to external flux in the form of rotation. Present work reports the experimental study on rotary motion of a horizontal cylinder between the interface of air and water to observe the penetration of gas inside the liquid. Experiments have been performed to establish entrainment of air mass in water alongside the cylindrical surface. The movement of tracer and seeded particles have been tracked to calculate the speed and path of the entrained air inside water. Simplified particle image velocimetry technique has been used to trace the movement of particles/tracers at the moment they are injected inside the entrainment zone and suspended beads have been used to replicate the particle movement with respect to time in order to determine the flow dynamics of the fluid along the cylinder. Present paper establishes a thorough experimental analysis of the rotary entrainment phenomenon between air and water keeping in interest the extent to which we can intermix the two and also to study its entrainment trajectories.

Keywords: entrainment, gas-liquid flow, particle image velocimetry, stratified layer mixing

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Authors: Amirah Azzeri, Fatiha H. Shabaruddin, Scott A. McDonald, Rosmawati Mohamed, Maznah Dahlui

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Objective: A scaled-up treatment cascade with direct-acting antiviral (DAA) therapy is necessary to achieve global WHO targets for hepatitis C virus (HCV) elimination in Malaysia. Recently, limited access to Sofosbuvir/Daclatasvir (SOF/DAC) is available through compulsory licensing, with future access to Sofosbuvir/Velpatasvir (SOF/VEL) expected through voluntary licensing due to recent agreements. SOF/VEL has superior clinical outcomes, particularly for cirrhotic stages, but has higher drug acquisition costs compared to SOF/DAC. It has been proposed that a stratified treatment cascade might be the most cost-efficient approach for Malaysia whereby all HCV patients are treated with SOF/DAC except for patients with cirrhosis who are treated with SOF/VEL. This study aimed to conduct a five-year budget impact analysis from the provider perspective of the proposed stratified treatment cascade for HCV treatment in Malaysia. Method: A disease progression model that was developed based on model-predicted HCV epidemiology data in Malaysia was used for the analysis, where all HCV patients in scenario A were treated with SOF/DAC for all disease stages while in scenario B, SOF/DAC was used only for non-cirrhotic patients and SOF/VEL was used for the cirrhotic patients. The model projections estimated the annual numbers of patients in care and the numbers of patients to be initiated on DAA treatment nationally. Healthcare costs associated with DAA therapy and disease stage monitoring was included to estimate the downstream cost implications. For scenario B, the estimated treatment uptake of SOF/VEL for cirrhotic patients were 25%, 50%, 75%, 100% and 100% for 2018, 2019, 2020, 2021 and 2022 respectively. Healthcare costs were estimated based on standard clinical pathways for DAA treatment described in recent guidelines. All costs were reported in US dollars (conversion rate US$1=RM4.09, the price year 2018). Scenario analysis was conducted for 5% and 10% reduction of SOF/VEL acquisition cost anticipated from the competitive market pricing of generic DAA in Malaysia. Results: The stratified treatment cascade with SOF/VEL in Scenario B was found to be cost-saving compared to Scenario A. A substantial portion of the cost reduction was due to the costs associated with DAA therapy which resulted in USD 40 thousand (year 1) to USD 443 thousand (year 5) savings annually, with cumulative savings of USD 1.1 million after 5 years. Cost reductions for disease stage monitoring were seen in year three onwards which resulted in cumulative savings of USD 1.1 thousand. Scenario analysis estimated cumulative savings of USD 1.24 to USD 1.35 million when the acquisition cost of SOF/VEL was reduced. Conclusion: A stratified treatment cascade with SOF/VEL was expected to be cost-saving and can results in a budget impact reduction in overall healthcare expenditure in Malaysia compared to treatment with SOF/DAC. The better clinical efficacy with SOF/VEL is expected to halt patients’ HCV disease progression and may reduce downstream costs of treating advanced disease stages. The findings of this analysis may be useful to inform healthcare policies for HCV treatment in Malaysia.

Keywords: Malaysia, direct acting antiviral, compulsory licensing, voluntary licensing

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