Dominance, cost-effectiveness

Cycloahphatic amine production economics are dominated by raw material charges and process equipment capital costs. Acetone (isophorone), adiponitnle, aniline, and MDA are all large-volume specification organic intermediates bordering on commodity chemicals. They are each cost-effective precursors. 

Synthetic polymers have become extremely important as materials over the past 50 years and have replaced other materials because they possess high strength-to-weight ratios, easy processabiUty, and other desirable features. Used in appHcations previously dominated by metals, ceramics, and natural fibers, polymers make up much of the sales in the automotive, durables, and clothing markets. In these appHcations, polymers possess desired attributes, often at a much lower cost than the materials they replace. The emphasis in research has shifted from developing new synthetic macromolecules toward preparation of cost-effective multicomponent systems (ie, copolymers, polymer blends, and composites) rather than preparation of new and frequendy more expensive homopolymers. These multicomponent systems can be "tuned" to achieve the desired properties (within limits, of course) much easier than through the total synthesis of new macromolecules. 

In the thermochromic liquid crystal (TLC) the dominant reflected wavelength is temperature-dependent and it has been employed for full-field mapping of temperature fields for over three decades. Although it is non-intrusive and cost effective, there are some problems in applying it to micro-scale measurements, because of size (typically tens of micrometers) and time response (from a few milliseconds to several hundred milliseconds depending on the material and the form). Examples of application are micro-fabricated systems (Chaudhari et al. 1998 Liu et al. 2002) and electronic components (Azar et al. 1991). 

In all analyses, there is uncertainty about the accuracy of the results that may be dealt with via sensitivity analyses [1, 2]. In these analyses, one essentially asks the question What if These allow one to vary key values over clinically feasible ranges to determine whether the decision remains the same, that is, if the strategy initially found to be cost-effective remains the dominant strategy. By performing sensitivity analyses, one can increase the level of confidence in the conclusions. Sensitivity analyses also allow one to determine threshold values for these key parameters at which the decision would change. For example, in the previous example of a Bayesian evaluation embedded in a decision-analytic model of pancreatic cancer, a sensitivity analysis (Fig. 24.6) was conducted to evaluate the relationship... 

Hyphenated analytical techniques such as LC-MS, which combines liquid chromatography and mass spectrometry, are well-developed laboratory tools that are widely used in the pharmaceutical industry. Eor some compounds, mass spectrometry alone is insufficient for complete structural elucidation of unknown compounds nuclear magnetic resonance spectroscopy (NMR) can help elucidate the structure of these compounds (see Chapter 20). Traditionally, NMR experiments are performed on more or less pure samples, in which the signals of a single component dominate. Therefore, the structural analysis of individual components of complex mixtures is normally time-consuming and less cost-effective. The... 

Drugs that are more (or equally) effective than the comparator drug (or service) and which have total costs that are either equal to or less than those of the comparator drug are generally considered to be a cost-effective option. It should be noted that if a drug is both more effective and has lower overall costs than the comparator, it is said to dominate the alternative. Readers should be aware that in cases of dominance some study authors will not provide the cost-effectiveness ratio rather, they will simply state that the comparator drug was dominated. 

Markets for pharmaceutical products worldwide are less than well balanced. Markets dominated by the monopsonistic (single-buyer) power of government can exercise undue power over the supply side of the market and depress prices to dynamically inefficient levels. At the other extreme, markets with an ill-informed and typically feeble demand side, weakened further by moral hazard inherent in health third-party payment, are unduly dominated by the supply side. What is needed instead are markets with more evenly balanced of power, in which both sides of the market are accurately informed about the prices, clinical effectiveness, and cost effectiveness of the rival products being offered for sale. Creating such markets is one of the major challenges confronting health care policy makers around the globe. 

Cost-effective technologies have been gaining importance in the last few years due to the expiration of patents of the first-generation biopharmaceuticals (Table 16.2). In the past, the concept of time-to-market dominated the industrial arena. Nowadays, companies are willing to focus on process optimization and cost reduction. Important tools for this purpose are the use of advanced genetic manipulation techniques to increase the cell specific productivity, as well as the development of perfusion processes, to increase volumetric productivity, and more efficient purification processes, to improve yield (see Chapters 3, 9, 11 and 12). 

The greater the number of such characteristics the greater the scale of potential reengineering required. In fact it may reach a stage where it is more cost-effective to entirely replace the system. Pharmaceutical and healthcare companies are encouraged to collect their own metrics to make this decision process more objective. Typically such decisions are very subjective, and care should be taken to make sure the decision is not unduly influenced by dominant personalities rather than real needs. 

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