Impact of radiofrequency ablation for patients with varicose veins on the budget of the German statutory health insurance system

Objectives: In contrast to other countries, surgery still represents the common invasive treatment for varicose veins in Germany. However, radiofrequency ablation, e.g. ClosureFast, becomes more and more popular in other countries due to potential better results and reduced side effects. This treatment option may cause less follow-up costs and is a more convenient procedure for patients, which could justify an introduction in the statutory benefits catalogue. Therefore, we aim at calculating the budget impact of a general reimbursement of ClosureFast in Germany. Methods: To assess the budget impact of including ClosureFast in the German statutory benefits catalogue, we developed a multi-cohort Markov model and compared the costs of a “World with ClosureFast” with a “World without ClosureFast” over a time horizon of five years. To address the uncertainty of input parameters, we conducted three different types of sensitivity analysis (one-way, scenario, probabilistic). Results: In the Base Case scenario, the introduction of the ClosureFast system for the treatment of varicose veins saves costs of about 19.1 Mio. € over a time horizon of five years in Germany. However, the results scatter in the sensitivity analyses due to limited evidence of some key input parameters. Conclusions: Results of the budget impact analysis indicate that a general reimbursement of ClosureFast has the potential to be cost-saving in the German Statutory Health Insurance.

The impact of geometric non-linearities on the fatigue analysis of trailing edge bond lines in wind turbine rotor blades

The accurate prediction of stress histories for the fatigue analysis is of utmost importance for the design process of wind turbine rotor blades. As detailed, transient, and geometrically non-linear three-dimensional finite element analyses are computationally weigh too expensive, it is commonly regarded sufficient to calculate the stresses with a geometrically linear analysis and superimpose different stress states in order to obtain the complete stress histories. In order to quantify the error from geometrically linear simulations for the calculation of stress histories and to verify the practical applicability of the superposition principal in fatigue analyses, this paper studies the influence of geometric non-linearity in the example of a trailing edge bond line, as this subcomponent suffers from high strains in span-wise direction. The blade under consideration is that of the IWES IWT-7.5-164 reference wind turbine. From turbine simulations the highest edgewise loading scenario from the fatigue load cases is used as the reference. A 3D finite element model of the blade is created and the bond line fatigue assessment is performed according to the GL certification guidelines in its 2010 edition, and in comparison to the latest DNV GL standard from end of 2015. The results show a significant difference between the geometrically linear and non-linear stress analyses when the bending moments are approximated via a corresponding external loading, especially in case of the 2010 GL certification guidelines. This finding emphasizes the demand to reconsider the application of the superposition principal in fatigue analyses of modern flexible rotor blades, where geometrical nonlinearities become significant. In addition, a new load application methodology is introduced that reduces the geometrically non-linear behaviour of the blade in the finite element analysis.