Costa Rica’s annual mean precipitation is above 3300 mm, but this precipitation is not evenly distributed in time or space, producing clear differentiated wet and dry seasons in most of the country. Droughts are also common phenomena which greatly affect the availability of water resources. Managed aquifer recharge (MAR) schemes are being taken into consideration to enhance the underground water storage capacity of the country. The present study constitutes the first assessment for the identification of suitable sites for the implementation of MAR technology spreading methods (SM) in Costa Rica. The suitable sites are identified by means of a geographic information system multi-criteria decision analysis (GIS-MCDA) based on four criteria: hydrogeological aptitude, terrain slope, top soil texture and drainage network density. Four steps are performed in order to identify these sites: problem definition, screening for suitable areas, suitability mapping, and sensitivity analysis. The suitability map was divided in two zones after the screening: suitable and unsuitable, the first zone was further divided in five classes according to the weighted linear combination (WLC) ranking. The results indicate that 61% of the country is suitable for conducting SM. This map is a tool for future implementation of MAR techniques in the country.

This research presents an overview of different sustainable energy development scenarios in Central Europe and East Asia, and is aimed to evaluate the efficiency and availability for introducing a specific sustainable energy source. Accordingly: wind, hydropower, solar, bioenergy, geothermal, nuclear energy. By conducting analysis though multi criteria decision analysis (MCDA) and analytic hierarchy process (AHP) models, divergences among energy options in Central Europe and East Asia are emphasised due to its preferences in hierarchy. A short introduction, related to the present energy outlook with a series of relative regressions and a case study based on corresponding statistics, is presented firstly. This gives insights to assess the evaluation of sustainable energy development options. Evaluation results indicating Central Europe and East Asia should introduce different sustainable energy technologies on account of their own strengths and drawbacks in energy judgements and criterions. Keywords Sustainable energy, energy development, Central Europe, East Asia, energy scenario, energy option, evaluation, multi criteria decision analysis (MCDA), analytic hierarchy process (AHP)

Au Canada, il y a environ 21 000 décès et 84 069 hospitalisations liés à un infarctus du myocarde (IM) par année, ce qui représente environ 1,27 milliard de dollars canadiens ($ CA) en coûts directs reliés aux traitements aigus et chroniques. Parmi ces traitements, la double thérapie antiplaquettaire (DAPT) a été démontrée efficace pour diminuer le risque de complications reliées à l’IM. Cependant, malgré ces avantages cliniques, la persistance au traitement observée dans la vie réelle au Québec avec le DAPT à base de ticagrélor est inférieure à celle des autres inhibiteurs du récepteur P2Y12. L’objectif de ce projet était d’élaborer un modèle décisionnel permettant d’évaluer le rapport coût-utilité du ticagrélor-DAPT dans des conditions de persistance imparfaite chez les patients québécois souffrant d’IM et ainsi, déterminer si une intervention à l’échelle de la province visant à accroître la persistance serait justifiable. Un arbre de décision, modélisant l’évolution des patients atteints d’un IM sur une période d’un an, a été développé pour comparer quatre durées de persistance avec une observance parfaite avec le ticagrélor-DAPT (3, 6, 9 et 12 mois) à une stratégie d’observance parfaite avec 12 mois de clopidogrel-DAPT (traitement de référence). Trois événements cliniques ont été modélisés : l’IM récurent, le décès cardiovasculaire et le saignement majeur. Les probabilités de ces événements ont été extraites d’essais cliniques randomisés pertinents en utilisant les courbes de survie de Kaplan-Meier publiées. Les utilités nécessaires pour calculer les QALYs ont été dérivées de la littérature. Les coûts ont été estimés à partir de la littérature canadienne et de la liste des médicaments de la Régie de l'assurance maladie du Québec et ont été exprimés en $ CA de 2018. L’analyse principale consistait en une simulation probabiliste de Monte-Carlo. À un coût moyen par année de vie gagnée ajustée pour la qualité de vie (QALY) de 43 398 $ CA, les résultats de l’analyse principale ont démontré que 3 mois de ticagrélor-DAPT avait 59,31 % des chances d’être rentable à un seuil décisionnel (« willingness-to-pay ») de 50 000 $ CA par QALY. De plus, les analyses de sensibilité démontrent que le rapport coût-efficacité du ticagrélor-DAPT était sensible au coût du décès cardiovasculaire et au coût du ticagrélor. En présumant un coût de ticagrélor compatible avec un médicament générique, 3 mois, 6 mois et 9 mois de ticagrélor-DAPT étaient dominants et 12 mois de ticagrélor-DAPT avaient une forte probabilité d'être rentable (98,8 %). Cette analyse en arrive aussi à la conclusion que 3 mois de ticagrélor-DAPT sont probablement rentables par rapport à 12 mois de clopidogrel-DAPT. Avec un niveau de preuve de modéré à fort, nous concluons donc qu'aucune intervention particulière n'est justifiée en ce qui concerne la politique provinciale pour améliorer le taux de persistance au ticagrélor après un IM. / In Canada, there are approximately 21,000 deaths and 84,069 hospitalizations related to myocardial infarction (MI) per year, representing approximately Can$1.27 billion in direct costs related to acute and chronic care. Despite the demonstrated health benefits of dual antiplatelet therapy (DAPT) after an MI, observed real-world persistence to treatment with ticagrelor-based DAPT in Québec is lower than that observed with other P2Y12 receptor inhibitors. The objective of this project was to develop a decision-making model to evaluate the cost-utility ratio of ticagrelor-DAPT under conditions of imperfect persistence in Quebec patients suffering from MI, and thus to determine whether a province-wide intervention to increase persistence would be justifiable. A decision tree describing the patient course in the first year following an MI was developed in order to compare four different durations of persistence with perfect adherence with ticagrelor-DAPT (3, 6, 9 and 12 months) to perfect adherence with a 12-month regimen clopidogrel-DAPT (reference treatment). Three clinical events were modeled: recurrent MI, cardiovascular death and major bleeding. The probabilities of these events were extracted from relevant randomized clinical trials using published Kaplan-Meier survival curves. The utilities needed to calculate the QALYs were derived from the literature. The costs were estimated from the Canadian literature and the list of medications from the Régie de l'assurance maladie du Québec and were expressed in Can$ 2018. The reference case analysis consisted of a probabilistic Monte Carlo simulation. At a mean cost per quality adjusted life year (QALY) gained of Can$43,398, the results of the base case analysis showed that 3 months of ticagrelor-DAPT had a 59.31% likelihood of being considered cost-effective using a willingness-to-pay threshold of Can$50,000/QALY. Moreover, the sensitivity analyses showed that the cost-effectiveness of ticagrelor-DAPT was sensitive to the cost of cardiovascular death and the cost of ticagrelor. Assuming a cost of ticagrelor compatible with a generic drug, the 4 durations of persistence with ticagrelor-DAPT are almost guaranteed to be profitable. When a generic cost of ticagrelor was assumed, 3 months, 6 months and 9 months of ticagrelor-DAPT were dominant and 12 months of ticagrelor-DAPT were highly likely to be cost-effective (98.8%). This analysis also conclude that as little as 3 months of ticagrelor-DAPT is likely to be cost-effective compared to 12 months of clopidogrel-DAPT. With a moderate to strong level of evidence, we therefore conclude that no specific intervention is warranted at the provincial policy level to improve persistence rate with ticagrelor treatment after MI.

Research in the area of public procurement has gained increasing attention with increasing interest in researching different evaluation methods for incoming tenders in procurement. The study analyzed the structure for procurement with a multi-criteria model for observation of changes in ranking and studied the importance of correct scoring. A sensitivity and robustness analysis were used as a tool to study the stability and the strength of a contracting entity's priorities. The purpose of this thesis was a study to determine if the ranking of tenders became more sensitive to the structure of the model or for each tender's evaluation, where it was found that the ability to correctly score points was more crucial than being critical of weights assigned to the criteria in the procurement, respectively. Relationship between price and quality turned out to be unknown to some extent, the connection could be determined after all tenders were submitted and accumulated points were available. / Forskning inom området offentlig upphandling har fått allt mer uppmärksamhet när intresset hamnat på undersökning av olika utvärderingsmetoder för inkommande anbud vid en upphandling. I studien analyserades uppbyggnaden för upphandlingar med en multikriteriemodell för observation över förändringar hos rangordning samt studerandet av vikten för en korrekt poängsättning. En känslighets- och robusthetsanalys tillämpades som verktyg för att studera stabiliteten och styrkan hos en upphandlande entitets prioriteringar. Syftet med uppsatsen var en undersökning för en bedömning om rangordningen av upphandlingars anbud blev känsligast mot strukturen på modellen eller för varje anbuds värdering, där det visade sig att förmågan för korrekt poängtilldelning var mer avgörande än att vara kritisk till vikterna som tilldelades respektive kriterier inom upphandlingen. Relationen mellan pris och kvalitet visade sig vara okänd till viss del, sambandet kunde avgöras efter att alla anbud var inskickade och samlade poäng fanns att tillhandahålla.