Business plan

Business plan Project title: Early Environmental quality and life-course mental health effect Project Number: 874724 Project Acronym: Equal-Life Work package 10 – Deliverable D10.8 Table 1. History of changes Version Publication date Change 01 30.09.2024 • Original draft 02 16.04.2025 • Revised version based on comments 03 !6.06.2025 • Final version ready for submission H2020 program Grant agreement numbers 874724 (Equal-Life), Project start date: Jan 1st 2020 Duration: 66 months Project Coördinator: Irene van Kamp (RIVM) WP (number and title) EQUAL-LIFE WP10 Deliverable Number EQUAL-LIFE D10.8 Deliverable Title Business plan Due date M45 Actual date M65 D10.8 2 This project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 874724 Dissemination Level Public Lead beneficiary RIVM Responsible authors Irene van Kamp, Hendriek Boshuizen E-mail / phone responsible authors [email protected] +31 30886893222 Co-authors Sonja Jeram [email protected] Dirk Schreckenberg [email protected] Peter van den Hazel [email protected] Marco Balduini [email protected] Kim van Wijk [email protected] Katja Kanninen [email protected] Dick Botteldooren [email protected] Maarten Hornikx [email protected] Achilleas Psyllidis [email protected] Reviewers Erik Lebret [email protected] Contents Summary .................................................................................................................................................... 4 1. Introduction ........................................................................................................................................ 5 2. Frameworks of action ......................................................................................................................... 5 2.1 Three ‘E’ Framework of intervention ......................................................................................... 8 3. Economic impacts : Early intervention pays off ................................................................................. 9 4. Expected impact of Equal-Life and related interventions ................................................................ 10 5. Products to be exploited .................................................................................................................. 11 5.1 Training protocol for the tools ................................................................................................. 13 Training is one of the main elements mentioned by Maibach and of the “roof” in the 'temple of interdisciplinary intervention'. It is needed for successful dissemination of the results. .................... 13 5.2 Patent Mental Health Biomarkers ............................................................................................ 17 5.3 Innovative noise models ........................................................................................................... 18 6. Conclusion and future action ........................................................................................................... 21 D10.8 4 This project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 874724 Summary The Equal-Life project seeks to evaluate the impact of the environments in which European children are raised on their mental health and cognitive development from conception to young adulthood. The guidelines and tools developed in this project are designed for use by a variety of end-users, including researchers, policymakers, and practitioners. For optimal dissemination, collaboration between many different types of practitioners and decision-makers is ideally needed. This includes the people who shape public health and health care programs and policies. But it also includes the people who perform impact assessments, shape environments (urban planners) and influence programs and policies in a wide variety of other aspects of the public sector (including public health, education, housing, transportation, environment, urban planning and economic development), and in the non-profit and for-profit sectors (e.g., childcare, education, free time activities). Successfully addressing these dissemination challenges will require a combination of methods including communication outreach, marketing, advocacy, illustrated with successful examples, technical and training assistance, and enabling the adaptation of evidence-based models to new circumstances and their assessment. We make a distinction between profit and non-profit exploitation of the results of the project. In separate reports we have provided an overview of all the different products of the Equal-Life project, and a dissemination strategy. These include the repository of Horizon2020 projectsZenodo (https://zenodo.org/communities/equal_life) and the Equal-Life website (Equal-Life website) and the website where the tools are hosted ((https://www.equal-life-toolbox.eu/). Potential users have been described in D10.7 which is also publicly available. Most of the products, metadata and data and codes of the project will be made publicly available and allow for non-commercial exploitation. Of the different products which were described in detail in D10.6 four were identified as having potential to be commercially of interest. These include 1) The training protocols for the tools, 2) The biomarkers for mental health and 3) the innovative noise models, developed in Equal Life 4) Urban Analytics Tools. The principal objective for exploitation in the Equal-Life project is to implement a strategy to facilitate the successful exploitation and adoption of results and benefits within public health initiatives, research communities and policy advisers. Exploitation activities in the Equal-Life project aim to ensure the longevity of the project’s results through either policy uptake, further research or commercial applications. This deliverable comprises the final plan for business and exploitation of results. D10.8 5 This project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 874724 1. Introduction Early life stage exposures to physical and social environments have a strong impact on mental health, cognitive development, and health inequalities later in life. The overall aim of Equal-Life project is to assess the developmental consequences of the environments European children grow up in for their mental health and cognitive development from conception to young adulthood. This will form the basis for improving unfavourable environments and development of supportive and restorative environments for children and adolescents. Consequently, Equal-Life will contribute significantly to reducing the burden of disease associated with mental health issues and cognitive development challenges. o by providing insight in the key social and physical predictors of mental ill-health and cognitive development of children, based on the exposome approach; o by linking exposures to biological and social indicators of mental ill-health and cognitive development; o by better understanding the key mechanisms linking the exposome (internal, external, social) via intermediate effects (biomarkers) to a distinct set of outcomes symptoms, and diagnosed disorders); o by laying a scientific base for a set of interventions improving children's health and cognitive development; o by providing instructions for risk assessment of physical and social exposures associated with (mental) health and cognitive development of children; o by delivering a toolkit for policymakers, urban planners, educational, social, environmental and health practitioners which will be publicly available; o with guidance to identify, acquire and use the information needed to assess hazards, negative as well as beneficial exposures and the corresponding (mental) health risks and improvements in their given social context at local and/or national level; and o access to information about implementation and good practice examples for interventions. Key question is what the spin off could be of Equal-Life results and what the requirements are to do so in an effective and sustainable way. Companies that prepare spatial plans should include topics for children and topics on social, environmental and health aspects. However, this should be written in the legislation as guidelines may not be enough to implement the change. 2. Frameworks of action To start giving an answer to these questions about spin-off and profit as well as non-profit users of the results we use the framework of action developed by Maibach et al (2007), see Figure 1, that describes the different fields of influence in the public health domain, based on a People & Places Framework. This framework describes the relevant attributes of people as operating in individual, social network, and community or population levels of analysis, and the relevant attributes of places as operating in local and distal levels of analysis. This framework is well aligned with the ecological model of Bronfenbrenner, see Figure 2, and the approach we use of the fit of children and their environments from different perspectives as we described in the original proposal of Equal-Life. (van Kamp et al, 2022). a) D10.8 6 This project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 874724 Figure 1: People and place framework (Maibach et al, 2007) 1 Figure 2: Bronfenbrenner's ecological model. Adapted by Joel Gibbs12 1 Safety and perception should be added to community aspects D10.8 7 This project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 874724 The organizations mentioned in the layer of the local and immediate environment, offer some good examples of stakeholders, profit as well as non-profit who could and would use our work. Within the ecological model this is the immediate family. Local environment refers to local level (Maibach) and the local environment, formal networks and services (Bronfenbrenner). Also policymakers representing the domains in the broader economic, policy, and other layers. These parties do not operate in isolation and a multidisciplinary effort is needed to develop any business case. These frameworks have the assumption in common that health is shaped in a complex interplay between factors which play a role in the interaction of a person/in our case young people from 0-21 and their physical and social environment. Understanding these processes could help identify the key stakeholders who are also the potential end users of our tools and in particular contributing to preventive action. Herby we should be aware that the end users mentioned in D10.7 are not necessarily those who will apply our tools and results. This includes a broad range of parties such as urban planners, social workers, (landscape) architects, acousticians, teachers, transport systems, cultural organisations, media, risk assessor. The notion that processes at different scale levels play a role in human behaviour and health is not new and dates to more than a century ago. One of the key representatives from the social domain is Durkheim who commented: “The group thinks, feels and acts entirely differently from the way its members would if they were isolated. If therefore we begin by studying these members separately, we will understand nothing about what is taking place in the group”. Even though Durkheim's work over a century ago illustrated the importance of population attributes on health (on mental health issues), the relevant attributes of groups, communities, and populations with regard to health behaviours and health are perhaps the least well understood thus far. What we are trying to achieve here is to develop a business plan from a holistic point of view. The challenges we are confronted with in public health prevention were well worded by Maibach et al, 2007. “Conceptually, the challenges are straight-forward: encouraging practitioners and policy makers to factor the evidence-base into their decision-making; and making it easy for them to effectively do so. To fully harness the value of the evidence-based public health paradigm, however, we must successfully address these dissemination challenges with many different types of practitioners and decision-makers. Most obviously, this includes the people who shape public health and health care programs and policies. But it also includes the people who influence programs and policies in a wide variety of other aspects of the public sector (including planning, education, housing, transportation, environment, and economic development), and in the non-profit and for-profit sectors (e.g., childcare, education, elder care). Successfully addressing these dissemination challenges will require a combination of methods including communication outreach, marketing, advocacy, illustrating with successful examples, technical assistance, and enabling the adaptation of evidence-based models to new circumstances.” methods including communication outreach, marketing, advocacy, illustrating with successful examples, technical assistance, and enabling the adaptation of evidence-based models to new circumstances.” Most of the steps described here fall outside the scope of this project. However, the Equal-Life tools and training protocol and the Guidebook explaining how to use them efficiently form the first step to include the evidence in planning and decision making. D10.8 8 This project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 874724 2.1 Three ‘E’ Framework of intervention A prominent framework for interdisciplinary work on interventions, for example, for improving health protection are the so-called 3 E's, Engineering, Education, Enforcement, typically used in road safety policy (Damon, 1958), but also in other fields, e.g., sustainability (Reames et al., 2020]). There are several extensions to the three E's, e.g. one of them being Engineering, Education, Enforcement, Engagement/Encouragement, and Evaluation (Evenson et al., 2023). Each of the E's form a pillar together underpinning the roof of a "temple of intervention". To the five pillars a sixth 'E' could be added (see Figure 3), namely considering 'Equity' and, thus, avoiding interventional inequity, as it is pointed out in Equal Life WP4. Enforcement stands for the setting of regulations/guidance to push forward the planning and constructing of a physical environment, healthy for children and young people and in combination with that the implementation of social programs or at least consideration of social (equity) issues in urban planning. Engineering points out the design of a physical and social environment beneficial for the children's mental health and their cognitive development. Education means training both the children and their families as well as the policy maker, planers, and researcher in addressing and dealing with both the physical and social exposure regarding children's mental health and cognitive development. Encouragement/engagement means the active involvement of children and families in co-designing their physical and social environment they are exposed to. For planers and policy makers this means, instead of designing for children moving to taking over the child's perspective and designing with the children. Finally, Evaluation means, that efforts and results of interventional programs should be monitored and evaluated, both regarding the intervention process as well as outcomes. The business plan includes consultancy and tools provided for each of the six pillars as outcomes of Equal life. A main issue is that all pillars are needed to stabilize the 'temple of intervention'. Thus, whereas one tool, one guideline developed in Equal Life may belong to one pillar and provided to the public mostly for open access, consultancy and training will be needed to bring them all together, for example when forming an interdisciplinary team on a local or national level with a comprehensive, combined action program (all under one 'roof'). This is exactly what follows at best the exposome approach where the focus as in Equal Life lies on the combined impact on children's mental health and cognitive development. D10.8 9 This project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 874724 Figure 3: The 6 'E'-pillars of the 'temple of interdisciplinary intervention' 3. Economic impacts : Early intervention pays off The field of epigenetics has demonstrated that genetic expression is strongly influenced by environmental influences – both at the physical and social level -and that environmental effects on gene expression can be inherited, rather than that they are genetically determined. Interventions at an early age thus might improve cognitive development and mental health and via these pathways positively affect inequalities at later life stages in an indirect way. The benefits of these interventions have been shown to outweigh the costs in the long term. Poorer selfregulation, as evidenced by greater difficulties with attentional control, delayed gratification, and inhibitory control has been associated with growing up in poverty. The Heckman Curve shows that the highest rate of economic returns comes from the earliest investments D10.8 16 This project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 874724 D10.8 17 This project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 874724 5.2 Patent Mental Health Biomarkers During Equal-Life analysis made it to the stage where initial potential biomarkers have been discovered. Now they would need to be validated using different cohorts and different methods. Once that is done, we would also need to carry out the following activities to determine whether the findings have commercial potential. • feasibility studies and other studies related to intellectual property rights and the freedom to operate • the examination of the research idea from the commercialization perspective (proof of relevance) • the determination of the customer value, market surveys, customer studies • the identification of competing solutions • the experimental verification of the idea's viability (proof of concept) • the identification of business models the protection of intellectual property rights to the idea (excluding maintenance costs) • the identification of funding models and potential financiers • Trademark costs are not eligible) • communication related to the identification of potential customers and financiers • commercialization and entrepreneurship skills coaching aimed to advance the project In view of this it is too early to talk about a business plan for biomarkers. To be able to carry out the above activities, new funding and manpower would be needed, which is not available within the framework of the project. D10.8 18 This project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 874724 5.3 Innovative noise models 5.3.1 SGUL Modelling local traffic (i.e., minor or residential roads) to increase the density of traffic noise sources is an essential consideration for noise exposure assessment. More work should be done to improve the density of traffic models and extend traffic models to other areas, applying performance evaluation studies (i.e., comparing estimated and measured traffic counts) where possible. A large degree of exposure misclassification will occur without improved traffic data (flows and speeds). Furthermore, epidemiological research and health impact assessment should consider noise variability around dwellings (and not just the nosiest façade) to obtain a more representative exposure assessment. Against this background City St George’s, University London and University of Leicester developed a reproducible traffic flow model for noise modelling across Europe. The traffic flow prediction model was first validated in the UK, Spain and Denmark (see D3.2). Road traffic noise modelling (~500,000 dwellings) revealed significant exposure contrasts of up to 30 dB(A) between the loudest and quietest façades. It was investigated whether residents have "respite" zones from high noise levels. The exercise highlighted quality inconsistencies in OpenStreetMap road data for road traffic flow modelling and environmental noise modelling. The noise modelling was completed for all of the cohort and in-depth studies in Equal-Life (see D3.4). D10.8 19 This project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 874724 5.3.2 UGhent There is sufficient direct and indirect evidence to support the relevance of the sound environment when characterized using innovative traffic noise indicators—for mental health, well-being, and cognitive development. This warrants further exploration of the sleep disturbance index at both the least and most exposed façades of dwellings, as well as median or 90th percentile noise levels during the evening at these façades. Results are publicly available in D3.6. The surrogate model that was developed in Equal Life allows to calculate these new indicators alongside classical ones approximately 100 times faster at the expense of 3 to 5 dBA imprecision on level indicators (evaluated in a different country as the one where the model was trained). The source code for running the model is openly available and a publication is under preparation. Commercially there may be some value in supporting future use of the model and indicators by epidemiologists. Prior to generating commercial value by supporting environmental health policy makers, urban planner, etc., further proof of the value of the additional indicators is needed as well as software development for user friendliness. 5.3.3 Propagation models TU/e Equal-Life noise modelling by TU Eindhoven has significantly advanced indoor noise exposure assessment by developing and validating analytical models that accurately predict indoor noise levels from outdoor sources (Terzakis, ). The models enable the prediction of indoor noise exposure indicators based on existing outdoor noise exposure indicators (e.g. from noise maps) and features of the environment and building characteristics (e.g. as percentage of window area in the façade). The model was developed in WP3 of the project and has been reported in D3.7. The developed calculation models are mostly of interest for research studies that aim to extend noiseexposure relationships towards noise-exposure relationships for indoor noise exposure due to environmental noise. The commercial value of the model is initially considered limited, as it is mainly of interest to researchers (epidemiologists) interested in indoor exposure. At a later stage, it may be of interest to urban planners and policy makers. D10.8 20 This project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 874724 5.3.4 Urban Analytics tools (TUD) The open-source Urban Analytics tools developed by TUD, such as the various components of the Data Collection & Enrichment tool detailed in Deliverables D5.7 and D5.8, have potential for commercial application, particularly within the context of the Equal-Life project. These tools facilitate the integration and analysis of diverse spatial and environmental datasets, enabling stakeholders to assess the impact of urban environments on children’s mental health and cognitive development. Commercializing these tools can follow a Software-as-a-Service (SaaS) model, providing subscriptionbased access to the various platforms tailored to the needs of public health and urban planning professionals. This approach allows for scalability and customization, ensuring that users have access to the latest features and models. Moreover, offering tailored training modules and support services can improve user proficiency and engagement. To effectively bring these tools to market, collaboration with key stakeholders is essential. Partnerships with governmental agencies, research institutions, and non-profit organizations can facilitate data sharing, piloting, and the co-development of features that address specific community needs (e.g., identifying local accessibility barriers to play spaces). Engaging with these partners ensures that the tools remain relevant, user-friendly, and impactful in promoting children’s mental health and cognitive development in urban settings. D10.8 21 This project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 874724 6. Conclusion and future action Most of the products of Equal-Life, including data, metadata, coding routines, and software tools of the project, will be made publicly available and allow for non-commercial exploitation. We identified four products that might be commercially exploitable in the future, namely 1) the training protocols focused on how to use the Equal-Life tools and included products in a sensible way, 2) the new mental health biomarkers to be patented 3) the novel transport/traffic and noise which were developed during the project and 4) the training module for the use of the open source Urban Analytics software tools. The specific parties who might be interested in the commercial exploitation of these products still need to be identified, but could be sought primarily at the municipal level, where it concerns noise modelling and the use of training protocols, and at the pharmaceutical industry end where it concerns mental health markers. Regarding the Urban Analytics tools, relevant parties are the local public health and urban planning professionals, educational and research institutions, and non-profit organizations. Additional/new funding is needed to further explore the potential spin-off of the project, both profit and non-profit which is not available within the framework of the project. A detailed financial and sustainability plan for the training is provided in Annex 1. D10.8 22 This project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 874724 References Bronfenbrenner U. Ecology of the family as a context for human development: Research perspectives. Developmental psychology. 1986 Nov;22(6):723. Damon, N. (1958). The Action Program for Highway Safety. The ANNALS of the American Academy of Political and Social Science, 320(1), 15–26. doi:10.1177/000271625832000104 Reames, T. G., Blackmar, J. M., & Pierce, J. C. (2020). Teaching the Three E’s of Sustainability Through Service‐Learning in a Professional Program. New Directions for Teaching and Learning, 2020(161), 73– 82. doi:10.1002/tl.20374 Evenson, K.R., Laleunesse, S., Keefe, E., Naumann, R.B. (2023). Mixed-methods approach to describing Vision Zero initiatives in United States’ municipalities. Accident Analysis and Prevention 184, 107012. https://doi.org/10.1016/j.aap.2023.107012 Durkheim E. Rules for the Explanation of Social Facts. Chapter V. In: The rules of the sociological method. 1982 ed. New York: The Free Press; 1895. Internet: http://varenne.tc.columbia.edu/bib/texts/durkheim_rules_chap5.html, consulted: 20-04-2012 Durkheim E: Suicide: a study in sociology Glencoe, IL: Free Press (1987,1951) Health Council of the Netherlands Social Aspects of the Living Environment in Relation to Environmental Health No. 2012/10E, The Hague, July 11, 2012 Edited by I. van Kamp and W. Passchier Maibach, EW Lorien C Abroms and Mark Marosit Communication and marketing as tools to cultivate the public's health: a proposed "people and places" framework BMC Public Health 2007, 7:88 doi:10.1186/1471-2458-7-88Cunha F, Heckman JJ. Formulating, identifying and estimating the technology of cognitive and noncognitive skill formation. Journal of human resources. 2008 Oct 2;43(4):738‐82. Heckman J. Investing in disadvantaged young children is good economics and good public policy. Testimony before the Joint Economic Committee, Washington, DC, June. 2007 Jun 23;27. Heckman JJ, LaLonde RJ, Smith JA. The economics and econometrics of active labor market programs. In Handbook of labor economics 1999 Jan 1 (Vol. 3, pp. 1865-2097). Elsevier.7 James J. Heckman Seong Hyeok Moon Rodrigo Pinto Peter Savelyev Adam Yavitz A new-cost benefit and rate of return analysis for the perry preschool program :a summary Working Paper 16180 Kamp, Irene vana,*; Persson Waye, Kerstinb; Kanninen, Katjac; Gulliver, Johnd; Bozzon, Alessandroe; Psyllidis, Achillease; Boshuizen, Hendriekf; Selander, Jennyg; van den Hazel, Peterh; Brambilla, Marcoi; Foraster, Mariaj; Julvez, Jordik; Klatte, Marial; Jeram, Sonjam; Lercher, Petern; Botteldooren, Dicko; Ristovska, Gordanap; Kaprio, Jaakkoq; Schreckenberg, Dirkr; Hornikx, Maartens; Fels, Janinat; Weber, Miriamu; Braat-Eggen, Ellav; Hartmann, Juliaa; Clark, Charlottew; Vrijkotte, Tanjax; Brown, Lexy; Bolte, Gabrielez; Equal-Life Scientific Team**. Early environmental quality and life-course mental health effects: The Equal-Life project. Environmental Epidemiology 6(1):p e183, February 2022. | DOI: 10.1097/EE9.0000000000000183 D10.8 23 This project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 874724 Equal-Life deliverable 3.2 Traffic flow modelling Gulliver et al. 2024. Equal-Life deliverable 3.4 Innovative noise modelling Gulliver et al. 2024. Equal-Life Deliverable 3.6 - New Noise metrics for mental health, December 2024. Equal-Life Deliverable D5.7 – Data Collection and Enrichment Tool v3. March 2023. Equal-Life Deliverable D5.8 – Report on Data Collection and Enrichment Tools. March 2023. Terzakis, M. E. (2025). Outdoor-to-indoor sound propagation models for noise exposure studies. [Dissertation TU/e), Built Environment]. Eindhoven University of Technology. D10.8 24 This project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 874724 Annex 1: Financial and Sustainability Plan for In-Person Trainings - Post-EU Project Model Purpose of the Document To define a self-sustaining, post-EU project model to offer in-person training days aimed at external clients (companies, public bodies, professionals), ensuring cost coverage and a profit margin. Structure of a Typical Training Day • Duration: 1 day (approx. 8 hours) • Delivery Team: – 1 staff member from our company (coordination and technical support) – 2 trainers from project partners or external experts • Target audience: paying participants (final users) • Modality: in-person, at equipped locations b) During the Equal-Life project, external trainers were not remunerated, only their costs were covered by the funding. However, in the commercial model after the project, they must be properly compensated. The cost of a single training day therefore includes: • Fees for each trainer • Board and lodging expenses, covered by the organizing company Overview of Training Costs During the Equal-Life Project c) The following are actual costs from in-person training sessions held during the EUfunded phase: • Cork Cost Type Amount (€) Internal costs 3,205.84 Partner costs 2,239.83 Service costs 1,691.83 Total 7,137.50 • Amsterdam Cost Type Amount (€) Internal costs 2,778.86 Partner costs 535.70 Service costs 2,732.75 Total 6,047.31 • Ljubljana + Vienna Cost Type Amount (€) Internal costs 1,455.15 D10.8 25 This project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 874724 Cost Type Amount (€) Partner costs 1,972.49 Service costs 1,717.50 Total 5,145.14 Estimated Costs per Training Day Cost Item Estimated Amount Trainer fees (2 x €1,000) €2,000 Board and lodging for trainers €800 Internal staff (incl. meals/lodg) €800 Venue + catering €1,500 Organizational costs €1,000 Travel and logistics €1,000 Total €7,100 Note: Costs may vary slightly depending on location and trainers involved, but €7,100 represents a realistic average in the post-project commercial model. Proposed Commercial Model • Price per participant: €800 (all-inclusive) • Break-even: 9 participants (€800 x 9 = €7,200) • Optimal group size: 10–12 participants d) Examples: Participants Total Revenue Gross Profit Margin % 9 €7,200 €100 1.4% 10 €8,000 €900 12.7% 12 €9,600 €2,500 26.0% Gross margin can be reinvested in: • Marketing and promotion of future sessions • Development and updating of training content • Covering underbooked sessions Annual Plan – Simulation Training Days/Year Avg. Participants Total Revenue Total Costs Gross Profit 6 10 €48,000 €42,600 €5,400 12 10 €96,000 €85,200 €10,800 18 12 €172,800 €127,800 €45,000