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10.1021/acs.jcim.7b00347 shows that take into account the ligand hydration shell improves the MMPBSA calculation. This does not add any dramatic extra computational cost:
Calculate the closest N waters to the ligand.
Create a temporal index file that includes these water molecules as part of the receptor.
Run benchmark and check if there are improvements.
10.1021/acs.jcim.7b00347 shows that take into account the ligand hydration shell improves the MMPBSA calculation. This does not add any dramatic extra computational cost: