Cost of operating room time for endovascular transcatheter aortic valve replacement

Abstract

Background: Procedural efficiencies can contribute to cost reductions in transcatheter aortic valve replacement procedures (TAVR). The objective of this study is to determine operating room (OR) variable cost per minute in endovascular TAVR procedures, in a real-world hospital setting.

Methods: Using Premier data from January 2015–June 2016 for patients undergoing a primary endovascular TAVR (primary ICD-9 code of 35.05, ICD-10 code of 02RF37Z, 02RF38Z, 02RF3JZ, or 02RF3KZ) procedure, the OR cost per minute was calculated for each patient by dividing the total hospital OR variable cost by the OR time (minutes).

Results: Of the 4,573 patients in the cohort, the average age was 80 years, 77% were admitted electively, and the vast majority were discharged home with (30%) or without (45%) home care. Median OR time for endovascular TAVR procedures was 180?min. The trimmed mean OR cost per minute was $43.59 (SD = $28.68). When stratified by Elixhauser Risk score and Charlson comorbidity index, OR cost per minute increased with higher risk and comorbidity (p?<?0.0001 and p?<?0.041, respectively).

Conclusions: This contemporary estimate of the real-world variable OR cost per minute provides researchers with a critical parameter to refine economic models of TAVR and aid clinical program directors in resource planning according to a priori risk and comorbidity.     

The real rate of protection: the income and insurance effects of agricultural policy

Agricultural price policies in developed countries aim at protecting farmers against both low and volatile world market prices. However, traditional indicators of protection only refer to the income (level) effect of policy. Following other research, it is argued that public policy can also yield an insurance (stabilizing) effect. In this paper a way to measure these dual effects is proposed. The method is illustrated with wheat market data for the USA and the European Union. Strong evidence is found that the insurance effect is an important component of protection, albeit a small one relative to the income effect. Policy support provided higher income and lower insurance effects in the EU than in the USA. For both markets, policy reforms in the 1990s led to significantly reduced income effects and smaller insurance effects. Without accounting for the influence of policy on income variability, traditional measures of protection will understate the real rate of protection.     

Mentoring as a mechanism for improvement in local government

This article reports on a scheme to secure improvement in local government using a peer mentoring network. Mentoring promoted learning, and hence improvement, in many of the participating authorities. Mentoring schemes must be carefully designed to achieve positive outcomes—it is essential to have a clear understanding of what mentoring is and how it should be administered, and to involve members and relevant partners of the mentored organization.     

The determinants of corporate divestment in the UK

It has been widely suggested that since the early 1980s many diversified firms narrowed the scope of their activities by refocusing on their core businesses, primarily through divestment activity. This study examines the extent and determinants of divestment across a large sample of UK firms over the period 1985–1989. Divestment is analysed using both a proportions and count data (Poisson and negative binomial regressions) approach. The results confirm that corporate divestment is not merely a reflection of managerial idiosyncrasies or mean reversion behaviour in the activities undertaken, but is a purposeful response to exogenous change in a manner broadly consistent with both the agency theoretic and strategic views of the firm.     

Micro Convergence and Macro Convergence: Factor Price Equalization and Per Capita Income

Factor price equalization implies the equality of prices of the same productive factors across countries owing to free trade. The present paper examines the relationship between factor price equalization and the equality of per capita (per worker) incomes in the contexts of the static Heckscher–Ohlin trade model and the dynamic two-sector neoclassical growth model. Factor price equalization is shown to be neither necessary nor sufficient for equality of per capita incomes across trading countries.     

The value of informal learning within work-based learning: The economic benefits of WBL

Recent updates to federal policy governing career and technical education (CTE) in the United States have emphasised the need to include work-based learning (WBL) experiences as central components of CTE programming. Many of these experiences showcase an informal learning component which has strong ties to early career success as suggested by the Human Capital Theory. This study explores the following questions: What is the relationship between WBL and early career income? Are there differential relationships based on the type of WBL experience? The Education Longitudinal Study of 2002 (ELS) includes nationally representative data for student participation in WBL and early career income. We used school-fixed effects and propensity score matching techniques to respond to our questions regarding the potential relationship between WBL participation and early career income. We found that students who participated in at least one WBL experience in high school could expect to have an average 7% higher income compared to non-WBL participants. With respect to specific WBL experiences, job shadowing, community service, and mentoring had the largest positive relationship to higher early career income. Findings from this study indicate that participation in WBL experiences can have a positive impact on a high school graduate's college and career readiness as measured through early career income. Given the differential relationships observed for different types of WBL, schools, policymakers, and students should explore WBL options that best align with their personal goals.     

Impact investing in biodiversity conservation with bonds: An analysis of financial and environmental risk

Impact investments have the dual goals of generating profit and environmental and/or social impact from the same project or enterprise. This article examines recent impact investments in biodiversity conservation—specifically, debt finance in the form of conventional bonds and impact bonds. The proceeds of these bonds finance projects aiming to enhance forest management, sustainable agriculture, endangered species protection, ecosystem service provision, and nature-based solutions to climate change such as REDD+. The article scrutinises whether these dual goals are achievable by evaluating the financial risks and impact risks within each bond's theory of change. Risks stem from projects with vague cashflow forecasts, project sites with low or ambiguous threat statuses, and simplified impact metrics that may measure activities or outputs—rather than impact. Risk mitigation strategies involve using baselines and counterfactuals to establish additionality, and guarantors to protect investors if revenues are insufficient. Implications for biodiversity management and for-profit conservation are discussed.