The cost implications of the use of telmisartan or ramipril in patients at high risk for vascular events: the ONTARGET study

Abstract

Background:

The recently published ONTARGET trial found that telmisartan was non-inferior to ramipril in reducing CV death, MI, stroke, or heart failure in patients with vascular disease or high-risk diabetes. The cost implications of ramipril and telmisartan monotherapy use based on the ONTARGET study are reported here.

Methods and Results:

Only healthcare system costs were considered. Healthcare resource utilization was collected for each patient during the trial. The authors obtained country-specific unit costs to the different healthcare care resources consumed (i.e., hospitalizations events, procedures, non-study, and study drugs) for all enrolled patients. Purchasing power parities were used to convert country-specific costs into US dollars (US$ 2008). The total undiscounted costs of the study for the telmisartan group was $12,762 per patient and is higher than the ramipril group at $12,007 per patient, an un-discounted difference of $755 (95% confidence interval [CI], $218–$1292); The discounted costs for the telmisartan group was $11,722 compared with $11,019 for the ramipril group; a difference of $703 (95% CI, $209–$1197). The difference in costs is exclusively related to the acquisition cost of telmisartan over generic ramipril.

Limitations:

This analysis only considered direct healthcare system costs. Costs accrued outside the hospital were not collected. Combination therapy was excluded since it would likely be more expensive than ramipril alone, with no additional benefit and a risk of some harm.

Conclusions:

Based on these results, it is suggested that for the ONTARGET patients, the use of telmisartan instead of ramipril increases costs by 6.3%. These findings suggest that the choice to put patients on telmisartan should be justified based on the patient’s susceptibility to specific adverse events to minimize the cost implications.     

Data Mining For Hotel Occupancy Rate: An Independent Component Analysis Approach

The recent global financial crisis and the threat of a worldwide H1N1 influenza epidemic have greatly affected the tourism and hospitality industries around the world. Both hospitality practitioners and researchers are interested in finding analytical methods that enable forecasts to be made of hotel room demand under the uncertain conditions likely to affect the industry. In this article, a novel data mining technique called independent component analysis (ICA) is proposed to establish the major factors determining the hotel occupancy rate in Hong Kong. Then, extension of the model is suggested, incorporating these factors to decompose hotel occupancy rates and examine the effect of each factor on the hotel occupancy rate. Empirical findings show that outbreaks of infectious diseases, economic performance, and service price were the major determinants of the hotel occupancy rate in Hong Kong over the period studied.     

计算机蠕虫病毒动力学分析及其传播途径研究

蠕虫也是一种病毒,随着计算机网络的应用和普及,蠕虫对网络系统安全构成了很大的威胁,其破坏能力和传染性不容忽视。本文从传染病动力学入手,介绍了传染病动力学模型的基本形式和蠕虫病毒的危害及传播特性,最后列举了网络蠕虫病毒的几种传播模型并对如何防范蠕虫病毒提出了一些看法。     

脂肪与人体健康关系的的辩证分析

脂肪作为6大营养素之一,在人体中发挥着重要的生理作用,但摄入过多易导致肥胖、心脑血管疾病等健康问题,危害人体健康.因此,正确的脂肪摄入对人体至关重要.本文简要分析了脂肪与人体健康之间的辩证关系,简述脂肪的正确摄取方式,为人们保持健康体质提供简要依据.     

农村宅基地使用权有偿退出的扩散效应研究 ——以浙江省嘉兴市得胜村为例

研究目的:探究农户客观经济因素(自身固有倾向或实际需要)、从众心理(已退出农户数量)以及由于从众心理而可能导致的后悔心理,对农村宅基地使用权有偿退出的影响效应。研究方法:以传染病学理论为基础,构建农村宅基地使用权有偿退出的扩散模型,并利用浙江省嘉兴市得胜村的调查数据进行实证研究。研究结果:(1)农村宅基地使用权有偿退出受到客观经济因素的显著影响,表现为农户自身固有倾向或实际需要是影响农村宅基地使用权有偿退出的重要因素;(2)农村宅基地使用权有偿退出受到从众心理因素的显著影响,表现为已退出农户数量是农户决定是否参加农村宅基地使用权有偿退出政策的参考依据;(3)农村宅基地使用权有偿退出进程中存在后悔心理,但对农村宅基地使用权有偿退出趋势并未产生显著影响。研究结论:农村宅基地使用权有偿退出问题是一个外部客观经济因素驱动及内部成员互相作用的过程。     

印度甘蔗主要病虫草害的防治技术研究

介绍了印度甘蔗主要病虫草害的发生和为害情况以及防治的具体措施,分析总结了印度甘蔗病虫草害的综合防控技术,如重视选育并推广甘蔗良种和高抗病虫品种,实行严格的种苗检疫制度和多样的种苗处理方法等措施.通过比对我国甘蔗病虫草害的防治现状,阐述了印度甘蔗防治技术的研究与应用对我国甘蔗产业的发展具有不可低估的参考和借鉴价值,其成功做法对我国糖业的可持续发展有启示作用.最后,对我国甘蔗产业植保技术的未来发展方向提出了4点建议,具体是:大力培育甘蔗良种和抗病虫品种;加速推广健康脱毒种苗;建立完善的甘蔗有害生物预警监测系统,推广实施生物防治;加大资金投入,加强技术培训.     

The effectiveness of information interventions to improve domestic food safety among rural consumers

Consumer education on food handling behavior is regarded as an effective method to improve domestic food safety and prevent foodborne illness, but is usually overlooked in rural areas. Using a presurvey and two rounds of postsurveys targeted at rural consumers from China included in a randomized controlled trial, this study investigated the effectiveness of two information interventions—a leaflet with tips for best practices and the leaflet plus consumer education sessions conveyed by phone—and compared them with a control group. Cloth use behavior was the target in the trial and five specific aspects were evaluated: (1) whether the cloth was made of old clothes, (2) whether the one used to clean kitchen tables was also used to wash dishes, (3) whether it was hung to dry, (4) how it was disinfected, and (5) how long the cloth was used before being discarded. Firstly, consumers' behavior was scored by summing the above-mentioned five behaviors. The results estimated using the difference-in-difference model showed that respondents in the leaflet-only group improved to a greater extent than those in the control group, but their difference in progress was not statistically significant until the second round of the postsurvey. Respondents in the leaflet-plus-phone group were quicker to adopt suggested practices and made discernible improvements compared with those in the leaflet-only group in the first round of the postsurvey, but the gap between these groups narrowed to statistically insignificant in the second round of the postsurvey. It was concluded that one consumer education session was effective and made a difference in the long term, whereas more education sessions produced normative behavior at faster rates, showing a significant improvement in the short term. Then, the study estimated the effectiveness of interventions on the five specific behaviors separately. The results were estimated using a probit difference-in-difference model and showed that the suggested behaviors with lower costs or a greater difference from past behaviors were more likely to be adopted by consumers. Consumer education facilitates proper food handling practices among rural households, which should be considered by policy makers.     

Testing the predictive accuracy of COVID-19 forecasts

We test the predictive accuracy of forecasts of the number of COVID-19 fatalities produced by several forecasting teams and collected by the United States Centers for Disease Control and Prevention for the epidemic in the United States. We find three main results. First, at the short horizon (1 week ahead) no forecasting team outperforms a simple time-series benchmark. Second, at longer horizons (3 and 4 week ahead) forecasters are more successful and sometimes outperform the benchmark. Third, one of the best performing forecasts is the Ensemble forecast, that combines all available predictions using uniform weights. In view of these results, collecting a wide range of forecasts and combining them in an ensemble forecast may be a superior approach for health authorities, rather than relying on a small number of forecasts.     

Infectious diseases tracking and sectoral stock market returns: A quantile regression analysis

This paper investigates the relationship between changes in the newspaper-based infectious diseases tracking index (ITI) of Baker et al. (2020) and sectoral stock market returns in the US. Our results spanning the period 1985:01 to 2020:03 reveal the presence of a negative (positive) relationship between returns and ITI at lower (higher) return quantiles (representing different market conditions) in a majority of the sectors. For the health care sector, this relationship is negative at all quantiles. Interestingly, inclusion of the COVID-19 period in the sample data leads to the detection of a stronger relationship for smaller quantiles across all sectors. An asymmetric relationship between returns and the ITI is witnessed across different market conditions for the Consumer Staples, Healthcare, Industrial and Technology sectors. Results from a rolling regression uncover differences in the magnitudes of responses to various infectious diseases over time. Our results carry important implications regarding investment strategies for US sectoral returns in the presence of news relating to infectious diseases.     

New perspectives on the contribution of sanitary investments to mortality decline in English cities, 1845–1909

Health improved in English cities in the last third of the nineteenth century, in tandem with substantial increases in public spending on water supplies and sanitation. However, previous efforts to measure the contribution of public expenditures to mortality improvements have been hampered by difficulties in quantifying public health investments and the lack of mortality data for specifically urban populations. We improve upon the existing evidence base by (1) creating measures of the stock of urban district sanitary capital, by type, on the basis of capital expenditure flows, rather than loan stocks; (2) using mortality and capital stock data that relate to the same administrative units (urban districts), and (3) studying the period 1880–1909 as well as the earlier period from 1845. The stock of sewerage capital was robustly related to improvements in all-cause mortality after 1880. The size of this effect varied with the extent of public investment in water supplies, suggesting complementarity between the two assets. For the period 1845–84, investments in water were associated with declines in infant and child mortality but the effect was much smaller and less precisely estimated in later decades. Our results suggest that improvements in water and sewerage targeted different transmission pathways for faecal–oral diseases.