Cost utility of allogeneic stem cell transplantation with matched unrelated donor versus treatment with imatinib for adult patients with newly diagnosed chronic myeloid leukaemia

Objective: To estimate, from the perspective of the German statutory health insurance, the cost utility of allogeneic stem cell transplantation with matched unrelated donor (MUD-SCT) in newly diagnosed, chronic-phase chronic myeloid leukaemia (CML) patients aged 40 years or younger, relative to the treatment with imatinib.

Methods: The incremental cost-effectiveness ratio (ICER) of the additional cost of imatinib versus MUD-SCT per quality-adjusted life year (QALY) gained was chosen as a target assessment. ICER was quantified using a Markov cohort modelling approach. The evaluation encompassed 5 years of treatment with either approach, and only direct medical costs (in €, year 2005) were considered.

Results: There were incremental costs of €77,410 for imatinib therapy per QALY gained versus MUD-SCT. No strategy was clearly dominant; on average, during 5 years, cost savings of €63,433 were obtained and 0.82 QALY lost by SCT compared to treatment with imatinib. QALYs gained in CML patients with either treatment resulted in considerable cost to the third-party payer in Germany. The results were particularly sensitive to the price of imatinib.

Conclusions: The analysis finds that imatinib is more costly but more effective (as measured in QALYs) over a 5-year time horizon. The resulting ICER of €77,410 per QALY is higher than commonly cited thresholds. The cost utility of MUD-SCT to treat CML in patients with a European Group for Blood and Marrow Transplantation score ≤ to 2 compares with that of the imatinib strategy.     

Health IT adoption,productivity and quality in primary care

Within the last decade, there has been a growing push towards the use of electronic medical records and health information technology (IT) within primary care physician practices. Despite financial subsidies, smaller practices remain reluctant to adopt these information systems. Using a nationally representative survey of physicians, this study explores the relationship between physician, practice and area attributes and the adoption of health IT systems. Controlling for these attributes, the analysis subsequently studies the relationship between health IT, physician productivity and perceived quality of care. It finds that smaller practices and physicians with lower incomes are less likely to adopt health IT systems and that adoption varies with the type of medical conditions the practice typically treats. With regards to productivity, health IT adopters are more likely to see fewer patients and spend a larger amount of time on each visit with marginal increases in time on administrative tasks and no differences in perceived ability to deliver quality health care.     

企业职工基本养老保险分级平衡省级统筹体制存在问题研究

在省级统筹、分级平衡体制下,市县级政府基本养老保险基金支付出现赤字时,解决的步骤是先由当地历年结存基金部分支付,不足的剩余由当地财政和省级调剂金按照相同比例进行弥补。但这一规定使那些基本养老金存量较大、上缴调剂金数量较多的市县级政府在遇到支付缺口时,动用结存养老金,但在弥补所剩赤字时,不能得到更多的省级调剂金。因而容易引发市县级政府在基本养老保险金征管中＂逆向选择＂,影响基本养老保险金的征管,此问题应得到关注解决。     

集体建设用地土地级别评定探讨  ———以新野县为例

该文从集体建设用地定级特点出发,分析了定级中存在的双重差异和定级单元划分中存在的问 题,构建了宏观趋势指标与微观差异指标共存的指标体系,分析了采用差异单元格的优点,并以新野县为 例进行了实证研究。结果表明:采用宏观趋势指标与微观差异指标共存的指标体系和差异单元格进行集体 建设用地级别评定,其结果符合研究区域实际,具有较强的操作性。研究结论:宏观趋势指标与微观差异 指标共存的指标体系和差异单元格可用于集体建设用地土地级别评定。     

基于快递运输的手机零件供应链改进研究

一些手机零件企业没有设置产品安全库存。他们完全按照客户订单从供应商处采购产品,并使用快递运输。然而供应链中的各种不确定因素造成了频繁的交货延误。作者对这种供应链进行了简单介绍,分析了其中存在的问题,建立了包含安全库存成本和快递运输成本的供应链成本模型．并且以手机扬声器为例计算了安全库存,为企业对快递公司的评价和安全库存的设置提供了参考工具。     

提高出生人口素质的孕前—围孕保健模式的再讨论

随着人口再生产类型和疾病模式发生根本性的转变,我国政府已对提高出生人口素质和出生缺陷预防给予了高度重视。在过去十年中,随着对孕前保健和出生缺陷-级预防重要性认识的逐步加深,我国出生缺陷预防工作正努力从产前—围产保健模式逐步扩展到孕前—围孕保健模式。尽管如此,近几年的实践表明出生缺陷预防模式的转变依然面临诸多的挑战。对孕前—围孕保健预防模式相关的几个问题进行了讨论,包括计划怀孕的重要性、-级预防应采取何种策略、能力建设和发展。     

基于单元化分装对企业备品备件的储存空间优化研究

文章主要针对日立环球存储科技公司的技术革新、产品升级、机器更换升级后造成备品备件的库存大量增加,空间利用率下降这一问题．通过现场库存和物料特性分析,运用单元化分装管理方法,达到库存优化管理和空间的有效利用,降低物流管理成本．规范公司备品备件的管理。     

我国经济欠发达地区中小学美术教育存在质量问题及对策研究

本文通过研究经济欠发达地区中小学美术教育质量面临的问题入手,以甘肃省农村学校为例,深入了解他们在教学中存在的问题,并给出切实有效的对策,全面推进素质教育,提高经济欠发达地区教学质量,推进民族文化的全面发展。     

企业初次分配中劳动报酬决定机制研究 ——基于湖北省企业职工收入分配状况的调查

报告在实证调查的基础上,对湖北省企业职工劳动报酬的决定机制以及工资增长情况作了理论分析。报告认为,湖北省企业职工工资水平总体在增长,但初次分配中存在诸多问题,以致劳动报酬在初次分配中的比例较低。报告建议应针对初次分配中劳动报酬过低的问题,加强政府的监控指导,提高职工的参与程度,应通过对工资集体协商的推进来完善初次分配中劳动报酬的决定机制。     

公平与效率：我国房地产税制的功能取向与税种设置改革研究

鉴于我国土地资源不合理利用严重与财产和收入分配差距的不断扩大,我国房地产税制改革的主体功能目标应该是促进土地资源配置效率的提高与维护财产和收入分配的社会公平,其税种设置应按照“宽税基、低税率、少减免、简便征管”原则分别在地产税和房产税目下进行,地产税目下按土地取得途径不同设置耕地占用税和城镇土地使用税,房产税目下在房产的交易环节仅设契税、印花税和营业税,在保有环节设置物业税。