企业“病毒”及其“免疫”机制研究

企业"病毒"对企业生产经营活动造成影响和破坏,而企业组织免疫系统则有助于预防和消灭企业"病毒",使企业不断适应环境的变化。本文借鉴免疫学和组织免疫系统的研究成果,从企业"病毒"的传染特性角度,对企业"病毒"的类型进行了分类,系统分析了企业"病毒"的传染机制和传染方式,最后,从非特异性免疫和特异性免疫两个角度,讨论了企业实施"病毒"免疫的路径。     

Cost-effectiveness of hydrophilic-coated intermittent catheters compared with uncoated catheters in Canada: a public payer perspective

Study design: A Markov model was used to analyze cost-effectiveness over a lifetime horizon.

Objective: To investigate the cost-effectiveness of hydrophilic-coated intermittent catheters (HCICs) compared with uncoated catheters (UCs) among individuals with neurogenic bladder dysfunction (NB) due to spinal cord injury (SCI).

Setting: A Canadian public payer perspective based on data from Ontario; including a scenario analysis from the societal perspective.

Methods: A previously published Markov decision model was modified to compare the lifetime costs and quality-adjusted life years (QALYs) for the two interventions. Three renal function and three urinary tract infection (UTI) health states as well as other catheter-related events were included. Scenario analyses, including utility gain from compact catheter and phthalate free catheter use, were performed. Deterministic and probabilistic sensitivity analyses were conducted to evaluate the robustness of the model.

Results: The model predicted that a 50-year-old patient with SCI would gain an additional 0.72 QALYs if HCICs were used instead of UCs at an incremental cost of $48,016, leading to an incremental cost-effectiveness ratio (ICER) of $66,634/QALY. Moreover, using HCICs could reduce the lifetime number of UTI events by 11%. From the societal perspective, HCICs cost less than UCs, while providing superior outcomes in terms of QALYs, life years gained (LYG), and UTIs. The cost per QALY further decreased when health-related quality-of-life (HRQoL) gains associated with compact HCICs or catheters not containing phthalates were included.

Conclusion: In general, ICERs in the range of CAD$50–100,000 could be considered cost-effective. The ICERs for the base case and sensitivity analyses suggest that HCICs could be cost-effective. From the societal perspective, HCICs were associated with potential cost savings in our model. The results suggest that reimbursement of HCICs should be considered in these settings.     

Estimating the clinical effectiveness and value-based price range of erenumab for the prevention of migraine in patients with prior treatment failures: a US societal perspective

Background: Frequent migraine with four or more headache days per month is a common, disabling neurovascular disease. From a US societal perspective, this analysis models the clinical efficacy and estimates the value-based price (VBP) for erenumab, a fully human monoclonal antibody that inhibits the calcitonin gene-related peptide receptor.

Methods: A Markov health state transition model was developed to estimate the incremental costs, quality-adjusted life-years (QALYs), and value-based price range for erenumab in migraine prevention. The model comprises “on preventive treatment”, “off preventive treatment”, and “death” health states across a 10-year time horizon. The evaluation compared erenumab to no preventive treatment in episodic and chronic migraine patients that have failed at least one preventive therapy. Therapeutic benefits are based on estimated changes in monthly migraine days (MMD) from erenumab pivotal clinical trials and a network meta-analysis of migraine studies. Utilities were estimated using previously published mapping algorithms. A VBP analysis was performed to identify maximum erenumab annual prices at willingness-to-pay (WTP) thresholds of $100,000–$200,000 per QALY. Estimates of VBP under different scenarios such as choice of different comparators, assumptions around inclusion of placebo effect, and exclusion of work productivity losses were also generated.

Results: Erenumab resulted in incremental QALYs of 0.185 vs supportive care (SC) and estimated cost offsets due to reduced MMD of $8,482 over 10 years, with an average duration of treatment of 2.01 years. The estimated VBP at WTP thresholds of $100,000–$200,000 for erenumab compared to SC ranged from $14,238–$23,998. VBP estimates including the placebo effect and excluding work productivity ranged from $7,445–$13,809; increasing to $12,151–$18,589 with onabotulinumtoxinA as a comparator in chronic migraine.

Conclusion: Erenumab is predicted to reduce migraine-related direct and indirect costs, and increase QALYs compared to SC.     

Does site-of-care for oncology infusion therapy influence treatment patterns,cost, and quality in the United States?

Background: The increase in hospital acquisition of community oncology clinics in the US has led to a shift in the site-of-care (SOC) for infusion therapy from the physician office (PO) to the hospital outpatient (HO) setting.

Objective: To investigate differences by SOC in treatment patterns, quality, and cost among patients with cancer undergoing first-line infusion therapy.

Research design and methods: This retrospective analysis identified adult patients from Humana medical claims who initiated infusion therapy from 2008–2012 for five common cancer types in which infusion therapy is likely, including early stage breast cancer; metastatic breast, lung, and colorectal cancers; and non-Hodgkin’s lymphoma or chronic lymphocytic leukemia. Differences by SOC in first-line treatment patterns and quality of care at end-of-life, defined as infusions or hospitalizations 30 days prior to death, were evaluated using Wilcoxon-Rank Sum and Chi-square tests where appropriate. Differences in cost by SOC were evaluated using risk-adjusted generalized linear models.

Main outcome measures: Treatment patterns, quality of care at end of life, healthcare costs.

Results: There were differences in duration of therapy and number of infusions for some therapy regimens by SOC, in which patients in the HO had shorter duration of therapy and fewer infusions. There were no differences in quality of care at end-of-life by SOC. Total healthcare costs were 15% higher among patients in HO ($55,965) compared with PO ($48,439), p?<?.0001.

Limitations: Analyses was restricted to a claims-based population of cancer patients within a health plan.

Conclusion: This study, in an older, predominantly Medicare Advantage oncology cohort, found differences by SOC in treatment patterns and cost, but not quality. Where differences were found, patients receiving care in the HO had shorter duration of therapy and fewer infusions for specific treatment regimens, but higher healthcare costs than those treated in a PO.     

健康冲击对中国老年家庭资产组合选择的影响

利用中国健康与养老追踪调查(CHARLS)数据,研究健康冲击对老年家庭资产组合的影响。把健康冲击分为急性健康冲击和慢性健康冲击两类。遭受急性健康冲击时,老年家庭持有的风险资产减少;遭受慢性健康冲击时,投资于耐用消费性资产的量减少,但拥有房产价值的量增加;健康冲击对城乡老年家庭资产组合的影响不尽相同。     

Perceptions of predictive testing for those at risk of developing a chronic inflammatory disease: a meta-synthesis of qualitative studies*

Background: The availability of tests to predict the risk of developing chronic diseases is increasing. The identification of individuals at high risk of disease can trigger early intervention to reduce the risk of disease and its severity. In order for predictive tests to be accepted and used by those at risk, there is a need to understand people’s perceptions of predictive testing. Method: A meta-synthesis of qualitative research that explored patient and public perceptions of predictive testing for chronic inflammatory diseases was conducted. Studies were coded by researchers and patient research partners, and then organised into common themes associated with the acceptability or use of predictive testing. Results: Perceived barriers to predictive testing were identified, including a concern about a lack of confidentiality around the use of risk information; a lack of motivation for change; poor communication of information; and a possible impact on emotional well-being. In order to reduce these barriers, the literature shows that a patient-centred approach is required at each stage of the testing process. This includes the consideration of individual needs, such as accessibility and building motivation for change; readily available and easy to understand pre and post-test information; support for patients on how to deal with the implications of their results; and the development of condition specific lifestyle intervention programmes to facilitate sustainable lifestyle changes. Conclusion: Patients and members of the public had some concerns about predictive testing; however, a number of strategies to reduce barriers and increase acceptability are available. Further research is required to inform the development of a resource that supports the individual to make an informed decision about whether to engage in a predictive test, what test results mean, and how to access post-test support.     

Towards Ending the Silence: Working Women Caring for Children with Chronic Illness

This paper presents stories from women who work and care for a child with a significant chronic illness or disability. The purpose of this paper is to move towards ending the silence on their lives. A three-phase emergent research design responds to the question: What is life like for a full-time worker who is concurrently the primary carer of a chronically ill child? This paper considers the theory of Silencing the Self (Jack, 1991) in relation to the emergent themes of “Otherness” and “Doing it All.” As in Jack’s study, these women also engaged in silencing of the self. However, unlike the respondents in Jack’s study, these women did not demonstrate feelings of worthlessness and hopelessness for the future, nor were they alone in contributing to their silence. Indeed, many experienced silencing behaviors from others around them, and many rallied against the silence, not accepting that their burden should continue. Consideration of Jack’s theory is made to point out the distinctions between the women in this study and Jack’s study, and analytical commentary is provided to demonstrate the relevance of this analysis in light of the current debates surrounding the Work–Home Conflict and the rising levels of informal care provided by women in our communities.     

Expectations of Consistency in Organizational Life: Stories of Inconsistency from People with Unseen Chronic Illness

This paper commences by considering that the current global climate of terrorism and human suffering demands a more critical consideration of flawed expectations. Addressed here is the flawed expectation of consistency in organizational life. Work life narratives from people with unseen chronic illness, that is, illness that is ongoing, may not be treatable or curable, and cannot be seen by colleagues, are considered to portray the problematic outcomes of expectations of consistency. Respondents of this phenomenological study demonstrate that expectations of consistency, from themselves and others, were unreasonable as their responses to situations and their illness demands varied from day to day and minute to minute—a problem for one working in the rational workplace. What is concluded is that recognition of the postmodern perspective, especially its appreciation of the multiphrenic qualities in these peoples lives, may assist understanding of these people's experiences, as well as the experiences of other traumatized individuals. Adherence to flawed expectations may make things worse.     

Using Data Mining to Evaluate Patient-oriented Medical Services for Chronic Senility Outpatients

The problem with previous research of health care service were failed to isolate the study objects. Therefore, the purpose of this study is using data mining to analysis disease clusters of chronic senility to enhance quality of health care service. This study used cluster and association analysis of data mining to analyze the health insurance data of outpatients suffering from chronic senility in a hospital in Taiwan, over the period from January to December 2002 (N = 5836). According to analysis of revisit frequency, and disease correlation, the patients were grouped into different clusters, after which expert interviews discovered target clusters with abnormal numbers of revisits. This information was assist planning service strategy for difference groups of patients. Through analysis, two target clusters were isolated, Clusters 4 and 7. Cluster 4 (n=114), had excessive return visit times, and had 13 chronic diseases on average, with 27.2 revisits per year. Cluster 7 (n = 426), had in frequent return visits, and had 4 chronic diseases on average, with 2.68 return visit times per year. After expert interviews, the goal for Cluster 4 was to effectively control chronic diseases, to enhance the patient health and to raise satisfaction levels. The goal of Cluster 7 was to promote patient loyalty.     

Chronic consumer debtors: the need for specific intervention

Many studies of consumer debtors have identified risk factors associated with chronic consumer debt. Chronic consumer debtors exist in an environment of ongoing efforts to survive financially and meet their debt commitments. Despite otherwise favourable economic conditions for the community at large such as low interest rates and low levels of unemployment, the chronic consumer debtor remains continuously at peril of overcommitment. An analysis of financial counselling interviews in New South Wales (the largest state in Australia) has been used to identify the group that the authors believe to be most at risk of chronic consumer debt in Australia. Other independent studies are provided to support the choice of the identified group. The situation for chronic consumer debtors is contrasted to the situation for acute cases. While financial literacy and support programmes can be provided to the community, the ability to target programmes towards a specifically identifiable group concentrates activities on measures aimed to alleviate the distress caused by ongoing financial hardship for one particular consumer group. The challenge of reducing chronic consumer debt has the potential to raise awareness and understanding of risk factors for consumer debtors generally. Thus, concentrated efforts towards alleviating chronic consumer debt may lead to a reduction in consumer financial overcommitment.