Comparing post-operative resource consumption following transcatheter aortic valve implantation (TAVI) and conventional aortic valve replacement in the UK

Objective:

To define the in-hospital and 6-month post-discharge resource use, following Transcatheter Aortic Valve Implantation (TAVI) and conventional Aortic Valve Replacement (AVR) surgery within a single UK hospital.

Methods:

A local service evaluation of patients undergoing TAVI or AVR between January 2011 and May 2012 captured data until 6-months post-procedure, collected from hospital records and via a General Practitioner questionnaire. The main end-points were mortality, time in ITU/HDU, hospital length of stay (LoS), discharge destination, re-admission, and post-discharge primary/secondary care resource use. Sub-group analyses were performed for AVR patients aged ≥80 (AVR?≥?80) and with EuroSCORE of ≥10 (AVR ES?≥?10) to allow more direct comparison with ‘TAVI type’ patients.

Results:

Results are given as means (standard deviation) for TAVI (n?=?51), AVR (n?=?188), AVR?≥?80 (n?=?48), and AVR ES?≥?10 (n?=?47), respectively, unless otherwise stated. Age in years was 83.0 (8.1), 71.2 (13.1), 84.1 (2.7), 79.4 (7.1); EuroSCORE was 24.7 (11.9), 8.1 (6.4), 12.0 (6.0), and 16.5 (6.6); post-operative LoS (days) was 11.5 (11.2), 10.9 (10.8), 14.3 (16.7), and 15.2 (17.7). For discharged patients, 0%, 7%, 13%, and 9% had unplanned cardiac-related re-admissions within 30-days of discharge. Time to first readmission was 74.6 (34.0), 35.0 (34.2), 20.8 (9.7), and 22.6 (14.3) days.

Limitations:

This was a single-center retrospective evaluation, not prospectively powered to confirm differences in outcomes.

Conclusions:

Despite TAVI being performed in an older, higher risk population, LoS was similar to AVR. Most strikingly there were no cardiac-related re-admissions within 30-days for TAVI and time to first re-admission was significantly longer. This evaluation suggests that TAVI is clinically appropriate and provides economic advantages in both the hospital and post-discharge setting in this high risk group. Many patients undergoing TAVI are considered unfit for surgery and, hence, TAVI offers a treatment that delivers similar results to traditional AVR without the high risk associated with surgery.     

National Papers of Interest to Economic Educators

The author argues that while advances in technology may have made long-range and long-term planning less critical, they have not made long-run decisionmaking obsolete.     

Minimum option prices under decreasing absolute risk aversion

We establish bounds on option prices in an economy where the representative investor has an unknown utility function that is constrained to belong to the family of nonincreasing absolute risk averse functions. For any distribution of terminal consumption, we identify a procedure that establishes the lower bound of option prices. We prove that the lower bound derives from a particular negative exponential utility function. We also identify lower bounds of option prices in a decreasing relative risk averse economy. For this case, we find that the lower bound is determined by a power utility function. Similar to other recent findings, for the latter case, we confirm that under lognormality of consumption, the Black Scholes price is a lower bound. The main advantage of our bounding methodology is that it can be applied to any arbitrary marginal distribution for consumption. This revised version was published online in June 2006 with corrections to the Cover Date.     

Antecedents of cognitive age: A replication and extension

Cognitive age has been an important construct in studies of older consumers. The present study builds upon previous research by providing theory‐based antecedents of cognitive age. The results suggest that differences in cognitive age do not merely reflect differences in chronological age, and that a person's cognitive age is influenced by his or her experiences of life events that serve as markers of transitions into social roles people are expected to enact at different stages in life. In addition, the experiences of health‐related events, such as chronic conditions, make people aware of their aging, affecting their cognitive age. The influence of cognitive age on consumer‐behavior variables is also examined, and directions for future research are suggested. © 2005 Wiley Periodicals, Inc.     

Long- and short-term interest rates in 19 countries: Tests of cointegration and parameter instability

This paper examines the long-run relationship between short-term and long-term interest rates (both nominal and real) in 19 countries, and explores the possibility that the relationship is statistically stable using Lc, MeanF, and SupF statistics suggested by Hansen [1992]. Empirical results obtained from various cointegration techniques (Johansen, Phillips and Hansen, Stock and Watson, and Park) and quarterly data (1973–1998) show considerable support for the expectations hypothesis in all countries (except the United Kingdom). In a majority of cases, it is also found that a stable relationship exists between the short-term and long-term interest rates.