Cost and mortality impact of an algorithm-driven sepsis prediction system

Aims: To compute the financial and mortality impact of InSight, an algorithm-driven biomarker, which forecasts the onset of sepsis with minimal use of electronic health record data.

Methods: This study compares InSight with existing sepsis screening tools and computes the differential life and cost savings associated with its use in the inpatient setting. To do so, mortality reduction is obtained from an increase in the number of sepsis cases correctly identified by InSight. Early sepsis detection by InSight is also associated with a reduction in length-of-stay, from which cost savings are directly computed.

Results: InSight identifies more true positive cases of severe sepsis, with fewer false alarms, than comparable methods. For an individual ICU with 50 beds, for example, it is determined that InSight annually saves 75 additional lives and reduces sepsis-related costs by $560,000.

Limitations: InSight performance results are derived from analysis of a single-center cohort. Mortality reduction results rely on a simplified use case, which fixes prediction times at 0, 1, and 2?h before sepsis onset, likely leading to under-estimates of lives saved. The corresponding cost reduction numbers are based on national averages for daily patient length-of-stay cost.

Conclusions: InSight has the potential to reduce sepsis-related deaths and to lead to substantial cost savings for healthcare facilities.     

Costs and utilization of hemophilia A and B patients with and without inhibitors

Objective:

To evaluate the health system costs among patients with hemophilia A and B with and without inhibitors over 5 years.

Methods:

This was a retrospective, observational study utilizing medical and pharmacy electronic medical records and administrative encounters/claims data tracking US patients between 2006–2011. Patients with diagnosis codes for hemophilia A and B were identified. Patients with inhibitors were characterized by utilization of bypassing agents activated prothrombin complex concentrate or factor VIIa on two or more distinct dates. Severity was classified as mild, moderate, or severe based on laboratory tests of clotting factor.

Results:

There were 160 hemophilia A patients and 54 hemophilia B patients identified. From this group, seven were designated as patients with inhibitors (five with hemophilia A and two with hemophilia B). Hemophilia A patients without inhibitors reported 65 (41.9%) as being severe, 19 (12.3%) as moderate, and 71 (45.8%) as mild. Hemophilia B patients without inhibitors reported nine (17.3%) had severe, 13 (25.0%) had moderate, and 30 (57.7%) had mild hemophilia. All patients with inhibitors had been hospitalized in the previous 5 years compared to 64 (41.3%) with hemophilia A without inhibitors and 22 (42.3%) with hemophilia B without inhibitors. The median aggregate cost per year (including factor and health resource use) was $325,780 for patients with inhibitors compared to $98,334 for hemophilia A patients without inhibitors and $23,265 for hemophilia B patients without inhibitors.

Conclusions:

The results suggest that, while the frequency of inhibitors within the hemophilia cohort was low, there was a higher frequency of hospitalizations, and the associated median aggregate costs per year were 3-fold higher than those patients without inhibitors. In contrast, hemophilia B patients experience less severe disease and account for lower aggregate yearly costs compared to either patients with hemophilia A or patients with inhibitors.     

Wage and employment effects of Malawi's fertilizer subsidy program

This article uses three waves of nationally representative household‐level panel data from Malawi to estimate how a large‐scale fertilizer subsidy program impacts the agricultural labor market, known as ganyu in that country. I find that when looking across the entire population of smallholders, receiving an additional 100 kg of subsidized fertilizer causes the average household to supply about three fewer days of ganyu. The fertilizer subsidy program also has a small positive effect on the probability that a household demands agricultural labor, with the results approaching statistical significance. In addition, a 10 kg increase in the average amount of subsidized fertilizer acquired per household in a community boosts the median agricultural wage rate by 1.4% in that community. The increase in wage rates translates to a US $1.40 per year increase in average household income in the years after Malawi's subsidy program was scaled up, and a US $1.86 per year increase in average household income for those who sold their labor before the subsidy program was scaled up. This finding suggests that households who sell their labor off farm may experience some small spillover benefit from the program in the form of higher agricultural wage rates.     

The effects of disclosure type and audit committee expertise on Chief Audit Executives’ tolerance for financial misstatements

This study involves an experiment where 73 Chief Audit Executives and deputy Chief Audit Executives determine the amount of adjustment required to correct a misstatement. We manipulate the financial reporting location of the misstatement (recognized vs. disclosed) and the level of audit committee expertise (high vs. low). The results indicate that financial reporting location has significant effects on internal auditors’ decisions to correct misstatements. Specifically, internal auditors are more willing to waive disclosed misstatements relative to recognized misstatements. Contrary to expectations, the results do not indicate that increased audit committee expertise and associated increases in audit committee members’ perceived powers cause internal auditors to be less willing to waive misstatements.     

Economic aspects of diffusion models

This paper presents possible effects of economic and marketing variables on the diffusion process of new products. The variables examined are price, advertising, and consumer's income. It is shown that under certain conditions the diffusion process depends on the income elasticity of the new product introduced.     

The role of attention and memory in accounting decisions

Behavioral research in accounting has ignored the concepts of attention and memory which are crucial both to the development of a complete understanding of how accounting information is processed by humans and to the interpretation of existing research. In this paper, a review of literature from psychology, marketing and artificial intelligence is used to develop a series of significant research areas to increase accountants' understanding of the roles that attention and memory have in the human processing of accounting information.     

Protection and international stability

Summary Since World War II trade negotiations under GATT reduced tariff protection to one-eighth of its pre-war level. From the mid 1970s however, protection increased again, in particular non-tariff barriers were being used. Furthermore, strategic trade policies use subsidies and other non-border protective measures. Protection prevents the world economy from gaining full benefits from specialization combined with expansion of trade. Unlike tariffs, non-tariff barriers fragment the market and encourage a bilateral approach in negotiating trade agreements. Strategic trade policies are difficult to apply properly and may evoke retaliation. Nondiscrimination is the main principle of GATT, on which the present international trading system is based. In order to maintain it, trade negotiations under GATT will hopefully lead to international consensus on the proper use of non-tariff barriers and instruments of strategic trade policies.[/p]