历史的教训：逆向思维者胜

经济动荡期的管理是一种至关重要的商业能力。在经济低迷期,良好的企业管理不仅能够使企业的经营业绩优异于竞争对手,而且,在经济低迷期建立起来的竞争优势更具有可持续性。     

Healthcare costs for Crohn’s disease patients treated with infliximab: a propensity weighted comparison of the effects of treatment adherence

Objective:

The objective for the research was to evaluate the direct healthcare costs for Crohn’s disease (CD) patients categorized by adherence status.

Methods:

Adult patients with ≥1 claim for infliximab and ≥2 claims for CD who were continuously insured for 12 months before and after their first infliximab infusion (index date) were identified in a 2006–2009 US managed care database. Patients were excluded if they had rheumatoid arthritis claims, received infliximab billed as a pharmacy benefit, or received another biologic drug. Patients were categorized as being either adherent or intermittently adherent to infliximab using a pre-defined algorithm. Total and component direct costs, CD-related costs, rates of surgery, and days of hospitalization were estimated for the 360-day post-index period. Propensity weighted generalized linear models were used to adjust the cost estimates for potential confounding variables.

Results:

The total propensity weighted cost for infliximab adherent patients was $40,425 (95% CI?=?[$38,686, $42,242]), compared to $41,082 (95% CI?=?[$38,163, $44,223]) for the intermittently adherent (p?=?0.71). However, adherent patients had lower total direct medical costs, exclusive of infliximab, that were $13,097 (95% CI?=?[$12,141, $14,127]) compared with $20,068 (95% CI?=?[$17,676, $22,784]) for intermittently adherent patients as a result of substantially lower hospital and outpatient costs (p?Conclusions:

Greater drug-related costs for infliximab adherent patients were offset by lower costs from hospitalization and outpatient visits. These findings indicate that adherent patients have improved clinical outcomes, at a similar aggregate cost, than patients who are only intermittently adherent to therapy.     

Are there ENSO signals in the macroeconomy?

Whether ENSO has affected U.S. macroeconomic performance has been a matter of dispute. To address the issue we explore whether there has been any co-cyclicality of ENSO fluctuations and the rates of inflation and economic growth over the 1894-1999 timespan and, failing this, whether aperiodic ENSO shocks have had any impact on these variables. Neither co-cyclicality nor aperiodic shocks are discernible. While ENSO may briefly influence the performance of particular sectors of the economy in particular regions, as documented by the previous literature, such locally-important effects vanish into the noise surrounding macroeconomic trends in an economy as large and complex as that of the U.S.