Assessment of Resource Use and Costs Associated with Parathyroidectomy for Secondary Hyperparathyroidism in End Stage Renal Disease in the UK

Introduction:

Secondary hyperparathyroidism (SHPT) is a major complication of end stage renal disease (ESRD). For the National Health Service (NHS) to make appropriate choices between medical and surgical management, it needs to understand the cost implications of each. A recent pilot study suggested that the current NHS healthcare resource group tariff for parathyroidectomy (PTX) (£2071 and £1859 in patients with and without complications, respectively) is not representative of the true costs of surgery in patients with SHPT.

Objective:

This study aims to provide an estimate of healthcare resources used to manage patients and estimate the cost of PTX in a UK tertiary care centre.

Methods:

Resource use was identified by combining data from the Proton renal database and routine hospital data for adults undergoing PTX for SHPT at the University Hospital of Wales, Cardiff, from 2000–2008. Data were supplemented by a questionnaire, completed by clinicians in six centres across the UK. Costs were obtained from NHS reference costs, British National Formulary and published literature. Costs were applied for the pre-surgical, surgical, peri-surgical, and post-surgical periods so as to calculate the total cost associated with PTX.

Results:

One hundred and twenty-four patients (mean age?=?51.0 years) were identified in the database and 79 from the questionnaires. The main costs identified in the database were the surgical stay (mean?=?£4066, SD?=?£,130), the first month post-discharge (£465, SD?=?£176), and 3 months prior to surgery (£399, SD?=?£188); the average total cost was £4932 (SD?=?£4129). From the questionnaires the total cost was £5459 (SD?=?£943). It is possible that the study was limited due to missing data within the database, as well as the possibility of recall bias associated with the clinicians completing the questionnaires.

Conclusion:

This analysis suggests that the costs associated with PTX in SHPT exceed the current NHS tariffs for PTX. The cost implications associated with PTX need to be considered in the context of clinical assessment and decision-making, but healthcare policy and planning may warrant review in the light of these results.     

Short interest and the stock market relation with news sentiment from traditional and social media sources

We examine how the stock market relation to news sentiment—from traditional and social media (Twitter) sources—interacts with short selling of stocks. Our sample includes the S&P500 constituents for the period January 2016 to December 2020, providing 704,452 firm-day observations. We find evidence that both news sources are positively related to returns. The relationship is stronger for firms with a high short interest ratio, for small firms, and particularly for firms that are both small and highly shorted. This is consistent with short sellers targeting firms that are most responsive to (negative) news releases and so more likely to compensate for the additional costs encountered in shorting.     

Commodity Price Instability and Debt-linking by Developing Countries

Most developing countries borrow in world capital markets. Typically this borrowing is denominated in one of the major currencies and requires periodic servicing. The foreign exchange required to meet the service obligation is often dependent on the export of one or a small number of commodities. This demand usually competes with a number of other claims on export earnings, including both consumption and capital goods imports. This paper investigates the use of commodity-linked borrowing by developing countries. If the interest and/or principal payments on external debt are linked to the price of a country's principal exports, the risk of default can be shifted to better-diversified lenders. The social cost of linking is much smaller than that of other compensating arrangements. In addition, commodity-linked debt may reduce the borrower's direct lending costs. This will depend on the quantity of linked debt supplied and the dispersion of expectations about the future price of the commodity. If the supply is small relative to the demand among investors who expect the commodity price to increase, the resulting reduction in the cost of borrowing may be sufficient to offset the premium for bearing the risk associated with the commodity's future price.     

Researching Strategy Formation Process: An Abductive Methodology

Methodological challenges in researching subjective social construct formation processes (such as business strategy formation) are described. A solution is derived step by step, based on classic contributions to the literature and first principles. Two major methodological risk factors in interpretive research are identified as horns of a dilemma, and a practical solution is offered. In the process, a basis is offered for carrying out interpretive research in which meaningful data coding can occur across multiple case studies. The methodology developed for the author’s own research is used as an illustration. The author wishes to acknowledge the assistance of Associate Professor Erica Hallebone of RMIT University, who read successive drafts of this article and provided valuable suggestions.     

Export Diversification in the Gulf: The Kuwait Experience

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Fuel-Mining Exports and Economic Growth: Evidence from the UAE

International Advances in Economic Research -