Healthcare resource utilization and direct medical costs associated with index and recurrent Clostridioides difficile infection: a real-world data analysis

Abstract

Aims: This study aimed to evaluate all-cause economic outcomes, healthcare resource utilization (HRU), and costs in patients with Clostridioides difficile infection (CDI) and recurrent CDI (rCDI) using commercial claims from a large database representing various healthcare settings.

Materials and methods: A retrospective analysis of commercial claims data from the IQVIA PharMetrics Plus database was conducted for patients aged 18–64 years with CDI episodes requiring inpatient stay with CDI diagnosis code or an outpatient medical claim for CDI plus a CDI treatment. Index CDI episodes occurred between 1 January 2010 and 30 June 2017, including only those where patients were observable 6 months before and 12 months after the index episode. Each CDI episode was followed by a 14-d claim-free period. rCDI was defined as another CDI episode within an 8-week window following the claim-free period. HRU, all-cause direct medical costs and time to rCDI were calculated over 12 months and stratified by number of rCDI episodes.

Results: A total of 46,571 patients with index CDI were included. Mean time from one CDI episode to the next was approximately 1 month. In the 12-month follow-up period, those with no recurrence had 1.4 inpatient visits per person and those with 3 or more recurrences had 5.8. Most patients with 3 or more recurrences had 2 or more hospital admissions. The mean annual, total all-cause direct medical costs per patient were $71,980 for those with no recurrence and $207,733 for those with 3 or more recurrences.

Limitations: The study included individuals 18–64 years only. A stringent definition of rCDI was used, which may have underestimated the incidence of rCDI.

Conclusions: CDI and rCDI are associated with substantial healthcare resource utilization and direct medical costs. Timing of recurrences can be predictable, providing a window of opportunity for interventions. Prevention of multiple rCDI appears essential to reduce healthcare costs.     

洞庭湖流域植被覆盖变化及其协同治理

植被覆盖变化是评估生态效应与治理成效的关键性因素之一。基于洞庭湖流域2000—2019年MODISNDVI和同期气温、降水、土地利用等相关数据,运用Sen+Mann-Kendall、Hurst指数、偏相关分析、残差分析等多种方法,全面分析了流域植被覆盖时空演化与未来变化趋势,主要结论如下：(1)年际变化上,流域生长季NVDI呈分阶段波动上升趋势,植被覆盖显著增加。(2)空间分布上,流域大部分区域植被覆盖状况良好,呈“西高东低”分布特征;但未来流域大部区域植被NDVI可能呈增长放缓或退化趋势。(3)气候影响因素上,流域生长季NDVI与降水和气温变化均呈正相关,但气温对植被生长的正向促进作用强于降水。(4)人类影响因素上,农业生产与生态工程建设对流域植被变化具有正面效应;土地利用变化对流域植被变化具有双重影响作用;城市扩张则是导致NDVI减少的主要因素之一。未来流域生态治理范围应重点关注残差呈持续减少特征的湖区沿线、经济较发达区域以及已建成经济区的周边扩展区域,构建“有为政府、有效市场、有机社会”三位一体的生态协同治理新格局。     

Location incentives in the low-income housing tax credit: Are qualified census tracts necessary?

The low-income housing tax credit (LIHTC) is the largest project-based housing subsidy in the United States. Within the program, private developers receive a subsidy in exchange for constructing apartment units that rent for a predetermined affordable rate. Because the subsidy requires apartment buildings to charge a lower rental rate, the opportunity cost of developing subsidized housing in a location is the market rent that a developer could have charged if he had not received the subsidy. This study characterizes how profit incentives motivate location decisions within the LIHTC program by showing that opportunity cost causes more LIHTC development in locations with low market rent. This result implies that additional financial incentives, like the qualified census tract, may not be necessary to promote construction of subsidized housing in low-rent areas.     

Voluntary Disclosure and Analyst Forecast

Empiricists document that firms more often voluntarily disclose bad news than good news and link this pessimism to managers’ increased incentives not to fall short of earnings expectations. This paper analyzes the voluntary disclosure of a manager’s private information by explicitly considering her incentives to meet or beat an analyst’s earnings forecast. The model predicts that managers who face strong incentives to meet or beat these forecasts more frequently disclose bad news than good news in order to guide analysts’ expectations about future earnings downward. This pessimism is higher in markets with less informed managers and may hold even if the manager has strong incentives for high stock prices and meet-or-beat incentives are comparably low.     

Alberta Consumers’ Valuation of Extrinsic and Intrinsic Red Meat Attributes: A Choice Experimental Approach

This paper analyzes Alberta consumers’ perceptions toward extrinsic and intrinsic attributes of bison and beef steaks. In contrast to published Canadian consumer studies on bison meat that were undertaken prior to May 2003, before the first BSE case of Canadian origin was identified in beef cattle, this study provides a “post-BSE” assessment of consumer perceptions toward selected bison meat attributes. The results from an attribute-based choice experiment provide little support that simple traceability assurance schemes have value to consumers of bison and beef steaks, thus confirming similar findings of earlier beef studies that have employed different methodological approaches. The results also suggest that consumers are willing to pay significant premiums for bison steaks that are certified as being produced without genetically modified organisms, an attribute that has so far been unexplored in previous published bison studies. Le présent article analyse les perceptions des consommateurs de l’Alberta envers des attributs intrinsèques et extrinsèques du bifteck de bœuf et de bison. Contrairement aux études canadiennes sur la consommation de viande de bison publiées avant mai 2003, soit avant l’apparition du premier cas d’ESB dans un troupeau de bovins canadien, la présente étude livre une évaluation « post-ESB » des perceptions des consommateurs envers des attributs sélectionnés de la viande de bison. Les résultats obtenus à partir de la méthode des choix multi-attributs apportent peu d’appui à l’idée voulant que les mécanismes simples d’assurance de la traçabilité aient de la valeur pour les consommateurs de bifteck de bison et de bœuf, ce qui confirme les résultats similaires d’études antérieures sur le bœuf effectuées à l’aide de diverses approches méthodologiques. De plus, les résultats ont montré que les consommateurs sont prêts à payer un supplément appréciable pour du bifteck de bison certifié sans organisme génétiquement modifié (OGM), un attribut qui n’a pas été examiné dans les études sur le bison publiées antérieurement.     

成本控制概述

企业是微观经济的主体,其财务会计的最终目标是实现利润最大化、企业价值最大化。成本作为企业一定时期内生产特定种类和数量产品的资金耗费,是任何时代的任何企业都十分重视的一个问题,在走向市场经济的今天更是如此,所以本文主要对成本控制的涵义、内容和方法阐述了自己的一些看法。     

煤炭企业固定资产存在的问题及解决办法

煤炭业是我国国民经济中的支柱产业,经济社会可持续发展的基础,在经济社会中具有重要的作用,固定资产在煤炭企业中投入占矿井建设、生产投资比例也越来越大,怎样更好的管理和核算固定资产已成为煤炭企业当今不容忽视的问题。     

Who controls Allianz?

With cross-ownership among firms a separation between dividend rights on common stocks and voting rights may occur. This paper proposes a method to trace control rights in a company that is based purely upon accounting identities and the underlying data on cross-ownership relations among firms and privately held shares. Examples show that under cross-ownership, control and ownership of dividend rights may be entirely separated, and multiple equilibria may exist in such economies. The proposed methodology is then applied to the conglomerate around the German ‘Allianz’ group.     

滞胀是创新的起点

经济出现滞胀能够带来创新，包括孕育出一个全新价值观的民族，甚至孕育出些全新的产业，滞胀可以带来一个社会全新改变。     

Die aktuelle Weltwirtschaftskrise und der ökologische Umbau der Wirtschaft

Die aktuelle Finanz- und Wirtschaftskrise und der Klimawandel haben gemeinsame Wurzeln, aber ganz unterschiedliche Wirkungen. Sie werden deshalb auch sehr verschieden wahrgenommen. Sie lassen sich nur bek?mpfen, wenn man klug aufeinander abgestimmte politische Ma?nahmen ergreift.