The impact of frailty on the economic evaluation of geriatric surgery: hospital costs and opportunity costs based on meta-analysis

Abstract

Objectives: We used a systematic review and meta-analysis to analyze the difference in costs between surgery for frail and non-frail elderly patients. The opportunity cost of frailty in geriatric surgery is estimated using the results.

Methodology: Two literature reviews were carried out between 2000 and 2019: (1) studies comparing total hospital costs of frail and non-frail surgical patients; (2) studies evaluating the length of hospital stay and cost for surgical geriatric patients. We performed a meta-analysis of the items selected in the first review. We subsequently calculated the opportunity cost of frail patients, based on the design of a cost/time variable.

Results: Twelve articles in the first review were selected (272,717 non-frail and 16,461 frail). Fourteen articles were selected from the second review. Frail patients had higher hospital costs than non-frail patients (22,282.541 € and 16,388.844, p?<?.001) and a longer hospital stay (10.16 days and 8.4 (p?<?.001)). The estimated opportunity cost in frail patients is 1,019.56 € (cost/time unit factor of 579.30 €/day).

Conclusions: Frail surgical geriatric patients generate a higher total hospital cost, and an opportunity cost arising from not operating in the best possible state of health. Preoperatively treating the frailty of elderly patients will improve the use of health resources     

The ‘Troubling Tradeoffs’ Paradox and a Resolution

Ravallion ( 2012a ) argues that the Human Development Index (HDI) embeds questionable tradeoffs between the dimensions used to compute the index. To alleviate these problems he proposes the adoption of one of the indices developed by Chakravarty ( 2003 ). In this paper I identify the following paradox: while the Chakravarty indices clearly exhibit more sensible tradeoffs than the HDI, the HDI produces more sensible rankings than the Chakravarty indices. To solve the paradox I identify the axioms behind each methodology responsible for the unintuitive tradeoffs and rankings and illustrate how to develop an index with these questionable axioms removed. This approach can result in methodologies that exhibit more intuitive tradeoffs by design, as it seeks inputs from the public as to what those tradeoffs ought to be, and produces rankings that are more in line with what the HDI wishes to measure: human development and capabilities, as conceptualized by Sen ( 1985 ).     

Profits and Fractal Properties: Notes on Marx,Countertendencies and Simulation Models

There are new reasons for revisiting Marx’s elaboration on the rate of profit because contemporary debates provide findings from the MEGA Project, long-term data on the rate of profit, and tools for dealing with complexity and non-equilibrium systems. This article proposes that the interplay between the tendency and the countertendencies of the rate of profit to fall can be translated into a simple system of equations, one based on each chapter of Section Three of Capital—as if Marx sought to mathematically formalise his insights. This article reviews previous debates, presents data and runs a simulation model, showing that the rate of profit behaves as fractals.     

The opportunity costs of commuting: the value of a commuting satellite account framework with an example from Lisbon Metropolitan Area*

Commuting affects regional and urban economies. It shapes urban areas, defines their relationships with neighboring regions, intensifies economic flows and exacerbates energy consumption and greenhouse gas emissions. This paper sets out a proposal for an innovative commuting satellite account (CSA), integrated in a multi-regional input–output model. This framework combines commuting activities with regional distribution of income, distinct household consumption structures, real estate renting activities and the energy consumption and environmental flows incorporated in the different industries. To assess the opportunity costs of commuting, the CSA framework is applied to the Lisbon Metropolitan Area. The socio-economic-environmental impacts of a scenario in which commuters become non-commuters by moving their residence to the municipality in which they work are estimated. The analysis indicates that: commuting, in general, induces significant economic and environmental opportunity costs. Finally, the adoption of policy-oriented recommendations contributing to limit sprawling in metropolitan regions is discussed.     

Model selection via genetic algorithms illustrated with cross-country growth data

We provide a new simple procedure for selecting econometric models, which is used to select the regressors of the cross-country growth model regression. This procedure is based on a heuristic approach called genetic algorithms which are used to explore the universe of models made available by a General Unrestricted Model. This search process of the correct model is only guided by the Schwarz information criterion, which acts as the loss function of the genetic algorithm in order to rank the models. Our procedure shows good performance relative to other alternative methodologies when they are compared in a simulation environment. This research was supported by the Spanish Ministry of Science and Education through the project SEJ2006-07701.     

Poisoned grapes,mad cows and protectionism

This paper studies two episodes where a ban on imports was imposed to safeguard people's health. The first case is the poisoned grapes crisis involving Chile and the United States in 1989. The second is the “mad cows” dispute, which broke out in 1996, between the United Kingdom and the European Union. These case studies motivate a new definition of “protectionist measure” which is applied to argue that the European Union's ban on British beef exports was not protectionist, while the US ban on Chilean fruit possibly classifies as such a measure.     

Reconciling the Invisible Hand and innovation

It is generally agreed that Adam Smith invoked the Invisible Hand to send the message to posterity that a free-market economy is the best form of economic organization. Strictly speaking, the Invisible Hand of Adam Smith is a conjecture about the virtues of a free-market economy. There are three claims in this paper concerning the interpretation of the Invisible Hand conjecture. First, the neoclassical interpretation engenders a conceptual confusion – identified here as the ‘double paradox’ of the Invisible Hand. Second, the interpretation of Adam Smith's conjecture on the beneficial effects of the free-market economy cannot – and should not – be confined to the production and consumption of existing products. Failure to distinguish the Invisible Hand Theorem from the Invisible Hand Doctrine distorts thinking about Adam Smith's message, creating the misconception that the Invisible Hand passage excludes business innovation. Third, the central message conveyed by Invisible Hand is to be read in the context of modern evolutionary economics.     

How efficient is the banking system of Asia’s next economic dragon? Evidence from rolling DEA windows

Vietnam is now widely regarded as a rising economic star and the next economic dragon of Asia. Its banking system has played a key role in this stellar economic performance. Since 1990, Vietnam’s banking system has undergone significant changes which saw its composition transformed from being state banks only to now being both state as well as private banks, and has performed generally well in terms of growth, profitability and stability. But is it efficient? We conduct a dynamic analysis of the level and trend of the cost and profit efficiency of the Vietnamese banking sector over the period 1995 to 2011 taking into account the Asian and Global Financial crises. We use the Data Envelopment Analysis (DEA) Windows Analysis approach and adjust for bank size in calculating the average efficiency score of the banking system. Our empirical findings show that the cost and profit efficiency of the Vietnamese banking system averaged around 0.90 and 0.75, respectively, with the state banks being more efficient than the private banks and with efficiency experiencing an upward trend over the analysis period. Moreover, we find that the Global Financial Crisis (GFC) and Asian Financial Crisis (AFC) did not significantly affect the efficiency of the whole Vietnamese banking system.     

Crypto-currency bubbles: an application of the Phillips–Shi–Yu (2013) methodology on Mt. Gox bitcoin prices

The creation of bitcoin heralded the arrival of digital or crypto-currency and has been regarded as a phenomenon. Since its introduction, it has experienced a meteoric rise in price and rapid growth accompanied by huge volatility swings, and also attracted plenty of controversies which even involved law enforcement agencies. Hence, claims abound that bitcoin has been characterized by bubbles ready to burst any time (e.g. the recent collapse of bitcoin’s biggest exchange, Mt Gox). This has earned plenty of coverage in the media but surprisingly not in the academic literature. We therefore fill this knowledge gap. We conduct an econometric investigation of the existence of bubbles in the bitcoin market based on a recently developed technique that is robust in detecting bubbles – that of Phillips et al. (2013a). Over the period 2010–2014, we detected a number of short-lived bubbles; most importantly, we found three huge bubbles in the latter part of the period 2011–2013 lasting from 66 to 106 days, with the last and biggest one being the one that ‘broke the camel’s back’ – the demise of the Mt Gox exchange.