Incremental costs associated with myocardial infarction and stroke in patients with type 2 diabetes mellitus: an overview for economic modeling

Objective:

To identify cost estimates related to myocardial infarction (MI) or stroke in patients with type 2 diabetes mellitus (T2DM) for use in economic models.

Methods:

A systematic literature review was conducted. Electronic databases and conference abstracts were screened against inclusion criteria, which included studies performed in patients who had T2DM before experiencing an MI or stroke. Primary cost studies and economic models were included. Costs were converted to 2012 pounds sterling.

Results:

Fifty-four studies were identified: 13 primary cost studies and 41 economic evaluations using secondary sources for complication costs. Primary studies provided costs from 10 countries. Estimates for a fatal event ranged from £2482–£5222 for MI and from £4900–£6694 for stroke. Costs for the year a non-fatal event occurred ranged from £5071–£29,249 for MI and from £5171–£38,732 for stroke. Annual follow-up costs ranged from £945–£1616 for an MI and from £4704–£12,926 for a stroke. Economic evaluations from 12 countries were identified, and costs of complications showed similar variability to the primary studies.

Discussion:

The costs identified within primary studies varied between and within countries. Many studies used costs estimated in studies not specific to patients with T2DM. Data gaps included a detailed breakdown of resource use, which affected the ability to compare data across countries.

Conclusions:

In the development of economic models for patients with T2DM, the use of accurate estimates of costs associated with MI and stroke is important. When country-specific costs are not available, clear justification for the choice of estimates should be provided.     

Multiple-objective methods in regulatory decision making: A conceptual framework applied to U.S. automobile safety standards

Public policy making is a complex matter. Policy makers are charged with balancing a broad spectrum of competing objectives, reflecting in varying degrees the interests and aspirations of a diverse range of constituencies and stakeholders. Policy decisions have differential impacts on differing constituencies and the contributions of these impacts to objectives are frequently uncertain, difficult to quantify, and hotly disputed. Formal methods of decision analysis have been advanced as aids for coping with complexity and have been applied to some public policy issues, most notably the management of water resources. While formal methods have the apparent benefit of rationalizing the policy process and improving the efficacy and equity of policy decisions, serious questions remain concerning the acceptability and ultimate usefulness of formal analyses in the public arena. In this article we examine these questions in the context of policy making relating to government regulation of automobile designs for safety. We consider what would be involved in attempting to use a relatively modern, multiple-objective approach in this context. The key questions are how and, more importantly, why multiple-objective methods might be used. The article begins with an illustrative case study, describes the current policymaking process, identifies the parties involved in and affected by this process, elicits key objectives, looks briefly at some scalar-objective approaches, and then outlines a multiple-objective approach. The framework developed arguably is useful in assisting policy making, at least at a qualitative level. Issues which impede a more quantitative resolution of this framework are discussed. This article is intended as a pilot study which may promote research toward the achievement of a useable multiple-objective procedure applicable in the public domain.     

Explaining the Cross‐Section of Stock Returns in Japan: Factors or Characteristics?

Japanese stock returns are even more closely related to their book-to-market ratios than are their U.S. counterparts, and thus provide a good setting for testing whether the return premia associated with these characteristics arise because the characteristics are proxies for covariance with priced factors. Our tests, which replicate the Daniel and Titman (1997) tests on a Japanese sample, reject the Fama and French (1993) three-factor model, but fail to reject the characteristic model.     

Disability and Perceptions of Work and Management

Matched employee–employer data from the 2004 Workplace Employment Relations Survey are used to examine differences in work‐related perceptions between disabled and non‐disabled employees. Even after accounting for differences in personal, job and workplace characteristics, disabled employees are found to hold more negative views on the treatment of workers by managers and, consistent with this, they express less job satisfaction and commitment towards their organization. The influence of disability is also examined across workplaces defined by sector, the presence of disability‐related policies and practices, and employee views of management to explore the role of corporate culture.     

The relationship between wellness participation and health care benefit utilization

To examine the relationship between participation in a wellness program and the amount of absenteeism and medical claims, seven years of retrospective absenteeism and medical claims records were collected for 207 employees (pre- and postwellness intervention) and entered into a database. A proportional stratified random sample of workers by wellness participation was selected. While there was no significant change in the amount of sick leave taken over time, a log transformation revealed a significant increase in the dollar amount of medical claims over time, particularly for the middle-aged group of employees. This confirms that wellness intervention slowed the rate of increasing claims among middle-aged participants after just three years of wellness intervention.     

Individual Agents,Firms, and the Real Estate Brokerage Process

This study examines how individual agents affect house selling prices and time on the market while controlling for brokerage firm-specific effects as well as supply and demand conditions that vary by neighborhood. Firm size effects disappear once firm specialization and agent characteristics are taken into account but geographic concentration by firms leads to higher selling prices. For individual agents, neither sex nor selling own listings affects price or selling time, but there are gains from partnering transactions across firms. Agents who specialize in listing properties obtain higher prices for their sellers while those who specialize in selling obtain lower prices for their buyers. Houses nearer to other transactions of an agent sell for higher prices. Finally, greater scale of listing and selling activity by an agent tends to lower selling price or lengthen the time on the market.

Visual displays: analytical study and applications to graphs and real data

Principal axis methods such as principal component analysis (PCA) and correspondence analysis (CA) are useful for identifying structures in data through interesting planar graphic displays. However, some kinds of data sets can be dealt alternatively with PCA or CA. This paper focuses on methods, such as PCA and CA, and on visual displays. Our aim is to illustrate the implications for a potential user of selecting either method, and its advantages and disadvantages, from an applied point of view. This is a matter covered broadly in textbooks and elsewhere considering theoretical arguments. Our purpose is to contribute to the comparison between these methods, over the same data set, in order to illustrate them for the practitioner. In the first part of this paper we present a novel analytical study of a binary matrix associated with a non-oriented axis-symmetric graph and show that CA outperforms standardized PCA for the reconstitution and visualization of such kind of graphs. In the second part we present a case using real data dealing with the distribution of employees in different economic sectors for the countries of the European Union, analyzed by means of standardized PCA and two-way CA, in order to see the differences between the two methods in practice.     

Container storage and transshipment marine terminals

This study addresses the storage arrangement of transshipment containers on a container yard, in order to carry out efficiently the ship handling operations at a terminal where mega-containerships call. An optimization model is specified to investigate the flow of containers from the mega-containership to feeder ships using intermediate storage at the yard. A heuristic based on the lagrangian relaxation is formulated. The quality of the heuristic approach is tested in a number of experiments. In the experiments, various situations are analyzed with respect to mega-containership arrival rates, some strategies for stack arrangements and terminal layouts.