Cost–consequence analysis of a hemostatic matrix alone or in combination for spine surgery patients

Background: A five-year retrospective database analysis comparing the use of Floseal¹ flowable topical hemostat alone (F) and in combination with gelatin/thrombin (F?+?G/T) to achieve hemostasis and control surgical bleeding showed higher resource utilization for F?+?G/T cases relative to F matched pairs during spinal surgery. Lower resource use in the F group was characterized by shorter hospital length of stay and surgical time as well as fewer blood transfusions and less hemostat agent used per surgery.

Objective: To evaluate the cost–consequence of using F compared to F?+?G/T in minor, major and severe spinal surgery from the US hospital perspective.

Methods: A cost–consequence model was developed using the US hospital perspective. Model inputs include clinical inputs from the literature, cost inputs (hemostatic matrices, blood product transfusion, hospital stay and operating room time) from the literature, and an analysis of annual spine surgery volume (minor, major and severe) using the 2012 National Inpatient Sample (NIS) database. Costs are reported in 2017?US dollars. One-way and probabilistic sensitivity analyses address sources of variability in the results.

Results: A medium-volume hospital (130 spine surgeries per year) using F versus F?+?G/T for spine surgeries is expected to require 85 less hours of surgical time, 58 fewer hospital days and 7 fewer blood transfusions in addition to hemostat volume savings (F: 1?mL, thrombin: 1994?mL). The cost savings associated with the hospital resources for a medium-volume hospital are expected to be $317,959 (surgical hours?=?$154,746, hospital days?=?$125,237, blood transfusions?=?$19,023, hemostatic agents?=?$18,953) or $2445 per spine surgery.

Conclusions: The use of F versus F?+?G/T could lead to annual cost savings for US hospitals performing a low to high volume of spinal surgeries per year.     

Anticipating converging industries using publicly available data

Industry convergence, described as the blurring of boundaries between industries, plays an increasingly pivotal role in shaping markets and industries. Traditionally, this phenomenon has been discussed in respect to telecommunications, information technologies and electronics, but more recently also the chemical and its related industries find themselves affected by a larger convergence process. With the primary example of phytosterols in the two converging industries of Cosmeceuticals and of Nutraceuticals and Functional Foods, we analyze 7455 scientific and patent references in respect to first indicators for signs of convergence. Furthermore, we present and discuss a multiple indicator concept for monitoring convergence in an R&D-intensive field on the basis of publicly available data.     

GHG Registries: Participation and Performance Under the Canadian Voluntary Climate Challenge Program

Between 1994 and 2004, the Voluntary Challenge and Registry (VCR) played an important role in Canadian climate change policy. In this paper, we examine the decision of firms to participate in the VCR, the extent of their involvement, and then ask if greenhouse gas emissions are related to past VCR participation. As an information provision program, we find evidence that firms may participate in VCR to signal their environmental responsibility to regulators and to some extent investors, but not to consumers. We also find that past involvement in the VCR is a strong and significant determinant of current involvement in the registry. Greenhouse gas emissions reported to the Mandatory Greenhouse Gas Reporting Program in 2004, however, do not appear to be different between VCR reporters and non-reporters. GHG emissions are observed to be significantly lower among firms that are smaller, emit fewer toxic releases, use more renewable energy sources, are intermediate good producers, and are located in Quebec, Ontario, and Manitoba.     

Research opportunities in supply chain management

Since its introduction as a concept in the 1980s, supply chain management (SCM) has undergone significant modification and expansion. A qualitative analysis of 166 unique definitions of SCM published in the literature identified three major themes associated with the supply chain and SCM: (1) activities; (2) benefits; and (3) constituents/components. Utilizing these themes, key research questions and issues within the supply chain and SCM are identified that could be examined by marketing scholars.     

Determinants of ICT adoption: evidence from firm-level data

We analyse factors driving inter- and intra-firm diffusion of Information and Communication Technologies (ICT) using data from Irish manufacturing firms over the period 2001 to 2004. We find that the path of ICT diffusion has been uneven across firms, industries and space, which is consistent with the theory of new technology adoption. Our results suggest that firms that are larger, younger, fast growing, skill-intensive, export-intensive and firms located in the capital city region have been relatively more successful in adopting and using ICT. We find positive technology spillovers from firms that have adopted ICT located in the same industry and region.     

Assessing the employment effects of the German welfare reform – an integrated CGE-microsimulation approach

The purpose of this article is to quantify the employment effects of the recent German welfare reform. The key element of this reform was to merge the coexisting transfer systems Social Assistance (SA) and Unemployment Assistance (UA) into one unified benefit (Arbeitslosengeld II – ALG II). We also consider a second reform scenario that is intended to further improve the labour supply incentives of low-skilled workers. Our methodological contribution is to use an integrated CGE-microsimulation model. In adopting such an approach, we are able to combine the advantages of microsimulation studies by accounting for the large amount of heterogeneity in terms of households’ preferences and budget constraints with the advantages of an applied general equilibrium model. The latter permits us to identify potential general equilibrium repercussions through changes in wages and unemployment. The simulations indicate that the introduction of ALG II results in a negligible increase in employment of only 45?000 individuals. In contrast, a cut in benefit levels combined with a decrease in transfer withdrawal is shown to produce somewhat larger employment effects of about 190?000 individuals.     

Taking stock: A comparative analysis of payments for environmental services programs in developed and developing countries

Payments for environmental services (PES) are an innovative approach to conservation that has been applied increasingly often in both developed and developing countries. To date, however, few efforts have been made to systematically compare PES experiences. Drawing on the wealth of case studies in this Special Issue, we synthesize the information presented, according to case characteristics with respect to design, costs, environmental effectiveness, and other outcomes. PES programs often differ substantially one from the other. Some of the differences reflect adaptation of the basic concept to very different ecological, socioeconomic, or institutional conditions; others reflect poor design, due either to mistakes or to the need to accommodate political pressures. We find significant differences between user-financed PES programs, in which funding comes from the users of the ES being provided, and government-financed programs, in which funding comes from a third party. The user-financed programs in our sample were better targeted, more closely tailored to local conditions and needs, had better monitoring and a greater willingness to enforce conditionality, and had far fewer confounding side objectives than government-financed programs. We finish by outlining some perspectives on how both user- and government-financed PES programs could be made more effective and cost-efficient.     

Is the Relationship between Inflation and Its Uncertainty Linear?

Abstract. We use parametric power ARCH models of the conditional variance of inflation to model the relationship between inflation and its uncertainty using monthly data for Germany, the Netherlands and Sweden over a period ranging from 1962 to 2004. For all three countries inflation significantly raises inflation uncertainty as predicted by Friedman. Increased uncertainty affects inflation in all countries but not in the same manner. For Sweden we find a negative impact in accordance with the Holland hypothesis, whereas for Germany and the Netherlands we find the opposite in support of the Cukierman–Meltzer hypothesis. In a sensitivity analysis we show that an arbitrary choice of the heteroscedasticity parameter influences this relationship significantly.