Medication,equipment, and supply costs for common interventions providing extended post-surgical analgesia following total knee arthroplasty in US hospitals

Aims: To estimate the cost to hospitals of materials (i.e. medications, equipment, and supplies) required to administer common interventions for post-surgical analgesia after total knee arthroplasty (TKA), including single-injection peripheral nerve block (sPNB), continuous peripheral nerve block (cPNB), periarticular infiltration of multi-drug cocktails, continuous epidural analgesia, intravenous patient-controlled analgesia (IV PCA), and local infiltration of bupivacaine liposome injectable suspension (BLIS).

Materials and methods: This analysis was conducted using a mixed methods approach combining published literature, publicly available data sources, and administrative data, to first identify the materials required to administer these interventions, and then estimate the cost to the hospital of those materials. Medication costs were estimated primarily using the Wholesale Acquisition Costs (WAC), the cost of reusable equipment was obtained from published sources, and costs for disposable supplies were obtained from the US Government Services Administration (GSA) database. Where uncertainty existed about the technique used when administering these interventions, costs were calculated for multiple scenarios reflecting different assumptions.

Results: The total cost of materials (i.e. medications, equipment, and supplies) required to provide post-surgical analgesia was $41.88 for sPNB with bupivacaine; $756.57 for cFNB with ropivacaine; $16.38 for periarticular infiltration with bupivacaine, morphine, methylprednisolone, and cefuroxime; $453.84 for continuous epidural analgesia with fentanyl and ropivacaine; $178.94 for IV PCA with morphine; and $319.00 for BLIS.

Limitations: This analysis did not consider the cost of healthcare providers required to administer these interventions. In addition, this analysis focused on the cost of materials and, therefore, did not consider aspects of relative efficacy or safety, or how the choice of intervention for post-surgical analgesia might impact outcomes such as length of stay, re-admissions, discharge status, adverse events, or total hospitalization costs.

Conclusions: This study provided an estimate of the costs to hospitals for materials required to administer commonly used interventions for post-surgical analgesia after TKA.     

Firepower: Geopolitical Cultures in the Anthropocene

ABSTRACT

The human control of fire is a relatively neglected part of the discussion of the contemporary transformation of the planet. Thinking about it in terms of geopolitics is a way to link climate adaptation, extinction and the possibilities of extending traditional analyses of political ecology to the global scale. Such thinking is explicitly rejected as the appropriate premises for foreign policy action by the Trump administration which poses American greatness in terms of traditional understandings of firepower. This clash of geopolitical cultures is now key to global politics, where dramatic landscape transformation, related species extinctions as well as climate change results directly and indirectly from human control of combustion. Firepower is a matter of military technology as well as, in the form of fossil fuel combustion, the essential energy source that fuels the global economy. Focusing on combustion as a key geophysical force in contemporary geopolitics offers useful insights into the Anthropocene discussion and, in particular, the two planetary boundaries of climate change and biodiversity loss, which are key to contemporary efforts at global environmental governance.     

The ABC of complementary products mergers

We present a simple model where mergers benefit consumers, harm outsiders and, depending on the shape of demand, can be profitable for insiders (and where mergers do not involve cost synergies).     

Aid and public sector fiscal behaviour in failing states

This paper looks at interactions between foreign aid and the public sector in developing countries, especially those considered to be fragile or failing states. A model is proposed which employs actual budgetary appropriations and revenue estimates (rather than estimated target variables) and allows for asymmetric preferences. Variants of the model are estimated using time-series data for Papua New Guinea (PNG). PNG is classified as a fragile state by the international community owing to perceived policy and institutional inadequacies. Results obtained suggest that foreign aid increases consumption and investment expenditures and decreases tax revenues and the level of borrowing.     

The effects of (incentivized) belief elicitation in public goods experiments

Belief elicitation is an important methodological issue for experimental economists. There are two generic questions: 1) Do incentives increase belief accuracy? 2) Are there interaction effects of beliefs and decisions? We investigate these questions in the case of finitely repeated public goods experiments. We find that belief accuracy is significantly higher when beliefs are incentivized. The relationship between contributions and beliefs is slightly steeper under incentives. However, we find that incentivized beliefs tend to lead to higher contribution levels than either non-incentivized beliefs or no beliefs at all. We discuss the implications of our results for the design of public good experiments.     

Political Instability and Economic Growth: UK Time Series Evidence

This paper tests for the influence of political instability on UK economic growth between 1961 and 1997. We construct six variables that quantify political instability and examine the effect on growth. The results suggest that there is a strong link. GARCH‐M models reveal negative effects of instability on growth and positive effects on growth uncertainty. Uncertainty in itself does not affect growth.     

Linking sustainable business models and supply chains — Toward an integrated value creation framework

Extant literature on sustainable business models highlights that value creation stems from resources exchanged in relationships between a focal firm and its stakeholders. In this context, the literature has, so far, focused on direct relationships. However, despite the acknowledged relevance of sustainability issues in supply chains, this relational view of the focal company and its direct stakeholders has not been extended toward value creation for and with indirect stakeholders, such as stakeholders of suppliers. Addressing this gap, this conceptual article integrates a relational view of sustainable supply chain management into the management of sustainable business models. It extends the scope of sustainable business models from relationships between the focal firm and its direct stakeholders to indirect relationships with stakeholders of suppliers. A framework is developed that supports analysis and management of value-creating relationships between the focal firm, suppliers, and stakeholders of suppliers. By extending the conceptualization of sustainable business models to consider relationship chains beyond direct relationships, this article proposes that a focal firm has to actively manage interactions both with suppliers and with suppliers' stakeholders.     

An Ordered-Probit Analysis of Price and Performance in Competitively Tendered Contracts

Abstract
This article adopts an ordered-probit estimation procedure to investigate the influence of competitive tendering on contract price and performance. Using a two-equation recursive system the findings of Domberger, Hall and Li (1995) turned out to be robust to the ordered-probit methodology which confirmed the strong negative effect of competitive tendering on contract price. The evidence also suggested that performance was either enhanced or remained the same in the presence of competition. Overall, the results of this investigation support the view that competitive tendering generates efficiency gains without adverse effects on quality of service .