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.     

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.     

Are serial Condorcet rules strategy-proof?

Abstract. This paper explores the extent to which majority rule is invulnerable to manipulation by individuals and coalitions, even when majority rule is used to select more than one alternative. The resulting rule may or may not be strategy-proof, depending on the size of the coalitions that can form, and on the nature of the individual preferences over sets of alternatives. No individual can manipulate with respect to a wide family of preferences over sets. The only restriction on the domain of true and revealed individual preferences is that the selection rule is always well defined. Received: 1 November 1999 / Accepted: 7 May 2001 We thank two anonymous referees for suggestions that have significantly improved the paper. We are also grateful to l'Université de Caen for sponsoring a Workshop on Social Choice Theory, where a first draft of this paper was presented in May, 1999, and to the workshop participants for helpful observations. Work on the final version of the paper was done while one of the authors was a guest of the Project on Intergenerational Equity supported by the Ministry of Education, Science, and Technology of Japan. We are grateful to the Ministry and to the project leader, Professor Kotaro Suzumura, for their support.     

Book Reviews

Geoffrey Jones. The Evolution of International Business. An Introduction.
Hugo Armstron and Dick Gross. Tricontinental: The Rise and Fall of a Merchant Bank.
Bob Catley. Globalising Australian Capitalism.
Peter Groenewegen. A Soaring Eagle: Alfred Marshall 1842–1924.
Michael Schneider. J. A. Hobson.
Roy MacLeod and Deepar Kumar (eds). Technology and the Raj: Western Technology and Technical Transfers to India 1700–1947.
Tirthankar Roy (ed.). Cloth and Commerce. Textiles in Colonial India.
Deborah Oxley. Convict Maids.     

Executive Compensation and Earnings Persistence

Governing boards utilize executive compensation contracts in an attempt to align executive actions with corporate goals. The objective is to ensure that executive performance provides value to the organization in terms of successful outcomes. A key performance criteria typically specified in CEO compensation contracts is earnings targets. However, using earnings as a performance evaluation may be problematic because some firms exhibit robust and sustained earnings over time (high earnings persistence), and other firms, such as high growth oriented firms, exhibit weak or sometimes negative earnings over time (low earnings persistence). Our study reveals that the effect of high earnings persistence results in firms that focus more heavily on cash compensation (salary and bonus) rather than on equity compensation (stock options, etc.) to compensate executive performance. Additionally, for firms characterized by low earnings persistence, our study indicates that cash flows from operations act as a supplementary performance measure to accounting earnings, and become increasingly important as a means to justify executive cash compensation.     

Crisis costs and debtor discipline: the efficacy of public policy in sovereign debt crises

Recent debate on the reform of the international financial architecture has highlighted the potentially important role of the official sector in crisis management. We examine how such public intervention in sovereign debt crises affects efficiency, ex ante and ex post. Our results shed light on the scale of capital inflows and the implications for debtor country output of such a regime. The efficacy of measures such as officially sanctioned stays on creditor litigation depend critically on the quality of public sector surveillance and the size of the costs of sovereign debt crises.