Hospital costs associated with thyroidectomy performed with a Harmonic device compared to conventional techniques: a systematic review and meta-analysis

Objectives: Harmonic devices have become a world-wide standard for dissection and hemostasis in thyroidectomy. Numerous systematic reviews have reported superior operating times, blood loss, post-operative pain, length of stay, and overall safety outcomes. What has not been extensively evaluated in a robust manner is their economic impact. The purpose of this study is to evaluate the hospital costs associated with open thyroidectomy using Harmonic devices compared with conventional techniques for hemostasis. Methods: A systematic review of Medline, Scopus, and CENTRAL was performed from January 1, 2000 to May 23, 2014 without language restrictions for randomized clinical trials comparing Harmonic surgical devices to conventional methods in thyroidectomy. The main outcome measure was total reported costs. Costs were pooled using the ratio of means and a random effects model. Sensitivity analyses assessed whether differences in patient and trial characteristics, healthcare setting, or choice of statistical model affected outcomes. Results: Seven studies met the inclusion criteria. A total of 476 participants had procedures performed with Harmonic devices and 478 with conventional monopolar electrosurgery and clamp, cut and tie techniques. Compared with conventional techniques, Harmonic devices reduced total reported costs by 10% (p?=?0.007), resulting in a $229?US dollars (USD) absolute reduction from mean baseline costs. Results remained relatively robust to additional sensitivity analyses. Conclusions: This systematic review and meta-analysis demonstrates that the Harmonic family of surgical devices is associated with a reduction in total reported costs in thyroidectomy compared with conventional techniques. A large portion of the overall savings derives from a reduction in operative costs.     

论碳交易平台对碳交易成本的影响--以深圳碳排放权交易体系为例

根据科斯定理,市场可以在政府不干预的情况下以有效方式消除温室气体污染的外部性。碳交易成本的大小对碳排放交易机制能否起作用有重要影响。碳交易平台对交易成本中的交易费用有直接影响,对交易成本中的管理成本和机会成本有一定程度的影响,对交易成本中的监测、报告和核查成本基本没有影响。交易平台可以从结构性和市场性两方面影响交易成本。     

财务管理中的杠杆效应与风险探析

财务管理学中的经营杠杆、财务杠杆和复合杠杆相关理论是企业优化资本结构、获取经营杠杆收益、控制经营风险、实现股东收益最大化与控制企业财务风险的重要理论,涉及筹资活动、投资活动与经营活动多个方面,是筹资决策、投资决策和经营决策的重要依据。本论从经营杠杆、财务杠杆相关理论依据与内涵入手,在分析经营杠杆、财务杠杆和复合杠杆计算及公式的基础上,重点对其三项指标的性质与作用进行分析与评价。以达到全面的、正确的理解杠杆效应与风险程度的相互关系,明晰经营风险和财务风险之间的联系,以实现经营(投资)决策与筹资决策的相互配合,共同控制与降低企业复合风险。     

城市化影响金融业竞争力了吗？ ——个理论模型及来自江苏省的证据

摘在已有文献的基础上,本文构建了一个城市化影响金融业竞争力的理论模型,推导结果表明,城市化对金融业竞争力同时存在积聚效应和负向效应。随后本文利用江苏省面板数据进行实证分析,研究结果表明,城市化对金融业竞争力的影响存在不确定性：城市化本身有助于提升金融业竞争力,工资成本起到了增强金融业竞争力的作用,但住房成本削弱了金融业竞争力。金融业能够起到优化配置经济资源的作用,在发挥金融业支持城市化建设这一作用的同时,我们需要关注城市化提升金融业竞争力的路径和对策,力争达成城市化和金融业发展并行不悖的良好境界。     

地方公共服务、要素流动与要素空间配置——基于本地交易成本的均衡分析

通过"两区域、两要素与两部门"模型研究发现,即使存在区域内与区域间两类交易成本,增加公共服务仍有利于吸引要素流入,并产生要素空间聚集效应;增加公共支出以改善区内贸易条件对要素流动及其空间分布具有不同的影响;我国地方公共支出规模与全要素生产率之间存在明显的长期因果关系.     

所有权结构、代理成本与公司价值－来自中国上市公司的经验证据

本文从理论上分析了股权结构与公司价值间的关系,并通过实证研究考察上市公司所有权结构及由此而产生的代理成本与其市场价值之间的关系。检验结果与理论分析相一致：（1）上市公司存在控股股东,会使公司市场价值折价。（2）上市公司存在股权制衡,能够有效的减少公司代理成本,提升公司价值。（3）不同性质的控股股东所产生的代理成本不同,国家股东的非人格化使得公司的代理成本高于非国有股东。本文得出结论：我国的上市公司普遍存在控股股东,由此产生的代理成本减低了企业的价值,国有股东的代理问题尤为严重,股权制衡的模式能够在一定程度上缓解代理问题。     

CEV模型下有交易成本和随机波动率的亚式期权定价问题的文献综述

随着金融衍生品的发展,对其进行定价成为理论和实务操作中的重点。亚式期权作为一种强依赖路径的衍生品,在金融市场中有套期保值作用,在管理中有经理股票期权激励作用。因此,设计出更加切合市场实际的定价模型非常重要。本文选取了相比较B-S模型更加实际的CEV模型作为标底资产的路径过程,加入随机波波动率服从有限Markov链的情况下有交易成本的亚式期权定价公式。在已有的相关文献参考下,可以得出其偏微分方程。并且通过二叉树算法,实现定价计算。     

露天矿山矿用大车成本控制措施

文章主要介绍了矿用大车运行中成苓控制的方法与措施。通过多种措施来降低企业成本,向管理要效益,为企业又好又快发展作出贡献。     

Real-world dosing and drug costs with everolimus or axitinib as second targeted therapies for advanced renal cell carcinoma: a retrospective chart review in the US

Objective:

To describe dosing patterns and to compare the drug costs per month spent in progression-free survival (PFS) among patients with advanced renal cell carcinoma (aRCC) treated with everolimus or axitinib following a first tyrosine kinase inhibitor (TKI).

Methods:

A medical record retrospective review was conducted among medical oncologists and hematologists/oncologists in the US. Patient eligibility criteria included: (1) age ≥18 years; (2) discontinuation of first TKI (sunitinib, sorafenib, or pazopanib) for medical reasons; (3) initiation of axitinib or everolimus as a second targeted therapy during February 2012–January 2013. Real-world dosing patterns were summarized. Dose-specific drug costs (as of October 2014) were based on wholesale acquisition costs from RED BOOK Online. PFS was compared between everolimus and axitinib using a multivariable Cox proportion hazards model. Everolimus and axitinib drug costs per month of PFS were compared using multivariable gamma regression models.

Results:

A total of 325 patients received everolimus and 127 patients received axitinib as second targeted therapy. Higher proportions of patients treated with axitinib vs everolimus started on a higher than label-recommended starting dose (14% vs 2%) or experienced dose escalation (11% vs 1%) on second targeted therapy. The PFS did not differ significantly between patients receiving everolimus or axitinib (adjusted hazard ratio (HR)?=?1.16; 95% confidence interval [CI]?=?0.73–1.82). After baseline characteristics adjustment, axitinib was associated with 17% ($1830) higher drug costs per month of PFS compared to everolimus ($12,467 vs $10,637; p?<?0.001).

Limitations:

Retrospective observational study design and only drug acquisition costs considered in drug costs estimates.

Conclusions:

Patients with aRCC receiving axitinib as second targeted therapy were more likely to initiate at a higher than label-recommended dose and were more likely to dose escalate than patients receiving everolimus. With similar observed durations of PFS, drug costs were significantly higher—by 17% per month of PFS—with axitinib than with everolimus.