Healthcare costs of stroke and major bleeding in patients with atrial fibrillation treated with non-vitamin K antagonist oral anticoagulants

Objective: To assess long-term healthcare costs related to ischemic stroke and systemic embolism (stroke/SE) and major bleeding (MB) events in patients with non-valvular atrial fibrillation (NVAF) treated with non-vitamin K antagonist oral anticoagulants (NOACs).

Materials and methods: Optum’s Clinformatics Data Mart database from 1/2009–12/2016 was analyzed. Adult patients with ≥1 stroke/SE hospitalization (index date) were matched 1:1 to patients without stroke/SE (random index date), based on propensity scores. Patients with an MB event were matched to patients without MB. All patients had an NOAC dispensing overlapping index date, ≥12?months of eligibility pre-index date, and ≥1 NVAF diagnosis. The observation period spanned from the index date until the earliest date of death, switch to warfarin, end of insurance coverage, or end of data availability. Mean costs were evaluated: (1) per-patient-per-year (PPPY) and (2) at 1, 2, 3, and 4?years using Lin's method.

Results: The cost differences were, respectively, $48,807 and $28,298 PPPY for NOAC users with stroke/SE (n?=?1,340) and those with MB (n?=?3,774) events compared to controls. Cost differences of patients with vs without stroke/SE were $49,876, $51,627, $57,822, and $60,691 at 1, 2, 3, and 4?years post-index, respectively (p?p?Limitations: Limitations include unobserved confounders, coding and/or billing inaccuracies, limited sample sizes over longer follow-up, and the under-reporting of mortality for deaths occurring after 2011.

Conclusions: The incremental healthcare costs incurred by patients with vs without stroke/SE was nearly twice as high as those of patients with vs without MB. Moreover, each additional year up to 4?years after the first event was associated with an incremental cost for patients with a stroke/SE or MB event compared to those without an event.     

The burden of blood transfusion: a utilization and economic analysis – a pilot study in patients with chemotherapy-induced anemia (CIA)

Abstract

Objective:

The objective is to measure the burden of blood transfusion of Packed Red Blood Cells (PRBCs) in patients with chemotherapy-induced anemia (CIA) on the institutional outpatient transfusion center.

Methods:

This is a retrospective chart review (starting July 1, 2010, working backwards until 120 evaluable patients are accrued) at a single institutional transfusion center in the US. The mean and standard deviation (SD) were calculated for patient’s age, pre-transfusion Hgb level, and other transfusion-related activities.

Results:

One hundred and twenty records were reviewed. The majority included patients who were female (71%), African American (61%), and had either Medicare (48%) or private insurance (39%). The mean patient age was 59 years and the average pre-transfusion Hgb was 7.9?g/dL. The average patient visit to facility ranged from 213?min for one PRBC unit to 411 minutes for three PRBC units. The mean staff time for patient evaluation was 66 minutes. Actual time for transfusion was ～100?min for each PRBC unit; 90% of patients received two PRBC units. Staff was engaged in direct patient care for an average of 322?min for two PRBC units. The labor cost of transfusion (in 2011 $US) ranged from $46.13–$49.33 per PRBC unit. The estimated fully loaded bundled cost was $596.49 for transfusion of one unit of PRBC. Limitations of the study include: the site included in this study may not be applicable to all sites in practice and the evaluated patient population was varied, with the exception that all patients were treated for some type of malignancy; and the review of blood bank records for 120 patients was not 120 independent events and, as such, may not have adequately captured actual variability.

Conclusions:

This analysis quantifies expense in terms of time for administration of the transfusion, as well as costs associated with outpatient blood transfusions.     

Confirming the timing of phase-based costing in oncology studies: a case example in advanced melanoma

Aims: The utilization of healthcare services and costs among patients with cancer is often estimated by the phase of care: initial, interim, or terminal. Although their durations are often set arbitrarily, we sought to establish data-driven phases of care using joinpoint regression in an advanced melanoma population as a case example.

Methods: A retrospective claims database study was conducted to assess the costs of advanced melanoma from distant metastasis diagnosis to death during January 2010–September 2014. Joinpoint regression analysis was applied to identify the best-fitting points, where statistically significant changes in the trend of average monthly costs occurred. To identify the initial phase, average monthly costs were modeled from metastasis diagnosis to death; and were modeled backward from death to metastasis diagnosis for the terminal phase. Points of monthly cost trend inflection denoted ending and starting points. The months between represented the interim phase.

Results: A total of 1,671 patients with advanced melanoma who died met the eligibility criteria. Initial phase was identified as the 5-month period starting with diagnosis of metastasis, after which there was a sharp, significant decline in monthly cost trend (monthly percent change [MPC]?=?–13.0%; 95% CI?=?–16.9% to –8.8%). Terminal phase was defined as the 5-month period before death (MPC?=?–14.0%; 95% CI?=?–17.6% to –10.2%).

Limitations: The claims-based algorithm may under-estimate patients due to misclassifications, and may over-estimate terminal phase costs because hospital and emergency visits were used as a death proxy. Also, recently approved therapies were not included, which may under-estimate advanced melanoma costs.

Conclusions: In this advanced melanoma population, optimal duration of the initial and terminal phases of care was 5 months immediately after diagnosis of metastasis and before death, respectively. Joinpoint regression can be used to provide data-supported phase of cancer care durations, but should be combined with clinical judgement.     

会计准则国际趋同问题研究:回顾与展望

文章系统回顾了国内外关于会计准则国际趋同的概念、路径、策略及其影响的研究成果,明确了相关研究对于评价我国会计准则国际趋同路径与策略选择的参考价值,指出我国会计准则国际趋同问题进一步研究的重点方向与研究的理论和现实意义。     

物流系统规划-仿真集成化技术研究

通过对物流系统规划与仿真模型的分析，归纳出系统规划模型与系统仿真模型的共有属性和关系，采用集成化的技术，建立集成化规划一仿真系统模型，并通过Solidworks和Flexsim研究实现其集成化，并在相关课题中获得成功应用，突破了现有软件在规划与仿真之间数据共享的壁垒。     

What Drives the Property Price-Trading Volume Correlation? Evidence from a Commercial Real Estate Market

The significant price-trading volume correlation found in the residential property market presents a challenge to the rational expectation hypothesis. Existing theories account for this fact with either capital market imperfection (down-payment effect or loss-aversion consideration) or imperfect information (search theoretic models). This paper employs data from a commercial real estate market, which face a different degree of severity of capital market constraint than the residential market, and thus provide an indirect but effective test for alternative theories. Policy implications are also discussed.     

云南九大高原湖泊的演变与生态安全调控

系统梳理了云南九大高原湖泊(滇池、洱海、抚仙湖、程海、泸沽湖、杞麓湖、星云湖、阳宗海、异龙湖)的演变历程,依据湖泊演化阶段、湖泊生态系统发育阶段、流域社会经济特征、湖泊富营养化阶段、水质类别、生态安全水平、主导功能核心导向划分9个湖泊的管理类型,并提出了预防型、控制型、治理型湖泊流域生态安全调控途径。     

基于解吸能力的外向型技术转移研究框架——以网络嵌入性为视角

在开放式创新研究的基础上,从网络嵌入性的视角,探索外向型开放式创新中技术转移的机制和影响因素,揭示了解吸能力在整个技术转移过程中的作用机制,构建了外向型技术转移研究框架,为企业实践外向型技术转移和创新提供了理论基础。     

城市拆迁进程中弱势群体的风险治理

作为城市化建设的必经过程和必然趋势,城市拆迁的主旨是持续稳步推促城市化进程的展开,改善和提高城镇居民的生活质量和经济标准。然而由于某些原因,城市拆迁非但没有达到城市化进程的初衷,反而制造了新的贫困和弱势群体。与以往研究拆迁问题的角度有别,从风险社会理论的视角对城市拆迁问题进行探讨,对现行城市拆迁决策及其相关补偿安置制度进行反思,可以重塑政府责任伦理机制与矫正制度化风险,并能探寻政府风险管理和规避的应对策略。     

Domestic Political Institutions,Diplomatic Style and Trade Agreements: A Comparative Study of China and Japan

Through an analysis of the formation of free trade agreements (FTAs), this article seeks to examine the factors that caused the gap in Japan and China's relationship with Southeast Asia to emerge and expand in the new millennium. In order to address this question, the article focuses on China and Japan's diplomatic styles and domestic political institutions and examines how these two elements influenced negotiations on the formation of FTAs, as well as the evolving perceptions that the Southeast Asian nations have of these two states. The article argues that Japan and China possess different kinds of weaknesses in implementing feasible external policies – a lack of policy decisiveness for Japan and weak policy credibility for China – which have resulted from the operation of domestic political institutions. Given these differences, while China implemented pragmatic diplomacy that helped improve its policy credibility, Japan's bargaining diplomatic style did not serve to rectify its weak policy decisiveness. Such differences in their diplomatic approach have led to the differing influence of these two states on Southeast Asia.