Anxiety disorders,major depressive disorder and the dynamic relationship between these conditions: treatment patterns and cost analysis

Abstract

Objective: To determine the treatment pattern and impact on healthcare costs of anxiety disorders and major depressive disorder (MDD), and influence of their concomitance and subsequence.

Methods: A retrospective cohort study was conducted using a US reimbursement claims database. Adult patients with an incident diagnosis of anxiety or MDD (index date) were included. Their sociodemographic data, diagnoses, healthcare resource use and associated costs were collected over the 6 months preceding and 12 months following index date.

Results: A total of 599,624 patients were identified and included. Patients with phobia or post-traumatic stress disorder had the highest 12-month costs ($8,442 and $8,383, respectively). Patients with social anxiety disorder had the lowest costs ($3,772); generalized anxiety disorder ($6,472) incurred costs similar to MDD ($7,170). Costs were substantially increased with emergence of anxiety during follow-up in MDD patients ($10,031) or emergence of MDD in anxiety patients ($9,387). This was not observed in patients with both anxiety and MDD at index date ($6,148).

Conclusion: This study confirms the high burden of costs of anxiety, which were within the same range as MDD. Interestingly, the emergence of anxiety or MDD in the year following a first diagnosis of MDD or anxiety, respectively, increased costs substantially. Major limitations were short follow-up and lack of absenteeism costs.     

煤矿建设工程造价控制研究

随着市场经济的发展,煤炭市场在经过黄金十年的辉煌后,受产能过剩、环境保护压力以及进口煤激增等因素影响,煤价下跌、库存增加、成本上升,整个行业陷入亏损的泥潭中。在当前的煤矿建设过程中,如何应对严峻的市场形势及时代发展潮流,以辩证发展的眼光看待煤炭工程建设造价管理工作显得尤为重要。做好煤炭建设工程造价管理工作在整个经济社会及企业发展中具有至关重要的作用与意义。     

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.     

基于虚拟利润的高新技术企业成本管理方法研究

高新技术产品成本具有高投入,高收益、高风险和高不确定性的特点。降低成本最有效的方法就是在设计—制造—维护的循环中持续地创新,这使得成本具有关联性和放大性,应该用系统的方法来考察全流程的成本。研发成本、市场成本与收益是非线形关系并且具有边际收益递增的特征,由此导致扩张性成本的产生,其理念几乎与传统成本管理理论对立。可持续发展要求企业追求利润,技术、质量等多重目标,如何合理地评价非财务收益和控制其成本是成本管理的难点。本文提出了利用虚拟利润建立高新技术企业成本管理方法的设想。     

MA公司物流成本的会计核算探析

以MA公司为例,对MA公司会计核算现状进行了探讨,当前MA公司物流成本会计核算内容、核算科目设置、核算信息管理等还存在诸多缺陷,制约了MA公司对物流成本的科学管理,也在一定程度上影响了MA公司的发展,从MA公司物流成本的会计核算内容丰富、会计核算科目及账户设置、会计核算的信息管理等角度提出了对策建议。     

论虚拟仿真技术与群体支持系统在工程管理中联合应用

工程施工计划是一项复杂的工作，不断增长的复杂因素决定了工程管理人员需要采取新的、从未被用过、检测过的工程施工方法。缺乏便于工程策划人员进行评估和确认施工计划是否合理的工具，会在工程施工阶段造成许多重复性工作，造成成本浪费。虚拟现实技术为解决上述问题提供了一个很好的方法，会生成虚拟环境，允许项目决策人员在施工之前合理优化和选择施工方案，资源优化，降低成本，从而获得更好的投资效益。利用群体支持系统建立与工程施工计划相呼应的模型，工程数据作为其处理问题与人机交互的依据，辅助人员决策，进行项目的预算和分析，提高工程项目的价值管理。     

不同质量水平下的总质量成本研究

质量成本(COQ,Cost of Quality)是衡量提高质量活动的效果和效率的标准.COQ模型在质量成本研究中起着重要的作用.基于"6σ管理"中"持续改进"的思想和方法,用"kσ"作为质量水平(QL,Quality Level)的度量,笔者得到了不同质量水平下的动态总COQ模型.进而,还提供了不同质量水平下的总质量成本曲线.