Invasive pneumococcal disease (IPD) and pneumococcal pneumonia cause substantial morbidity and mortality worldwide. This retrospective study was conducted to estimate the disease burden from pneumococcal disease in older adults in Taiwan from a health insurer’s perspective.
Methods:
Data for the years 2002–2009 from patients aged ≥50 years with insurance records indicating pneumococcal meningitis, pneumococcal bacteremia, or hospitalized or outpatient pneumonia were obtained from the National Health Insurance Research Database in Taiwan. Admission data for inpatients, visit data for outpatients, and associated costs were extracted from the database to estimate the incidence, case fatality rates, and direct and indirect costs of pneumococcal disease episodes. These data were applied to the estimated population of Taiwan in 2010 to provide an estimated disease burden for a single year from the payer perspective.
Results:
The average incidence per 100,000 person years was 2.4 for IPD, 278.8 for hospitalized pneumococcal pneumonia, and 1376.4 for outpatient pneumococcal pneumonia. The average case fatality rate was 12.3% for IPD and 10.0% for hospitalized pneumonia. Hospitalized pneumonia accounted for over 90% of direct medical costs. The incidence of hospitalized pneumococcal pneumonia per 100,000 person years was 84.4 for adults of 50–64 years, 313.1 for adults of 65–74 years, 820.3 for adults of 75–84 years, and 1650.9 for adults of 85+ year of age. In 2010, it was estimated there were over 113,000 episodes of pneumococcal disease, causing almost 2000 deaths, with direct medical costs of more than NT$3.4 billion annually.
Conclusions:
Pneumococcal disease is a significant cause of mortality and excess healthcare expense among the elderly in Taiwan. Disease burden in older adults increases with advancing age. 相似文献
A paper survey of 835 Chinese college students was conducted to examine young Chinese consumers' social media use, market mavenism, viral marketing attitude, and product recommendation behavior. Structural model testing results showed that young Chinese consumers' perceived pleasure, affection outcome expectation, and subjective norm of viral marketing affected their market mavenism while their subjective norm and pleasure influenced their viral marketing attitude. More importantly, young Chinese consumers' frequency of product recommendations on social networking websites was determined by their social media use, viral marketing attitude, and electronic word of mouth motive to help the company and market mavenism. 相似文献
Addressing uncertainty is a key requirement to follow the principle of precaution in sustainable ecosystem management. The maximization of worst-case outcomes according to the “maximin” decision rule, based on the two parameters mean and variance of a financial indicator, is a prominent approach to integrate uncertainty in decision-making. In forestry, the problem of selecting the optimum tree species combination for a forest plantation investment can be seen as a problem of optimal portfolio selection, to be solved according to the “maximin” decision rule. Yet, it is well known that portfolios computed from expected means and variances are highly sensitive to changes in the estimated parameters. The financial results may be poor if we rely too much on the historical data. This paper tests an extended worst-case model that considers a lower bound for the expected mean net present value (NPV) of a tree species portfolio and an upper bound for its variance. Biased expected mean NPVs, variances and correlations for the tree species Picea abies [L.] Karst. (Spruce) and Fagus sylvatica L. (Beech) were used to test the variability of the resulting tree species portfolios (27 scenarios). A comprehensive simulated data set, which was adopted from an existing study and defined as the independent reference, served to evaluate the financial performance of the tree species portfolios obtained from optimization with the biased data. Compared with the results of classical worst-case optimization instances, it was feasible to reduce the variability of tree species shares effectively when the optimization was carried out with the extended worst-case approach. Furthermore, the financial performance of this approach was better when tested with the independent data. The worst-case forest NPVs achieved with the extended approach were on average 10% (statistical confidence 0.95) or 147% (statistical confidence 0.99) greater in comparison to the results of the classical approach. The influence of the uncertainty parameter selection was tested and the results were discussed against the controversial viewpoints on the usefulness of the “information-gap decision theory”. Finally, the significance of our results for sustainable ecosystem management is pointed out. 相似文献
