Major bleeding risk and healthcare economic outcomes of non-valvular atrial fibrillation patients newly-initiated with oral anticoagulant therapy in the real-world setting

Aims: This study compared the risk for major bleeding (MB) and healthcare economic outcomes of patients with non-valvular atrial fibrillation (NVAF) after initiating treatment with apixaban vs rivaroxaban, dabigatran, or warfarin.

Methods: NVAF patients who initiated apixaban, rivaroxaban, dabigatran, or warfarin were identified from the IMS Pharmetrics Plus database (January 1, 2013–September 30, 2015). Propensity score matching (PSM) was used to balance differences in patient characteristics between study cohorts: patients treated with apixaban vs rivaroxaban, apixaban vs dabigatran, and apixaban vs warfarin. Risk of hospitalization and healthcare costs (all-cause and MB-related) were compared between matched cohorts during the follow-up.

Results: During the follow-up, risks for all-cause (hazard ratio [HR]?=?1.44, 95% confidence interval [CI]?=?1.2–1.7) and MB-related (HR?=?1.57, 95% CI?=?1.0–2.4) hospitalizations were significantly greater for patients treated with rivaroxaban vs apixaban. Adjusted total all-cause healthcare costs were significantly lower for patients treated with apixaban vs rivaroxaban ($3,950 vs $4,333 per patient per month [PPPM], p?=?.002) and MB-related medical costs were not statistically significantly different ($100 vs $233 PPPM, p?=?.096). Risk for all-cause hospitalization (HR?=?1.98, 95% CI?=?1.6–2.4) was significantly greater for patients treated with dabigatran vs apixaban, although total all-cause healthcare costs were not statistically different. Risks for all-cause (HR?=?2.22, 95% CI?=?1.9–2.5) and MB-related (HR?=?2.05, 95% CI?=?1.4–3.0) hospitalizations were significantly greater for patients treated with warfarin vs apixaban. Total all-cause healthcare costs ($3,919 vs $4,177 PPPM, p?=?.025) and MB-related medical costs ($96 vs $212 PPPM, p?=?.026) were significantly lower for patients treated with apixaban vs warfarin.

Limitations: This retrospective database analysis does not establish causation.

Conclusions: In the real-world setting, compared with rivaroxaban and warfarin, apixaban is associated with reduced risk of hospitalization and lower healthcare costs. Compared with dabigatran, apixaban is associated with lower risk of hospitalizations.     

粤港澳大湾区城市建设用地和经济规模增长格局演变及协同关系

文章研究了1990—2017年期间粤港澳大湾区各城市建设用地增长情况及经济规模变化情况,并对二者之间的协同关系进行了分析。主要结论如下:1990—2017年,粤港澳大湾区各城市建设用地增长速度总体呈加快态势,各城市在不同时期建设用地增长速度的变化与城市所处发展阶段的变化密切相关。大湾区内城市经济规模多数在广东—港澳范围内排行前列,且位序逐渐攀升,仅有肇庆和澳门在1990—2017年经济规模在广东—港澳范围内排序明显下降。以1990年为基期,至2017年,大湾区整体建设用地与经济规模增长的协同度一直处于上升的态势,有序性不断增强,上升速度2010—2017年期间与之前相比有明显的下降,体现出近年来随着城市化进程的不断推进,建设用地增长和经济规模增长二者之间的相互依赖程度有所下降。各城市间建设用地与经济规模增长的协同度演变差异性十分明显。深圳、珠海、中山三个城市建设用地增长对经济规模增长的作用效率在研究期间不断上升,其他多数城市研究期间该效率在2000—2010年期间达到最高,2010—2017年期间均出现明显下降。各城市间产业的发展阶段以及目标定位的不同造成了建设用地和经济规模增长协同性...     

农村土地集体所有制对劳资关系形成的积极影响及启示

农村土地集体所有制作为一种"普照的光",使中国劳资关系形成跨越了残酷的原始积累阶段,避免了劳资关系发展初期易发的尖锐冲突,使中国劳资关系伴随着工业化城市化进程协调发展。社会主义公有制不仅需要而且可以与市场经济相结合,并使市场经济的作用得到有益发挥。必须坚定不移走社会主义道路,积极发挥社会主义基本制度的优势,更好更快地推进中国现代化进程,实现中华民族伟大复兴。     

Overall survival,costs, and healthcare resource use by line of therapy in Medicare patients with newly diagnosed metastatic urothelial carcinoma

Aims: Medicare patients with metastatic or surgically unresectable urothelial carcinoma (mUC) often receive platinum-based chemotherapy as first line of therapy (LOT), but invariably progress, requiring additional LOTs and healthcare resource use (HCRU). To better understand the evolving mUC treatment landscape, the economic burden of chemotherapy-based mUC treatments among US Medicare patients was estimated.

Methods: Newly diagnosed Medicare patients with mUC were identified from the Surveillance, Epidemiology, and End Results (SEER)-Medicare database. Patients were followed from diagnosis to death, disenrollment, or end of study to characterize LOTs (first [LOT1], second [LOT2], and third or greater [LOT3+]). Kaplan-Meier methods were used to estimate overall survival (OS) by LOT. HCRU and mean costs were reported over the follow-up period, LOT duration, and maximum LOT received.

Results: Among 1,873 eligible patients with mUC (median age?=?77?years; median follow-up?=?7.5?months), 1,035 (55%) received no chemotherapy. Among chemotherapy-treated patients, 61% had LOT1 only, 25% had LOT1 and LOT2 only, and 14% had LOT3+. Median OS was 8.1?months, range was 4.3 (untreated) to 29.8 (LOT3+) months. HCRU frequency increased with additional LOTs. Mean cumulative per-patient cost was $82,912 for all patients, increasing with additional LOTs (untreated?=?$57,207; LOT1?=?$99,213; LOT2?=?$125,190; LOT3+?=?$163,884). Mean per patient per month cost was $18,827 for all patients, decreasing with increasing number of LOTs received (untreated?=?$27,211; LOT1?=?$9,601; LOT2?=?$7,325; LOT3+?=?$6,017).

Limitations: Potential for treatment misclassification when using the algorithm defining LOTs and non-generalizability of results to younger patients.

Conclusions: Over 50% of Medicare patients with mUC received no chemotherapy. Among chemotherapy-treated patients, most received only one LOT. Additional LOTs led to higher mean costs and HCRU, but as patients were followed longer, monthly costs decreased. As treatments evolve to include immuno-oncology agents, these findings provide a clinically relevant economic benchmark for mUC treatment across different traditional LOTs.     

两型社会建设中建设用地集约利用问题探讨——以长株潭城市群为分析对象

集约利用建设用地是长株潭土地资源利用机制创新的关键。长株潭城市群应以交通建设为契机,推广人车人流节地模式、开发园区土地集约模式等成功做法,建立节约集约利用建设土地约束机制,加强建设用地控制标准建设评价工作和相关配套制度建设和改革,推动长株潭城市群建设用地的集约利用。     

杭州湾萧山围垦区环境变化和土地集约利用研究

萧山围垦是建国以来与海持续争地的历史,其业绩为中外瞩目;围垦缓解了萧山人多地少的矛盾,对发展国民经济具有战略意义;围垦后在河道、输沙量和土地利用构成等方面发生了相应的变化;为使垦区可持续发展,提出围垦区土地集约利用的指导思想、近期开发目标和处理资源开发与保护关系应注意的几个问题。     

重庆物流用地布局探讨——论重庆如何建设区域性物流中心城市

本文分析了重庆经济和物流业现状,论述了重庆建设成区域性物流中心城市的必要性和优势,提出了物流用地布局要素及重庆物流用地布局.     

无线局域网的现状及前景展望

无线局域网技术(包括IEEE802.11、蓝牙技术、HomeRF等)将是新世纪无线通信领域最有良好发展前景的重大技术之一。文中着重介绍了无线局域网标准的进展,IEEE802.11、蓝牙技术、HomeRF等几种主流标准的比较,分析了无线局域网技术、现状、局限与应用前景。     

海峡西岸快速城市化中土地利用变化的影响因素

利用2003—2007年海西的遥感和统计资料,根据海西的城市化发展和土地利用动态变化,选取12个影响海西土地利用变化的因子,构建影响土地利用变化的指标体系,并进行相关性分析和多元逐步回归分析,得出影响因子的最优多元线性回归方程。从定性与定量相结合的角度探讨海西土地利用变化的驱动因素。研究表明:①在影响指标体系的相关性分析中,所选取的指标基本上都与海西土地利用变化具有显著的相关性,特别是人口增长、经济发展、产业结构变化及城市化水平等因子。②在多元回归分析中,城市化水平、第一产业占GDP的比重、进出口总额、非农业人口比重、总人口等因素成为了各类土地利用类型变更的重要影响因素。③人口、城市化水平、产业结构等因素是影响土地利用变化的最主要因素。在未来海西城市的发展过程中,应该调整好城市发展中的各因素与土地利用的关系,促进土地的合理利用。