Medical resource use and costs associated with chylomicronemia

Abstract

Background:

The prevalence of severe hypertriglyceridemia (TG?>?1000?mg/dl) is estimated at 150–400 per 100,000 individuals in North America. Severe hypertriglyceridemia in the fasting state is associated with increased acute pancreatitis risk and is a sign of chylomicronemia which reflects the accumulation in the bloodstream of chylomicrons, the large lipoprotein particles produced in the gut after a meal.

Objective:

To assess medical resource use and costs associated with chylomicronemia.

Methods:

Patients with chylomicronemia of different causes (≥2 diagnoses with ICD-9 code 272.3) were identified from a large US claims database (years 2000 to 2009) and matched 1:1 to controls free of chylomicronemia based on age, gender, demographics, comorbidities, and use of lipid lowering drugs. During a 1-year study period, medical resource use and costs associated with chylomicronemia or acute pancreatitis were compared between matched cases and controls.

Results:

Among 6472 matched pairs, annual per-patient medical costs, calculated independently of the occurrence of acute pancreatitis, were significantly greater by $808 for chylomicronemia cases vs controls ($8029 vs $7220, p?<?0.01), half of which was attributable to chylomicronemia-related services (p?<?0.01). Chylomicronemia cases with a history of acute pancreatitis (n?=?46) had greater rates of inpatient visits (p?<?0.05) and greater average costs for subsequent acute pancreatitis or abdominal pain (p?<?0.01) as well as greater total medical costs ($33,587 vs $4402, p?<?0.01) vs matched controls. The average episode of acute pancreatitis (n?=?104 episodes) generated medical costs of $31,820, almost entirely due to inpatient stays.

Limitations:

Triglyceride levels were not available to characterize disease severity.

Conclusions:

Patients with chylomicronemia, and especially those with a history of acute pancreatitis, incurred significantly greater total medical costs compared with individuals without chylomicronemia but with an otherwise comparable health profile.     

Differentiation of the Peasantry Under Feudalism and the Transition to Capitalism: In Defence of Rodney Hilton

The focus of the essay is one specific theme pursued by Rodney Hilton: that of differentiation of the English feudal peasantry and the implications this had for the development of capitalism in England. His contribution on this, along with those of E. A. Kosminsky and of Maurice Dobb, are considered and are contrasted with the view of Robert Brenner. For Brenner peasant differentiation has no causal importance: it is an outcome of transformation and not a driving force in its securing. For Hilton, it is central to transformation: it is not an outcome but a determining variable, a causa causans rather than a causa causata. The Brenner position, it is argued, is incomplete in its ignoring of peasant differentiation in feudal England. It was one of Hilton's accomplishments to explore this in scholarly detail, and with analytical precision. It is suggested that if this is abstracted from an adequate examination of the transition to capitalism in England cannot proceed.     

东部地区产业结构调整的新特点与启示

当前我国东部地区正在进行的新一轮产业结构调整,表现出二、三产业并重、产业结构迅速知识化、产业间分工与产业内分工并举等诸多崭新的特点,可以为中、西部地区承接产业转移和提高产业竞争力提供有益的启示。     

The option of joint purchase in vertically differentiated markets

Summary. Within the framework proposed by Mussa and Rosen (1978) for modelling quality differentiation, consumers are assumed to make mutually exclusive purchases. A unique pure strategy equilibrium exists in this case. In this note, we allow consumers to buy simultaneously different variants of the differentiated good. We call this the “joint purchase option”. The paper proposes a detailed analysis of price competition when this option is opened: first, we show that either uniqueness, or multiplicity, or absence of price equilibrium arise, depending on the utility derived from joint purchase relative to exclusive purchase. Second, we characterize these equilibria, whenever they exist. Received: July 25, 2001; revised version: October 21, 2002 RID="*" ID="*" The second author gratefully acknowledges the financial support from Interuniversity Attraction Pole Program- Belgian State- Federal Office for Scientific, Technical and Cultural Affairs under contract PAI 5/26. Correspondence to: X.Y. Wauthy     

Deregulation and environmental differentiation in the electric utility industry

This paper analyzes how economic deregulation impacts firm strategies and environmental quality in the electric utility industry. We find evidence that the deregulation introduced to this historically staid industry has stimulated environmental differentiation. Differentiation is most likely to appear where its point of uniqueness is valued by customers, and we confirm this relationship in our sample. Specifically, utilities that served customers who exhibited higher levels of environmental sensitivity generated more ‘green’ power. The tendency for firms to differentiate in this way is lessened if they are relatively more dependent on coal‐fired generation or relatively more efficient. Thus, there is evidence that firms sort themselves into either differentiation or low‐cost strategies as the competitive realities of a deregulated world unfold. Deregulation and the ensuing environmental differentiation illustrate how utilities exploited formerly unmet customer demand for green power. The result has been greater levels of renewable generation and, hence, a cleaner environment. Copyright © 2007 John Wiley & Sons, Ltd.     

后危机时代海外共同基金业的发展

共同基金作为历史悠久、运作规范的主流投资品种,在资产管理行业中具有举足轻重的地位。在次贷危机对全球金融业产生严重冲击的背景下,全球共同基金业也未能独善其身。但随着危机热浪退去,海外共同基金业又重新显示出旺盛的生命力。本文梳理了2009年以来海外共同基金的发展状况,从规模、类型、申购、费率、交易自动化等多个角度进行深入分析,从而得出共同基金产业后危机时代呈现出的一些新特点,及其与全球金融市场之间的联动与契合。     

Decomposing Local: A Conjoint Analysis of Locally Produced Foods

Increasingly, foods are marketed as "locally grown." We use stated preference data from a choice-based conjoint instrument to address two issues surrounding consumer demand for locally produced goods: (1) what is the geographical extent of "local," and (2) is the value consumers place on "local" production distinct from other factors that are often confounded with locally produced foods such as farm size and product freshness? We find our subjects place similar value on products produced "in state" and "nearby" and that consumers' willingness to pay for local production is independent from values associated with product freshness and farm size.     

Entry Facilitation by Environmental Groups

We consider a model of vertical product differentiation where consumers care about the environmental damage their consumption causes. An environmental group is capable of increasing consumers’ environmental concern via a costly campaign. We show that the prospect of such a campaign can induce entry by a firm that is able to employ a cleaner technology than the one used by the incumbent. We further demonstrate that the subsequent competition can lead to an adverse effect on aggregate pollution, i.e. the decline in average industry pollution per product is offset by the increase in aggregate production.      

The dynamics of innovation and horizontal differentiation

We study innovation in a dynamic stochastic discrete-time duopoly with endogenous horizontal differentiation. Innovation takes the form of a quality ladder; horizontal differentiation is Hotelling competition. We compute Markov-perfect equilibria and study the effects on long-run innovation of changes in taste heterogeneity (transport costs) and firms' costs of relocating products. Innovation rises as the industry's long-run position moves toward products that are permanently co-located in the space of horizontal tastes. A large enough fall in taste heterogeneity will raise long-run innovation, while more costly product relocation lowers innovation if taste heterogeneity is high, and raises it otherwise.