Healthcare resource utilization among commercially insured patients with cold agglutinin disease in the United States

Abstract

Aims: Cold agglutinin disease (CAD) is a rare subtype of autoimmune hemolytic anemia associated with increased thromboembolism risk and early mortality. Healthcare resource utilization (HRU) in CAD has not been reported. We aimed to compare HRU of patients with CAD with a matched non-CAD cohort in the United States.

Materials and methods: Patients with CAD were identified from 2006 to 2016 in the Optum-Humedica database using CAD terms in clinical notes and hematologist review. Patients were required to have Integrated Delivery Network records and ≥6 months’ follow-up before and after the first CAD mention date (index date). Patients with CAD were matched to a non-CAD cohort based on demographics. Multivariate analyses assessed inpatient hospitalizations, outpatient visits, emergency room visits, and transfusion use between cohorts 6 months before and 12 months after the index date.

Results: Of 814 patients with CAD, 410 met inclusion criteria and were matched to 3,390 patients without CAD. Mean age of patients with CAD was 68.0 years; approximately 62% were female. In the 12 months after the index date, mean inpatient hospitalizations (0.83 vs. 0.25), outpatient visits (17.26 vs. 6.77), emergency room visits (0.55 vs. 0.32), and transfusion days (1.05 vs. 0.05) were higher for patients with CAD than the matched non-CAD cohort (all p?<?.0001). Similarly, in the 6 months before the index date, patients with CAD had higher HRU than matched patients without CAD for all measures evaluated.

Limitations: Results of this study are based on patient information from the Optum-Humedica database, which is limited to commercially insured patients and may not represent the overall CAD population.

Conclusions: CAD places a substantial burden on patients and healthcare systems. In addition, the high HRU for patients with CAD observed in the 6 months before diagnosis indicates that disease awareness and better diagnostic practices may be needed.     

东北地区脑血管病的护理

结合哈医大二院神经内科具体病例的特点和脑血管病的成因,给出了东北地区脑血管病的注意事项和患者的康复护理措施,最后对医疗机构提出建立全民医疗保险的建议。     

Economic evaluation of tocilizumab combination in the treatment of moderate-to-severe rheumatoid arthritis in Italy

Abstract

Objective:

This study was designed to evaluate the cost utility of tocilizumab in rheumatoid arthritis (RA) patients, with inadequate responses to traditional disease-modifying anti-rheumatic drugs (tDMARDs) from a payer’s perspective in Italy.

Methods:

An individual patient simulation model was used to project lifetime medical costs (payer’s perspective) and quality-adjusted life-years (QALYs). Treatment sequences starting with tocilizumab or the most commonly prescribed biologics (etanercept, adalimumab, or infliximab) were compared. The addition of tocilizumab to standard of care, without the replacement of anti-tumor necrosis factor (TNF)-α treatments, was also evaluated. Patient characteristics, treatment efficacy, and quality-of-life data were based on three phase 3 tocilizumab clinical trials (TOcilizumab Pivotal Trial in Methotrexate Inadequate respONders [OPTION], Tocilizumab in cOmbination With traditional DMARD therapy [TOWARD], and TociLIzumab Safety and THE Prevention of Structural Joint Damage [LITHE]). Mixed-treatment comparison was used to estimate response probabilities. Resource utilization, treatment acquisition, administration, and monitoring costs were estimated using Italian secondary sources. Uncertainty in model parameters was evaluated by probabilistic sensitivity analysis.

Results:

Replacement of anti-TNF-α treatments with tocilizumab reduced total costs over a patient’s lifetime (base-case analysis: tocilizumab sequence, €141,100 vs standard of care sequence, €143,500). Patients receiving tocilizumab realized more QALYs than patients receiving standard of care (9.8881 vs 9.3502 QALYs). Therefore, according to the base-case analysis, the tocilizumab sequence dominated the standard of care. In a sensitivity analysis, the model base-case result was robust to input changes. When tocilizumab was added to standard of care, without replacing anti-TNF-α treatments, the incremental cost-effectiveness ratio was €17,100 per QALY.

Conclusion:

The analysis demonstrates that, in Italy, replacing another biologic DMARD with tocilizumab or adding tocilizumab to the current standard of care is a cost-effective strategy in the treatment of RA patients with inadequate responses to tDMARDs.     

粤东温室蝴蝶兰有害生物调查及发生规律分析

通过对温室蝴蝶兰有害生物的调查,发现危害蝴蝶兰的斜纹夜蛾、介壳虫、螨类、粉虱、蓟马、蜗牛以及病毒等是出口值得关注的有害生物,同时发现鳞长跳虫对蝴蝶兰根部的危害和太平洋细须螨的传入扩散;蝴蝶兰的细菌性褐斑病和眼蕈蚊在粤东危害较为严重,尤其要重点预防。由于温室栽培过程高温高湿,有害生物常年发生,其中虫害发生不规则,细菌性和真菌性病害多以夏季及初秋发生较为严重,而病毒应以防止感染传播为主。     

牛病毒性腹泻-粘膜病的检测技术研究进展

对牛病毒性腹泻-粘膜病的病毒分离、琼脂扩散试验、微量中和试验、免疫荧光技术、酶联免疫吸附试验、核酸杂交技术、聚合酶链反应等检测技术进行了综述,对7种技术运用于牛病毒性腹泻-粘膜病的检测作了简要介绍,为进一步研究牛病毒性腹泻病毒提供参考。     

Does oil substitute for patriarchy?

Critics of Ross's (American Political Science Review, 102, 2008, 107) gendered resource curse thesis argue that culture trumps oil wealth as a determinant of female labor force participation (FLFP). Here, I argue that, while cultural attributes do indeed affect the female labor supply, oil wealth reduces the demand for female labor by hurting the export‐oriented industries that employ female labor intensively. By reducing the demand for female labor in this way, oil wealth undermines the positive effect of gender egalitarianism on FLFP. Thus, oil curses women. Using data from the World Values Survey and the World Bank, I find support for the argument.     

Years of life lost due to metastatic melanoma in 12 countries

Background:

Regionally or distantly metastatic melanoma (stages IIIB/C and IV) place a high burden on society. To quantify this burden, this study estimated years of life lost (YLL) per patient for adults with metastatic melanoma in 12 countries in 2014.

Methods:

General population growth and life expectancy were estimated from the Organization for Economic Co-operation and Development data and life tables for each country. Incidence of melanoma and mortality rates for the disease were based on GLOBOCAN and US registry data. The prevalence of metastatic melanoma was calculated using mortality rates and survival data from patients with melanoma. YLL per patient was estimated by the difference between the disease-free life expectancy and the life expectancy with metastatic melanoma.

Results:

YLL per patient were as follows: Australia, men?=?19.9 years, women?=?22.7 years; Brazil, 16.3, 19.8; Canada, 19.4, 22.3; France, 18.8, 23.1; Germany, 18.3, 20.8; Italy, 19.3, 22.7; Mexico, 17.2, 19.0; the Netherlands, 18.5, 21.5; Spain, 19.2, 23.1; Sweden 19.4, 22.0; the UK, 18.7, 21.2; and the US, 17.9, 20.6.

Conclusions:

The burden of metastatic melanoma as measured by YLL is substantial in all 12 countries; although there is variation across countries and between men and women.     

中国式荷兰病影响中国收入分配的实证分析

文章以源于入世后外向型劳动力密集型产业繁荣的中国式荷兰病理论为基础,对中国式荷兰病通过体制惰性效应、人民币汇率效应、资源转移效应等渠道影响中国收入分配问题进行了深入细致的实证研究。文章发现,在体制惰性效应影响下,我国国富民穷、东西部差距以及城乡差距问题日益恶化;但在人民币汇率效应作用下,东西部差距呈明显减缓趋势。文章最后建议加快城乡统筹发展步伐,积极推行改善民生和扩大内需的财政税收体制改革,适时扩大人民币汇率浮动区间,以确保中国经济增长方式顺利转变以及社会经济健康、协调与可持续发展。     

Controlling diseases and nuisances: Time-based rights and agricultural production

In controlling diseases, governments take actions that denigrate property interests. Losses by property owners under a citrus canker eradication program led to a legal challenge concerning the Florida state government's authority to destroy property without compensation. A court adopted time-based rights to determine when the state needed to pay for property destroyed. Time-based rights have also been adopted by state legislatures to limit nuisance actions against agricultural producers. This paper addresses the adoption of time-based rights to determine whether the changes from space-based to time-based rights provide a superior response for eradicating plant diseases and responding to nuisances. The changes are projected to lead to different producer responses which in turn will affect agricultural production.     

新冠疫情的经济金融影响与应对建议--基于传染病视角的分析

传染病疫情一直威胁着人类的生命健康,对经济社会发展造成较大影响。未来传染病疫情仍然会继续存在,并可能呈多发的趋势。虽然传染病疫情本身难以有效预测,传染病疫情对经济的冲击具有短期、外生性的特点,但是仍然有必要从传染病疫情应对政策方面进行总结研究,形成框架性的政策思路,以有效应对传染病疫情并降低其对经济金融的负面影响。本文结合新型冠状病毒肺炎疫情的经济金融影响和应对政策实践,探讨了传染病疫情应对的政策框架建议。