Hospitalization expenses of acute ischemic stroke patients with atrial fibrillation relative to those with normal sinus rhythm

Background and objective: Atrial fibrillation (AF) is a risk factor for acute ischemic stroke (AIS). In mainland China, little is known of the hospitalization expenses of AIS patients with AF compared to those with normal sinus rhythm (SR). This study compared the itemized expenses of AIS patients with or without AF in a hospital in Huizhou City.

Methods: Patients hospitalized for AIS from March 2014 to March 2015 were enrolled, including 73 with AF and 751 with normal SR. Stroke severity was scored using the National Institutes of Health Stroke Scale (NIHSS). Non-parametric statistical tests were used to determine differences in hospital expenses between the two groups, of which influencing factors were analyzed using single factor and multiple stepwise linear regression analyses.

Results: Medicine was the predominant expense during hospitalization of all AIS patients. Patients with AF incurred significantly higher expenses for medicine, bed, treatments, examinations, laboratory tests, and nursing than patients with normal SR (p?p?p?Conclusion: AIS patients with AF incurred higher expenses during hospitalization compared with those with normal SR, due to greater stroke severity, higher rates of pulmonary infection and congestive heart failure, and longer hospital stays.     

Lucky names: Superstitious beliefs in Chinese corporate branding strategy for bank marketing

Of all the Chinese supernatural beliefs, name-giving, whether applied to a person or a product, is extremely important, and is often considered to be closely related to fate. To this respect, this study examined the relationship between branding practices and supernatural beliefs in Chinese corporate branding strategy for bank marketing. Analytical results demonstrated that in over 50% of cases, these brand names involved a lucky number of total strokes. Finally, we suggest that the lucky-stroke-number naming strategy can be used as a tool in Chinese brand naming. Especially marketers can achieve more effective corporate branding in the Chinese business world.     

谈变电站的雷击危害及防雷措施

变电站遭遇雷击引起的跳闸事故很多,文章分析了变电站雷电危害的形式,同时针对各种不同拍雷电危害形式采取不同的防雷措施,以达到有效地防止雷击引起事故的目的。     

数学建模在医学病例中的构建及分析应用

此文依据2012"高教社杯"全国大学生数学建模竞赛C题提供的资料,针对中脑卒中发病病例信息以及相应期间当地的逐日气象资料,通过对脑卒中的发病环境、职业人群和发病年龄等因素进行统计分析。借助MATLAB计算软件,对平均压温湿度影响因素进行多元回归模型最小平方法(0LS)估计分析,并对回归模型进行分布检验,确定各项指标的权重,建立环境因素的数据模型,并有针对性进行对影响因素采取干预措施和预防措施提供数据依据。     

Use of real-world evidence in meta-analyses and cost-effectiveness models

Abstract

Real-world evidence (RWE) provides external validity, supplementing and enhancing the randomized controlled trial data with valuable information on patient behaviors and outcomes, turning efficacy and safety results into real-world effectiveness and risks, but the use of RWE is associated with challenges. The objectives of this communication were to (1) summarize all guidance on how to conduct an RWE meta-analysis (MA) and how to develop an RWE cost-effectiveness model, (2) to describe our experience, challenges faced and solutions identified, (3) to provide recommendations on how to conduct such analyses. No formal guidelines on how to conduct an RWE MA or to develop an RWE cost-effectiveness model were identified. Using the context of non-vitamin K antagonist oral anticoagulants in stroke prevention in atrial fibrillation, we conducted an RWE MA, after having identified sources of uncertainty. We then implemented the results in an RWE cost-effectiveness model, defined as a model where all inputs come from RWE, including all parameters related to treatment effect. Based on challenges faced, our first recommendation relates to the necessity of conducting sensitivity analyses, either based on clinical or methodological considerations. Our second recommendation is the need for extensive collaboration with a wide range of experts, during the development of the analyses protocols, the implementation of the analyses and the interpretation of the results. RWE may address a number of gaps related to the treatment effect, and RWE economic evaluations for the treatment effect can provide extremely valuable insights into real-world economic value of interventions. As the increased recognition of the value of RWE could influence health technology assessment decision, and current practices, this communication supports the urgent need of more formal guidelines.     

Cost-effectiveness of mechanical thrombectomy for acute ischemic stroke: an Australian payer perspective

Aims: The goal of this study was to assess the cost-effectiveness of mechanical thrombectomy (MT) for acute ischemic stroke (AIS) from an Australian payer perspective.

Methods: This study used a Markov model that employed a life-time time horizon, modeling patients from symptom onset of stroke until end of life. Clinical efficacy and safety data were taken from an individual patient level data (IPD) meta-analysis of clinical studies. The treatment effect of MT compared to usual care was measured by changes in modified Rankin Score (mRS). Post-treatment mRS scores were used to determine short- and long-term stroke care costs. Treatment costs were modeled, with health state utility values determined by literature review. All analyses were conducted using Microsoft Excel.

Results: In comparison to usual care, MT is associated with higher costs ($10,666 per patient) and additional quality-adjusted life years (QALYs) (0.8281 per patient), resulting in an incremental cost per QALY of $12,880. Sensitivity analyses demonstrated the reliability of the base case results across a range of assumptions. The higher cost associated with MT is, to an extent, offset by the cost savings resulting from lower stroke care costs due to improved patient outcomes. The life-time cost savings in terms of stroke care costs are estimated to be more than $8,000 per patient for patients who had received MT in combination with usual care.

Limitations: Stroke care costs based on patient disability/functional level were not available and were derived. As a consequence, long-term care costs for patients with poorer outcomes may be under-estimated. Patient outcomes at 90 days were extrapolated to a lifetime horizon, but this approach was supported by long-term evidence on stroke survival.

Conclusions: Mechanical thrombectomy is a cost-effective treatment option for AIS, with clinical benefits translating to short- and long-term cost benefits. This analysis supports rapid update of stroke care pathways to incorporate this therapy as a treatment option.     

谈变电站的雷击危害及防雷措施

变电站遭遇雷击引起的跳闸事故很多,文章分析了变电站雷电危害的形式,同时针对各种不同的雷电危害形式采取不同的防雷措施,以达到有效地防止雷击引起事故的目的。     

Cost-effectiveness of percutaneous closure of a patent foramen ovale compared with medical management in patients with a cryptogenic stroke: from the US payer perspective

Abstract

Aims: To evaluate the cost-effectiveness of percutaneous patent foramen ovale (PFO) closure, from a US payer perspective. Lower rates of recurrent ischemic stroke have been documented following percutaneous PFO closure in properly selected patients. Stroke in patients aged <60?years is particularly interesting because this population is typically at peak economic productivity and vulnerable to prolonged disability.

Materials and methods: A Markov model comprising six health states (Stable after index stroke, Transient ischemic attack, Post-Transient Ischemic Attack, Clinical ischemic stroke, Post-clinical ischemic stroke, and Death) was constructed to evaluate the cost-effectiveness of PFO closure in combination with medical management versus medical management alone. The base-case model employed a 5-year time-horizon, with transition probabilities, clinical inputs, costs, and utility values ascertained from published and national costing sources. Incremental cost-effectiveness ratio (ICER) was evaluated per US guidelines, utilizing a discount rate of 3.0%.

Results: At 5?years, overall costs and quality-adjusted life-years (QALYs) obtained from PFO closure compared with medical management were $16,323 vs $7,670 and 4.18 vs 3.77, respectively. At 5?years, PFO closure achieved an ICER of $21,049, beneficially lower than the conventional threshold of $50,000. PFO closure reached cost-effectiveness at 2.3?years (ICER = $47,145). Applying discount rates of 0% and 6% had a negligible impact on base-case model findings. Furthermore, PFO closure was 95.4% likely to be cost-effective, with a willingness-to-pay (WTP) threshold of $50,000 and a 5-year time horizon.

Limitations: From a cost perspective, our economic model employed a US patient sub-population, so cost data may not extrapolate to other non-US stroke populations.

Conclusion: Percutaneous PFO closure plus medical management represents a cost-effective approach for lowering the risk of recurrent stroke compared with medical management alone.     

Cost of stroke in Canada: a 1-year prospective study

Summary

The objective of this study was to estimate the 1-year cost of stroke for patients in Canada in 2004 and to determine the factors that contribute to this cost.

This work was based on a prospective follow-up study of all patients presenting with a stroke or transient ischaemic attack (TIA) to the emergency room in a large teaching hospital over a 6-month prospective period. All healthcare, social services, patient and caregiver resource utilisation attributable to strokes or TIAs were included in the analysis. There were 365 patients who met the

inclusion criteria. The average 1-year cost of managing patients with TIA was the lowest at $17,769, followed by ischaemic strokes at $53,576 and haemorrhagic strokes at $56,573. Predictors for 1-year cost were: type of stroke; discharge severity of stroke; death; marital status; discharge destination; and the presence of diabetes and congestive heart failure.

Initial hospitalisation costs represented the majority of 1-year costs of stroke. However, caregiver expenses are significant at between 11% and 27% of the total are 1-year cost.     

“技术制图”国家标准中几个问题的探析

对技术制图方面的几个国家标准在应用术语时存在的不规范问题进行探讨 ;就 GB/ T1 6 6 75 .1～ 1 6 6 75 .2— 1 996《技术制图　简化表示法》标准中的问题提出质疑 ,以期标准制定部门适时纠正。