Economic evaluation of BST-CarGel as an adjunct to microfracture vs microfracture alone in knee cartilage surgery

Objectives:

Knee cartilage damage is a common cause of referral for orthopedic surgery. Treatment aims to reduce pain and symptoms by repairing cartilage. Microfracture, the current standard of care, yields good short-term clinical outcomes; however, treatment might fail after 2–3 years. A Chitosan-Beta glycerolphosphate-based medical device (BST-CarGel) is used as an adjunct to microfracture and demonstrates improvements in quantity and quality of repaired tissue, potentially reducing the risk of treatment failure. This study aimed to establish the economic value of BST-CarGel vs microfracture alone in knee cartilage repair from the societal perspective, using Germany as the reference market.

Methods:

A decision tree with a 20-year time-horizon was constructed, in which undesirable clinical events were inferred following initial surgery. These events consisted of pain management, surgery, and total knee replacement. Clinical outcomes were taken from the pivotal clinical trial, supplemented by other literature. Data and assumptions were validated by a Delphi panel. All relevant resource use and costs for procedures and events were considered.

Results:

In a group of patients with all lesion sizes, the model inferred that BST-CarGel yields a positive return on investment at year 4 (with 20-year cumulative cost savings of €6448). Reducing the incremental risk of treatment failure gap between the device and microfracture by 25–50% does not alter this conclusion. Cost savings are greatest for patients with large lesions; results for patients with small lesions are more modest.

Limitations:

Clinical evidence for microfracture and other interventions varies in quality. Comparative long-term data are lacking. The comparison is limited to microfracture and looks only at costs without considering quality-of-life.

Conclusion:

BST-CarGel potentially represents a cost-saving alternative for patients with knee cartilage injury by reducing the risk of clinical events through regeneration of chondral tissue with hyaline characteristics. Since the burden of this condition is high, both to the patient and society, an effective and economically viable alternative is of importance.     

An analysis of the intra-firm sales activities of Japanese multinational enterprises in the United States: 1977 to 1989

This paper examines the activities of the largest Japanese multinational enterprises (MNEs) operating in the United States by looking at data on exports, imports, and intra-firm trade between the Japanese subsidiaries in the United States and their parent and other foreign groups. It also examines how much of the domestic sales in the United States are accounted for by local production of the Japanese subsidiaries. Sales data provide an indication of the advantages of being multinational, which are mirrored in the growth of the post-investment sales of overseas units (both manufacturing and non-manufacturing). Data on the flows and stocks of foreign direct investment (FDI) represent the initial decisions to undertake FDI and largely ignore the learning effects of having overseas production.The authors are from the City University of Hong Kong and NORTACK Software Limited. We would like to thank the Editor, Dr Leung Hing-Man, the anonymous referees, and Don Daly, Wendy Dobson, Hiroaki Izumi, Terutomo Ozawa, Alan M Rugman and Rob Tran for their helpful comments. All errors and omissions, however, remain the responsibility of the authors.     

Competition in the electricity industry in England and Wales

When the electricity industry was privatized, the governmentmade structural changes to encourage competition in generationand in supply to consumers. The conventional power stationswere only divided between two companies, however, and we showthat duopolistic competition in an unregulated spot market mightimply undesirably high prices. Most sales are hedged in thecontract market, which makes the spot market more competitive,and a realistic threat of entry could also force generatorsto keep their prices down. In the event, a large amount of entrytook place, supported by the regional electricity companies'franchise monopoly over smaller consumers. That monopoly endsin 1998, so that further entry might become very difficult,while competition between firms already in the generation marketis still limited. Vertical integration between the major generatorsand regional electricity companies might make entry even harder,and should be blocked until the industry is more competitive.     

A transactions data analysis of nonsynchronous trading

Weekly returns of stock portfolios exhibit substantial autocorrelation.Analytical studies suggest that nonsynchronous trading is capableof explaining from 5% to 65% of the autocorrelation. The varyingimportance of nonsynchronous trading in these studies arisesprimarily from differing assumptions regarding nontrading periodsof stocks. We simulate the effects of nonsynchronous tradingby sampling stock returns from a return generating process usingtransactions data to obtain the precise time of each stock'slast trade. We find that simulated weekly portfolio returnsexhibit autocorrelations that are roughly 25% that of theirobserved (CRSP) weekly returns.     

Advanced practice nurse outcomes 1990-2008: a systematic review

Advanced practice registered nurses have assumed an increasing role as providers in the health care system, particularly for underserved populations. The aim of this systematic review was to answer the following question: Compared to other providers (physicians or teams without APRNs) are APRN patient outcomes of care similar? This systematic review of published literature between 1990 and 2008 on care provided by APRNs indicates patient outcomes of care provided by nurse practitioners and certified nurse midwives in collaboration with physicians are similar to and in some ways better than care provided by physicians alone for the populations and in the settings included. Use of clinical nurse specialists in acute care settings can reduce length of stay and cost of care for hospitalized patients. These results extend what is known about APRN outcomes from previous reviews by assessing all types of APRNs over a span of 18 years, using a systematic process with intentionally broad inclusion of outcomes, patient populations, and settings. The results indicate APRNs provide effective and high-quality patient care, have an important role in improving the quality of patient care in the United States, and could help to address concerns about whether care provided by APRNs can safely augment the physician supply to support reform efforts aimed at expanding access to care.     

马克思主义的最高命题与中国共产党人的伟大实践

在马克思主义的经典理论中,人的全面发展理论是其重要的组成部分,而其核心：“一切人自由而全面的发展”则是马克思主义的最高命题。坚持马克思主义,首先应当坚持马克思主义的这一根本价值和最高命题。中国共产党人在中国革命与社会主义建设的进程中,将马克思主义与中国实际相结合,通过艰难探索,丰富和发展了人的全面发展理论。历代中央领导集体在践行这一最高命题上都作出了贡献,尤其是新一代中央领导集体在党的十六大以来提出了科学发展观和构建社会主义和谐社会等一系列重大战略思想,对马克思主义人的全面发展理论再度进行理论创新,在践行马克思主义最高命题上开辟了新道路。