W. H. Hutt (1899–1988): Free Markets and Social Justice

W.H. Hutt reaffirmed the principles of classical economics and classical liberalism and, by applying them to urgent issues he observed in the world around him, he demonstrated the contemporary relevance of freedom and competitive institutions. A wide‐ranging critique of Keynes was founded upon a classical analysis of the labour market, while his trenchant opposition to apartheid advanced along economic and political paths. Hutt questioned the justice of the accumulation of wealth from the exploitation of monopoly power over generations. In all of these respects there are affinities between Hutt's thought and that of ‘Bleeding Heart Libertarians’.     

Observational evaluation of outcomes and resource utilization from hemostatic matrices in spine surgery

Abstract

Objective:

Studies have indicated that outcomes may differ by choice of flowable hemostat, but there is limited evidence in spine surgery. The objective of this study was to conduct a comparison of outcomes following use of advanced flowable hemostatic matrices in a large spine surgery population.     

In-hospital risk of venous thromboembolism and bleeding and associated costs for patients undergoing total hip or knee arthroplasty

Abstract

Objective:

Benefits of anti-coagulation for venous thromboembolism (VTE) prevention in total hip and knee arthroplasty (THA/TKA) may be offset by increased risk of bleeding. The aim was to assess in-hospital risk of VTE and bleeding after THA/TKA and quantify any increased costs.

Methods:

Healthcare claims from the Premier Perspective^TM Comparative Hospital Database (January 2000–September 2008) were selected for subjects ≥18 years with ≥1 diagnosis code for THA/TKA. VTE was defined as ≥1 code for deep vein thrombosis or pulmonary embolism. Bleeding was classified as major/non-major. Incremental in-hospital costs associated with VTE and bleeding were calculated as cost differences between inpatients with VTE or bleeding matched 1:1 with inpatients without VTE or bleeding.

Results:

A total of 820,197 inpatient stays were identified: 8042 had a VTE event and 7401 a bleeding event (2740 major bleeding). The risks of VTE, any bleeding, and major bleeding were 0.98, 0.90, and 0.33/100 inpatient stays, respectively. Mean incremental in-hospital costs per inpatient were $2663 for VTE, $2028 for bleeding, and $3198 for major bleeding.

Limitations:

These included possible inaccuracies or omissions in procedures, diagnoses, or costs of claims data; no information on the amount of blood transfused or decreases in the hemoglobin level to evaluate bleeding event severity; and potential biases due to the observational design of the study.

Conclusions:

In-hospital risk and incremental all-cause costs with THA/TKA were higher for VTE than for bleeding. Despite higher costs, major bleeding occurred less frequently than VTE, suggesting a favorable benefit/risk profile for VTE prophylaxis in THA/TKA.     

The clinical and economic burden of significant bleeding during lung resection surgery: A retrospective matched cohort analysis of real-world data

Objectives: The objective of this retrospective study was to quantify the clinical and economic burden of significant bleeding in lung resection surgery in the US.

Methods: This study utilized 2009–2012 data from the Premier Perspective Database^TM. Adult patients with primary pulmonary lobectomy or segmentectomy procedures were categorized by the surgical approach (VATS vs open) and primary diagnosis (primary or metastatic lung cancer vs non-lung cancer). Patients requiring ≥3 units of blood products with at least 1 unit of PRBCs: “significant bleeding” cohort; those requiring <3 units: “non-significant bleeding” cohort; and those not requiring blood products: “no bleeding” cohort. A matched cohort analysis was performed between the “significant bleeding” and the “no bleeding cohort” using matching variables: hospital, lung cancer diagnosis, year of surgery, APR-DRG severity score, procedure type and approach, age, and gender.

Results: The “All-patient” cohort comprised 21,429 patients: 213 “significant bleeding”; 2,780 “non-significant bleeding”; and 18,436 “no bleeding”. Overall incidence of significant chest bleeding was 0.99%. Patients from “significant bleeding” cohort and “non-significant bleeding” cohort had 2.5 days and 2 days (p?p?Conclusions: Although significant bleeding during lung resection surgery is rare, patients with such complication could stay longer at the hospital and cost an average of $13,103 more than those without.     

卡前列素氨丁三醇联合缩宫素治疗对产后出血产妇血小板计数、活化部分凝血活酶时间、凝血酶原时间水平的影响

目的 探讨卡前列素氨丁三醇联合缩宫素治疗对产后出血产妇血小板计数(PLT)、活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)水平的影响.方法 选取2019年6月至2020年2月方大医疗(营口)群众医院妇科收治的78例产后出血产妇作为研究对象,按照抽签方法随机分为对照组和观察组,各39例.对照组患者给予单一缩宫素进...     

结肠息肉切除术后并发出血的内镜治疗

目的探讨内镜治疗结肠息肉切除术后并发出血患者的临床疗效。方法选取2007年6月至2014年6月在我院接受结肠息肉切除术治疗的16例术后并发出血患者,均采用急诊结肠镜检查,同时在内镜下进行止血治疗。结果本组16例患者经急诊结肠镜检查的同时在内镜下均得到成功止血。结论内镜治疗结肠息肉切除术后并发出血的效果良好,可有效止血。     

内镜联合喷洒血凝酶、质子泵抑制剂治疗消化性溃疡出血患者的临床疗效

目的 探讨应用内镜联合喷洒血凝酶、质子泵抑制剂(PPI)治疗消化性溃疡出血患者的临床效果.方法 选取2019年2月至2021年1月盘锦市人民医院收治102例消化性溃疡出血患者作为研究对象,按随机数字表法分为对照组与观察组,各51例.对照组患者单纯接受PPI治疗(兰索拉唑静脉滴注治疗),观察组患者在对照组基础上接受内镜联...     

Risks and cost burden of venous thromboembolism and bleeding for patients undergoing total hip or knee replacement in a managed-care population

Abstract

Background:

Total hip and total knee replacement (THR/TKR) patients are at increased risk of developing venous thromboembolism (VTE). VTE prevention using anticoagulation therapy increases the risk of bleeding. Therefore, any assessment of the cost of VTE and its prevention should also take into consideration risks and costs of bleeding.

Objective:

To assess the risks of developing VTE and bleeding in patients after THR or TKR given real-world use of thromboprophylaxis, and to quantify the incremental cost associated with each.

Methods:

Analyses of insurance healthcare claims from the Ingenix IMPACT National Managed Care Database^TM from January 2004 to December 2008 were conducted. Subjects were ≥18 years and had ≥1 procedure code for THR or TKR. Patients had to have ≥180 days of observation prior to surgery and were observed for ≤3 months after THR or TKR. VTE was defined as ≥1 diagnosis code for deep vein thrombosis or pulmonary embolism. Bleeding events were classified as major or non-major. Risks of VTE or bleeding events were calculated as number of patients with an event divided by number of patients with the procedure. Incremental all-cause healthcare costs associated with VTE or bleeding were calculated as the difference between cohorts of patients without VTE or bleeding matched 1:1 to patients with VTE or bleeding.

Results:

Of 119,729 patients (43,670 THR and 76,059 TKR), 7974 had a VTE event and 4849 had a bleeding event (2216 major bleeding [a subset of ‘any bleeding’]). The risks of VTE, any bleeding, and major bleeding were 6.7, 4.0, and 1.9 events, respectively, per 100 patients. Up to 3 months after THR/TKR, mean incremental all-cause healthcare costs per patient per month associated with VTE, bleeding, and major bleeding were $2729, $2696, and $4304, respectively. Total monthly costs versus matched controls over 3 months were: VTE: $12,333 vs. $9604; any bleeding: $12,481 vs. $9785; major bleeding: $14,015 vs. $9710; p?<?0.001 for all.

Limitations:

Key limitations included potential inaccuracies or omissions in procedures, diagnoses, or costs of claims data; lack of information on the amount of blood transfused or decreases in the hemoglobin level to evaluate the severity of a bleeding event; and potential biases due to the observational design of the study.

Conclusion:

From the managed-care population perspective, in THR/TKR patients the greater incidence of VTE compared to any bleeding and major bleeding translated into a higher cumulative cost burden.     

Burden of menstrual symptoms in Japanese women: results from a survey-based study

Abstract

Objective:

Menstrual symptoms are associated with various health problems in women and may also significantly impact their lives. This study aims to assess the current burden of menstrual symptoms in Japanese women.

Methods:

Two online surveys were conducted among women aged 15–49 years, where sampling was designed to approximate the age and geographic distribution in Japan. The first survey collected data on menstrual symptom severity based on a modified, 35-item, Japanese version of the Menstrual Distress Questionnaire (mMDQ), current treatments, and impact on work productivity. The second survey collected costs of outpatient treatment within the previous 3 months. Additional outcomes of the second survey will be presented in a separate paper.

Results:

In this study, 19,254 women had menses, with 74% suffering from menstrual symptoms. A total of 50% reported pain and 19% reported heavy bleeding. Increasing severity of menstrual symptoms and self-reported heavy bleeding were related to more outpatient visits and greater work productivity loss. Among subjects with heavy bleeding, increasing severity of symptoms was related to greater interference with daily life. The estimated annual economic burden extrapolated to the Japanese female population was 683 billion Japanese Yen (JPY) or ～8.6 billion United States Dollars (USD).

Limitations:

The study population may be biased due to the online survey method.

Conclusions:

To the authors’ knowledge, this is the first large-scale research assessing outcomes by severity categories for all menstrual symptoms and women’s perception of bleeding. A large proportion of women suffer from menstrual symptoms, and symptom severity impacts women’s lives. Menstrual symptoms lead to significant economic burden, mainly due to work productivity loss. However, the majority of women do not visit a gynecologist, even when their menstrual symptoms are severe. Thus, increasing public awareness on the recently available medical treatments has the potential to improve the overall burden of menstrual problems.