US Dollars Research Articles

Cost-effectiveness Analysis of Japanese Encephalitis Vaccination for Children

Japanese encephalitis (JE) is preventable using the affordable, effective, and safe live attenuated SA 14-14-2 JE vaccine (CD-JEV). We used a Markov model to evaluate the cost-effectiveness of 1 dose of CD-JEV compared with no vaccination in 3 vaccination strategies in Bangladesh: subnational campaign and routine immunization, subnational campaign and national routine immunization, and national routine immunization alone. For input parameters, we gathered information from a cost-of-illness study, medical literature, government documents, and expert opinions. The base-case analysis estimated that a subnational campaign for children <15 years of age and routine immunization over 20 birth cohorts in Rajshahi, Rangpur, and Chattogram yielded (in 2021 US dollars) a cost of $82.2 million, $981/disability-adjusted life years averted, $9,964/case averted, and $49,819/death averted (societal perspective). We projected CD-JEV vaccination would be cost-effective across cost perspectives and vaccination strategies in Bangladesh, yielding an incremental cost-effectiveness ratio of approximately one third of per capita national gross domestic product.

The Impact of Fed Rate Hikes on The Chinese Economy

The United States is the world's largest economy and a major financial center. As the central bank of the United States, the Federal Reserve's monetary policy decisions not only have a significant impact on the country's economic and trade development, but also lead to changes in global capital flows, exchange rate fluctuations, and international trade conditions. Since March 2022, persistent high inflation and overheating of the economy have led the Federal Reserve to raise interest rates dozens of times. As of September 2023, the Federal Reserve's interest rate has increased from 0 to 5.5%. The total rate hike by the Federal Reserve has reached 550 basis points. As the US dollar is the world's reserve currency, China's economy inevitably experiences varying degrees of impact. Therefore, studying the impact of the Federal Reserve's rate hikes on the Chinese economy will help our country formulate better response measures and reduce its adverse effects on our economy.

Parameters of Russian finance in the context of sanctions

Subject. This article discusses the parameters of Russian finance in the context of sanctions. Objectives. The article aims to determine the parameters of Russian finance in the context of sanctions. Methods. For the study, I used analysis and synthesis, special economic and mathematical methods, in particular, correlation and regression analysis, as well as a graphical method of presenting the results obtained. Results. The article reveals the peculiarities characteristic of Russian finance in the context of sanctions at present. Conclusions. The identified parameters of Russian finance under sanctions can help the expert community understand and assess the relationship between the increase in the share of the Chinese yuan and the dominance of the US dollar in the over-the-counter cash turnover of the Russian foreign exchange market.

Cost-effectiveness analysis of immune checkpoint inhibitors combined with targeted therapy and chemotherapy for HPV/HIV-related cervical cancer.

To systematically assess the cost-effectiveness of immune checkpoint inhibitors compared to the current standard therapy for human papillomavirus (HPV) and human immunodeficiency virus (HIV)-related cervical cancer. A partitioned survival model spanning a 20-year period was created to evaluate the cost and effectiveness of atezolizumab combined with bevacizumab and chemotherapy (ABC), and pembrolizumab combined with bevacizumab and chemotherapy (PBC) vs bevacizumab combined with chemotherapy (BC), based on clinical data from the BEATcc and KEYNOTE-826 trials. Royston-Parmar models were used for survival estimation. Costs and health state utilities were sourced from existing literature and publicly accessible databases. Cumulative costs (in US dollars), life years, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs) were measured and compared. The evaluation was from the US healthcare payer perspective, with the willingness-to-pay threshold set at $100,000 to $150,000. Deterministic sensitivity analysis (DSA), probabilistic sensitivity analysis (PSA), and scenario analyses were conducted. The base-case analysis showed QALYs of 2.05 for BC, 3.18 for PBC, and 2.85 for ABC. PBC increased life-years by 1.76 and ABC by 1.18, with PBC showing the highest effectiveness. Total costs were $272,377 for BC, $715,472 for ABC, and $694,239 for PBC; severe adverse event (SAE) costs were $6189 for BC, $7603.31 for ABC, and $13,640 for PBC, indicating BC had the lowest SAE costs. The ICERs compared to BC were $372,151/QALY for PBC and $553,995/QALY for ABC. Given that the willingness-to-pay threshold was $100,000 to $150,000/QALY, both PBC and ABC exceed this threshold and were not considered cost-effective. BC had the lowest QALYs and the lowest costs, making it the least expensive option and the most cost-effective choice. DSA results indicated that drug prices and utility values were the main factors affecting cost-effectiveness. PSA confirmed BC as the most cost-effective option within a willingness-to-pay threshold of $0 to $300,000, primarily because it was the least costly. Immune checkpoint inhibitors significantly improve survival benefits for patients. However, their addition is costly and unlikely to be cost-effective for HPV/HIV-related metastatic cervical cancer.

The economic value of seasonal weather and climate services for maize farmers in Manicaland Province of Zimbabwe

Most rural areas in Zimbabwe are extremely vulnerable to changing climatic conditions, particularly droughts, which threaten smallholder farmers' livelihoods. Seasonal weather forecast services can help farmers adapt, optimise production, and implement risk reduction strategies. To support increased investment in these services, this study seeks to provide quantitative evidence on the economic value of locality-specific seasonal weather forecasts by eliciting maize producers' willingness to pay (WTP) through the contingent valuation approach. The results of the study show that among 502 farmers, 68 % would pay for seasonal weather forecasts, highlighting their perceived economic value and practical utility in agricultural decision-making. On average, farmers were willing to pay one (1) United States dollar (US$1) per month for seasonal weather forecast services. Extrapolating this demand nationally, we estimate an annual economic value of around US$ 53.2 million for these services. This valuation underscores the substantial economic benefits that weather and climate services could offer to Zimbabwe's agriculture sector, justifying the case for increased resource allocation towards the delivery of location-specific weather forecasts. Using the Heckman selection model, the study further identified that maize producers' climate change perceptions, radio ownership, and prior participation in agricultural policy development significantly increased their likelihood of paying for seasonal weather forecasts. These factors highlight the role of both access to information and engagement in policy processes in shaping farmers' valuation of seasonal weather forecasts. Establishing district-level climate change dialogue platforms can significantly enhance maize producers' awareness of climate change, deepen their understanding of the value of weather forecasts, and encourage their participation in policy-making processes. By creating spaces for knowledge exchange and farmer engagement, these platforms not only support informed farm decision-making but also help tailor climate services to farmers' needs. Nevertheless, farmers from the Ndau ethnic group and those in remote areas showed reluctance to pay for seasonal weather forecasts, indicating that factors like ethnicity and remoteness affect WTP. This reluctance highlights how social marginalisation and inadequate infrastructure in remote areas limit access to weather information, thereby reducing farmers' perceived value of these services. Enhanced telecommunication infrastructure and radio signals in rural areas, especially community radios, could help to expand the access and tailoring of forecast messages in local languages, making it understandable and thus supporting informed decision-making across diverse farming communities.

Hybrid metaheuristic algorithm methods and econometric models in prediction of dogecoin price

Purpose This paper aims to predict Dogecoin price by using artificial intelligence (AI) methods and comparing the results with the econometrics models. Design/methodology/approach An artificial neural network (ANN) was applied as a prediction method without any optimization techniques. Additionally, the genetic algorithm (GA) is used to select the most appropriate input variables. Additionally, based on the literature review and the relationships between crypto-price and global indices, 20 economic indicators, such as Coinbase Bitcoin, Coinbase Litecoin and US dollars, along with main global stock indices such as FTSE100 and NIFTY50, are identified as input variables for the model. Lichtenberg algorithm (LA) and aquila optimization (AO) algorithm are used to make the ANN more robust. To validate our algorithms, they have been implemented on daily data for the last three years. To demonstrate the superiority of the models over traditional methods such as econometrics, regression analysis and curve fitting techniques are used. The effectiveness of these models is then evaluated and compared using criteria such as recall, accuracy and precision. Findings The results indicate that AI-based algorithms not only enhance the accuracy, recall and precision of calculations but also expedite the process without requiring the numerous and restrictive assumptions associated with time series and econometric models. Originality/value The main contribution of this paper is the application of novel approaches such as AO and LA to improve the predictive capabilities of the ANN method for various cryptocurrencies’ prices. It demonstrates the superiority of the proposed algorithms over traditional econometric models using real-life data.

Hospitalization due to pneumococcal disease in the Unified Health System in Brazil: A retrospective analysis of administrative data

IntroductionCommunity-Acquired Pneumonia (CAP) caused by pneumococcus and Invasive Pneumococcal Disease (IPD) pose a substantial economic burden on health systems. The objective of the present study is to explore hospitalization costs of pneumococcal disease in the public health system in Brazil, the Unified Health System. MethodsRetrospective analysis of administrative data on hospitalized cases of pneumococcal disease from January 2019 to July 2023. Hospitalization cases recorded with ICD-10 codes of CAP due to S. pneumoniae and IPD were retrieved from DATASUS, the inpatient information system of the Unified Health System in Brazil. Costs were converted to US dollars by Using Purchasing Power Parity (USD-PPP). Absolute number of hospitalizations, costs of hospitalizations and healthcare resource utilization were presented descriptively. The annual cost estimate was calculated. Differences in costs by type of clinical presentation and age group were assessed. Factors associated with higher costs were explored by multiple linear regression models. ResultsA total of 22,498 hospitalization episodes were analyzed. Total cost of hospitalizations was USD-PPP 13,958,959 (BRL 34,659,578) with an annual mean estimate of USD-PPP 3,045,591 (BRL 7,562,090). Cost per hospitalization episode was significantly higher for meningitis, followed by septicemia, CAP and arthritis, with median values ranging from USD-PPP 190.93 to 615.14 (BRL 476.20 to 1529.02). (Kruskal-Wallis χ2 = 6473, df = 3, p-value < 0.0001). Costs were significantly higher among individuals aged 60-years and older. (Kruskal-Wallis test; χ2 = 773.53; df = 2, p-value < 0.0001). There were differences in age at hospitalization, length of stay, and ICU utilization among types of clinical presentations. ConclusionsOur findings reveal the economic burden associated with pneumococcal disease in the Unified Health System in Brazil. Hospitalization costs were higher for cases of meningitis and among individuals aged 60-years and above.

U.S. Dollar Activeness Forecasting: Application of the Seasonal ARIMA Model

This article selects the US Dollar Activeness as the research object, and through the study, it predicts the US Dollar Activeness 12 months later. It also attempts to analyze the reasons for the fluctuations of the US Dollar Activeness at different stages. The US Dollar Activeness holds a high position in the international currency market, and its fluctuations can reflect the strength or weakness of the US dollar and the health of the economy. In the prediction process, this article introduces the ARIMA model to predict the future trend of the US Dollar Activeness and tries to identify its influencing factors. By using the seasonal ARIMA model, a forecast chart of the US Dollar Activeness for the next 12 months was obtained. The US Dollar Activeness is likely to maintain its strength in the short term, but there are still uncertainties. Predicting the US Dollar Index can influence future exchange rate fluctuations and monetary policy formulation, as it reflects the value of the dollar against a basket of foreign currencies, exerting a broad impact on global financial markets and economic activities.

Tests of Global Flights to Safety With US Financial Firm Bankruptcy Announcements

ABSTRACTThis paper investigates whether bankruptcy announcements by large US financial institutions can induce flights to safety, leading investors to seek safer investments. To test this relationship, we employ a short‐horizon event study methodology and show that low‐risk investments—such as the US dollar, sovereign bonds and gold—exhibit significant appreciation following such announcements. This result is more pronounced when the local country‐level investor sentiment declines in the postannouncement period. We also analyze the transmission mechanism through which bankruptcy announcements cause flights to safety and empirically identify a global information contagion channel via negative shocks to the cash flows of stocks.

Incremental healthcare costs of the simple SOF measure of phenotypic frailty in community-dwelling older adults.

Frailty defined by the Cardiovascular Health Study (CHS) phenotype is associated with higher healthcare expenditures in community-dwelling Medicare beneficiaries after accounting for claims-based cost indicators. However, frailty assessment using the CHS phenotype is often not feasible in routine clinical practice. We evaluated whether frailty identified by the simple Study of Osteoporotic Fractures (SOF) phenotype is associated with subsequent incremental costs after accounting for claims-derived cost indicators. Prospective study utilizing data from four cohort studies of older adults linked with Medicare claims composed of 8264 community-dwelling fee-for-service beneficiaries (4389 women, 3875 men). SOF Frailty Phenotype (three components: weight loss, poor energy, and inability to rise from chair five times without using arms) and CHS Frailty Phenotype (operationalized using five components) derived from cohort data. Participants were classified as robust, prefrail, or frail using each phenotype. Multimorbidity index (CMS Hierarchical Conditions Categories score) and Kim frailty indicator (approximating the deficit accumulation index) derived from claims. Annualized total and sector-specific healthcare costs ascertained for 36 months after frailty assessment. Average annualized total healthcare costs (2023 US dollars) were $15,021 in women and $15,711 in men. After accounting for claims-based multimorbidity and frailty indicators, average incremental costs of SOF phenotypic frailty (two or three components) versus robust (none) were $7142 in women and $5961 in men, only modestly lower than incremental costs of CHS phenotypic frailty ($9422 in women, $6479 in men). SOF phenotypic frailty in both sexes was associated with higher subsequent expenditures in the inpatient, skilled nursing facility, and home healthcare sectors. As observed with CHS phenotypic frailty, SOF phenotypic frailty is associated with higher subsequent total and sector-specific expenditures after accounting for claims-derived indicators. The parsimonious SOF phenotype can be readily assessed in space-constrained and time-limited practice settings to improve identification of older adults at high risk of costly care.

Simultaneous optimization of simulated moving bed adsorption and distillation for 2,3‐butanediol recovery

AbstractA combined simulated moving bed (SMB) and distillation separation scheme is developed to recover 2,3‐butanediol (BDO) from a dilute fermentation broth. The scheme was integrated into a lignocellulosic biorefinery that produces hydrocarbon fuels from corn stover with BDO as an intermediate. BDO recovery is one of the most challenging processes in this biorefinery; and given the high associated energy duties, direct distillation is considered cost‐prohibitive. An alternative separation is SMB adsorption in nanoporous materials, which can reject 90% of the water and reduce subsequent distillation costs. Rigorous models were used to optimize the SMB and distillation simultaneously. The separation can be added to the biorefinery while keeping the projected minimum fuel selling price (MFSP) below $0.66 USD (US dollars) per liter gasoline‐equivalent ($2.50/GGE, gallon gasoline equivalent). Finally, sensitivity analyses were conducted to assess the effects of cost and lifetime of the adsorbent, titer concentration, and BDO purity.

Predicting multi-frequency crude oil price dynamics: Based on MIDAS and STL methods

Accurate prediction of crude oil prices is important for national energy security and socioeconomic development. Research on crude oil price forecasting has primarily focused on the overall price, overlooking the differentiated investment needs of different entities. To solve this problem, we introduce the Seasonal and Trend decomposition using Loess (STL) method into the Mixed Data Sampling (MIDAS) model. This enables us to more accurately analyze the predictive capability of predictors for crude oil prices at different frequencies. Selected predictors include the Dow Jones Index, US Dollar exchange rate, economic policy uncertainty, related crude oil and energy prices, carbon asset prices, and investor attention. Empirical results indicate that these predictors significantly enhance the forecasting accuracy across all components, with the strongest impact in the trend component. Interestingly, a lag effect is observed in the predictors' impact on the seasonal and residual components, but not on the trend component. Moreover, we calculate the duration of each predictor's effectiveness for different components of crude oil prices, distinguishing short-term and long-term effective predictors. This research offers novel insights into the design of crude oil price forecasting models, which is crucial for enhancing investor returns and maintaining stability in the energy market.

Cost-Effectiveness of Maternal Vaccination to Prevent Respiratory Syncytial Virus Illness.

Respiratory syncytial virus (RSV) commonly causes hospitalization among US infants. A maternal vaccine preventing RSV in infants, RSV bivalent prefusion F maternal vaccine (RSVpreF), was approved by the US Food and Drug Administration and recommended by the Advisory Committee on Immunization Practices. Our objective was to evaluate the health benefits and cost-effectiveness of vaccinating pregnant persons in the United States using RSVpreF. We simulated RSV infection and disease with and without seasonal RSVpreF vaccination in half of the pregnant persons in the annual US birth cohort during weeks 32 through 36 of gestation. Model inputs came from peer-reviewed literature, Food and Drug Administration records, and epidemiological surveillance databases. The results are reported using a societal perspective in 2022 US dollars for a 1-year time frame, discounting future health outcomes and costs at 3%. Sensitivity and scenario analyses were performed. Year-round maternal vaccination with RSVpreF would prevent 45 693 outpatient visits, 15 866 ED visits, and 7571 hospitalizations among infants each year. Vaccination had a societal incremental cost of $396 280 per quality-adjusted life-year (QALY) saved. Vaccination from September through January cost $163 513 per QALY saved. The most influential inputs were QALYs lost from RSV disease, the cost of the vaccine, and RSV-associated hospitalization costs; changes in these inputs yielded outcomes ranging from cost-saving to $800 000 per QALY saved. Seasonal maternal RSV vaccination designed to prevent RSV lower respiratory tract infection in infants may be cost-effective, particularly if administered to pregnant persons immediately before or at the beginning of the RSV season.

Cost-Effectiveness of Nirsevimab for Respiratory Syncytial Virus in Infants and Young Children.

Respiratory syncytial virus (RSV) causes substantial hospitalization in US infants. The Advisory Committee on Immunization Practices recommended nirsevimab in infants younger than 8 months born during or entering their first RSV season and for children aged 8 to 19 months at increased risk of RSV hospitalization in their second season. This study's objective was to evaluate the cost-effectiveness of nirsevimab in all infants in their first RSV season and in high-risk children in their second season. We simulated healthcare utilization and deaths from RSV with and without nirsevimab among infants aged 0 to 7 months and those 8 to 19 months old over a single RSV season. Data came from published literature, US Food and Drug Administration approval documents, and epidemiologic surveillance data. We evaluated societal outcomes over a lifetime discounting at 3% and reporting in 2022 US dollars. Sensitivity and scenario analyses identified influential variables. We estimated that 107 253 outpatient visits, 38 204 emergency department visits, and 14 341 hospitalizations could be averted each year if half of the US birth cohort receives nirsevimab. This would cost $153 517 per quality-adjusted life year (QALY) saved. Nirsevimab in the second season for children facing a 10-fold higher risk of hospitalization would cost $308 468 per QALY saved. Sensitivity analyses showed RSV hospitalization costs, nirsevimab cost, and QALYs lost from RSV disease were the most influential parameters with cost-effectiveness ratios between cost-saving and $323 788 per QALY saved. Nirsevimab for infants may be cost-effective, particularly among those with higher risks and costs of RSV.

Modeling Health and Economic Outcomes of Eliminating Sex Disparities in Youth Physical Activity

Sex disparities in physical activity (PA) and sports participation among US children and adolescents have been persistent. Quantifying the impact of reducing or eliminating these disparities may help determine how much to prioritize this problem and invest in interventions and policies to reduce them. To quantify what might happen if existing PA and sports participation disparities were reduced or eliminated between male and female children and adolescents. This simulation study used an agent-based model representing all children (aged 6 to 17 years) in the US, their PA and sports participation levels, and relevant physical and physiologic characteristics (eg, body mass index) as of 2023. Experiments conducted from April 5, 2024, to September 10, 2024, simulated what would happen during the lifetime of each cohort member if PA and sports participation levels for female participants were increased (to varying degrees) to match male participants in the same age group. Health outcomes, such as body mass index, incidence of weight-related conditions (eg, stroke, coronary heart disease, type 2 diabetes, and cancer), and economic outcomes (eg, direct medical costs and productivity losses). This simulation study modeled 8 299 353 US children and adolescents (4 240 119 [51.1%] male and 4 059 234 [48.9%] female) aged 6 to 17 years. Eliminating PA sex disparities averted 28 061 (95% CI, 25 358-30 763) overweight and obesity cases per cohort by age 18 years, which in turn averted 4869 (95% CI, 4007-5732) weight-related disease cases during their lifetimes and resulted in recurring savings of $333.45 million (95% CI, $290.22 million to $376.68 million) in direct medical costs and $446.42 million (95% CI, $327.39 million to $565.44 million) in productivity losses (in 2024 US dollars) for every new cohort of 6- to 17-year-olds. Reducing PA disparities by 50% averted 9027 (95% CI, 6942-11 112) overweight and obesity cases. Eliminating sex disparities in sports participation averted 41 499 (95% CI, 37 874-45 125) cases of overweight and obesity and 8939 (95% CI, 8088-9790) weight-related disease cases during their lifetimes, generating recurring savings of $713.48 million (95% CI, $668.80 million to $758.16 million) in direct medical costs and $839.68 million (95% CI, $721.18 million to $958.18 million) in productivity losses. In this simulation study of youth PA and sports participation, eliminating sex disparities could save millions of dollars for each new cohort of 6- to 17-year-olds, which could exceed the cost of programs and investments that could enable greater equity.

Cost-Utility Analysis of Multigene Assays to Guide Treatment Decisions for Node-Negative Early Breast Cancer.

Clinicopathologic and patient factors, such as tumor grade, size, age, and menopausal status, provide limited prognostic and predictive information in hormone receptor positive (HR +), human epidermal growth receptor 2 negative (HER2-), node-negative early-stage breast cancer, leading to potential over- or under-treatment. Multigene expression profile tests used in clinical practice in the USA, including the 21-gene assay, 70-gene assay, 12-gene assay, and 50-gene assay, offer prognostic information beyond traditional clinicopathologic features to improve treatment decisions. This study aimed to estimate the cost-effectiveness of these four multigene assays compared with clinicopathologic risk assessment alone. A decision tree categorized hypothetical patients with HR + /HER2- early-stage invasive breast cancer according to clinical and genomic risk, and integrated clinical expert insights for chemotherapy allocation with literature inputs. A Markov model simulated lifetime costs and outcomes of chemotherapy decisions over a patient's lifetime. The probability of distant breast cancer recurrence was derived from TAILORx (21-gene assay), MINDACT (70-gene assay), and TransATAC (12-gene assay, 50-gene assay) studies. Costs were calculated from a US societal perspective in 2021 US dollars, considering healthcare costs, lost productivity, and patient out-of-pocket expenses. The 21-gene assay and 50-gene assay were less costly ( -$12,189 and -$2410, respectively) and more effective [0.23 and 0.07 quality-adjusted life years (QALYs), respectively] compared with clinicopathologic risk alone. Similarly, the 70-gene assay and 12-gene assay are also cost-effective alternatives [incremental cost-effectiveness ratio (ICER): 27,760 and 7942, respectively]. All four multigene assays were cost-effective from a societal perspective, offering low net lifetime costs or savings with improved outcomes compared with clinicopathologic risk assessment alone. These assays can help refine treatment decisions by providing prognostic risk estimates. In the case of the 21-gene assay, it can also predict chemotherapy benefit leading to the highest lifetime cost savings and greatest QALY gain.

Fungus Fighters: Wood Ants (Formica polyctena) and Their Associated Microbes Inhibit Plant Pathogenic Fungi

Plant diseases cost the global economy billions of US dollars every year. The problem has mainly been addressed by using chemical pesticides, but recently, the use of ants has shown promising effects against plant pathogens. However, the mechanisms accounting for these effects have not yet been determined. One possible explanation is antimicrobial microorganisms associated with ants. Through controlled laboratory experiments, we investigated the inhibitory effects of wood ants (Formica polyctena) and their associated microorganisms against economically important plant pathogenic fungi. All live ants, extracts from crushed ants, and extracts from washed ants significantly inhibited the apple brown rot (Monilinia fructigena) while yielding the growth of other microbes. Furthermore, all investigated wood ants transferred microorganisms to their surroundings within 10 s when walking across a surface. We isolated the most dominant microorganisms deposited by walking ants and from washed ant extracts (i.e., strains likely found on the surface of ants), resulting in four bacterial cultures and one yeast. Two of these isolates, strain I3 (most closely related to Pseudomonas sichuanensis and P. entomophila) and strain I1b (most closely related to Bacillus mycoides), showed inhibitory effects against apple brown rot and apple scab (Venturia inaequalis), while strain I3 also inhibited gray mold (Botrytis cinerea) and Fusarium head blight (Fusarium graminearum). These results suggest that wood ants have potential as biological control agents against commercially relevant plant pathogens, and that their inhibitory effect might be at least partially caused by antibiotic compounds produced by their associated microorganisms.

Experiencing chronic cough symptoms for 3 years is associated with increased rates of healthcare resource use and higher healthcare costs in the United States compared to resolved chronic cough

Objective Chronic cough (CC) symptoms can persist as refractory or unexplained CC (RCC). We sought to characterize the clinical and economic burden of RCC. Methods In this retrospective US cohort study using data from Optum’s de-identified CDM Database (01/2015–03/2022), CC was identified as ≥1 CC diagnosis or ≥3 cough events (with ≥8 weeks and ≤120 days between the first and third events and ≥3 weeks between any 2 events). The index date was set as the earliest date of meeting the CC definition. The baseline period was defined as the 364 days prior to and including the index date. Adults with CC at baseline who met CC requirements (≥1 CC diagnosis, or ≥2 cough events occurring ≥8 weeks but ≤120 days apart) in both follow-up year 2 and follow-up year 3 were defined as having ‘3-year chronic cough’ (3YCC), a proxy measure of RCC, and compared to adults with CC at baseline who did not meet CC requirements in follow-up years 2 and 3 (non-3YCC). A propensity score weighting approach was used to adjust for baseline differences between the 3YCC and non-3YCC groups to compare clinical characteristics and healthcare resource use and costs in the two groups during the follow-up period. Results At baseline, the 3YCC group (N = 3,338) had significantly more comorbidities and higher all-cause healthcare resource use and costs than the non-3YCC group (N = 43,122) in unweighted analyses. After weighting, the groups (N = 3,338 with 3YCC and N = 3,145 without) were compared during a 3-year follow-up period. The 3YCC group had significantly more comorbidities, higher levels of all-cause healthcare resource use, and higher all-cause healthcare costs during the follow-up period compared to the non-3YCC group, after adjusting for baseline differences. For example, the mean total healthcare costs (in 2022 US dollars) were significantly higher among the 3YCC group than the non-3YCC group in each follow-up year, at $49,454 versus $42,144 in follow-up year 1, $49,339 versus $36,939 in follow-up year 2, and $51,737 versus $36,503 in follow-up year 3 (p<0.001 for each comparison). Conclusions After adjusting for baseline differences, persistent symptoms of CC were associated with significantly higher comorbidity, healthcare resource use, and healthcare costs compared to CC that resolved. Effective treatments for RCC would thus be expected to result in improved health as well as substantial healthcare cost offsets.

Cost Effectiveness of Catheter Ablation Versus Antiarrhythmic Drugs for Atrial Fibrillation: A Systematic Review and Meta-analysis.

Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia and is associated with substantial morbidity and mortality. Current international guidelines recommend antiarrhythmic drugs or catheter ablation (CA) as rhythm-control strategies for AF. This study aimed to comprehensively assess economic evaluations (EEs) of the treatment of AF by country income level. Seven electronic databases were systematically searched for EE literature until March 30, 2024, with no constraints on time or language. Two independent reviewers selected the studies, extracted the data, and assessed the quality of the data. Full EEs comparing CA with antiarrhythmic drugs for rhythm-control treatment were included; surgical or rate-control treatments were excluded. The quality of the included articles was assessed using the ECOBIAS checklist. Costs were converted to purchasing power parity US dollars for 2023. A random-effects meta-analysis was applied to pool incremental net benefit (INB) based on a heterogeneity test and its degree (I2 > 25% or Cochran's Q test < 0.1). We also explored heterogeneity and potential publication bias and conducted sensitivity and subgroup analyses. In total, 27 studies across nine countries were eligible, predominantly from high-income countries (n = 25), with a smaller subset from upper-middle-income countries (n = 2). Because of the heterogeneity among the studies, a random-effects model was selected over a fixed-effects model to pool INBs. Most studies (n = 21) favored CA as the cost-effective intervention, yielding an INB of $US23,796 (95% confidence interval [CI] 15,341-32,251) in high-income countries. However, heterogeneity was substantial (I2 = 99.67%). In upper-middle-income countries, the estimated INB was $US18,330 (95% CI - 11,900-48,526). The publication bias results showed no evidence of asymmetrical funnel plots. In this meta-analysis, CA emerged as a cost-effective rhythm-control treatment for AF when compared with antiarrhythmic drugs, particularly in high-income countries. However, economic evidence for upper-middle-income countries is lacking, and no primary evaluations were found for low-middle-income and low-income countries. Further EEs are necessary to expand the understanding of AF treatment globally.

Cost-Effectiveness of Nonoperative Management vs Upfront Laparoscopic Appendectomy for Pediatric Uncomplicated Appendicitis Over 1 Year.

Non-operative management (NOM) with antibiotics alone for pediatric uncomplicated appendicitis is accepted to be safe and effective. However, the relative cost-effectiveness of this approach compared to appendectomy remains unknown. We aimed to evaluate the cost-effectiveness of non-operative versus operative management for pediatric uncomplicated acute appendicitis. A trial-based real-world economic evaluation from the healthcare sector perspective was performed using data collected from a multi-institutional non-randomized controlled trial investigating NOM versus surgery. The time horizon was 1 year, with costs in 2023 US dollars. Ratio of costs-to-charges (RCC)-based data for the initial hospitalization, readmissions, and unplanned emergency department visits were extracted from the Pediatric Health Information System (PHIS). Utility data were derived from patient-reported disability days and health-related quality-of-life scores. Multiple scenarios and one-way deterministic and probabilistic sensitivity analyses accounted for parameter uncertainty. Willingness-to-pay (WTP) threshold was set at $100,000 per quality-adjusted life year (QALY) or disability-adjusted life year (DALY). Primary outcome measures included total and incremental mean costs, QALY, DALY, and incremental cost-effectiveness ratios (ICERs). Of 1,068 participants, 370 (35%) selected NOM and 698 (65%) selected urgent laparoscopic appendectomy. Operative management cost an average of $9,791/patient and yielded an average of 0.884 QALYs while NOM cost an average of $8,044/patient and yielded an average of 0.895 QALYs. NOM was both less costly and more effective in base case and scenario analyses using disability days and alternate methods of calculating utilities. NOM is cost-effective compared to laparoscopic appendectomy for pediatric uncomplicated appendicitis over 1 year.