Economic Modeling Research Articles

Analysis of factors associated with use of real-world data in single technology appraisals of cancer drugs by the National Institute for Health and Care Excellence

ObjectivesThis study investigates factors associated with use of real-world data (RWD) in economic modelling for single technology appraisals (STAs) of cancer drugs by the National Institute for Health and Care Excellence (NICE) to improve systematic understanding of the use of RWD. MethodsThe data were extracted from STAs of cancer drugs, for which NICE issued guidance between January 2011 and December 2022 (n=267). Binary regression was used to test hypotheses concerning the greater or lesser use of RWD. Bonferroni-Holm correction was used to control error rates in multiple hypotheses tests. Several explanatory variables were considered in this analysis, including time (Time), incidence rate of disease (IR), availability of direct treatment comparison (AD), generalisability of trial data (GE), maturity of survival data in trial (MS) and previous technology recommendations by NICE (PR). The primary outcome variable was any use of RWD. Secondary outcome variables were specific uses of RWD in economic models. ResultsAD had a statistical negative association with any use of RWD whereas no associations with non-parametric and parametric use of RWD were found. Time had several statistical associations with use of RWD (validating survival distributions for the intervention, estimating progression-free survival for the intervention, estimating overall survival for comparators and transition probabilities). ConclusionsRWD were more likely to be used in economic modelling of cancer drugs when randomised controlled trials failed to provide relevant clinical information of the drug for appraisals, particularly in the absence of direct treatment comparisons. These results, based on analysis of data systematically collected from previous appraisals, suggest that uses of RWD were associated with data gaps in the economic modelling. While this result may support some of the claimed advantages of using RWD when evidence is absent, the question, the extent to which use of RWD in indirect treatment comparisons reduces uncertainty is still to be determined.

П РОГНОЗИРОВАНИЕ И СТРАТЕГИРОВАНИЕ РЕГИОНАЛЬНОЙ СИСТЕМЫ ОБЩЕГО ОБРАЗОВАНИЯ

In this research project of Sevastopol State University (Sevastopol, Russian Federation), an urgent scientific task has been implemented to analyze and predict the effectiveness, as well as strategize the regional system of general education. At the first stage of the study, the criteria and indicators of the effectiveness of the educational organization and the regional education system as a whole were determined. At the second stage, a non-random sample of twelve secondary schools of the city with declining educational performance was formed and analyzed, which amounted to about twenty percent of their total number, as a result of which “problem points” were identified and a forecast of the effectiveness of these educational organizations was built. At the same time, the tools of economic and mathematical modeling were used: correlation and regression analysis, time series analysis, the principal components method and cluster analysis. At the third stage, individual and general strategies have been developed for the sample schools that optimally correspond to the identified “problem points”, in addition, planning for the implementation of the proposed strategies for each of the considered educational organizations has been carried out.

ОСНОВНЫЕ ПРОБЛЕМЫ ПЕНСИОННОЙ СИСТЕМЫ РОССИЙСКОЙ ФЕДЕРАЦИИ В АСПЕКТЕ ОБЕСПЕЧЕНИЯ ЭКОНОМИЧЕСКОЙ БЕЗОПАСНОСТИ

The article examines the main problems of the pension system in terms of ensuring economic security. The relevance of the topic is due to the lack of research on this topic from the side of ensuring the vital economic interests of the individual, the business entity and the state. In modern conditions of economic uncertainty and global challenges, ensuring economic security is becoming a priority for every country, including the Russian Federation. The study will analyze the existing pension system in Russia, assess its effectiveness and compliance with modern requirements. Further work will analyze the economic security of Russia, as well as develop the concept of the pension system through economic and mathematical modeling in order to balance the interests of all economic entities.

Modelling what matters: How do current models handle environmental limits and social outcomes?

Models that represent the economy, society, and environment are critical macroeconomic policy tools. However, economic output as measured by Gross Domestic Product (GDP) is increasingly being seen as an unreliable and undesirable economic indicator and policy goal. Instead, multiple indicators of environmental impacts and social outcomes are needed to make decisions about sustainable development.Drawing on the Doughnut of social and planetary boundaries, and the Sustainable Development Goals, we analyse 50 models to assess the state of the art in modelling the environment, society, and economy. We categorise models according to their economic foundation and modelling approach, assess their coverage of 15 environmental and 21 social indicators, and identify feedbacks between different model parts. We further construct a targeted sample of 15 models that represents the diversity in modelling approaches and indicator coverage, and use this sample to investigate how environmental and social indicators are linked to macroeconomic drivers.For the environment, indicator coverage is best for climate change, energy use, and land conversion. Within current models, environmental impact is largely driven by GDP and agricultural production. For society, coverage is best for jobs, income (wages and inequality), and productivity. Within current models, social outcomes are largely driven by income per capita, government spending, and governance. Models rarely contain feedbacks from the environment and society to the economy, and few include any biophysical limits.The current focus on monetary flows limits understanding of the interconnections between environmental, social, and economic systems. We argue that modellers should rely less on economic variables as determinants of social and environmental outcomes. Specific provisioning systems could be modelled in more detail to allow models to explore growth-agnostic ways of achieving a good life for all within environmental limits.

Exploring the significance and priority of digital product passports implementation in building renovation projects targeting circular economy

PurposeThis study explores the significance and implementation priorities for Digital Product Passports (DPP) in the context of building renovation projects. It aims to reveal bottlenecks and how a data-driven workflow bridges the DPP understanding/implementation gap, facilitating the transition towards practices aligned with the EU Green Deal goals.Design/methodology/approachA mixed-methods embedded design was employed for a real-case study exploration. Desk research and field observations ground the two-level analysis combining project documentation, namely the Bill of Quantities (BoQ), with different criteria in digitalisation and sustainability, such as economic ratio, 3D modelling, waste management, hazards, energy performance and facility management. All results were interpreted from the DPP lens.FindingsThe analysis revealed a system for identifying building products representing a significant part of the renovation budget. About 11 priority DPPs were found. Some are crucial for both the deconstruction and construction phases, highlighting the need for an incremental and strategic approach to DPP implementation.Research limitations/implicationsThe study is limited to a single case study. Constraints are minimised given the sample's archetype representativeness. The outcomes introduce the need for strategic thinking for incremental DPP implementation. Future research will explore additional criteria and cases.Originality/valueThe research has resulted in a classification framework for DPPs' significance and priority, which is provided with case results. The outcome of the framework provides views on concept alignment to make the implementation in construction more straightforward. Its practical use can be replicated in other projects, emphasizing the importance of data structure and management for the circular economy.

Strengthening China’s National Essential Public Health Services Package for hypertension and diabetes care: protocol for an interrupted time series study with mixed-methods process evaluation and health economic evaluation

BackgroundDespite major primary health care (PHC) reforms in China with the 2009 launch of the National Essential Public Health Service Package, the country experiences many challenges in improving the management of non-communicable diseases in PHC facilities. “EMERALD” is a multifaceted implementation strategy to strengthen the management of hypertension and type-2 diabetes mellitus (T2DM) in PHC facilities. The study aims to: (1) examine the effectiveness of EMERALD in improving hypertension and T2DM management; (2) evaluate the implementation of the interventions; and (3) use the study findings to model the long-term health economic impact of the interventions.MethodsThe EMERALD intervention components include: (1) empowerment for PHC providers through training and capacity building; (2) empowerment for patient communities through multi-media health education; and (3) empowerment for local health administrators through health data monitoring and strengthening governance of local PHC programs. An interrupted time series design will be used to determine the effectiveness of the interventions based on routinely collected health data extracted from local health information systems. The primary effectiveness outcome is the guideline-recommended treatment rates for people with hypertension and T2DM. Secondary effectiveness outcomes include hypertension and T2DM diagnosis and control rates, and enrolment and adherence rates to the recommended care processes in the National Essential Public Health Service Package. A mixed-methods process evaluation will be conducted to evaluate the implementation of the interventions, including the reach of the target population, adequacy of adoption, level of implementation fidelity, and maintenance. Qualitative interviews with policy makers, health administrators, PHC providers, and patients with hypertension and/or T2DM will be conducted to further identify factors influencing the implementation. In addition, health economic modelling will be performed to explore the long-term incremental costs and benefits of the interventions.DiscussionThis study is expected to generate important evidence on the effectiveness, implementation, and health economic impact of complex PHC interventions to strengthen the primary care sector’s contribution to addressing the growing burden of non-communicable diseases in China.Trial registrationThe study has been registered on Chinese Clinical Trial Registry at https://www.chictr.org.cn/ (Registration number ChiCTR2400082036, on March 19th 2024).

Economic growth and sustainable development: evidence from OIC countries

Purpose This paper aims to examine the dynamic relationship between economic growth and sustainable development, integrating the Environmental Kuznets Curve (EKC) in 22 Organization of Islamic Cooperation (OIC) member countries across income groups. Design/methodology/approach Using annual data between 1990 and 2022, the authors apply the cross-correlation coefficient (CCC) approach of Narayan et al. (Economic Modeling, 2016, 53, 388–397) to examine the lead/lag relationship between GDP per capita and sustainable development. This study further validates the findings through a panel Granger causality test and a fixed panel regression model. Findings This research provides evidence of a U-shaped EKC for only 1 out of 22 (5%) OIC countries. For 13 out of the 22 (59%) OIC countries, increasing income growth is expected to enhance sustainable development in the future. The results show that as income levels rise, there will be a more significant decline in sustainable development for high-income OIC countries in the future than for both middle-income groups, contradicting the EKC hypothesis. The findings from the panel Granger causality and panel regression models also support the CCC results. Originality/value This study proposes a reverse version of the EKC hypothesis and contributes to the literature on economic growth and environmental sustainability. With increasing economic growth, the results can assist OIC member governments and policy-makers in designing tailored policies and practical measures for future sustainable development.

DEFINING COMPONENTS OF THE METHODOLOGICAL PLATFORM FOR FORMING A BUSINESS PORTFOLIO OF A COMPANY IN THE UPDATED FORMAT OF MODERN DEVELOPMENT

The article is devoted to the analysis of the economic and operational imperatives of forming a business portfolio for a development company in the construction sector. A successful business portfolio management strategy requires the integration of financial, organizational, and technological aspects to ensure the sustainability and competitiveness of the business. In modern conditions, real estate development is one of the key factors that determines the dynamics of enterprise development, as it includes a comprehensive approach to asset management, from planning and financing to the construction and operation of objects. The theoretical and methodological foundations of the genesis of development at the current stage of the construction market's evolution have been analyzed.The methodological platform for forming a business portfolio should be based on the principles of rational resource management, risk analysis, and technological optimization. Changes in development activities require the active use of digital tools and a comprehensive approach to managing residential, commercial, and industrial properties, which allows for the maximization of profitability and minimization of risks.The article discusses the main stages of portfolio formation, such as strategic planning, selection of investment objects, and their integration into the overall structure of the enterprise. An economic and mathematical formalization of the process is also provided. For the successful operation of a development company, it is crucial to ensure coordinated work at all stages of the project — from planning and financing to construction and commissioning of the facilities.Particular attention is paid to the methods of economic and mathematical modelling (EMM) and quantitative risk analysis, which have become the basis for the development of the latest asset management strategies. The study analyses 35 different techniques. Each methodology offers unique tools for the effective management of development projects that allow forecasting financial flows, determining optimal investment strategies, and building the best plans for the development of a real estate portfolio. The specific methods used to value residential, commercial and industrial real estate are also discussed, taking into account their different levels of risk and return.It is important to note that the updated methodological platform is suitable for adaptation to the latest technologies and digital tools. This includes the introduction of a project management system, the use of artificial intelligence technologies to analyse large amounts of data, and the use of analytical tools to predict market trends. This approach helps to optimise asset management in a changing market environment. The analysis of the main components of the business portfolio formation platform also showed that important factors for the successful implementation of development projects are the speed of response to market changes, flexibility of management decisions, and the ability to minimise risks at all stages of the project.

General Population Mortality Adjustment in Survival Extrapolation of Cancer Trials: Exploring Plausibility and Implications for Cost-Effectiveness Analyses in HER2-Positive Breast Cancer in Sweden.

In economic evaluations of novel therapies, assessing lifetime effects based on trial data often necessitates survival extrapolation, with the choice of model affecting outcomes. The aim of this study was to assess accuracy and variability between alternative approaches to survival extrapolation. Data on HER2-positive breast cancer patients from the Swedish National Breast Cancer Register were used to fit standard parametric distribution (SPD) models and excess hazard (EH) models adjusting the survival projections based on general population mortality (GPM). Models were fitted using 6-y data for stage I and II, 4-y data for stage III, and 2-y data for stage IV cancer reflecting an early data cutoff while maintaining sufficient events for comparison of model estimates with actual long-term outcomes. We compared model projections of 15-y survival and restricted mean survival time (RMST) to 15-y registry data and explored the variability between models in extrapolations of long-term survival. Among 11,224 patients compared with the observed registry 15-y RMST estimates across the disease stages, EH cure models provided the most accurate estimates in patients with stage I to III cancer, whereas EH models without cure most closely matched survival in patients with stage IV cancer, in which cure assumption was less plausible. The Akaike information criterion-averaged model projections varied as follows: -8.2% to +5.3% for SPD models, -4.9% to +5.2% for the EH model without a cure assumption, and -19.3% to -0.2% for the EH model with a cure assumption. EH models significantly reduced between-model variance in the predicted RMSTs over a 50-y time horizon compared with SPD models. EH models may be considered as alternatives to SPD models to produce more accurate and plausible survival extrapolation that accounts for general population mortality. Excess hazard (EH) methods have been suggested as an approach to incorporate background mortality rates in economic evaluation using survival extrapolation.We highlight that EH models with or without a cure assumption can produce more accurate survival projections and significantly reduce between-model variability in comparison with standard parametric distribution models across cancer stages.EH models may be a preferred modeling method to reduce model uncertainty in health economic modeling since models that would otherwise have produced implausible extrapolations are constrained by the EH framework.Reduced uncertainty in economic evaluations will enhance the application of evidence-based health care decision making.

A comparative review of de- and post-growth modeling studies

In recent years, a small but rapidly growing field of modeling alternatives to growth as represented by the de- (DG) and post-growth (PG) discourses has emerged. We compare selected model characteristics of 75 DG and PG related modeling studies, compiled through a systematic literature review (2000−2023), and link model structures and results to different theoretically contested debates surrounding DG/PG. The reviewed studies cover different geographical and temporal scopes, economic theories, modeling techniques and operationalizations of DG/PG. The majority of studies models DG/PG as intentional transition and does not question its compatibility with a capitalist system, while more radical strands of the DG/PG discourse are excluded. Although DG/PG modeling exercises frequently explore the effects of sustainability policies, they represent only a fraction of theoretical DG policy proposals, with the most frequent being: working time reduction, maximum income caps, carbon taxes and a universal basic income. DG/PG modeling studies have demonstrated the importance of integrating biophysical constraints in economic modeling but also have quantitatively assessed the feasibility of environmental integrity and social well-being without growth. Nonetheless, future modeling could be rendered more realistic by paying more attention to the Global South, introducing heterogeneous agents driving sustainability transitions and including multiple planetary boundaries.

Foslevodopa/foscarbidopa (LDp/CDp) in advanced Parkinson’s Disease (aPD): demonstration of savings from a societal perspective in the UK

Aims In advanced Parkinson’s disease (aPD), adequate 24-hour control of OFF-time may not be achievable using oral/transdermal therapies. Clinical trials of foslevodopa/foscarbidopa (LDp/CDP) demonstrate meaningful reductions in OFF-time and OFF-related sleep disturbance in aPD. Previous analyses have only considered direct medical costs: this analysis considers a broader societal perspective (direct non-medical costs, informal care, loss of earnings, productivity, and tax). Methods Inputs for the societal impact model were taken from a cost-utility model comparing LDp/CDp with best medical treatment (BMT), accepted by the UK National Institute of Health and Care Excellence (NICE). Quintiles of normalized OFF-time across a 16-hour waking day in each treatment group were applied to literature-based estimates for direct medical, non-medical, and indirect costs. The resulting state-specific cost estimates were applied to the modelled aPD patient population. Results The model estimates the potential UK population for LDp/CDp at 17,505. Continuous 24-hour delivery of LDp/CDp results in greater time spent in OFF-time states 0–1 (0–4 hours of OFF-time/16-hour waking day) vs BMT alone. Net savings if all eligible patients receive LDp/CDp are £79.1 M in year 1, £235.4 M in year 2, rising to £262.2 M in year 3, declining to £222.9 M in year 4 and £153.7 M in year 5 as disease progresses and the efficacy of LDp/CDp declines. The estimated total net savings are £953 M after 5 years. Results are robust in scenario analyses (excluding costs of excessive sleepiness, earnings loss, productivity, and tax loss). Limitations A NICE-accepted model was used as the economic modelling basis for the societal impact model, however, much of the data was derived from Adelphi datasets, with the potential for inconsistent definitions. Conclusion When considered from a societal perspective, the use of LDp/CDp in aPD patients inadequately controlled on oral therapy is associated with net healthcare and societal annual savings of over £79.1 M vs BMT.

Статистический анализ влияния инноваций на производительность труда в субъектах ЦФО

The relevance of the research topic is due to the contradiction between the innovation activity of organisations and their contribution to regional socio-economic development. Innovation should lead to productivity growth and contribute to the creation of high-productivity jobs. However, the situation in many Russian regions is paradoxical one – despite of high innovation activity of small and medium-sized enterprises their labour productivity remains at the same level or decreases. The purpose of the research is to assess the impact of innovations on labour productivity for the Russian economy on the example of the Central Federal District regions. The paper verifies the hypothesis on the presence of statistically significant relationship between the indicators characterising the innovation activity of small and medium-sized enterprises, the index of labour productivity, and the growth of high-productive jobs in the Central Federal District regions through the methods of economic and mathematical modelling. According to the research results, the parameters of small and medium-sized enterprises innovation activity do not have a significant impact on the dynamics of socio-economic development of the Central Federal District regions.

Методологічні засади макроекономічного оцінювання ефективності розвитку аграрної науки

The study’s purpose is to provide a comprehensive methodology for macroeconomic assessment of the efficiency of agricultural science development. Research methods: method of system analysis, synthesis, economic and mathematical modeling. Research results. A comprehensive methodology for macroeconomic assessment of the effectiveness of agricultural science development has been developed. It has been shown that the assessment of the national economic effect of agricultural science should consider the following main factors: the general macroeconomic state of the national economy; direct impact of scientific research; the accumulated impact of scientific research; geo-economic effect of scientific research; social aspects of the organization of scientific research It has been proved that macro-evaluation of the development efficiency of agricultural science and the activities of the National Academy of Agrarian Sciences of Ukraine should be carried out in the following sequence: analysis of the general macroeconomic situation of the national economy, the place and role of science in its development; analysis of the general state of development of the National Academy of Agrarian Sciences of Ukraine; analysis of the national economic importance of agricultural science by intersectoral balances; analysis of the macro-efficiency of the National Academy of Agrarian Sciences of Ukraine Scientific novelty. The methodology of macroeconomic assessment of the development efficiency of agricultural science is not just comprehensive, but it is also based on intersectoral balances and takes into account the activities of the main spending unit in this area – the National Academy of Agrarian Sciences of Ukraine. This comprehensive approach instills confidence in its thoroughness and reliability. Practical significance. The developed methodology is based on the statistical data and is fully applicable in its current form. Macroeconomic assessments of the effectiveness of agricultural science development are suitable for comparisons over time and between other sectors of science in Ukraine and internationally. Prospects for further research are promising. They include analyzing the efficiency of the development of domestic agricultural science and developing strategic directions for improving the efficiency of the National Academy of Agrarian Sciences of Ukraine. These future research prospects should inspire optimism about the potential advancements in the field. Keywords: corporate control, economic security, integration associations, joint-stock companies, organizational and methodological support, corporate management.

Aging In The Face of Diabetes: Severe Hypoglycemia in Older Adults

Global rates of type 1 and type 2 diabetes (T1D, T2D) continue to climb, despite medical advancements. Older adults constitute one of the fastest growing segments of the diabetes population, backed by the world’s unprecedented aging population, decreased diabetes mortality rates, and the obesity epidemic. In Canada, individuals aged ≥65 years account for more than a quarter of all prevalent diabetes cases, far exceeding the other age groups. Older adults with diabetes face the highest risks of microvascular and macrovascular complications, which, compared to younger age cohorts, can contribute to significant functional loss, frailty, and premature mortality. A considerable amount of research links intensive glucose-lowering with insulin or secretagogues to reduced cardiovascular disease. However, the consequent risk of severe hypoglycemia and related sequelae can be particularly catastrophic for older adults, exacerbated by coexisting health conditions and age-related social needs. Approximately 40% of Canadians with T2D aged ≥65 years currently use secretagogues, while 27% use insulin—alongside all those with T1D. Longitudinal evidence suggests that since the year 2000, hospital admission rates for hypoglycemia have consistently surpassed those for hyperglycemia, especially among individuals aged 75 years and above. Economic modelling estimates that the Canadian healthcare system spends $125,932 CAD per year on iatrogenic hypoglycemia, with the bulk of these costs likely allocated to people ≥65 years. Diabetes in older adults is a pressing public health issue in Canada, marked by clinical diversity and widespread use of medications that are prone to cause hypoglycemia. This review outlines recent epidemiologic findings on severe hypoglycemia among community-dwelling older adults with T1D or T2D treated with insulin or secretagogues. Understanding the complex factors contributing to severe hypoglycemia in this population is crucial for developing tailored prevention strategies that are both effective and safe.

Взаимодействие стейкхолдеров при формировании и управлении децентрализованными фондами капитального ремонта жилищно-коммунального хозяйства

Introduction. The purpose of this study is a systematic analysis of the stakeholder relations on the issue of the formation and management of decentralized capital repair funds. The high social significance of capital repairs of residential real estate, coupled with a high degree of wear and tear, determines the need for coordinated and effective stakeholder interaction, the involvement of public authorities in co-financing expenses and the development of effective mechanisms for the rational allocation of funds from decentralized capital repair funds formed in special accounts in banking organizations and protecting them from inflationary processes.Materials and methods. The authors explore institutional factors in the implementation of major renovations of apartment buildings, identify the key stakeholders of these processes, their interests and risks, and reveal the presence of an agency problem. Based on statistical data and regulations, the authors conduct economic modeling of the formation of a decentralized capital repair fund using the example of an existing homeowners' association, and calculate target indicators for the efficiency of capital repair fund management.Results. The conducted research revealed inconsistency of the current management approaches and the impossibility of forming major overhaul funds in sufficient size to replace elevator equipment after the shelf life expiry without external financing. The authors conduct a study of the agency problem that arises when managing funds placed in special accounts for major overhaul, and identify the presence of informal institutional factors that prevent the formation of a "mature real estate owner".Discussion. Based on the results of the study, the authors proposed regulatory measures that could positively affect the effectiveness of relations on the issue of formation and management of decentralized capital repair funds. In addition to regulatory measures, the authors consider it necessary to involve municipal deputies in awareness-raising activities aimed at creating a “mature property owner.” The scientific novelty of this study consists in the development of management and regulation methods for the formation of decentralized capital repair funds on the basis of the synthesis of stakeholder and institutional approaches.

Tapestry: Collaborative Tool for Regional Data and Modeling

This paper introduces and describes the Tapestry regional economic data and modeling project. Tapestry is an open source set of data generating algorithms, harmonization bridges, data organizing procedures and data models. It is also a database that provides access to Tapestry also represents a collaborative environment where researchers can use and improve data generating algorithms and methods. Tapestry represents many types of regional economic data and models, but ultimately it is designed to generate inter-regional social accounting matrices for every county in the United States.

Technology and the Global Economy

Interpreting individual heterogeneity in terms of probability theory has proved powerful in connecting behavior at the individual and aggregate levels. Returning to Ricardo's focus on comparative efficiency as a basis for international trade, much recent quantitative equilibrium modeling of the global economy builds on particular probabilistic assumptions about technology. We review these assumptions and discuss how they deliver a unified framework underlying a wide range of static and dynamic equilibrium models.

Multibenchmark reality checks

Empirical economic modelers often have to choose between two classes of models, with each class containing multiple models. In many cases, this decision is based on the predictive ability of the considered models. This entails that multiple testing and/or p-hacking pose known risks. This study presents a new statistical approach for comparing all model in a single test, serving as a multi-benchmark reality check test. The behavior of the test is studied asymptotically and in small finite samples. We show how the new approach works by analyzing whether one family of linear bivariate models outperforms a univariate family in predicting commodity prices. This paper raises new questions for future research. From an empirical viewpoint, we present several open questions in economic modeling that can be tested with multi-benchmark tests. Meanwhile, from a theoretical viewpoint, further studies can investigate whether a more general method for approximating or simulating the test distribution can be developed.

Transition of mild cognitive impairment to Alzheimer's disease: Medications as modifiable risk factors.

Mild cognitive impairment (MCI) is a pre-clinical stage of Alzheimer's disease (AD). Understanding the transition probabilities across the disease continuum of AD, ranging from MCI to AD to Mortality is crucial for the economic modeling of AD and effective planning of future interventions and healthcare resource allocation decisions. This study uses the Multi-state Markov model to quantify the transition probabilities along the disease progression and specifically investigates medications as modifiable risk factors of AD associated with accelerated or decelerated transition times from MCI to AD, MCI to mortality, and AD to mortality. Individuals with MCI were identified from the National Alzheimer's Coordinating Center between September 2005 and May 2021. A three-state Markov model was postulated to model the disease progression among three states: MCI, AD, and mortality with adjustment for demographics, genetic characteristics, comorbidities and medications. Transition probabilities, the total length of stay in each state, and the hazard ratios of the use of medications for diabetes, hypertension, and hypercholesterolemia (the known modifiable risk factors of AD) were evaluated for these transitions. 3,324 individuals with MCI were identified. The probability of developing AD after one year since the initial diagnosis of MCI is 14.9%. After approximately 6 years from the initial diagnosis of MCI, the probability of transitioning to AD increases to nearly 41.7% before experiencing a subsequent decline. The expected total lengths of stay were 5.38 (95% CI: 0.002-6.03) years at MCI state and 7.61 (95%CI: 0.002-8.88) years at AD state. Patients with active use of lipid-lowering agents were associated with significantly lower hazards of transitioning from MCI to AD (HR: 0.83, 95%CI:0.71-0.96), MCI to mortality (HR: 0.51, 95%CI:0.34-0.77), and AD to mortality (HR: 0.81, 95%CI:0.66-0.99). Results suggest that lipid-lowering agents may confer a protective effect, delaying the onset of AD. Additionally, lipid-lowering agents indicate a favorable association with a longer survival time.

Cost analysis of cardiac MRI for cardiac transplant surveillance

National health expenditures in the United States have risen steadily since 1960. While lifesaving therapies exist for acquired and congenital heart diseases, for some children heart transplantation is their only chance for a period of durable survival. Like many advanced therapies, however, heart transplantation confers a significant cost to families and the health care system at large. Current heart transplant health surveillance relies on frequent cardiac catheterization with endomyocardial biopsy (cath-EMB) as periodic assessment of graft health and detection of possible life-threatening acute rejection. Cardiac magnetic resonance imaging (MRI) has emerged as a diagnostic tool which can characterize the myocardium, providing insights into graft health and potentially acute/chronic graft rejection. The PEACE study (R01-HL164995-02) aims to systematically evaluate the potential for using cardiac MRI parametric mapping as a pre-cath-EMB screening tool to alleviate both patient anxiety and discomfort, as well as the financial burden of cath-EMB. The PEACE trial aims to establish definitive evidence and criteria for determining when cath EMB is needed. For a technique to be practical in the real world, though, it must also be cost effective.Therefore, the goal of this current research is to determine a minimal set of measurement properties (positive predictive value (PPV), etc.) that cardiac MRI must attain to be cost-effective. These data will guide the decision-making for the PEACE trial results. Consistent with the recent emphasis on “Value MRI,” we sought to understand the potential Medicare savings, through economic cost analysis modeling, if cardiac MRI is used for cardiac transplant surveillance rather than cath-EMB surveillance. At even the most pessimistic positive test rate for MRI considered, these modeling results suggest substantial Medicare cost savings when using cardiac MRI parametric mapping as a screening tool for detecting acute cardiac rejection. Longitudinal cost savings are notable too.