Economic Outcomes Research Articles

Evaluation of the Adult Migrant English Program for the Australian Government Department of Home Affairs

Objective and ApproachThe Adult Migrant English Program (AMEP) is a free service to help eligible migrants and humanitarian entrants with low English proficiency to improve their English skills and elevate their participation in Australian society. In partnership with AMEP funder, the Australian Government Department of Home Affairs, we have completed a longitudinal research study analysing the effectiveness of AMEP by linking participant information for over 400,000 AMEP clients with administrative data from social services, taxation, and the national census, from 2003 – 2019. This is the first time AMEP participant data has been linked with other data assets and represents the most comprehensive evaluation of AMEP since program inception in 1948. ResultsAMEP participation was associated with improved English proficiency of clients, especially when clients studied for longer periods. Migrants with higher levels of English on-entry had better labour market outcomes, higher income levels (male and female), lower rates of public housing tenancy, and were less likely to receive income support in the years following program exit. ConclusionsWhile the design does not support true causal inference, this evaluation provides good evidence that AMEP is effective at improving English proficiency and suggests AMEP participation can improve a range of economic and social outcomes for eligible migrants with low English proficiency. ImplicationsThe launch of these results coincided with new investment in AMEP and a broadening of eligibility criteria to make AMEP available to a wider range of migrants with low English proficiency.

Estimated Health and Economic Outcomes of Racial and Ethnic Tuberculosis Disparities in US-Born Persons

Despite significant progress made toward tuberculosis (TB) elimination, racial and ethnic disparities persist in TB incidence and case-fatality rates in the US. To estimate the health outcomes and economic cost of TB disparities among US-born persons from 2023 to 2035. Generalized additive regression models projecting trends in TB incidence and case-fatality rates from 2023 to 2035 were fit based on national TB surveillance data for 2010 to 2019 in the 50 US states and the District of Columbia among US-born persons. This baseline scenario was compared with alternative scenarios in which racial and ethnic disparities in age- and sex-adjusted incidence and case-fatality rates were eliminated by setting rates for each race and ethnicity to goal values. Additional scenarios were created examining the potential outcomes of delayed reduction of racial and ethnic disparities. The potential benefits of eliminating disparities from differences between baseline and alternative scenario outcomes were quantified. Data were analyzed from January 2010 to December 2019. Non-Hispanic American Indian or Alaska Native, non-Hispanic Asian, non-Hispanic Black, Hispanic, non-Hispanic Native Hawaiian or Other Pacific Islander, or non-Hispanic White race and ethnicity. TB cases and deaths averted, quality-adjusted life years gained, and associated costs from a societal perspective. The study included 31 811 persons with reported TB from 2010 to 2019 (mean [SD] age, 47 [24] years; 20 504 [64%] male; 1179 [4%] American Indian or Alaska Native persons; 1332 [4%] Asian persons; 12 152 [38%] Black persons; 6595 [21%] Hispanic persons; 299 [1%] Native Hawaiian or Other Pacific Islander persons; and 10 254 [32%] White persons). There were 3722 persons with a reported TB death. Persistent racial and ethnic disparities were associated with an estimated 11 901 of 26 203 TB cases among US-born persons (45%; 95% uncertainty interval [UI], 44%-47%), 1421 of 3264 TB deaths among US-born persons (44%; 95% UI, 39%-48%), and an economic cost of $914 (95% UI, $675-$1147) million from 2023 to 2035. Delayed goal attainment reduced the estimated avertable TB outcomes by 505 (95% UI, 495-518) TB cases, 55 (95% UI, 51-59) TB deaths, and $32 (95% UI, $24-$40) million in societal costs annually. In this modeling study of racial and ethnic disparities of TB, these disparities were associated with substantial future health and economic outcomes of TB among US-born persons without interventions beyond current efforts. Actions to eliminate disparities may reduce the excess TB burden among these persons and may contribute to accelerating TB elimination within the US.

Public Health and Economic Impact of Periodic COVID-19 Vaccination with BNT162b2 for Old Adults and High-Risk Patients in an Illustrative Prefecture of Japan: A Budget Impact Analysis.

Japan will be transitioning from the free-of-charge COVID-19 vaccination program to annual periodic vaccination under a national immunization program for old adults and high-risk patients from 2024 fall/winter season. The policy transition including out-of-pocket payment requirement may discourage vaccination, leading to a lower vaccination rate. This study aimed to estimate the impact of varying vaccination rates with BNT162b2 COVID-19 mRNA vaccine on economics and public health in an illustrative prefecture which administers and promotes the periodic vaccination program, using budget impact analysis. A combined cohort Markov decision tree model estimated the public health outcomes of COVID-19-related symptomatic cases, hospitalizations and deaths; and the economic outcomes including vaccine-related cost, non-vaccine-related medical cost, and productivity loss from the societal perspective. The base case examined the impact on the outcomes when vaccination coverage changed from the reference value of 50% to upper and lower values, respectively. Scenario analyses were performed based on multiple scenarios. Increase in the vaccination rate demonstrated improvement in all public health outcomes. At 50% vaccination, the vaccine-related cost for 3years in a prefecture was estimated at JPY 7.58 billion (USD 57.67 million), the non-vaccine-related medical cost at JPY 79.22 billion (USD 602.48 million), the productivity loss at JPY 253.11 billion (USD 1.92 billion), and the total cost at JPY 339.92 billion (USD 2.59 billion). When the vaccination rate increased to 90%, the total cost decreased by JPY 4.88 billion (USD 37.11 million) (1.4%). When the vaccination rate decreased to 10%, the total cost increased by JPY 5.73 billion (USD 43.58 million) (1.7%). Results were consistent across almost all scenario analyses. Maintaining a high vaccination rate with BNT162b2 is important from both public health and economic perspectives in Japan. The findings highlight to local governments the importance of continued effort to promote vaccination.

Evaluating Health Canada’s Proposed Front-of-Pack Labelling Policy: Burden of Healthcare Use Attributed to Health Canada’s Proposed Front-of-Pack Labelling Policy

The economic burden of disease due to consumption of poor diet costs billions of dollars annually to the Canadian healthcare system. This project is in response to the growing interest in the use of nutrient profiling systems on front-of-package (FOP) nutrition labels in Canada. There is a high demand for simplified healthy eating messaging. Health Canada announced improving food environments is a priority in the Healthy Eating Strategy and will implement the mandatory FOP label policy in 2026. Two Ontario-based studies examined the impacts of health behaviors (smoking, alcohol consumption, poor diet and physical inactivity) attributed to hospital bed-days and costs. They found 36% of hospital use was attributable to all health behaviours resulting in 900,000 bed-days annually. Between 2004-2013, 22% of healthcare costs totalling $89.4 billion were attributable to the four health behaviours. These are likely underestimates as diet was measured based on fruit/vegetables frequency. The objective is to evaluate Health Canada’s Proposed FOP policy on hospital bed-days. Detailed dietary data from the nationally representative cross-sectional national survey data Canadian Community Heath Survey-Nutrition 2004 linked to Discharge Abstract Database (2004-14) for hospital use will be used for analysis. Data-driven methodology will be employed and development of multivariable risk models using zero-inflated negative binomial regression with multiple exposure groups to test a dose-response. Results are undergoing, will be ready September 2024. This is the first study to analyze Health Canada’s proposed FOP policy related to economic outcomes. These findings will provide evidence-based recommendations to policymakers on nutrition policy.

Omnificence or Differentiation? An Empirical Study of Knowledge Structure and Career Development of IT Workers

This study explores the crucial yet underexamined labor supply side of the information technology (IT) job market, focusing on how IT professionals can strategically manage their knowledge diversity structures for career advancement. By introducing and operationalizing two novel metrics—knowledge omnificence and knowledge differentiation—the research examines their impact on IT workers’ salaries and job security. Through an extensive analysis of IT career data spanning from 2000 to 2016, the study reveals that moderate levels of knowledge omnificence and differentiation lead to the most favorable economic outcomes for IT professionals. Specifically, knowledge omnificence is associated with higher salary potential and career mobility, whereas knowledge differentiation is linked to enhanced job security. These findings provide actionable insights for IT workers aiming to optimize their career trajectories. Additionally, the study highlights the role of these knowledge structures in reducing gender disparities in the IT labor market, with women particularly benefiting from increased knowledge omnificence and differentiation. The research underscores the importance of strategic knowledge management for IT workers and offers valuable guidance for firms and policymakers to support a dynamic and equitable IT workforce.

The Impact of High Immigration in Lithuania: Addressing Challenges and Understanding Consequences

The maxim "too much of a good thing can turn sour" holds significant relevance across diverse aspects of life, indicating that exceeding optimal thresholds may result in negative outcomes if not carefully regulated; this principle can be observed in the context of immigration rates in Lithuania, an Eastern European country experiencing significant influxes of foreign nationals. Immigration, defined as the movement of individuals into a country for specific purposes, can lead to adverse consequences when unregulated, such as overcrowding, strained social amenities, increased costs due to heightened demand, and potential rises in crime rates. Lithuania has welcomed foreigners for work, business, research, studies, and other purposes. Additionally, the unstable situation in Ukraine has prompted the Lithuanian government to extend support to Ukrainian citizens, offering incentives such as subsidized education and various forms of assistance. However, the generous immigration policies have faced challenges. The Migration Department, under the Ministry of Interior, recently announced impending stricter immigration laws due to identified irregularities, including instances of fraudulent marriages with Lithuanian citizens. Moreover, the increased cost of amenities, food prices, and housing have raised concerns about the sustainability of current immigration levels. This research focuses on examining the immigration and emigration rates in Lithuania and their economic impact over a decade (2013-2022). The study will involve sourcing data from official websites, conducting statistical analyses, and drawing insights from the analyzed data. The goal is to postulate findings, offer recommendations, and draw conclusions on the relationship between immigration rates and economic outcomes in Lithuania.

Assessing urban water-energy nexus characteristics in China and the US

Abstract The Water-Energy Nexus (WEN) provides a comprehensive concept for the cooperative management of resources. Although the WEN system in cities is intricately connected to socioeconomic activities, relationship between WEN and economic systems remains understudied. This study introduces a tri-dimensional Nexus Pressure Index (NPI) to assess the pressure on WEN system. Gross Domestic Product (GDP) per capita and city tiers in the urban agglomeration were used to assess the relationship between the characteristics of WEN and economic system. We conducted a case study of 296 cities in China and 1330 counties in the United States from 2012 to 2019. During the 9 year study period, on average, pressure on WEN system have relieved by 22% in China and 27% in the United States, measured by NPI. Cities with most ideal characteristics (low pressure in all dimensions) rank merely in the middle of all eight classes, with GDP per capita 74% and 85% of the highest-GDP-per-capita class in China and the US respectively. Well-performing WEN system does not yield best economic outcomes. High water pressure correlates with better economic performance in the US, while high-energy-pressure cities had GDP per capita about 50% and 70% of the class with highest GDP per capita in China and the US, respectively, suggesting stronger economic constraints from energy stress. Urban agglomeration analysis revealed a negative relationship between WEN and economic performance. NPI in emerging cities is 0.6–1 lower than NPI in regionally-central cities in China, while 0.2–0.5 lower in the US. These results underscore the contradiction between preferred WEN characteristics and higher economic performance, and underpin the resource curse hypothesis at city-level in the two considered giants. A sustainable approach to harmonize WEN and economic system is in urgent need.

Nexus between Competitive Business Strategy and Firm Performance: Moderating Effect of Competitive Intensity

ABSTRACT Business strategy literature argues that firm survival and growth in any competitive environment depend on the adaptation of suitable competitive business strategies. Despite the growing interest in strategic management within the fish farming industry, there is a notable lack of empirical evidence exploring how the competitive environment influences companies’ business strategy and performance. This paper examines the direct effect of competitive strategy and the moderating effect of competitive intensity on business strategy-performance relationship. Using hierarchical regression to analyze 306 samples gathered from fish farming firms of south-Benin, empirical evidence shows that competitive strategy including cost-leadership, and both product quality and marketing differentiation strategies impact positively firm financial performance. This research highlights the relative importance of product quality differentiation strategy. In addition, findings indicate that competitive intensity structure contribute to firm success. Surprisingly, findings show that competitive intensity does not significantly moderate the effect of cost-leadership and product differentiation strategies. Besides, the effect of marketing strategy on firm performance becomes more negative under high competition in the domestic market. Study recommends that firms should gain organizational economic outcomes by pursuing cost-leadership strategy and product differentiation strategy whatever competitive intensity states in the domestic market of fish farming.

Resilient forces: The role of intangible capital in mitigating financial contagion dynamics

This essay explores the mechanics of financial shocks within a globalized framework, employing a two-country macroeconomic model to distinguish between core and periphery economies. Our research indicates that intangible assets, serving as stable collateral, respond more robustly to economic shocks than traditional physical forms. Moreover, the study highlights the complex transmission mechanisms of productivity and leverage shocks, revealing that while the financial sector effectively assimilates the positive economic outcomes resulting from a productivity shock, leverage shocks, despite depleting capital, paradoxically stimulate overall economic output.

International Humanitarian Assistance for Health: Türkiye’s Health Diplomacy Practices during the Covid-19 Pandemic

COVID-19 has significantly impacted the health systems of developed countries, leading to a surge in the demand for medical supplies and equipment. This study is dedicated to shedding light on Türkiye's health diplomacy practices and its pivotal role as a facilitator in addressing the escalating global humanitarian and medical aid demand for medical equipment, supplies, medicines, and vaccines due to COVID-19. The study employs the PRISMA systematic analysis method as a data collection protocol to scrutinize Türkiye's international humanitarian and medical assistance during the COVID-19 pandemic in the context of health diplomacy practices. The study's findings, which are categorized under four headings: international humanitarian aid based on COVID-19, international medical equipment and supplies, international ventilator aid, and Türkiye's international COVID-19 vaccine aid, reveal that Türkiye has extended a broad spectrum of medical aid and support, including ventilators, vaccines, and medical equipment, to 161 countries across five continents, demonstrating its global reach and impact. Furthermore, as a testament to its “entrepreneurial and humanitarian foreign policy,” Türkiye has underscored regional and international cooperation through its medical and humanitarian endeavors. Türkiye's international humanitarian assistance has gone beyond material aid to encourage dialogue and has been a message of international solidarity for communities. In future research, establishing a connection between Türkiye's regional and international medical assistance and tangible political, social, and economic outcomes will validate the impact and benefits of its humanitarian efforts.

Gender stereotypes in artificial intelligence within the accounting profession using large language models

This study investigates how artificial intelligence (AI) perpetuates gender stereotypes in the accounting profession. Through experiments employing large language models (LLMs), we scrutinize how these models assign gender labels to accounting job titles. Our findings reveal differing tendencies among LLMs, with one favouring male labels, another female labels, and a third showing a balanced approach. Statistical analyses indicate significant disparities in labelling patterns, and job titles classified as male are associated with higher salary ranges, suggesting gender-related bias in economic outcomes. This study reaffirms existing literature on gender stereotypes in LLMs and uncovers specific biases in the accounting context. It underscores the transfer of biases from the physical to the digital realm through LLMs and highlights broader implications across various sectors. We propose raising public awareness as a means to mitigate these biases, advocating for proactive measures over relying solely on human intervention.

Gamification and economic behavior: Geospatial insights into mobile exercise app usage in South Korea

This study investigates how mobile exercise app-enabled gamified benefits (epistemic, personal integrative, and social integrative) independently and interactively influence economic outcomes from a nationwide perspective. Utilizing unique data on physical exercise and shopping activities collected from 7558 South Korean exercise app users over 3 years, we employed aspatial and spatial econometric models, along with visualization techniques, to examine the spatially varying relationships between gamified benefits and shopping behaviors at the municipality level. The results indicate that while social integrative benefits decreased shopping frequency and amount, the interaction terms of epistemic and social integrative benefits positively influenced shopping frequency. Furthermore, our spatial analysis suggests that the gamification–shopping relationship varied based on specific gamified benefits and across individual and clustered districts, cities, and counties across South Korea. These insights can guide local governments and tourism firms, suggesting opportunities to promote destination-specific gamified services for boosting the local economy.

The Return on Investment for the Prevention and Treatment of Childhood and Adolescent Overweight and Obesity in Beijing: A Modeling Study.

Background: The increasing prevalence of child and adolescent overweight and obesity (CAOAO) in Beijing poses significant health and economic challenges. This study assesses the potential health and economic outcomes of implementing specific interventions to address CAOAO in Beijing. Methods: A deterministic Markov cohort model was used to estimate the impact of five interventions from 2025 to 2115: restrictions on unhealthy food marketing to children, mandatory front of package labeling (FOPL), family-based nutrition and exercise education, school-based nutritional health education, and nutritional counseling in primary healthcare. The model evaluated societal costs, healthcare savings, wages, and economic productivity in adulthood, calculating the return on investment (ROI) for each intervention and their combined effect. Result: Without intervention, Beijing is projected to experience a loss of 13.4 million disability-adjusted life years (DALYs) due to CAOAO. The health and economic impact of childhood obesity in Beijing is projected to be CNY 14.6 trillion (USD 2.1 trillion), or a lifetime loss of CNY 6.8 million (USD 0.96 million) per affected child, exceeding the sum of Beijing's GDP from 2021 to 2023. Restrictions on unhealthy food marketing to children and nutrition counseling in primary healthcare are projected to yield the highest returns, with benefits accruing within one year of implementation. Owing to the substantial upfront costs, including personnel, materials, and training, school-based and family-based interventions require a longer time horizon to realize significant health and economic benefits. Conclusions: Effective management of CAOAO in Beijing demands a multifaceted approach. The combination of restrictions on unhealthy food marketing to children, mandatory front of package labeling, nutrition counseling in primary healthcare, school-based intervention, and family-based intervention presents the most substantial health and economic returns. This comprehensive strategy aligns with global best practices and addresses the unique challenges faced by Beijing in combating childhood obesity.

Impact of crop management practices on maize yield: Insights from farming in tropical regions and predictive modeling using machine learning

Understanding the influence of crop management practices on maize yield is crucial amidst the changing environmental conditions. Smallholder farming in tropical regions has long puzzled decision-makers in terms of maize management. Balancing alternative management practices, environmental factors, and economic outcomes is essential. In this study, we examine the relationships between maize yield and various factors including climate variables, soil quality parameters, cultivars, tillage practices, and fertilizer usage in Chiapas, Mexico. Pearson's correlation coefficient and T-test were employed to determine the statistical significance of the correlations. Our findings reveal strong positive associations between maize yields and factors such as planting, cultivar, vapor pressure, temperature, solar radiations and fertilizer inputs for nitrogen, phosphorus, and potassium in lower elevation farms. Conversely, there is a negative correlation with elevation, slope, and system. Extensive data analysis was conducted to investigate the impact of different crop management practices on yield, utilizing both data visualization and analytics. Additionally, maize yield prediction was performed using six hybrid machine learning (ML) models, employing Grid Search and Random Search optimization techniques. Based on evaluation, Grid Search-based XGBoost exhibited the most accurate prediction results. Furthermore, explainable artificial intelligence (XAI) was employed to assess the individual impact of each input parameter on the ML model output.

Sexual and Reproductive Health Rights and Service Use among Undocumented Migrants in the EU: A Systematic Literature Review.

Most EU member states fail to provide essential sexual and reproductive health services to undocumented migrants, a vulnerable population facing limited access, utilization, and worse health-related outcomes. This study systematically reviewed the literature on access to and use of these services, as well as related health, economic, and migratory outcomes for undocumented migrants in the EU-EFTA region. The systematic review is reported based on the PRISMA 2020 checklist and includes 37 studies published between 2017 and 2024. Included studies were based upon original quantitative, qualitative, or mixed-methods data; conducted in one or more European countries; and published in one or more of the following languages: English, Spanish, French, Portuguese, or Romanian. A quality assessment was conducted using the CASP checklist for qualitative studies and the NHLBI Study Quality Assessment Tools for quantitative studies. The findings revealed numerous access barriers, including refusal of care, lack of knowledge about national healthcare schemes, bureaucratic hurdles, and affordability issues. Even when care was available, stigma, fear of deportation, socio-economic precarity, and abuse further hindered utilization. These barriers contributed to generally worse reproductive health outcomes for undocumented migrants in Europe, though the findings may not generalize to all EU-EFTA countries.

Corporate influence, conservative “model bills,” and state economic outcomes

AbstractResearchers have found positive relationships between economic freedom and economic growth and negative relationships between lobbying and growth. We test the impact of policies induced by lobbying for free markets, using state‐level data to evaluate the effects of high enactment rates for bills advocated by a prominent free‐market lobbyist, the American Legislative Exchange Council (ALEC). Our approach accounts for the probability ALEC targets states. We find that, holding constant existing economic freedom, there is no effect on output, possibly negative effects on employment, and wage increases. States raise more revenue and increase expenditures. Poverty and inequality rise.

A novel, scenario-based approach to comparing non-pharmaceutical intervention strategies across nations.

Comparing COVID-19 response strategies across nations is a key step in preparing for future pandemics. Conventional comparisons, which rank individual non-pharmaceutical intervention (NPI) effects, are limited by: (i) a focus on epidemiological outcomes; (ii) NPIs typically being applied as packages of interventions; and (iii) different political, economic and social conditions among nations. Here, we develop a coupled epidemiological-behavioural-macroeconomic model that can transfer NPI effects from a reference nation to a focal nation. This approach quantifies epidemiological, behavioural and economic outcomes while accounting for both packaged NPIs and differing conditions among nations. As a first proof of concept, we take Germany as our focal nation during Spring 2020, and New Zealand and Switzerland as reference nations with contrasting NPI strategies. Our results suggest that, while New Zealand's more aggressive strategy would have yielded modest epidemiological gains in Germany, it would have resulted in substantially higher economic costs while dramatically reducing social contacts. In contrast, Switzerland's more lenient strategy would have prolonged the first wave in Germany, but would also have increased relative costs. More generally, these findings indicate that our approach can provide novel, multifaceted insights on the efficacy of pandemic response strategies, and therefore merits further exploration and development.

Abstract P307: A Review Of The Burden, Management And Outcomes Of Patients With Aldosterone Dysregulation

Introduction: Aldosterone dysregulation (excess aldosterone production) is a complex physiological driver of uncontrolled hypertension as well as cardiovascular (CV) and kidney outcomes. Understanding the clinical and economic burden of excess aldosterone in routine practice is critical to optimizing treatment and improving long-term outcomes. This review examines the burden of excess aldosterone production as a driver of disease and its impact on clinical and economic outcomes. Hypothesis: Excess aldosterone production has a broad impact on long-term outcomes, and left untreated, contributes to worsened patient outcomes. Methods: A targeted literature review was conducted to identify articles on the burden, management and outcomes of patients with excess aldosterone production (2013 – 2024) with 27 manuscripts included. Results: More studies document the impact of excess aldosterone on organ function in the cardiovascular system and kidney (10, 8 manuscripts) compared to liver (1 manuscript). Excess aldosterone levels and aldosterone-induced oxidative stress and inflammation are associated with increased risk of CV events including myocardial infarction, heart failure, stroke, and increased morbidity and mortality. For example, Framingham Offspring Study showed increased CV disease risk with each rise in serum aldosterone levels (HR, 1.11; 95% CI, 1.02–1.21). Kidney, hepatic and metabolic manifestations are also well-documented, with implications for progression to chronic kidney disease, liver disease and metabolic syndrome. Another study reported an 11% increased risk of CKD progression associated with each doubling of serum aldosterone. Current pharmacological interventions for hypertension, including mineralocorticoid receptor antagonists, were not reported to restore normal aldosterone levels. No literature was found on the economic burden of excess aldosterone or the association between excess aldosterone production and clinical outcomes independent of blood pressure control. Conclusions: Currently available literature emphasizes the broad impact of excess aldosterone production on CV, kidney, hepatic, and metabolic outcomes. The impact on outcomes indicates that excess aldosterone production is underappreciated, with prognostic implications beyond primary aldosteronism. Current hypertension treatments do not address excess aldosterone production. These findings underscore the unmet need for novel management strategies that target excess aldosterone production.

The Schroth Method for Pediatric Scoliosis: A Systematic and Critical Analysis Review.

The Schroth method is the most commonly used patient scoliosis-specific exercise paradigm for treating pediatric scoliosis. The aim of this study is to systematically and critically examine the evidence for the Schroth method for pediatric scoliosis. PubMed, MEDLINE, CINAHL, and Web of Science were searched through April 5, 2024, for articles examining the Schroth method for pediatric scoliosis (<18 years old). Thirteen review questions were created spanning the study aim. Each included article was independently assessed for the level of evidence (I-IV). Research questions were given a grade of recommendation (A, B, C, and I [insufficient]). A total of 29 articles (41.4% Level I, 31.0% Level II, 13.8% Level II, and 13.8% Level IV) met inclusion criteria out of 845 initially retrieved, describing 1,555 patients with scoliosis aged 4 to 18 years. There was grade A evidence that the Schroth method is most commonly used for adolescent idiopathic scoliosis (AIS), can improve the angle of trunk rotation, and is safe; grade B evidence for improvement in posture; and grade I evidence for improvement in Cobb angle, cosmetic deformity, quality of life, ideal treatment parameters, economic value, utility in delaying/preventing surgery, effectiveness in relation to patient characteristics (e.g., skeletal maturity or curve size), and comparative effectiveness to other conservative interventions. While there is good evidence that the Schroth method is commonly and safely used in AIS and can minimally improve the angle of trunk rotation and fair evidence of improvement in posture, there is insufficient evidence regarding multiple important clinical and economic outcomes, such as comparative effectiveness to other conservative interventions and improvement of Cobb angle. Although clinicians may consider the Schroth method as 1 option of several conservative strategies, clinical benefit may be limited, and further high-quality research is needed to evaluate its performance in areas of insufficient evidence.

Cost-effectiveness of a pharmacist-led medication therapy management clinic for management of type 2 diabetes

ObjectivesThis study aimed to evaluate the lifetime cost-effectiveness of a pharmacist-led medication therapy management clinic (MTMC) compared to usual care for individuals with type 2 diabetes mellitus, from a U.S. payer perspective. MethodsA cohort simulation Markov model was developed including the effects of diabetes and major complications from diabetes. Transition probabilities, MTMC treatment effects, health state costs, and utilities, were based on data from electronic health records, and published literature. Outcomes evaluated were lifetime incremental costs, quality-adjusted life years (QALYs), and ratios. Sensitivity analyses were conducted on all model inputs; scenario analyses assessed the impact of preventing additional diabetes complications on economic outcomes and of reduced MTMC visit frequency. ResultsOver a lifetime, MTMC resulted in $160,145 total costs and 6.73 QALYs; usual care resulted in $152,806 total costs and 6.65 QALYs. The incremental cost-effectiveness ratio (ICER) of the MTMC compared to usual care was $93,375 per QALY gained, indicating cost-effectiveness at a willingness-to-pay threshold of $100,000 per QALY gained. Scenario analyses showed that modeling additional complications or reduced visit frequency lowered the ICER. The results were most sensitive to MTMC costs, and hazard ratios for occurrence of stroke, myocardial infarction, and renal failure, with an improvement in glycosylated hemoglobin and systolic blood pressure. ConclusionThe study demonstrates the potential cost-effectiveness of integrating clinical pharmacy services into comprehensive care strategies. Findings support the broader coverage and reimbursement of such services to optimize clinical outcomes and reduce long-term health care costs.