Economic Outcomes Research Articles

Clinical and economic burden of invasive pneumococcal disease and noninvasive all-cause pneumonia in hospitalized US adults: A multicenter analysis from 2015 to 2020

To evaluate the clinical and economic outcomes in adults hospitalized with invasive pneumococcal disease (IPD) and noninvasive all-cause pneumonia (ACP) overall and by antimicrobial resistance (AMR) status. Hospitalized adults from the BD Insights Research Database with an ICD10 code for IPD, noninvasive ACP or a positive Streptococcus pneumoniae culture/urine antigen test were included. Descriptive statistics and multivariable analyses were used to evaluate outcomes (in-hospital mortality, length of stay [LOS], cost per admission, and hospital margin [costs - payments]). The study included 88,182 adult patients at 90 US hospitals (October 2015-February 2020). Most (98.6%) had noninvasive ACP and 40.2% were <65 years old. Of 1450 culture-positive patients, 37.7% had an isolate resistant to ≥1 antibiotic class. Observed mortality, median LOS, cost per admission, and hospital margins were 8.3%, 6 days, $9791, and $11, respectively. Risk factors for mortality included ≥50 years of age, higher risk of pneumococcal disease (based on chronic or immunocompromising conditions), and intensive care unit admission. Patients with IPD had similar mortality rates and hospital margins compared with noninvasive ACP, but greater costs per admission and LOS. IPD and noninvasive ACP are associated with substantial clinical and economic burden across all adult age groups. Expanded pneumococcal vaccination programs may help reduce disease burden and decrease hospital costs.

The Price of Losing Autonomy: Assessing the Economic Impact of County-to-District Mergers in China

Amalgamations in democratic settings often result in disadvantages for small and peripheral units, as their political power diminishes in the merged jurisdictions. This article extends the discussion to China by assessing the economic outcomes of county-level units after their conversion into districts directly controlled by city authorities. Leveraging a large county-year panel dataset and employing an advanced causal effect estimator, my analysis reveals a generally less optimistic outlook for these county-turned districts following the mergers. The negative impacts are initially evident in microeconomic indicators, especially in resident deposits, and later materialize in the long-term trajectories of macroeconomic indicators. Furthermore, heterogeneous analysis and a comparative case study in Hangzhou city link the problem to the loss of administrative autonomy. Notably, the negative impacts are less likely to manifest in county-turned districts that are under provincial protection and therefore maintain a certain degree of administrative autonomy after the mergers.

Achieving Carbon Mitigation with Economic Benefits through High-Resolution Analysis of Renewable Resource Integration in Global Coastal Cities.

Coastal regions, home to more than half of the global population and contributing over 50% to the global economy, possess vast renewable resources, such as seawater and solar energy. The effective utilization of these resources, through the seawater-cooled district cooling system (SWDCS), seawater toilet flushing (SWTF), and rooftop solar photovoltaic system (RTPV), has the potential to significantly reduce carbon emissions. However, implementing these technologies in different geographic contexts to achieve the desired carbon and economic outcomes at the city level lacks a clear roadmap. To address this challenge, we comprehensively analyzed 12 coastal megacities worldwide by integrating geospatial building data. Our study evaluated the potential energy savings, carbon mitigation, and levelized carbon abatement costs (LCACs) from a life cycle perspective. The results revealed that using seawater and solar energy within urban boundaries can reduce electricity consumption from 1 to 24% across these cities. The spatial distribution of the LCAC for seawater-based systems exhibited more variation compared to the RTPV. By applying specific LCAC thresholds ranging from 0 to 225 USD/tCO2e, all cities could achieve both carbon reductions and economic benefits. These thresholds resulted in up to 80 million tonnes of carbon emission reductions and 5 billion USD of economic benefits, respectively. Our study provides valuable insights into integrating renewable resource systems, enabling coastal cities to achieve carbon and economic advantages at the city scale simultaneously.

Disentangling the direct and indirect impacts of non-pharmaceutical interventions on production activities and carbon emissions

Non-pharmaceutical interventions (NPIs) have been crucial in mitigating the COVID-19 pandemic, yet they've also heterogeneously disrupted production across sectors, highlighting socio-economic vulnerabilities. This study develops an ensemble model combining a Bayesian hierarchical model with supply chain dynamics to assess the direct and indirect impacts of three NPI themes—Gathering Restrictions, Mobility Restrictions, and Health Measures—on industrial output and carbon emissions in Beijing. The findings show that Health Measures enhanced local economic output by 1.12 %, yet also boosted regional carbon emissions by 6.15 %, primarily from the increased production in the Electric and Heat Power Production (EHP) sector, with a carbon intensity 1.96 times above the regional average. This emphasizes the urgent need for decarbonizing EHP to align health and environmental objectives in future pandemics. Furthermore, Mobility Restrictions had the most severe economic impact, 2.01 times greater than Gathering Restrictions, with Stationery Manufacturing being the most affected. Textile Manufacturing showed particular sensitivity to both Gathering Restrictions and Health Measures. These insights contribute to a more nuanced understanding of NPIs' impacts, supporting the development of balanced pandemic response strategies that consider economic, environmental, and health outcomes.

Financial Calculation Problems and Countermeasure Analysis of Large-Scale Engineering Construction Projects

The financial aspects of large-scale engineering construction projects profoundly influence their success. Strengthening cost control and establishing a scientific financial evaluation system can enhance the project’s economic benefits, minimize unnecessary costs, and provide decision-makers with a robust financial foundation. Additionally, implementing an effective cash flow control mechanism and conducting a comprehensive assessment of potential project risks can ensure financial stability and mitigate the risk of fund shortages. Developing a practical and feasible fundraising plan, along with stringent fund management practices, can prevent fund wastage and optimize fund utilization efficiency. These measures not only facilitate smooth project progression and improve project management efficiency but also enhance the project’s economic and social outcomes.

Using X, Facebook QR codes to optimise recruitment to a feasibility trial Enhancing Men’s Awareness of Testicular Diseases (E-MAT) in a cluster randomised Study Within A Trial (SWAT): Lessons learned.

Background Eight out of ten adults use social media, yet its efficacy in recruitment in clinical trials remains under-explored. The purpose of this SWAT was to determine which recruitment method, X, Facebook or QR code via posters, was more efficient and cost effective for recruiting participants to the host trial. Methods A cluster randomised cross-over design evaluated three recruitment strategies, X, Facebook and QR code. Seven Gaelic Athletic Association (GAA) clubs were randomised to receive either X, Facebook, or QR code. The seven clubs were re-randomised twice more, two weeks apart. There were two primary outcomes: 1. proportion of participants who consent to participate, relative to the number of players contacted; and 2. proportion of participants who consent to participate, relative to the number of players who clicked the link to register their interest. Results Fifty participants were randomised to three recruitment methods, and 47 were retained in the host trial. Participants mainly heard about the study through friends, with some engagement via social media platforms Facebook and X, and little to no engagement with the QR code. Primary outcomes were hindered by the inability to disaggregate data by GAA club. Economic outcomes revealed QR code as the costliest strategy, and while X was cheaper than Facebook in terms of the number of clicks, Facebook demonstrated better recruitment and retention and thus reduced the costs per participant. Conclusions While the inability to disaggregate data by club was a limitation, the study revealed that Facebook outperformed X and QR codes in terms of recruitment and participant retention and was thus considered to be more cost effective. The findings emphasise the importance of considering engagement patterns and cost-effectiveness in designing recruitment strategies for clinical trials, especially within the dynamic landscape of social media use.

Stock market liberalization and management earnings forecasts: Evidence from a quasi‐experiment in China

AbstractThis study examines the impact of Chinese stock market liberalization on the quality of firms' information disclosures. Although previous studies have explored the economic outcomes of stock market liberalization, little is known about its impact on the quality of management earnings forecasts. We treat China's Stock Connect program as a quasi‐experiment and draw data from Chinese A‐share‐listed companies from 2012 to 2017. Using a staggered difference‐in‐difference model, we find that eligible firms issue more accurate earnings forecasts after implementation of the Connect program compared with ineligible firms. Our mechanism analyses show that the positive effect is more pronounced for firms with initially opaque information environment and higher ex ante agency costs, suggesting that market liberalization facilitates higher‐opaque firms to issue more accurate earnings forecasts to meet the information demand from foreign investors, and facilitates monitoring in firms with weak internal governance, thereby improving earnings forecasts quality.

Zero Budget Natural Farming Impact on Tribal Rabi Rice Farming: Economic Analysis

This study examines the economic viability of implementing Zero Budget Natural Farming (ZBNF) interventions in rabi rice cultivation, focusing on cost-effectiveness and productivity outcomes. Data collected before (2014-15) and after (2018-19) ZBNF adoption in a selected tribal area of Visakhapatnam district of Andhra Pradesh, India were analysed. Results reveal a reduction in total variable costs by 10.20 per cent, primarily attributed to decreases in weeding and nutrient supply expenses. Despite a slight increase in operational costs, ZBNF led to a significant drop (51.30 per cent) in input expenditures. Yield experienced a notable 10.25 per cent increase, resulting in a decrease in production costs from ₹1161.23 to ₹934.34 per quintal. The calculated cost-to-benefit ratio of -1:1.17 demonstrates favourable economic outcomes, highlighting the potential of ZBNF to enhance economic viability and sustainability in rabi rice cultivation among tribal farmers.

Clinical and Economic Outcomes of Patients with Osteoporosis Undergoing Spine Fusion Surgery in Japan.

Spinal fusion surgery with instrumentation is a treatment of choice for many spinal disorders; however, there is little data related to factors associated with early and late outcomes, especially among patients with poor bone quality (e.g., osteoporosis). We conducted this study to characterize the epidemiology and outcomes of patients undergoing spinal fusion surgery with instrumentation in Japan, especially in patients with poor bone quality and those needing additional fixation methods. This retrospective observational study used real-world health insurance claims data from the Japanese Medical Data Vision. Adult patients undergoing an index spinal fusion procedure from April 1, 2010, to September 30, 2017, with procedural details, length of stay (LOS), total in-hospital costs, spine-related reoperation, all-cause readmission, and postoperative complications recorded. Data were summarized descriptively overall, by osteoporosis status, and additional fixation method used, and were analyzed in bivariate analyses. Multivariate logistic and linear regressions were used to explore associations between covariates and variables of interest. A total of 22,932 patients (mean age, 67.3 years; 51.2% male) met the study criteria and were included. A total of 5,288 (23.0%) patients had osteoporosis, and 2,507 (10.9%) needed additional fixation methods; these patients were older, more frequently female, and had higher Elixhauser comorbidity index scores. Osteoporosis and additional fixation use were also associated with longer LOS, higher hospital costs, and higher rates of complications. Patients with osteoporosis and those needing additional fixation methods have a higher risk for procedural and postoperative complications, reoperation, longer LOS, and higher total hospital costs.

The economic efficiency of using protective measures in combating rice pests

In the conducted research in the conditions of the Karatal District of the Zhetysu Region, an analysis of the economic efficiency of rice pest control methods was performed. Among the main pests damaging the crops are the coastal fly, barley miner, and rice midge. The use of the insecticide dimethoate led to a significant reduction in damage from the coastal fly, increasing the biological efficiency to 90.9-94.2%. This, in turn, resulted in an increase in yield by 2.7-3.6 tons/ha compared to the control group. Data analysis also showed that the application of dimethoate is accompanied by a reduction in rice cultivation costs and an increase in net income. The profitability level of using this insecticide was 69.4%, indicating its high effectiveness in terms of agricultural economics. Additionally, the return on additional expenses for protecting rice crops using dimethoate reaches 2.1 times, confirming the economic feasibility of this protection method. Thus, the research results underscore the importance of applying modern rice protection methods and their positive impact on the economic outcome in the region's agriculture. They also justify the need for further research in this area to optimize the rice cultivation process considering economic aspects. Data analysis also showed that the application of dimethoate is accompanied by a reduction in rice cultivation costs and an increase in net income. The profitability level of using this insecticide was 69.4%, indicating its high effectiveness in terms of agricultural economics. Additionally, the return on additional expenses for protecting rice crops using dimethoate reaches 2.1 times, confirming the economic feasibility of this protection method. Thus, the research results underscore the importance of applying modern rice protection methods and their positive impact on the economic outcome in the region's agriculture. They also justify the need for further research in this area to optimize the rice cultivation process considering economic aspects.

Economic returns to reproducing parents' field of study.

Research on the influence of family background on college graduates' earnings has not considered the importance of the match between parents' and children's field of study. Using a novel design based on within-family comparisons, I examine long-term earnings returns to reproducing parents' field of study in Denmark. I find that individuals whose field of study matches that of a parent have earnings that are 2 percent higher than those of their siblings with college degrees in different fields, on average. Earnings returns to field inheritance are highest in the fields of law (9 percent), medicine (6 percent), and engineering (4 percent) and are driven mainly by income from self-employment. I find no direct evidence of nepotism as the earnings advantage does not arise from inheritance of parents' firms or employment in parents' occupational network. My findings indicate that, although a college degree generally equalizes family background differences in economic outcomes, there are additional payoffs to field inheritance, particularly in traditional fields characterized by a high degree of social closure and self-employment.

Benchmarking lean construction conformance in Pakistan’s construction industry

PurposeLean construction (LC) is an innovative approach in the construction industry that has shown significant success in developed countries. Although LC has potential in the construction sector of Pakistan, it has not been extensively explored. This study aims to address this knowledge gap by identifying and predicting current lean practices and assessing the strengths and weaknesses of LC implementation in Pakistan.Design/methodology/approachUsing robust statistical methods to analyze 92 valid responses, the study reveals that approximately 54% of lean practices are currently in use in the construction industry of Pakistan, with a population mean ranging from 52.7% to 55.6%.FindingsSurprisingly, the research identifies instances where some construction firms in Pakistan are implementing LC practices, even though they have only a limited understanding of its underlying principles. Notably, certain subprinciples, such as visual management, top management commitment to change, employee training, process cycle time reduction and production optimization, are less integrated within the construction industry. Exploring the possibility of implementing LC, recommendations for strategies to implement LC in Pakistan are suggested, aligning with the conceptual model proposed by the researchers.Originality/valueThe novelty of this work offers insights that can serve as a comprehensive guide for developing nations. It provides a structured approach to assess and benchmark LC practices, which, in turn, can contribute to a more efficient and effective construction industry. Moreover, the strategies proposed in this research can aid developing countries in the efficient implementation of LC. This will have a positive implication for both economic and developmental outcomes.

Corruption, unemployment, and clientelism: A Political Economy approach

We present a theoretical general equilibrium model that incorporates capital allocation dynamics between licit and illicit activities, endogenous unemployment, idiosyncratic moral costs, and the influence of corrupt political power. Our inquiry focuses on the endogeneity of corruption, highlighting its reciprocal relationship with political power, which is mediated through clientelist practices. Using data from Sub-Saharan African countries, our model reveals multiple equilibria, establishing a negative correlation between output and corruption and a positive correlation between corruption and unemployment. In addition, our analysis suggests that implementing appropriate tax rates to fund unemployment benefits can effectively alleviate corruption by transforming unemployed individuals’ perception of subsidies; this shift in perspective diminishes their susceptibility to corrupt practices, underscoring the significance of policy interventions targeting unemployment reduction to weaken clientelist mechanisms and reduce corruption. This study enriches our comprehension of the nuanced impact of corruption on economic outcomes and offers valuable insights for formulating effective anti-corruption policies.

Sustainable impact analysis of freight pooling strategies on city crowdsourcing logistics platform

This study investigates the effects of freight pooling strategies on urban crowdsourcing logistics, focusing on economic, social, and environmental outcomes. Utilising a mixed-integer linear programming model with an adaptive large neighbourhood search algorithm, our goal is to optimise the cost-efficiency of the freight pooling system. Real-world delivery and driver trajectory data from a major Chinese crowdsourcing logistics platform, along with high-resolution vehicle telematics data, validate our model in five scenarios, each defined by distinct cost coefficients reflecting diverse stakeholder priorities. Results show potential for up to a 21.3% reduction in carbon emissions, a 28.3% decrease in truck activity spatial coverage, and a 7.6% increase in available drivers. However, deadheading trips, due to order consolidation into fewer vehicles without an increase in overall demand, could offset maximum carbon reduction benefits by 16.4%. Other effects on customers’ and drivers’ welfare are explored for a comprehensive quantitative assessment of freight pooling strategies’ sustainability benefits.

Heat waves and urban vulnerability: climate shelters, public services and innovative solutions. Lessons from Barcelona

ABSTRACT Future projections indicate a global increase in heat waves, especially in urban areas due to climate change and the heat island effect, leading to adverse human, economic, and environmental outcomes. Cities worldwide respond by integrating climate mitigation and adaptation measures. While long-term strategies dominate research, this paper explores the increasing interest in short-term solutions, examining the Barcelona Climate Shelter Network. Investigating climate shelter initiatives, it highlights the use of public or private spaces for respite during extreme heat. This model offers insights for other European cities facing escalating heat waves, encouraging reflections on reshaping public services amidst climate crises.

Bridging the rural-urban divide: An implementation plan for leveraging technology and artificial intelligence to improve health and economic outcomes in rural America.

Bridging the rural-urban divide: An implementation plan for leveraging technology and artificial intelligence to improve health and economic outcomes in rural America.

Extrapolative Uncertainty and Household Economic Behavior

We examine the uncertainty in households’ expectations regarding macroeconomic outcomes, namely inflation and the rate of nationwide home price growth. We document that people extrapolate from the instability of their personal and local environment when assessing the future volatility of these macroeconomic variables. Consequently, there are within-person spillovers in subjective uncertainty regarding different economic outcomes. This extrapolative behavior is more pronounced among lower-numeracy individuals, and it persists throughout the business cycle. People with more uncertain macroeconomic expectations are more likely to engage in precautionary behaviors regarding consumption and equity market exposure and are more concerned about credit market access. This paper was accepted by David Simchi-Levi, finance. Supplemental Material: The data files are available at https://doi.org/10.1287/mnsc.2023.00820 .

Cost-effectiveness comparison of dalpiciclib and abemaciclib combined with an aromatase inhibitor as first-line treatment for HR+/HER2− advanced breast cancer

ABSTRACT Objectives CDK4/6 inhibitors dalpiciclib and abemaciclib have been approved by the Chinese National Medical Products Administration as first-line treatment for postmenopausal females with hormone receptor-positive (HR+) and human epidermal growth factor receptor-2 negative (HER2−) advanced breast cancer (ABC). We aimed to assess the cost-effectiveness of dalpiciclib plus letrozole/anastrozole (non-steroidal aromatase inhibitor [NSAI]) compared with abemaciclib plus NSAI as a first-line treatment for HR+/HER2− ABC in China. Methods We constructed a Markov model with three health states to evaluate health and economic outcomes of first-line treatment with dalpiciclib plus NSAI and abemaciclib plus NSAI for HR+/HER2− ABC. Efficacy data was obtained from MONARCH3 and DAWNA-2 trials. Quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs) were calculated. Results Compared with abemaciclib plus NSAI, dalpiciclib plus NSAI resulted in 4.27 additional QALYs, with an ICER of $14827.4/QALY. At a willingness-to-pay threshold of 3 times gross domestic product per capita in China for 2023 ($37721.5/QALY), the cost-effectiveness probability of dalpiciclib plus NSAI was 77.42%. Conclusions From the perspective of Chinese payers, dalpiciclib plus NSAI appears to be a cost-effective strategy compared with abemaciclib plus NSAI for the first-line treatment of patients with HR+/HER2− ABC in China. Clinical trial registration MONARCH3, www.clinicaltrials.gov, identifier is NCT02246621 and DAWNA-2, www.clinicaltrials.gov, identifier is NCT03966898.

The economic and fiscal impact of incremental use of cell-based quadrivalent influenza vaccine for the prevention of seasonal influenza among healthcare workers in Italy

BackgroundSeasonal influenza has a significant impact on public health, generating substantial direct healthcare costs, production losses and fiscal effects. Understanding these consequences is crucial to effective decision-making and the development of preventive strategies. This study aimed to evaluate the economic and the fiscal impact of implementing an incremental strategy for seasonal influenza prevention using the cell-based quadrivalent influenza vaccine (QIVc) among healthcare workers (HCWs) in Italy.MethodsTo estimate the economic impact of implementing this strategy, we performed a cost analysis that considered direct healthcare costs, productivity losses and fiscal impact. The analysis considered a 3-year time horizon. A deterministic sensitivity analysis was also conducted.ResultsAssuming a vaccination coverage rate of 30% among HCWs, the analysis considered a total of 203 018 vaccinated subjects. On analysing the overall differential impact (including direct costs, indirect costs and fiscal impact), implementing QIVc vaccination as a preventative measure against influenza among HCWs in Italy would yield societal resource savings of €23 638.78 in the first year, €47 277.56 in the second year, and €70 916.35 in the third year, resulting in total resource savings of €141 832.69.ConclusionsThe study demonstrated that implementing the incremental use of QIVc as part of a preventive strategy for seasonal influenza among HCWs in Italy could yield positive economic outcomes, especially in terms of indirect costs and fiscal impact. The resources saved could be utilized to fund further public health interventions. Policy-makers should consider these findings when making decisions regarding influenza prevention strategies targeting HCWs.

Better off in the city? Economic outcomes of rural out‐migration in Sweden—sibling study of cohorts 1960–1984

AbstractThis study examines disparities in income levels and employment status between individuals who migrate from rural areas and their siblings who remained in rural settings in Sweden for cohorts born 1960–1984. Utilizing comprehensive Swedish register data, we track the economic outcomes at age 35 or rural residents who migrated between ages 15 and 25, comparing them to non‐migrating siblings. Our analysis, employing binomial logit and log‐linear models for employment odds and income levels, respectively, reveals that while rural out‐migration generally leads to higher income, it does not significantly impact employment status. The study underscores the role of individual and family‐specific factors—such as gender and education—and broader time‐ and place‐dependent structures in mediating migration's effects. We find that income disparity between migrants and non‐migrants has increased since the 1990s and that the differences increase with the urbanization level of the destination.