Proxy For Costs Research Articles

Prediction of intensive care units length of stay: a concise review.

The length of stay (LOS) in the intensive care unit (ICU) is one of the most commonly used metrics for quality of care. Despite its potential limitations, ICU LOS is easy to measure, reproducible and can be used as a proxy for resource use, costs, and efficiency.(1) Moreover, it is a patientcentered outcome; therefore, it is of interest to multiple stakeholders, such as patients and families, managers, payors, and ICU personnel. However, in most circumstances, the ICU LOS is used retrospectively to assess ICU efficiency or to understand patients with a long LOS and, thus, elevated costs of care. Therefore, patient LOS prediction at ICU admission could help coordinate care, implement preventive measures, and better communicate with managers, payors, and families, setting realistic expectations.

BOARD CHARACTERISTICS, CORPORATE GOVERNANCE AND AGENCY PROBLEMS IN INDIAN COMPANIES

This research paper explores how the board characteristics and other external governance mechanisms mitigate the agency conflicts prevailing in the Indian corporate sector based on panel data of 315 companies drawn from the BSE 500 index (Bombay Stock Exchange) during the period 2008-2018. Utilising the panel OLS regression methodology, this research paper has derived two alternative econometric models based on the proxies of agency cost (operating ratio and Tobin's Q) as dependent variables and the independent variables as the board size, independent directors, CEO-Chairperson separation, audit committee, nomination, and remuneration committee, stakeholders' relationship committee, promoters' holdings, leverage, bank debt, and firm size. The descriptive statistics establish that the Indian companies are subjected to severe agency problems. The multivariate regression results reveal that the board characteristics as governance mechanisms are not successful in mitigating agency conflict in Indian companies. However, Indian companies have been gradually assimilating corporate governance mechanisms.

THE EFFECT OF FREE CASH FLOW ON ASSET UTILIZATION WITH OWNERSHIP STRUCTURES AS MODERATING VARIABLES

This study aims to examine how free cash flow (FCF) affects on asset utilization (AU) as a proxy for agency cost, followed by investigating the influence of ownership structures as moderating variables in reducing the negative effect of FCF on asset utilization. The research sample of 465 companies consisted of all companies listed on the Indonesia Stock Exchange in 2013-2017 with purposive sampling method. The findings of this study showed that FCF negatively influences AU). Institutional ownership weakens the negative relationship between FCF and AU. Contrarily, managerial ownership strengthens the negative relationship between FCF and AU. This study also found that family ownership strengthens the negative relationship between FCF and AU. This study contributes to understanding the role of various ownership structures in utilizing company's resources to improve their asset utilization, especially in the family ownership that dominates Indonesian firms.

Alleviating Poverty through Islamic Microfinance: Outreach and Efficiency (Study on BMT and Islamic Cooperatives in Indonesia)

The involvement of Islamic Microfinance Institutions (IMFI) in building the national economy is paramount to help the poor. However, provision of access and services to lower-level households can potentially conflict with the sustainability of the institutions. This study analyses the social outreach factors that determine financial and social efficiencies. To reach the set goal and solve this issue, we used mixed methodology combining quantitative (statistical instruments, such as Data Envelopment Analysis (DEA) and multivariate analysis) and qualitative approaches (interviews to clarify or deepen the existing information). The assessment of the dependent variables is influenced by proxies of depth, breadth, length, scope, and cost. The results showed that the average loan instalments and the number of offices and branches significantly influence financial and social efficiency. The age of the institution only has an effect on financial efficiency. Simultaneously, profit orientation, the amount and type of financing and the amount and type of savings only have a high impact on social efficiency, whereas the impact of fund collection and cost per borrower is insignificant. There is a strong positive correlation between the two dependent variables. The influence of independent variables on financial and social efficiency is significant with the coefficient of determination 23.1274 % and 53.2941 %, respectively.

Patterns of foraging activity and fidelity in a southeast Asian flying fox

BackgroundImproved understanding of the foraging ecology of bats in the face of ongoing habitat loss and modification worldwide is essential to their conservation and maintaining the substantial ecosystem services they provide. It is also fundamental to assessing potential transmission risks of zoonotic pathogens in human-wildlife interfaces. We evaluated the influence of environmental and behavioral variables on the foraging patterns of Pteropus lylei (a reservoir of Nipah virus) in a heterogeneous landscape in Cambodia.MethodsWe employed an approach based on animal-movement modeling, which comprised a path-segmentation method (hidden Markov model) to identify individual foraging-behavior sequences in GPS data generated by eight P. lylei. We characterized foraging localities, foraging activity, and probability of returning to a given foraging locality over consecutive nights. Generalized linear mixed models were also applied to assess the influence of several variables including proxies for energetic costs and quality of foraging areas.ResultsBats performed few foraging bouts (area-restricted searches) during a given night, mainly in residential areas, and the duration of these decreased during the night. The probability of a bat revisiting a given foraging area within 48 h varied according to the duration previously spent there, its distance to the roost site, and the corresponding habitat type. We interpret these fine-scale patterns in relation to global habitat quality (including food-resource quality and predictability), habitat-familiarity and experience of each individual.ConclusionsOur study provides evidence that heterogeneous human-made environments may promote complex patterns of foraging-behavior and short-term re-visitation in fruit bat species that occur in such landscapes. This highlights the need for similarly detailed studies to understand the processes that maintain biodiversity in these environments and assess the potential for pathogen transmission in human-wildlife interfaces.

High-resolution land value maps reveal underestimation of conservation costs in the United States

The justification and targeting of conservation policy rests on reliable measures of public and private benefits from competing land uses. Advances in Earth system observation and modeling permit the mapping of public ecosystem services at unprecedented scales and resolutions, prompting new proposals for land protection policies and priorities. Data on private benefits from land use are not available at similar scales and resolutions, resulting in a data mismatch with unknown consequences. Here I show that private benefits from land can be quantified at large scales and high resolutions, and that doing so can have important implications for conservation policy models. I developed high-resolution estimates of fair market value of private lands in the contiguous United States by training tree-based ensemble models on 6 million land sales. The resulting estimates predict conservation cost with up to 8.5 times greater accuracy than earlier proxies. Studies using coarser cost proxies underestimate conservation costs, especially at the expensive tail of the distribution. This has led to underestimations of policy budgets by factors of up to 37.5 in recent work. More accurate cost accounting will help policy makers acknowledge the full magnitude of contemporary conservation challenges and can help improve the targeting of public ecosystem service investments.

Economic analysis of 90-day return to the emergency room and readmission after elective lumbar spine surgery: a single-center analysis of 5444 patients.

In the future, payers may not cover unplanned 90-day emergency room (ER) visits or readmissions after elective lumbar spine surgery. Prior studies using large administrative databases lack granularity and/or use a proxy for actual cost. The purpose of this study was to identify risk factors and subsequent costs associated with 90-day ER visits and readmissions after elective lumbar spine surgery. A prospective, multisurgeon, single-center electronic medical record was queried for elective lumbar spine fusion surgeries from 2013 to 2017. Predictive models were created for 90-day ER visits and readmissions. Of 5444 patients, 729 (13%) returned to the ER, most often for pain (n = 213, 29%). Predictors of an ER visit were prior ER visit (OR 2.5), underserved zip code (OR 1.4), and number of chronic medical conditions (OR 1.4). In total, 421 (8%) patients were readmitted, most frequently for wound infection (n = 123, 2%), exacerbation of chronic obstructive pulmonary disease (n = 24, 0.4%), and sepsis (n = 23, 0.4%). Predictors for readmission were prior ER visit (OR 1.96), multiple chronic conditions (OR 1.69), obesity (nonobese, OR 0.49), race (African American, OR 1.43), admission status (ER admission, OR 2.29), and elevated hemoglobin A1c (OR 1.80). The mean direct hospital cost for an ER visit was $1971, with 75% of visits costing less than $1890, and the average readmission cost was $7347, with 75% of readmissions costing less than $8820. Over the 5-year study period, the cost to the institution for 90-day return ER visits was $5.1 million. Risk factors for 90-day ER visit and readmission after elective lumbar spine surgery include medical comorbidities and socioeconomic factors. Proper patient counseling, appropriate postoperative pain management, and optimization of modifiable risk factors prior to surgery are areas to focus future efforts to lower 90-day ER visits and readmissions and reduce healthcare costs.

Using Weighted Data Envelopment Analysis to Measure Occupational Safety and Healthy Economic Performance of Taiwan’s Industrial Sectors

The socioeconomic costs of occupational accidents represent an important factor in the safety and healthy development of a country’s economy. Insurance payments (which cover workplace incidents, such as wounds or illness, disability and fatality) can be considered a proxy for the socioeconomic cost of occupational accidents. Occupational accidents in different industries cause important variations in these three socioeconomic costs—for example, in their frequency and severity. One of the most commonly used mathematical programming approaches that analyze the performance of inputs, economic outputs and occupational accidents is data envelopment analysis (DEA), which has also been used in recent years to estimate the relative performance related to occupational injuries. This study measures the safety and healthy economic performance of Taiwan’s 17 industrial sectors by incorporating the varying importance of the three socioeconomic costs of occupational accidents into a weighted DEA Model. The empirical results demonstrate that integrating the varying importance of the three socioeconomic costs of occupational accidents in the evaluation of safety and healthy economic performance is very important. To improve the occupational safety and healthy economic performance of Taiwan’s main industrial sectors, efforts should focus on reducing fatalities, which are very costly. These findings could help Taiwan’s policy makers effectively improve their safety and healthy economic performance, based on the specific context of each industry, especially the mining and quarrying industry.

248. Hepatitis C virus infection as a predictor of complications and increased costs following primary lumbar fusion surgery

BACKGROUND CONTEXT While joint arthroplasty literature has shown increased complication rates and costs for patients seropositive for HCV without liver disease compared to those without HCV, this comorbidity has not been explored in the spine literature. To our knowledge, this is the first publication in the lumbar spine literature to solely focus on HCV as the disease burden. PURPOSE To identify if HCV diagnosis influences in-hospital lengths of stay (LOS), postoperative complications, readmission rates or costs following primary posterior lumbar fusions in an elective setting. STUDY DESIGN/SETTING Retrospective review. PATIENT SAMPLE A national database was queried for patients who underwent primary lumbar spine fusion for degenerative lumbar pathology with Medicare insurance from 2005-2014. Patients with a diagnosis of degenerative lumbar disease were identified using ICD-9 diagnosis codes: 722.52. The database was subsequently queried for all patients with HCV using ICD-9 diagnosis codes: 070.51, 070.54, 070.71, and V02.62. A strict inclusion and exclusion criteria yielded a total cohort of 28,841 individuals undergoing primary lumbar fusion, which included 4,807 patients with HCV seropositivity, and 24,034 without HCV-positive status. Patients with HCV were designated as “HCV” and those without HCV were designated as “Controls.” OUTCOME MEASURES Primary outcomes analyzed in the study included: in-hospital LOS, readmission rates, medical complications and costs of care. Reimbursements were utilized as a proxy for cost, as used in previous studies. Medical complications analyzed included: myocardial infarction, cerebrovascular accidents, respiratory failure, pneumonia, paralytic ileus, urinary tract infections (UTIs), neurodegenerative complications, transfusion of blood products, dural tears and wound-/implant-related infections. METHODS A national database was queried for patients who underwent primary lumbar spine fusion for degenerative lumbar pathology with Medicare insurance from 2005-2014. The 90-day postoperative complication rates, readmission rates and treatment costs were queried. To limit confounding, HCV patients were matched with a control cohort of non-HCV patients using patient demographics, treatment modality, and comorbid conditions and then analyzed by multivariate logistic regression. Patients with active liver disease were excluded to better isolate HCV as the comorbidity. RESULTS A cohort of 28,841 patients was included in the final analysis. Postoperatively, compared to those without HCV infection, those with HCV had significantly higher odds of needing a blood transfusion (OR: 3.06), pneumonia (OR: 2.49), respiratory failure (OR: 2.49) UTIs (OR: 1.89), wound-/implant-related infections (OR: 1.74), cerebrovascular events (OR: 1.70), or any post-operative complication within 90 days (OR: 2.93; all p: CONCLUSIONS In patients undergoing primary lumbar fusion, a seropositivity for HCV without liver disease is associated with higher costs and complication rates, including higher rates of blood transfusion requirements and pneumonia-related complications. This data shed new light on elective spine surgery in HCV patients and may influence the risks and benefits considerations for surgeons considering lumbar fusion in this population. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

One Stop Shops for Public Services: Evidence from Citizen Service Centers in Brazil

AbstractCitizen Service Centers are government offices where different authorities are co‐located and where several public services are offered in the same physical location. The goal of implementing such One Stop Shops for public services is to solve problems with a malfunctioning government bureaucracy for frontline service delivery. In spite of reforms in at least 70 countries, however, there are few evaluations. This paper evaluates the impact of Poupatempo (“Savetime”), a Brazilian Citizen Service Center reform that has inspired similar programs in other countries. We collect data on one of the most common errands at the Brazilian bureaucracy, driver's license renewal, and evaluate the impact of Poupatempo on the time, number of trips, and payments needed to undertake the renewal, and on other variables representing transaction costs, red tape, and transparency in the citizen‐state interaction. Our difference‐in‐differences estimates indicate large reductions in the time expended by citizens and in proxies for transaction costs, but are less encouraging for the social quality of the licensing procedure, which we also evaluate. We discuss whether incentives to speed up processes prevailed where other steering instruments would have been more appropriate, and explore remedies. We also discuss limitations to establishing a true One Stop Shop.

Mobility costs and energy uptake mediate the effects of morphological traits on species' distribution and abundance.

Individuals of large or dark-colored ectothermic species often have a higher reproduction and activity than small or light-colored ones. However, investments into body size or darker colors should negatively affect the fitness of individuals as they increase their growth and maintenance costs. Thus, it is unlikely that morphological traits directly affect species' distribution and abundance. Yet, this simplification is frequently made in trait-based ecological analyses. Here, we integrated the energy allocation strategies of species into an ecophysiological framework to explore the mechanisms that link species' morphological traits and population dynamics. We hypothesized that the effects of morphological traits on species' distribution and abundance are not direct but mediated by components of the energy budget and that species can allocate more energy towards dispersal and reproduction if they compensate their energetic costs by reducing mobility costs or increasing energy uptake. To classify species' energy allocation strategies, we used easily measured proxies for the mobility costs and energy uptake of butterflies that can be also applied to other taxa. We demonstrated that contrasting effects of morphological traits on distribution and abundance of butterfly species offset each other when species' energy allocation strategies are not taken into account. Larger and darker butterfly species had wider distributions and were more abundant if they compensated the investment into body size and color darkness (i.e., melanin) by reducing their mobility costs or increasing energy uptake. Adults of darker species were more mobile and foraged less compared to lighter colored ones, if an investment into melanin was indirectly compensated via a size-dependent reduction of mobility costs or increase of energy uptake. Our results indicate that differences in the energy allocations strategies of species account for a considerable part of the variation in species' distribution and abundance that is left unexplained by morphological traits alone and ignoring these differences can lead to false mechanistic conclusions. Therefore, our findings highlight the potential of integrating proxies for species' energy allocation strategies into trait-based models not only for understanding the physiological mechanisms underlying variation in species' distribution and abundance, but also for improving predictions of the population dynamics of species.

Corporate Governance Quality, Ownership Structure, Agency Costs and Firm Performance. Evidence from an Emerging Economy

The purpose of this paper is to investigate the effect of corporate governance quality and ownership structure on the relationship between the agency cost and firm performance. Both the fixed-effects model and a more robust dynamic panel generalized method of moment estimation are applied to Chinese A-listed firms for the years 2008 to 2016. The results show that the agency–performance relationship is positively moderated by (1) corporate governance quality, (2) ownership concentration, and (3) non-state ownership. State ownership has a negative effect on the agency–performance relationship. Various robust tests of an alternative measure of agency cost confirm our main conclusions. The analysis adds to the empirical literature on agency theory by providing useful insights into how corporate governance and ownership concentration can help mitigate agency–performance relationship. It also highlights the impact of ownership type on the relationship between agency cost and firm performance. Our study supports the literature that agency cost and firm performance are negatively related to the Chinese listed firms. The investors should keep in mind the proxies of agency cost while choosing a specific stock. Secondly; the abuse of managerial appropriation is higher in state-held firms as compared to non-state firms. Policymakers can use these results to devise the investor protection rules so that managerial appropriation can be minimized.

How does eco-label competition affect environmental benefits? The case of Central Africa's forests

Increasingly, non-governmental organization (NGO) and industry eco-labels compete. Environmental benefits may increase or decrease with entry by an industry label, depending on the shape of consumers’ willingness to pay and the shape of the distribution of forest compliance costs. Using geospatial data from forests in Cameroon and Gabon to proxy for compliance costs, I test whether lower compliance cost forests are more likely to participate in stricter labels. Next, I use a semi-nonparametric estimator to estimate parameters for willingness to pay and the distribution of forest compliance costs to calculate benefits with and without label competition. I find that, in this context, eco-label competition decreases environmental benefits by 17%. The industry label lures away a sufficient number of forests that would have chosen an NGO standard in autarky, overwhelming gains from broader participation and a stricter NGO standard. The distribution of forest compliance cost is skewed toward high cost forests. Willingness to pay is bowed: initial increases in protection have a high marginal willingness-to-pay but additional increases are less valuable. Industry certified wood prices are predicted to be 14–28% higher than uncertified wood. NGO certified wood prices are predicted to be 9–17% higher than industry certified wood.

Volatility of relative prices and transportation costs: evidence for Brazilian cities

ABSTRACT This work estimates the effect of transport costs on relative price volatility in Brazilian cities. We use time-varying volatility measures and propose a new proxy for transportation costs. The results of the dynamic panel data models show (little) evidence of a positive impact of transport costs on relative price volatility, only in specifications without the relative wage volatility.

Does Excessive Alcohol Consumption Increase Economic Cost? An Investigation from Thailand

Excessive consumption of alcohol is linked with the various adverse health consequences, including liver diseases, cancer, kidney failure, cardiac problems, and digestive problems. It also results impulsive death, increases the cost of health care, increases crime rates, lowers the productivity of individuals, decreases output, reduces the possibility of earning and increases unemployment rate Therefore, present study aims to investigate the impact of excessive alcohol consumption on the economic cost of the nation. The study uses three proxies of economic cost, including health care cost, productivity cost and the cost of crimes. The study collected the data from the national data bases of Thailand. The study applies ordinary least square regression for the empirical estimation of results. Results of the study show positive impact of excessive consumption of alcohol on economic cost; health care cost, productivity cost and the cost of crimes. The study concluded that the excessive consumption of alcohol adversely affects the economy of Thailand. Therefore, it is suggested that government should take strict action against the excessive use of alcohol consumption in order to control the economic cost.

Cost Drivers Associated With Anterior Shoulder Stabilization Surgery.

Background:Arthroscopic Bankart repair, open Bankart repair, and the Latarjet procedure are common treatments for anterior shoulder instability; however, little is known of costs by patient- and surgeon-specific factors. This study aimed to identify areas where cost reduction may be achieved.Hypothesis:Increased total charges will be associated with low-volume surgeons and surgical facilities, hospital-owned facilities, open surgical techniques, and patients with at least 1 comorbidity.Study Design:Economic and decision analysis; Level of evidence, 3.Methods:The 2014 State Ambulatory Surgery and Services Databases from 6 states were utilized. There were 3 Current Procedural Terminology codes (23455, 23462, 29806) used to identify open Bankart repair, the Latarjet procedure, and arthroscopic Bankart repair, respectively. Patient demographic and surgical variables were evaluated on a univariate basis, and all significant factors were then included in the multiple linear regression to determine which factors had the largest effect on cost. Total charges billed for the encounter were used as a proxy for cost of surgery.Results:For open Bankart repair, arthroscopic Bankart repair, and the Latarjet procedure, longer operative times increased costs, and high-volume surgical facilities had decreased charges. For the arthroscopic Bankart group, additional factors that increased charges included postoperative hospital admission (US$11,516; P < .001), patient residence in a ZIP code with a below-median income (US$2909; P < .001), presence of a comorbidity (US$1982; P < .001), male sex (US$1545; P = .003), Hispanic race (US$2493; P = .005), and use of regional anesthesia (US$1898; P = .025). Additional cost drivers for the Latarjet procedure included postoperative hospital admission (US$7028; P = .022) and older age (US$187/y; P = .039).Conclusion:Postoperative admission to the hospital was the largest cost driver for arthroscopic Bankart repair and the Latarjet procedure. Low-volume facilities were the largest cost driver for open Bankart repair. High-volume surgery centers had lower costs when compared with low-volume surgery centers. Regional anesthesia increased costs in the arthroscopic Bankart group. These findings may help to show where cost savings can be achieved, particularly considering increasing trends toward bundled health care payments.

P0718HEALTH CARE COSTS IN CHRONIC KIDNEY DISEASE: A LONGITUDINAL STUDY FROM THE PIRP COHORT

Abstract Background and Aims Health care costs in patients with chronic kidney disease (CKD) vary widely according to patients’ severity. In patients followed up in a community-based project, it is of interest to determine cost variations over time, as a result of treatment and CKD progression. The aim of the study was to estimate the costs incurred by the health care system for CKD patients in an Italian region. Method Patients recruited in the Emilia-Romagna (Italy) PIRP project in the years 2007-2014 with CKD stage 3a to 5 were included in the study. Patients were stratified at baseline into 7 groups at different risk of progression according to the CT-PIRP classification (Rucci et al., A clinical stratification tool for chronic kidney disease progression rate based on classification tree analysis, NDT 2014). To calculate the annual medical costs, we multiplied the number of services used by the respective unit cost. Per capita costs were obtained dividing overall costs by person-years. We used DRG tariffs as a proxy of costs for hospital admissions, the regional nomenclator for outpatient visits and lab tests, and cost unit for prescribed drugs. Mixed effects generalized linear models were used to estimate the annual direct costs of CT-PIRP groups, adjusted for calendar year of entry in PIRP and local health authority of residence. Results The study cohort includes 7737 CKD patients, aged 73.2±11.6 years, 64.5% males, mostly in CKD stage 4 (3136, 40.5%) and 3b (2799, 36.2%); 697 patients (9.0%) entered the study at stage 5. The CT-PIRP classification and frequency distribution is shown in Tab.1. After 4 years, 5017 (64.8%) were still alive, 1743 (22.5%) died, 546 (7.2%) were on ESKD and 422 (5.5%) were lost. The overall direct costs of patients while still enrolled in the PIRP project decreased from 36.89 million € in the first year to 32.22 in the fourth year, while the per capita annual median costs were stable around 2200 €. The cost breakdown showed a decrease of hospitalization and drugs costs and an increase in specialty visits costs (Fig.1). The model-estimated average annual costs were significantly higher for proteinuric, low GFR patients of CT-PIRP groups 2 and 3 (7239 € and 8825 € respectively), while non-diabetic, younger patients of group 5 determined a significantly lower burden (3350 €).

Need for systematic de-escalation of care in HER2+ breast cancer patients.

e12657 Background: Over the last decade, there has been incredible progress in HER2-positive breast cancer patients with the adoption of targeted therapies like Trastuzumab and Pertuzumab to complement existing chemotherapies. Increasingly neoadjuvant therapy is the preferred method of therapy as it is better able to predict prognosis via pCR as well as guide adjuvant therapeutic strategy in cases with residual tumor. There are now a variety of combination therapies recommended for HER2-positive patients. As new therapies are developed, the standard-of-care shifts towards the regimen with highest pCR rate. The latest regimen being TCHP which produced pCR rates over 60% in clinical trials. While the improvement in pCR rates at a population level is encouraging, there is a growing sentiment among physicians that we may be over treating patients impacting both costs and resulting toxicity. Methods: We performed an analysis of Breast Cancer trials with pCR as the primary end point and stratification available based on HER2+ status. The cost (median insurance reimbursement) was also referenced from a recent ASCO observational study as a proxy for direct costs of drugs. Toxicities were referenced and each regimen scored (TS) from NCCN Evidence Blocks and adverse events from clinical trials. Potential savings were evaluated if a clinician had the ability to individualize regimen choice by patient. We utilized the SimBioSys TumorScope platform to perform in silico simulations to predict response to alternate therapies as it had previously used to analyze potential deescalate between AC-T vs TC in a HER2- cohort. Results: The following regimens were evaluated HP (pCR:17%,TS:1), TH (pCR: 29%,TS: 2) THP (pCR: 46%, TS: 3), TCH (pCR: 43%, TS: 4), TCHP (pCR: 64%, TS: 5), AC-TH (pCR: 43%, TS: 6), AC-THP(pCR: 55%, TS: 7). Based on an in-silico analysis and selection (where pCR was likely with multiple regimens), the lowest cost &amp; toxicity regimen was selected. The estimated average saving per case of over $100,000 for the overall treatment plan . The calculated toxicity score was also reduced by this method to under 4 from the TCHP(5) standard of care. Conclusions: While the results above are estimates and perfection in such individualization may not be possible, an in-silico approach provides a promising solution.

Corporate Governance and Agency Cost: Empirical Evidence from Vietnam

This study examines the impact of corporate governance, reflecting a wide spectrum of board characteristics and ownership structure on agency costs in 281 listed companies on Ho Chi Minh Stock Exchange (HOSE) in Vietnam in the period 2013–2018. For this purpose, three board characteristics were chosen: (1) the size of board of directors, (2) equilibrium between non-executive and executive members of the board of directors, (3) the CEO chair duality and three types of ownership structures were chosen: (1) management ownership, (2) government ownership, (3) foreign ownership. An inverse proxy of agency costs is used: asset utilization ratio (asset turnover), which reflects the managerial efficiency. The research methodology includes three statistical approaches: Ordinary least squares (OLS), fixed effects model (FEM) and random effects model (REM) are considered to employ to address econometric issues and to improve the accuracy of the regression coefficients. The results can create effective corporate governance mechanisms in controlling the managerial opportunistic behavior to lower agency conflicts, and hence lower agency costs.

Permanent inferior vena cava filters offer greater expected patient utility at lower predicted cost

ObjectiveRetrievable inferior vena cava (IVC) filters were first approved for use in the United States in 2003 to address the long-term complications of migration, thrombosis, fracture, and perforation observed with permanent IVC filter implantation. Although Food and Drug Administration approval of retrievable IVC filters includes permanent implantation, the incidence of complications from long-term implantation appears to be greater than that reported with existing permanent IVC filters. Also, only a small fraction of such retrievable IVC filters are ever retrieved. The purpose of the present study was to determine the threshold retrieval rate at which the use of retrievable IVC filters could be justified. MethodsA Markov decision tree was constructed comparing retrievable and permanent IVC filters regarding their effectiveness and cost. A review of the reported data provided outcome probabilities, and the Tufts Medical Center Cost-Effectiveness Analysis Registry was the source of the utility values for the various potential outcomes. Medicare reimbursement rates served as a proxy for costs. A sensitivity analysis was performed for various parameters, primarily to determine the retrieval rate threshold at which the use of retrievable IVC filters would outperform the use of permanent IVC filters. ResultsBase case analysis demonstrated a greater predicted effectiveness for permanent compared with retrievable IVC filter implantation (5.41 quality-adjusted life-years [QALY] vs 5.33 QALY) at a lower cost ($2070 vs $4650). Monte Carlo simulation at 10,000 iterations confirmed the expected utility (5.4 ± 3.0 QALY vs 5.3 ± 3.0 QALY; P = .0002) and cost ($1900 ± $7400 vs $4800 ± 9900; P < .0001) to be statistically superior for permanent IVC filters. A sensitivity analysis for the filter retrieval rate demonstrated that the strategy of using a retrievable IVC filter was never preferable for utility or cost. The superiority of permanent IVC filter placement for effectiveness and cost persisted, regardless of anticipated patient-predicted annual mortality. A two-way sensitivity analysis for both IVC filter removal rate and annual patient mortality confirmed the superiority of permanent IVC filter placement at all levels. ConclusionsThe predicted effectiveness of permanent IVC filters was greater and the predicted cost lower than those for retrievable IVC filters, regardless of the IVC filter retrieval rate. This interpretation of existing reported data using Markov decision analysis modeling supports the argument that unless the long-term complication rate of retrievable IVC filters can be significantly improved, their use should be abandoned in favor of currently available permanent IVC filters.