Rate Of Change In Costs Research Articles

Randomised trial of general practitioner online education for prescribing and test ordering

IntroductionPotentially inappropriate medicine prescriptions and low-value diagnostic testing pose risks to patient safety and increases in health system costs. The aim of the Clinical and Healthcare Improvement through My Health...

The Use and Costs of Paid and Unpaid Care for People with Dementia: Longitudinal Findings from the IDEAL Cohort.

The drivers of costs of care for people with dementia are not well understood and little is known on the costs of care for those with rarer dementias. To characterize use and costs of paid and unpaid care over time in a cohort of people with dementia living in Britain. To explore the relationship between cohort members' demographic and clinical characteristics and service costs. We calculated costs of health and social services, unpaid care, and out-of-pocket expenditure for people with mild-to-moderate dementia participating in three waves of the IDEAL cohort (2014-2018). Latent growth curve modelling investigated associations between participants' baseline sociodemographic and diagnostic characteristics and mean weekly service costs. Data were available on use of paid and unpaid care by 1,537 community-dwelling participants with dementia at Wave 1, 1,199 at Wave 2, and 910 at Wave 3. In models of paid service costs, being female was associated with lower baseline costs and living alone was associated with higher baseline costs. Dementia subtype and caregiver status were associated with variations in baseline costs and the rate of change in costs, which was additionally influenced by age. Lewy body and Parkinson's disease dementias were associated with higher service costs at the outset, and Lewy body and frontotemporal dementias with more steeply increasing costs overall, than Alzheimer's disease. Planners of dementia services should consider the needs of people with these relatively rare dementia subtypes as they may require more resources than people with more prevalent subtypes.

A National Analysis of Temporal Changes in Prescribing of Testosterone Replacement Therapy Considering Methods of Delivery and Government Regulation.

PurposeTestosterone replacement therapy (TRT) is commonly used for various causes of androgen deficiency and subsidized by the Pharmaceutical Benefits Scheme (PBS) in Australia when appropriate. In response to a sharp increase in the prescribing of subsidized TRT, the Australian government instituted new, stricter prescription criteria in April 2015. We aim to demonstrate longitudinal changes in the prescription patterns of subsidized TRT over time.Materials and MethodsThe publicly available PBS database was accessed for TRT prescription data between 1992–2018. Population estimate data was collected from the Australian Bureau of Statistics for population-adjustment. Data analysis was performed according to class and specific formulation of TRT. Total and population-adjusted trends were considered, as was indexation to 2015 when restrictions were implemented.ResultsLongitudinal trends in subsidized TRT prescription demonstrated a progressive overall increase since 2000, according to total prescriptions and population-adjusted estimates, with greater use of topical formulations (gel, patch, cream/spray) and injections. Since 2015, a 37% decline in total population-adjusted prescriptions was observed (1,399–883 per 100,000 persons). Since 2015, relatively increased use of injections (50%) and 1% gel (30%) comprise the majority of contemporary TRT. Annual financial burden due to TRT was $AU16,768 per 100,000 persons prior to 2000 (mean cost 1992–2000), increasing to $AU112,539 in 2018 (due to use of injections). The rate of change in costs slowed after the restrictions were introduced in 2015.ConclusionsThe restrictions in subsidized TRT eligibility enforced by the PBS have reduced overall TRT prescriptions and slowed the cumulative financial burden.

Has the robot caught up? National trends in utilization, perioperative outcomes, and cost for open, laparoscopic, and robotic pediatric pyeloplasty in the United States from 2003 to 2015

Since 2010, there have been few new data comparing perioperative outcomes and cost between open (OP) and robotic pyeloplasty (RP). In a post-adoption era, the value of RP may be converging with that of OP. To 1) characterize national trends in pyeloplasty utilization through 2015, 2) compare adjusted outcomes and median costs between OP and RP, and 3) determine the primary cost drivers for each procedure. We performed a retrospective cohort study using the Premier database, which provides a nationally representative sample of U.S. hospitalizations between 2003 and 2015. ICD9 codes and itemized billing were used to abstract our cohorts. Trends in utilization and cost were calculated and then stratified by age. We used propensity scores to weight our cohorts and then applied regression models to measure differences in the probability of prolonged operative time (pOT), prolonged length of stay (pLOS), complications, and cost. During the study period 11,899 pyeloplasties were performed: 75% open, 10% laparoscopic, and 15% robotic. The total number of pyeloplasty cases decreased by 7% annually; OP decreased by a rate of 10% while RP grew by 29% annually. In 2015, RP accounted for 40% of cases. The largest growth in RPs was among children and adolescents. The average annual rate of change in cost for RP and OP was near stagnant: -0.5% for open and -0.2% for robotic. The summary table provides results from our regression analyses. RP conferred an increased likelihood of pOT, but a reduced likelihood of pLOS. The odds of complications were equivalent. RP was associated with a significantly higher median cost, but the absolute difference per case was $1060. Despite advantages in room and board costs for RP, we found that the cost of equipment and OR time continue to make it more expensive. Although the absolute difference may be nominal, we likely underestimate the true cost because we did not capture amortization, hidden or down-stream costs. In addition, we did not measure patient satisfaction and pain control, which may provide the non-monetary data needed for comparative value. Despite an overall decline in pyeloplasties, RP utilization continues to increase. There has been little change in cost over time, and RP remains more expensive because of equipment and OR costs. The robotic approach confers a reduced likelihood of pLOS, but an increased likelihood of pOT. Complication rates are low and similar in each cohort.

Management Forecasts in Japan: Do Managers Accurately Estimate Costs When They Issue Management Forecasts?

Virtually all firms listed on Japanese stock exchanges report point forecasts of sales and earnings in their annual press releases. The availability of management forecasts in Japan provides a unique research opportunity to investigate managers’ prediction of cost behavior of their company. Forecasted costs are available by subtracting forecasted earnings from forecasted sales. Using recent “sticky cost” research methods, the forecasted rate of change in costs can be compared with the actual rate of change in costs. Specifically, I describe the forecasted rate of change in costs as a function of the forecasted rate of change in sales, and comparing the forecasted rate of change in costs with the actual rate of change in costs. The rationale for this approach is, in theory, that costs are resources sacrificed to generate sales; hence, it is generally expected that costs increase (decrease) as sales increase (decrease). Basically, focusing on the relationship between forecasted sales and costs provide deeper insights into management earnings forecasts than focusing on the forecasted earnings because earnings are the aggregated measure of sales and costs. The major findings of this paper are that managers underestimate the rate of increase in costs when sales are expected to increase; however, they tend to overestimate the rate of decrease in costs when sales are expected to decrease, indicating that costs are underestimated regardless of the forecasted direction of change in sales. These findings imply that optimistic bias in management earnings forecasts can partly be attributed to the forecast error of rate of change in costs.

Optimization modeling of plant root architecture for water and phosphorus acquisition

An optimization model is presented that examines the relationship between root architecture and multiple resource acquisition, specifically water and phosphorus in spatially heterogeneous environments. The basal root growth angle of an individual common bean plant, which determines the orientation and localization of the bulk of the root system, was modeled as the decision variable. The total payoff to the plant, the benefit obtained from water and phosphorus acquisition, minus the costs of spatial competition between roots, is given as a function of the ( x, y) coordinates of the basal root in two-dimensional Cartesian space. We obtained a general solution and applied it to four unique environmental cases which are as follows: (1) the case of uniformly distributed water and phosphorus; (2) the case of localized shallow phosphorus; (3) the case of localized deep water; and (4) the case of shallow phosphorus and deep water. The general solution states that the optimal basal root growth angle will occur at the point where the total rate of change in the value of the resources acquired equals the total rate of change in cost that results from locating the root deeper in the soil. An optimizing plant locates its roots deeper in the soil profile until the marginal benefit exactly equals the marginal cost. The model predicts that the basal root angle of an optimizing plant will be shallower for Case 2 and deeper for Case 3, relative to the basal root angle obtained in the case of uniformly distributed water and phosphorus. The optimal basal root angle for Case 4 will depend on the marginal rate of substitution of water availability for phosphorus availability that occurs with depth. Empirical observations of bean root architecture in the greenhouse and in the field confirm model results and are discussed. In addition, the potential importance of phenotypic plasticity and phenotypic variation are discussed in relation to optimization of traits and adaptation to spatially heterogeneous environments.

Variety and niche creation in aircraft, helicopters, motorcycles and microcomputers

Evolutionary theories of economic development stress the role of variety as both a determinant and a result of growth. Our empirical understanding of the role of variety, however, is still limited. We propose two variety measures, one based on entropy and one based on Weitzman's maximum likelihood procedure. It is argued that the two measures are complementary since they highlight different aspects of variety. Entropy is based on frequencies and indicates the statistical variety, while Weitzman's measure is based on the distance between products, and indicates the degree and structure of differentiation of a population. We apply the measures to product characteristics of four technologies (aircraft, helicopters, motorcycles, and microcomputers). The results on the three transport technologies show classic evolutionary specialisation patterns that can be understood on the basis of niche theory. In these cases, the changes in variety are related to changes the scope of services a technology can deliver analogous to the size of a habitat of a biological species. The results on microcomputers call for another explanation, since we found that variety decreased while the scope of services increased rapidly. In this case, the rapid fall in costs per unit service decreased so rapidly that the lower end of the market continuously disappears when the higher end of the market is extended. The results on microcomputers call for extending niche theory including the rate of change in costs.

Cost-of-Research Index, 1920–1970

The current study brings up through 1970 the cost-of-research index that was published in Operations Research 14, 977–991 (1966). This paper points out various economic aspects and effects of the R&D fluctuations between 1965 and 1970 within the framework of the index pattern for the twenty-year period 1950–1970. The objective of the index is to provide a measure of (l) the change in the cost of a technical man-year of research in the US, and (2) the change in the amount of research and development (R&D) effort in terms of technical man-years of effort applied to it as derived from total dollars spent on R&D. The index is a tool to be utilized in determining the rate of change in costs per technical man-year in R&D and for use in R&D planning and budgeting.