US Dollars Research Articles

Out-of-pocket payment and catastrophic health expenditure of tuberculosis patients in accessing care at public-private mix clinics in Myanmar, 2022

BackgroundThe financial burden of tuberculosis (TB) can hinder patients and their families, creating obstacles throughout the care cascade, despite TB prevention and control being provided free of charge. In Myanmar, patients can visit private providers operating under public-private mix (PPM) schemes, where TB services (diagnosis and treatment) are typically offered at no cost. The study focused on quantifying the financial burden faced by TB patients seeking care from Myanmar's PPM providers.MethodsThis cross-sectional telephone survey included 695 adults seeking TB treatment [drug-susceptible TB (DS-TB) and retreatment TB] from various private providers in four states and regions with high TB burden in Myanmar. Telephone interviews were conducted in May and June 2022. Both direct and indirect costs incurred from the patient and their household perspective were valued in 2022 and estimated throughout pre- and post-TB treatment episodes. The TB-affected households were defined as experiencing catastrophic health expenditure if their expenditure due to TB exceeded 20% of their capacity to pay, as recommended by the World Health Organization. All cost data were collected in Myanmar Kyats (MMK) and converted to USD (1 USD = 1850 MMK as of July 20, 2022). Logistic regression analysis was done to identify the determinants of catastrophic health expenditure.ResultsThe findings showed patients made a median of 7 times for clinic visits throughout their treatment, with the median total cost for the entire TB treatment being 53.4 US dollars (USD), including direct medical and testing costs (11.9 USD) and direct non-medical patient expenditure (11.6 USD). Pre-treatment costs were higher compared to post-treatment costs (the intensive phase and continuation phase). During the intensive phase, TB care cost was nearly free, but during the continuation phase, it was a median of 2.6 USD. About 34.5% of patients experienced catastrophic health expenditure due to TB treatment, with expenses exceeding 20% of their capacity to pay. Multivariate regression analysis revealed that patients with a history of hospitalization (aOR = 14.84; P < 0.01), seeking care from regions other than Yangon (aOR = 2.6; P < 0.01), and using coping strategies (aOR = 12.53; P < 0.01), were more likely to face catastrophic financial burdens. Higher monthly household income (over 162 USD) was associated with a decreased risk of incurring catastrophic health expenditure (aOR = 0.38; P < 0.01).ConclusionsTB patients and their households in Myanmar faced risk of catastrophic costs, even when treated in the private sector with free diagnostic charges and anti-TB medicine. The study highlighted the need for additional strategies or policies to make TB care affordable and mitigate the financial burden of TB-affected households.Graphical

Analysis of the Fluctuations of ASEAN Currencies Against the US Dollar

At the beginning of 2024, from January to April, there was a downward trend in the rupiah exchange rate against the United States dollar. This downward trend also occurred in various countries in ASEAN. This trend is of course influenced by several factors, both internal and external. This research aims to analyze the internal and external factors that cause this tendency. The data in this research is secondary data and comes from the International Monetary Fund (IMF) at CEIC. This research uses descriptive analytical-qualitative methods. The results of this research show that interest rates, inflation, and net exports in the short term do not have a significant effect on exchange rate movements. However, this depreciation factor trend is more influenced by global geopolitical problems and the size of a country's economy. Geopolitical issues and the size of the economy affect a country's balance of payments (BOP) and foreign exchange reserves, which in turn influence exchange rate movements. Researchers hope that this research can provide new information for the academic community and become material for consideration, suggestions, and input for government authorities who have internal decision-making authority regarding exchange rates.

CroCoDai : A Stablecoin for Cross-Chain Commerce

Decentralized Finance (DeFi), in which digital assets are exchanged without trusted intermediaries, has grown rapidly in value in recent years. Stablecoins , which are pegged to a non-volatile asset such as the US dollar, are a prominent feature of DeFi as they mitigate the risk associated with price fluctuations. However, existing stablecoin systems are tied to individual blockchain platforms, and trusted parties or complex protocols are needed to exchange stablecoin tokens between blockchains. Our goal is to design a practical stablecoin system for cross-chain commerce, and to do so we must overcome two main challenges. The first is to support a large and growing number of blockchains efficiently. The second is for the stablecoin to be resilient to blockchain platform failures and to price fluctuations that affect its collateral. We present CroCoDai to address these challenges. We demonstrate CroCoDai 's efficiency by comparing the performance of a prototype implementation to related baselines, and its resilience through an empirical analysis of historical token price data.

Antihypertensive Medication Adherence and Medical Costs, Health Care Use, and Labor Productivity Among People With Hypertension.

Hypertension affects nearly half of US adults yet remains inadequately controlled in over three-quarters of these cases. This study aimed to assess the association between adherence to antihypertensive medications and total medical costs, health care use, and productivity-related outcomes. We conducted cross-sectional analyses using MarketScan databases, which included individuals aged 18 to 64 years with noncapitated health insurance plans in 2019. Adherence was defined as ≥80% medication possession ratio for prescribed antihypertensive medications. We used a generalized linear model to estimate total medical costs, a negative binomial model to estimate health care use (emergency department visits and inpatient admissions), an exponential hurdle model to estimate productivity-related outcomes (number of sick absences, short-term disability, long-term disability), and a 2-part model to estimate productivity-related costs in 2019 US dollars. All models were adjusted for age, sex, urbanicity, census region, and comorbidities. We reported average marginal effects for outcomes related to antihypertensive medication adherence. Among 379 503 individuals with hypertension in 2019, 54.4% adhered to antihypertensives. Per person, antihypertensive medication adherence was associated with $1441 lower total medical costs, $11 lower sick absence costs, $291 lower short-term disability costs, and $69 lower long-term disability costs. Per 1000 individuals, medication adherence was associated with lower health care use, including 200 fewer emergency department visits and 90 fewer inpatient admissions, and productivity-related outcomes, including 20 fewer sick absence days and 442 fewer short-term disability days. Adherence to antihypertensives was consistently associated with lower total medical costs, reduced health care use, and improved productivity-related outcomes.

Real-World Assessment of Economic and Clinical Outcomes in Thai Patients With Respiratory Syncytial Virus Infection Across Age Groups: A Retrospective Cohort Analysis.

Respiratory syncytial virus (RSV) is an important cause of acute lower respiratory infections worldwide, including Thailand. This study aimed to assess clinical and economic burdens of RSV infections across different age groups in Thailand. A retrospective cohort study was conducted using data from a tertiary care hospital from 2014 to 2021. Patients who tested at least one positive RSV were included and stratified into five age groups (< 2, 2-5, 5-18, 18-65, and > 65 years). Healthcare resource utilization, direct medical costs, and clinical outcomes were analyzed with descriptive statistics. Generalized linear models with gamma distributions and log link were used to model cost outcomes. Costs were reported in 2021 US dollars (USD), with 1 USD = 31.98 Thai Baht. A total of 2122 RSV-positive patients were identified, half of which (1097) were hospitalized. The median (interquartile range [IQR]) total hospitalization costs ranged from USD780 (IQR: USD488-USD1185) in those < 2 years to USD2231 (IQR: USD1250-USD4989) in those aged 65+ years. Case fatality rates among hospitalized patients also varied from 2.5% to 28.4% depending on age. Increased age, presence of comorbidities, and need for critical care were associated with higher hospitalization costs. Among RSV-positive patients, younger children experienced the greatest burden, but poorer outcomes were observed in older adults. Higher costs were associated with older age, comorbidities and critical care needs. Understanding RSV economic burdens is crucial for assessing the cost-effectiveness and public health value of vaccination programs that prioritize at-risk groups to mitigate the public health impact.

Cost-Effectiveness of Total Neoadjuvant Therapy With Selective Nonoperative Management for Locally Advanced Rectal Cancer: Analysis of Data From the Organ Preservation for Rectal Adenocarcinoma Trial.

The clinical efficacy of total neoadjuvant therapy (TNT) followed by selective nonoperative management (NOM) for locally advanced rectal cancer (LARC) was examined in the Organ Preservation for Rectal Adenocarcinoma (OPRA) trial. We investigated the cost and quality-of-life implications of adopting this treatment approach. We analyzed clinical, cost, and quality-of-life outcomes for TNT with selective NOM in comparison with chemoradiotherapy (CRT)-surgery-adjuvant chemotherapy (standard of care [SOC]) using data from OPRA, prospective cohorts, and published studies. Cost-effectiveness was evaluated over varying willingness-to-pay thresholds, and sensitivity analyses evaluated cost-effectiveness for different surgical contexts and SOC variants as well as a 10-year time horizon. SOC was dominated by TNT with selective NOM in the base case analysis. TNT in which CRT was followed by consolidation chemotherapy (CNCT) was the least costly at $89,712 in Medicare proportionate US dollars (MP$), followed by TNT in which induction chemotherapy was followed by CRT (INCT) at MP$90,259 and SOC at MP$98,755. INCT was the preferred strategy, with 4.56 quality-adjusted life years, followed by CNCT at 4.42 and SOC at 4.29. TNT with selective NOM dominated SOC in all sensitivity analyses except when SOC omitted adjuvant chemotherapy without an impact on disease-free survival. CNCT was more cost effective than SOC when the proportion of patients entering NOM after TNT was ≥22% or ≥43%, for SOC with and without adjuvant therapy, both well below the rates seen in OPRA. TNT with selective NOM is cost effective. The cost-effectiveness of CNCT with NOM relative to SOC is dependent on CNCT being made available to a sufficiently large proportion of patients with LARC. Additional analyses are needed to validate these findings from a societal perspective and in the context of other emerging treatment paradigms for LARC.

The Prospects of Controlling Open Burning of Crop Residues in Thailand: A Quantitative Assessment of Implementation Barriers and Costs

The open burning of agricultural crop residues poses a sizable threat to Southeast Asia’s near-term prosperity and long-term sustainability. Though Southeast Asia’s policymakers have adopted burning bans and other solutions to curb this threat, few studies have systematically assessed their implementation prospects. This study offers a novel data-driven assessment of those prospects in Thailand. More concretely, it estimates how much economic, technological, institutional, and social barriers could slow the implementation of burning restrictions featured in Thailand’s PM2.5 control plan. This study finds that institutional/social barriers delay implementation more than technical/economic barriers, resulting in about twice the level of PM2.5 emissions relative to an effectively implemented policy scenario over a 10- to 20-year period. This study also demonstrates that the costs of overcoming social/institutional barriers are approximately 14 million US dollars annually over a ten-year period. This figure is equivalent to about a 70% increase on the 21 million US dollars planned for controlling burning in 2026 in Thailand. The approach employed in this study—though not free of imperfections—can also be used for finer-grained comparison of the barriers/costs of managing different crop residues in Thailand and beyond.

Changes in price, income and e-cigarette affordability for young people in the USA from 2015 to 2021

BackgroundE-cigarette products are the most popular tobacco/nicotine product used among youth and young adults in the USA. While emerging research has shown that e-cigarette taxes increase their price, no study to date has examined e-cigarette tax burdens nor their affordability for youth and young adults.MethodsUsing real (2021 US dollars) prices per mL of e-liquid data from NielsenIQ and annual real (2021 US dollars) personal income data from Integrated Public Use Microdata Series, we calculate relative income prices and examine average annual percentage changes in affordability using Joinpoint trend analysis from 2015 to 2021. In addition, we use tax data to calculate e-cigarette tax burdens as a percentage of price per 1 mL of e-liquid.ResultsIn all states analysed, tax burdens increased from 2015 to 2021. E-cigarette prices decreased considerably from 2019 to 2021; in 2021 the real (2021 US dollars) average price of 1 mL of e-liquid was US$4.45. E-cigarettes on average became more affordable for all age groups and states; however, e-cigarettes tended to be less affordable in states with ad-valorem tax structures. On average, 16–17-year-olds needed 31% of their annual income to purchase 100 mL of e-liquid, whereas 18–19-year-olds, 20–24-year-olds and 25–34-year-olds needed 9%, 3% and 1%, respectively.ConclusionsE-cigarettes have become more affordable for young people, but less so in states with ad-valorem tax structures. Policy efforts should focus on reducing e-cigarette affordability, especially for youth, through tax-induced increases in e-cigarette prices to levels high enough to outpace income growth.

Cost-effectiveness of semaglutide for secondary prevention of cardiovascular disease in the United States

Abstract Background In the SELECT trial, semaglutide produced a 20% reduction in the composite of cardiovascular death, non-fatal myocardial infarction (MI), and non-fatal stroke in individuals with overweight or obesity who did not have diabetes but had established pre-existing cardiovascular disease (CVD). Cost is an important barrier to widespread uptake of semaglutide, particularly in the US, and the cost-effectiveness for the secondary prevention of CVD is uncertain. Purpose To evaluate the cost-effectiveness of semaglutide vs. no obesity treatment for the secondary prevention of CVD from a US healthcare sector perspective. Methods The CVD Policy Model is an established, validated simulation model of fatal and non-fatal CVD outcomes and costs in the US population. Using data from the National Health and Nutrition Examination Survey, we created a nationally representative cohort of SELECT-eligible individuals (age ≥45, BMI ≥27kg/m2, no diabetes, pre-existing CVD). Healthcare costs associated with acute and chronic CVD were estimated from national survey and claims data and inflated to 2023 US dollars. The simulated control arm received usual care; the intervention arm received weekly semaglutide 2.4mg injections (assuming 8% discontinuation, which occurs year one). We reproduced the effectiveness of semaglutide based on results of the SELECT trial primary cardiovascular composite endpoint (non-fatal MI, non-fatal strokes and CVD death). The base case assumed 7% of patients receiving semaglutide developed injection-site reactions. Monthly cost of semaglutide was assumed to be $717 (US price net of rebates and discounts), but this was varied in sensitivity analyses. The analysis adopted a health system perspective over lifetime horizon. Results Approximately 4.7 million US adults would meet SELECT trial eligibility criteria. Over a lifetime horizon, semaglutide is projected to avert 538,000 major adverse cardiovascular events (241,000 nonfatal MIs; 80,000 nonfatal stokes, and 217,000 cardiovascular deaths) at an incremental cost of $613 billion. The incremental cost effectiveness ratio for semaglutide was $443,000 per quality-adjusted life year (QALY) gained. In order to meet cost-effectiveness thresholds of $50,000/QALY, $100,000/QALY, $150,000/QALY, drug costs would have to decline 90%, 79%, and 69% respectively. In sensitivity analyses, lowering drug cost to the current UK price (~ $220 per patient per month) would improve the incremental cost-effectiveness of semaglutide to &amp;lt;$150,000 per QALY gained, a potential upper threshold for cost-effectiveness in the US. Conclusion Widespread uptake of semaglutide in the SELECT-eligible U.S. population would prevent a large number of cardiovascular events, but its use would be low economic value at current US prices. Lowering prices in line with those in Europe (e.g., monthly price from $717 to $223) would make the therapy cost-effective at a threshold of $150,000 per QALY gained.

The Impact of Changes in the RMB Exchange Rate on the Export Competitiveness of China's Textiles and Clothing Industry

In recent years, the export volume of China's textiles and clothing industry and its international market share have increased year by year. Under such circumstances, studying the export status of China's textiles and clothing is conducive to further promoting the development of its textiles and clothing industry. This paper establishes a model based on the annual Revealed Comparative Advantage Index of China's textiles and clothing industry from 2000 to 2021, the nominal exchange rate of RMB against the US dollar, and the annual data of GDP. This paper then tests its stability, and continues to carry out the co-integration test and Granger-Causality under the condition that the data is stable in the same order to judge the relationship between the change of RMB exchange rate and the Revealed Comparative Advantage Index of China's textiles and clothing. Research shows that for every 1% appreciation of the nominal exchange rate of the RMB against the US dollar, the Revealed Comparative Advantage Index of China's textiles and clothing industry will increase by 0.0009647%. The rise of the RMB exchange rate has a certain effect on the RCA of China's textiles and clothing industry, and the results of Granger-Causality also show that the RMB exchange rate is the reason for RCA in China's textiles and clothing industry.

The Broken Promises of Neoliberal Soccer: Illusion and Disillusion of the 2022 FIFA World Cup

The 2022 FIFA World Cup in Qatar attracted over 3.4 million spectators and more than a million international visitors. However, the tournament required a colossal investment of 220 billion US dollars for facilities whose future use remains uncertain. It also highlighted the excesses of neoliberal soccer, dominated by financial interests. Since the World Cup was awarded in December 2010, controversies have emerged, particularly regarding the working conditions of migrant workers, which have led to several thousand deaths. There have been widespread denunciations of labor and civil rights violations, and the banning of the “One Love” armband has illustrated FIFA’s censorship. Environmental criticisms were also significant, questioning the event’s claimed carbon neutrality. Extravagant spending on stadium construction and hotel infrastructures, often seen as unnecessary luxury after the tournament, has been highlighted. Qatar has not fulfilled its promises to dismantle and repurpose the stadiums, which remain underused. The 2022 FIFA World Cup exposed the tensions between sporting values and economic realities and underscored the need for a thorough analysis of the long-term impact of mega-sporting events.

The Health and Economic Benefits of United States Investments in Measles and Rubella Control and Elimination

Background: Prior to measles vaccine introduction in 1963, measles virus caused hundreds of thousands of annual reported cases, which led to substantial US morbidity, mortality, and costs. Similarly, congenital rubella syndrome (CRS) led to highly visible and tragic lifelong disability for thousands of Americans, before rubella vaccine introduction in 1969. The US certified national virus transmission elimination of indigenous measles in 2000 and rubella in 2004. Methods: Applying an existing integrated transmission and economic model, this analysis characterizes the net benefits of US investments in measles (1963–2030) and rubella (1969–2030) immunization assuming continued high routine immunization coverage. Due to importation risks, the US maintains two doses of both vaccines in its routine immunization schedule. Results: This analysis estimates total US costs of 8.1 billion (economics reported in 2023 US dollars) for measles immunization for 1963–2023 and 14.1 billion for rubella immunization for 1969–2023. The analysis estimates an additional approximately 1.2 billion for measles immunization and 1.5 billion for rubella immunization expected for 2024–2030. Historical and future US investments prevented an estimated approximately 237 million measles infections, 228,000 measles deaths, 193 million rubella infections, and 166,000 CRS cases. These investments imply net benefits (from avoided treatment costs minus immunization costs) of approximately 310 billion for measles and 430 billion for rubella and CRS, even without incorporating avoided productivity losses and intangible costs. Conclusions: US investments in measles and rubella immunization continue to provide enormous savings of human and financial costs and to prevent substantial mortality and morbidity.

Social Determinants of Health and US Health Care Expenditures by Insurer

US health expenditures have been growing at an unsustainable rate, while health inequities and poor outcomes persist. Targeting social determinants of health (SDOH) may contribute to identifying and controlling health care expenditures. To determine whether SDOH are associated with US health care expenditures by Medicare, Medicaid, and private insurers. Cross-sectional study of adults, representing the US civilian, noninstitutionalized population with Medicare, Medicaid, or private coverage, from the 2021 Medical Expenditure Panel SDOH Survey. Data analysis was conducted from October 2023 to April 2024. SDOH as individual-level, health-related social needs categorized by Healthy People 2030 domains: (1) educational access and quality, (2) health care access and quality, (3) neighborhood and built environment,(4) economic stability, and (5) social and community context. The primary outcome was health care expenditures (US dollars) by Medicare, Medicaid, and private insurers. A 2-part econometric model (probit regression model and generalized linear model with gamma distribution) was used. Among the 14 918 insured adults in the analytic sample (mean [SD] age, 52.5 [17.9] years; 8471 female [56.8%]), the majority had middle to high family income (10 524 participants [70.5%]) and were privately insured (10 227 participants [68.5%]). Annual median (IQR) expenditure was $1648 ($389-$7126) for Medicaid, $3643 ($1321-$10 519) for Medicare, and $1369 ($456-$4078) for private insurers. Educational attainment and social isolation were associated with Medicaid expenditures. Medicaid beneficiaries with a high school diploma or general educational development certificate had on average (mean difference) $2245.39 lower annual Medicaid expenditures (95% CI, -$3700.97 to -$789.80) compared with beneficiaries with less than high school attainment. Compared with those who never felt isolated, Medicaid beneficiaries who often felt isolated had on average $2706.94 (95% CI, $1339.06-$4074.82) higher annual Medicaid expenditures. Health care access, built environment, and economic stability were associated with Medicare expenditures. Medicare beneficiaries living in neighborhoods with lower availability of parks had on average $5959.27 (95% CI, $1679.99 to $10 238.55) higher annual Medicare expenditures. Medicare beneficiaries who were very confident in covering unexpected expenses had on average $3743.98 lower annual Medicare expenditures (95% CI, -$6500.68 to -$987.28) compared with those who were not confident. Medical discrimination and economic stability were associated with private expenditures. Private insurance beneficiaries who experienced medical discrimination had on average $2599.93 (95% CI, $863.71-$4336.15) higher annual private expenditures compared with those who did not. Private beneficiaries who were contacted by debt collections in the past year had on average $2033.34 (95% CI, $896.82 to $3169.86) higher annual private expenditures compared with those who were not contacted. In this cross-sectional study of 14 918 insured adults, individual-level SDOH were significantly associated with US health care expenditures by Medicare, Medicaid, and private insurers. These findings may inform health insurers and policymakers to incorporate SDOH in their decision-making practices to identify and control health care expenditures, advancing health equity.

Free surgery for CHD through philanthropy—a sustainable model?

AbstractAmong the multiple challenges faced by children from low- and middle-income countries (LMICs) with congenital heart disease (CHD), the economics of care remains foremost, contributing significantly to morbidity and mortality. This paper evaluates the four existing finance models available for healthcare systems and proposes a new model—the GIVE model (government, institutions and individuals, values, and engagements)—as the fifth model for global sustainable healthcare systems. The paper presents an evaluation of a chain of three paediatric cardiac hospitals in India to assess the sustainability of their philanthropy-based operational model, through which surgeries are offered completely free of cost to children with CHD. The three Sri Sathya Sai Sanjeevani Centres for Child Heart Care in India have been proponents of this philanthropic model for over a decade. From February 2013 to January 2024, 19,684 patients with CHD received surgeries at no cost. The average cost of surgery was reported to be USD (United States Dollar) 1800. A case study of one of the Sanjeevani Centres showed that 23.8% of patients were in STAT Category 3 and above, as defined by the Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery, with an in-hospital mortality rate of 2.08%. The evaluation highlighted the institution’s numerous strategies to enable sustainability in key aspects of operations, economics, and social impact. Despite challenges, the Sai Sanjeevani philanthropic model, which encompasses both economic and social impact, is dependable and can be replicated. The proposed GIVE model is recommended for adoption by LMICs as a global way forward to enable free CHD surgeries through sustained philanthropy, strengthened by a shared vision and collaborations.

Financial and market risks of bitcoin adoption as legal tender: evidence from El Salvador

Bitcoin adoption as a legal tender threatens a financial crisis because of the lack of regulatory frameworks and systems for exchanging Bitcoin into local currencies. This study analyzes monthly data from 2010 to 2022 using a structural vector autoregressive model, estimating Bitcoin’s pass-through into remittance, money multiplier, the US Dollar index, and gold price. The results show that Bitcoin prices decrease the money multiplier and gold prices in both the short and long run, while remittances moderately increase in the long run. The implication of these results suggests the potential for international business opportunities to stimulate the credit, savings, and investment monetary policy channel. The results are robust to alternative SVAR identification strategies.

Does US Dollar Supply Trigger House Price Fluctuations? An International Comparison

Cyclical fluctuations in asset prices are closely related to the overall stability of the macroeconomy and have thus become a significant topic in academic and professional exploration. Among these fluctuations, changes in the supply of the U.S. dollar, the global reserve, and primary settlement currency have a broad and far-reaching impact on international financial markets. Since COVID-19, asset prices across various countries have shown differing trends due to fluctuations in the U.S. dollar supply. Housing prices, a key focus in asset pricing research, have been affected to varying degrees. This thesis utilizes seven house price indices from representative cities worldwide from 2020 to 2023 to compare the differential impacts across various countries using an empirical approach. The results indicate that the impact of the U.S. dollar money supply (M2) diminishes in a gradient from the U.S. to East Asia, and then to Europe.

Patient and provider costs of the new BPaL regimen for drug-resistant tuberculosis treatment in South Africa: A cost-effectiveness analysis.

Drug-resistant (DR) tuberculosis (TB) is typically characterized by resistance to a single or combination of first- and/or second-line anti-TB agents and commonly includes rifampicin-resistant (RR)-TB, multidrug-resistant (MDR)-TB, pre-extensively drug-resistant (pre-XDR)-TB and XDR-TB. Historically, all variations of DR-TB required treatment with second-line drugs which are less effective and more toxic than first-line options, have a longer treatment duration and are more expensive to both patients and providers. The World Health Organization (WHO) now recommends a new second-line 3-drug 6-month all-oral regimen consisting of bedaquiline, pretomanid, and linezolid referred to as BPaL. We estimate patient and provider costs of DR-TB treatment with BPaL compared to the current standard of care in South Africa. In coordination with South Africa's BPaL clinical access programme (CAP) we conducted an economic evaluation of A) patient costs through a cross-sectional patient cost survey and B) provider costs through a bottom-up costing analysis consisting of a retrospective medical record review (patient resource-use) and top-down financial record review (fixed/shared costs such as overhead). Across both costing perspectives, we compare costs of 1) BPaL, to current standard of care options including the 2) 9-11-month standard short oral regimen (SSOR) and 3) 18-21-month standard long oral regimen (SLOR). Eligible patients included those ≥14 years old with confirmed sputum pulmonary RR/MDR-TB, pre-XDR or XDR-TB. All costs are reported in 2022 United States Dollar (US$). A total of 72 patients were enrolled and completed the patient cost survey (41.7% on BPaL, 16.7% on the SSOR and 41.7% on the SLOR). Mean on-treatment patient costs were lowest among those on BPaL ($56.6) and increased four-fold among those on the SSOR ($228.1) and SLOR ($224.7). Direct medical patient costs were negligible across all treatment regimens, while direct non-medical patient and guardian costs for travel, food and nutritional supplementation accounted for the largest proportion of total costs ($54.6, $227.8 and $224.3 for BPaL, the SSOR and SLOR respectively). In assessing provider costs, a total of 112 medical records were reviewed (37.5%, 41.1% and 21.4% on BPaL, the SSOR and SLOR respectively). Total provider costs for producing a favorable treatment outcome (cured/completed treatment) were similar among those on BPaL ($4,948.7 per patient) and the SSOR ($4,905.6 per patient) with costs increasing substantially among those on the SLOR ($8,919.9 per patient). Based on incremental cost-effectiveness ratios (ICERs), at even the lowest willingness to pay (WTP) threshold, treatment with the new BPaL regimen was more cost-effective than current standard of care treatment options (ICER: $311.4 < WTP: $3,341). When using the newly recommended BPaL regimen, cost to patients decreased by 75% compared to current standard of care treatment options in South Africa. Due in part to higher resource-use within the BPaL CAP offsetting the shorter treatment duration, cost of treatment provision through BPaL and the 9-11-month SSOR were similar. However, when considering cost and treatment outcomes, BPaL was more cost-effective than other standard of care regimens currently available for DR-TB in South Africa.

Analysis in Decision Making for XAUUSD (Gold/USD) Pair Transactions in Futures Trading

Nowadays, many trading instruments, such as XAU/USD commodity futures trading, a label for spot gold traded in the foreign exchange market, are offered. Gold (XAU) is traded against the US dollar (USD), and its price represents the cost of one ounce of gold in USD. XAU/USD is traded like any other traditional currency in the forex market. This study explores how fundamental and technical analysis can be used as a basis for better decision-making in gold futures trading. The research method used is qualitative, with a descriptive analysis approach based on secondary data in the market. So, in the summary of the analysis results, it is found that fundamental and technical analysis is a tool used for decision-making in gold transactions and futures trading. Decision-making in gold transactions in futures trading should be based on fundamental and technical analysis at a minimum. Decision-making based solely on the results of one analysis alone can be fatal. Various sources of fundamental and technical analysis tools can be used as a decision-making tool in gold and futures trading.

Food-fuel nexus beyond mean-variance: New evidence from a quantile approach

This paper investigates the dynamic relationship between crude oil, ethanol, and corn markets across various quantiles of return distributions, as well as at higher statistical moments. Using a quantile vector autoregression model and data from 2007 to 2022, we find that the cross-market linkages are quantile dependent, with the strongest connections observed in the tails of the distribution. A shock to the oil market significantly impacts ethanol and corn returns under extreme bearish and bullish conditions. Positive shocks to the corn market reduce ethanol returns when the ethanol market is highly bullish, but this effect becomes positive in the left tail of the distribution. We also identify significant co-movement in higher statistical moments between these markets. Extreme excess kurtosis in the food-fuel nexus is more likely to occur with high financial market uncertainty, a bullish stock market, contracting industrial production, and a strong US dollar. In addition to these variables, credit spreads, futures market liquidity, futures term structure, and hedging pressure also influence kurtosis in individual markets within the nexus.

Pengaruh Faktor-Faktor Ekonomi Makro terhadap Jakarta Islamic Index (JII) Periode 2010-2019

This study aims to determine and analyze the influence of macroeconomic factors such as Gross Domestic Product (GDP), Inflation Rate, SBI Interest Rate, Rupiah / US Dollar exchange rate on the JII (Jakarta Islamic Index) Stock Price Index on the Indonesia Stock Exchange for the period 2010-2019. This study uses an associative quantitative approach which is intended to examine the relationship and influence between macroeconomic factors variables on the JII stock price index variable. Meanwhile, the analysis method used is multiple linear regression. The results of this study indicate that only the rupiah/US dollar exchange rate has a significant negative effect on the JII stock price index. While macroeconomic factors such as Gross Domestic Product, Inflation Rate, SBI Interest Rate have no significant effect on the JII stock price index.