scholarly journals MO486INSIDE CKD: MODELLING THE IMPACT OF IMPROVED SCREENING FOR CHRONIC KIDNEY DISEASE IN THE AMERICAS AND ASIA-PACIFIC REGION

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Juan Jose Garcia Sanchez ◽  
Alyshah Abdul Sultan ◽  
Marcelo Costa Batista ◽  
Claudia Cabrera ◽  
Joshua Card-Gowers ◽  
...  
Keyword(s):  
Primary Care ◽  
Healthcare Costs ◽  
Asia Pacific ◽  
Pacific Region ◽  
Current Clinical Practice ◽  
Microsimulation Model ◽  
Asia Pacific Region ◽  
Routine Measurement ◽  
The Us ◽  
Country Specific

Abstract Background and Aims With an estimated global prevalence of 10%, chronic kidney disease (CKD) and its associated complications place a substantial strain on healthcare systems worldwide, which is compounded by the burden of undiagnosed CKD. Early CKD diagnosis followed by guideline-recommended interventions can improve patient outcomes and reduce associated healthcare-related costs, particularly by delaying or preventing the development of complications and progression to kidney failure. Urinary albumin-to-creatinine ratio (UACR) can be used to screen for CKD, but adherence to screening recommendations is suboptimal in routine care. Inside CKD aims to model the global clinical and economic burden of CKD using country-specific, patient-level microsimulation models. We used the Inside CKD microsimulation to model the potential clinical and economic impacts of routine measurement of UACR followed by appropriate intervention in patients aged 45 years and over in the US and Canada. Method The Inside CKD microsimulation model was used to model the clinical and economic impacts associated with measurement of UACR with subsequent appropriate intervention during routine primary care visits versus current practice in individuals aged 45 years and over. The model covers the period 2020–2025. In preliminary analyses, virtual populations representing the general populations of the US and Canada were constructed using published country-specific data, including demographics, prevalence of CKD and comorbidities (type 2 diabetes, uncontrolled hypertension and heart failure), incidence of complications (heart failure, myocardial infarction, stroke and acute kidney injury) and costs associated with CKD. The model also included parameters relating to the proportion of patients who visit a primary care physician at least once a year, the proportion of patients who agreed to UACR measurements, and the diagnostic sensitivity and specificity of UACR measurements. The modelling is being expanded to additional countries in the Americas and the Asia-Pacific region. Results Preliminary results from the US and Canada show that over the 2020–2025 period routine measurement of UACR during primary care visits followed by appropriate intervention could prevent progression to CKD stages 3b–5 in approximately 1.3M patients in the US and 160 000 in Canada, compared with current clinical practice, with linear increases in the cumulative numbers of prevented cases (Figure). Associated savings in healthcare costs in 2025 are projected to be approximately US$16B in the US and C$2.5B in Canada, corresponding to a reduction in cost for that year of 4.4% and 7.4%, respectively, compared with current clinical practice. Conclusion Preliminary results from the Inside CKD microsimulation model in the US and Canada show that routine measurement of UACR with subsequent intervention in primary care would prevent progression to CKD stages 3b–5 in a substantial number of patients compared with current screening practices, and could therefore decrease associated healthcare costs considerably. This analysis is being extended to further countries in the Americas and the Asia-Pacific region.

MO518INSIDE CKD: MODELLING THE ECONOMIC BURDEN OF CHRONIC KIDNEY DISEASE IN THE AMERICAS AND THE ASIA-PACIFIC REGION USING PATIENT-LEVEL MICROSIMULATION

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Alyshah Abdul Sultan ◽  
Marcelo Costa Batista ◽  
Claudia Cabrera ◽  
Joshua Card-Gowers ◽  
Steven Chadban ◽  
...  
Keyword(s):  
Economic Burden ◽  
Healthcare Costs ◽  
Fold Increase ◽  
Relative Increase ◽  
Asia Pacific ◽  
Pacific Region ◽  
Asia Pacific Region ◽  
Absolute Increase ◽  
Ckd Stage ◽  
The Us

Abstract Background and Aims Chronic kidney disease (CKD) is a debilitating and costly condition, with an estimated global prevalence of approximately 10%. Progression of CKD is associated with end-stage renal disease, cardiovascular events and premature mortality, as well as increased requirement for renal replacement therapies (RRTs), which are associated with significant healthcare costs and resource use. Furthermore, patients with CKD often have additional comorbidities, which are associated with CKD progression and increased costs. The trajectories of CKD prevalence, progression, outcomes and the related costs are therefore critical considerations for public health and policy planning. Using country-specific, patient-level microsimulation, Inside CKD aims to model the global clinical and economic burden of CKD from 2020 to 2025. Method We used the Inside CKD microsimulation to model the economic burden of CKD in the Americas and Asia-Pacific region. We developed a virtual general population for each country using national survey data and relevant data from published literature. Data inputs included country demographics, the prevalence of CKD and RRT, comorbidities and complication rates as well as associated healthcare costs. CKD stages were defined according to Kidney Disease Improving Global Outcomes (KDIGO) 2012 recommendations and patients were categorized according to estimated glomerular filtration rate and albuminuria status. We calibrated the RRT modelling against historical trends from country-specific renal registries. We conducted model validation and calibration using established methods for health economic modelling. Here, we report the results from the US and Canada analyses, with further analyses currently underway for additional countries in the Americas and Asia-Pacific region. Results Initial results for the US and Canada revealed that, between 2020 and 2025, annual healthcare costs associated with CKD will increase linearly from US$232.3B to US$376.2B in the US and from C$21.4B to C$34.1B in Canada (this figure does not include complication costs). In the US, the largest absolute increase in cost was observed in CKD stage 3a ($98.4B); however, CKD stage 4 had the largest relative increase in cost with an approximately three-fold increase (US$7.30B to US$23.3B). In Canada, the largest absolute increase in cost was observed in CKD stage 3a (C$5.84B); whereas CKD stage 5 had the largest relative increase in cost with an approximately five-fold increase (C$0.27B to C$1.41B). By 2025, costs associated with CKD will increase across all age categories (18–34, 35–64 and 65+ years) in both countries. In the US, the 35–64 age group had the largest absolute increase in costs with an increase of $74B (US$58.3B to US$132B). The largest relative increase in cost was observed in the 18–34 age category, with approximately a three-fold increase in costs (US$3.76B to US$10.2B). In Canada, the 65+ age group had the largest absolute increase in costs with an increase of C$7.9B (C$16.4B to C$24.3B). Both the 18–34 and 35–64 age categories had the largest relative increase in costs, with an approximately two-fold increase (C$0.25B to C$0.49B and C$4.77B to C$9.31B, respectively). Conclusion Initial results from Inside CKD demonstrate that CKD poses a significant economic burden over the next 5 years. CKD stage 3a was associated with the most pronounced cost increases in both the US and Canada, likely due to the increased prevalence of this stage. In the US, the largest increase in CKD costs was observed in the 35–64-year-old ‘working’ population, whereas the largest increase in Canada was observed in the 65 years old and over population. Further policy interventions aimed at early diagnosis and proactive management should be considered to slow disease progression, improve patient outcomes and reduce the economic burden associated with CKD.

US INDO-PACIFIC STRATEGY AND EURASIA

2021 ◽  
pp. 135-153
Author(s):  
Vladimir Batyuk
Keyword(s):  
American Foreign Policy ◽  
The Philippines ◽  
Asia Pacific ◽  
Pacific Region ◽  
Middle Kingdom ◽  
Asia Pacific Region ◽  
American President ◽  
National Security Strategy ◽  
The Us ◽  
The Indian Ocean

Despite the critical attitude of the current American President towards his predecessor, the Trump administration actually continued the course of the Obama administration to turn the Asia-Pacific region into the most important priority of American foreign policy. Moreover, the US Asia-Pacific strategy was transformed under Trump into the Indo-Pacific strategy, when the Indian Ocean was added to the Asia-Pacific region in the US strategic thinking. The US Pacific command was renamed the Indo-Pacific command (May 2018), and the US Department of defense developed the Indo-Pacific strategy (published in June 2019). The Indo-Pacific strategy is an integral part of Trump’s national security strategy, according to which China, along with Russia, was declared US adversary. The American side complained about both the economic and military-political aspects of the Chinese presence in the Indo-Pacific region. At the same time, official Washington is no longer confident that it can cope with those adversaries, China and Russia, alone. Trying to implement the main provisions of the Indo-Pacific strategy, official Washington has staked not only on building up its military power in the Indo-Pacific, but also on trying to build an anti-Chinese system of alliances in this huge region. Along with such traditional American allies in the region as Japan, South Korea, Taiwan, Thailand, the Philippines and Singapore, the American side in the recent years has made active attempts to attract India, Indonesia, Malaysia and Vietnam to this system of alliances as well. These American attempts, however, can only cause serious concerns not only in Beijing, but also in Moscow, thereby contributing to the mutual rapprochement of the Russian Federation and China. Meanwhile, the Russian-Chinese tandem is able to devalue American efforts to strategically encircle China, creating a strong Eurasian rear for the Middle Kingdom.

American Mistakes

2020 ◽  
pp. 34-58
Author(s):  
Feng Zhang ◽  
Richard Ned Lebow
Keyword(s):  
Asia Pacific ◽  
Pacific Region ◽  
Regional Strategy ◽  
Management Issue ◽  
Asia Pacific Region ◽  
Obama Administration ◽  
The Us ◽  
Made In

This chapter examines the policy mistakes that the Obama administration made in managing the Sino-American relationship. The Obama administration developed no distinct China strategy and was in fact averse to developing such a strategy. It chose to embed largely reactive China policies within a regional strategy of the so-called “pivot” or “rebalance” to the Asia-Pacific region. While China was relegated to a management issue, the rebalance strategy damaged the US-China relationship by deepening strategic mistrust between the two countries and agitating China to seek strategic adventures in Asia. The rebalance did not cause Chinese assertiveness by itself, but the geopolitical setting it created served to exacerbate China’s already fermenting assertive inclinations and prompted its strategic adventurism.

The impact of the US economy on the Asia-Pacific region: does it matter?

2003 ◽  
Vol 14 (2) ◽  
pp. 219-241 ◽  
Author(s):  
Frank S.T Hsiao ◽  
Mei-chu W Hsiao ◽  
Akio Yamashita
Keyword(s):  
Asia Pacific ◽  
Pacific Region ◽  
Asia Pacific Region ◽  
Us Economy ◽  
The Us ◽  
The Impact

scholarly journals United States-Vietnam relations in light of geopolitics of the usa in Asia-Pacific region in 1945-1975

2020 ◽  
Vol 10 (27) ◽  
pp. 96-106
Author(s):  
Ivan Desiatnikov ◽  
Keyword(s):  
United States ◽  
Soviet Union ◽  
Vietnam War ◽  
The United States ◽  
Asia Pacific ◽  
Pacific Region ◽  
Asia Pacific Region ◽  
The Soviet Union ◽  
The Us ◽  
The Republic

The article focuses on the analysis of US-Vietnam relations during the period from 1945 to 1975. The aim of the article is to trace the changes that took place in the US-Vietnam relationship over that period, to identify the factors that influenced them, as well as the approaches used by the heads of the countries to tackle their foreign policy objectives in the region. The author traces the evolution of US policy in Vietnam pursued by Presidents H. Truman, D. Eisenhower, J. Kennedy, L. Johnson and R. Nixon. The United States had diametrically opposed position on relations with the Vietnamese governments, namely, confrontation and military conflict with the Democratic Republic of Vietnam, and cooperation, military and economic aid to the Republic of Vietnam. The author concludes that the US attitude towards Vietnam was determined by the international situation at that time, including the beginning of the Cold War. The policies of Presidents D. Eisenhower and J. Kennedy were to restrain the expansion of the Communist bloc's sphere of influence. The direct involvement of the US military in the Vietnam conflict, initiated by L. Johnson, pursued the goal of enhancing the prestige of the United States in the global confrontation with the USSR. The split between the Soviet Union and China was used by the US to get out of the Vietnam War and mend relations with China as a counterweight to the Soviet Union in the Asia-Pacific region. Instead, the Republic of Vietnam, which had been the "junior partner" of the United States, was left to its fate.

Redefining Security Roles: Japan's Response to the September 11 Terrorism

2002 ◽  
Vol 2 (1) ◽  
pp. 285-305 ◽  
Author(s):  
Go Ito
Keyword(s):  
Security Policy ◽  
Use Of Force ◽  
September 11 ◽  
Asia Pacific ◽  
Pacific Region ◽  
Regional Politics ◽  
Asia Pacific Region ◽  
The Us ◽  
The Government ◽  
Security Relationship

This paper examines Japan's security policy after the September 11 terrorism, arguing that its response has been part of a larger process of redefining its security role in the Asia-Pacific region for the last decade. The passage of the 1992 Peacekeeping Law and the 1999 US-Japan security guidelines were an important part of the drastic changes. The paper also discusses the Japanese government's response to the September 11 terrorism, looking into the question of how the government sought to maintain a balance between military contributions to US-Japan security alliance and the restriction on the “threat and use of force” prescribed in the Constitution. Japan's recent pro-activeness toward Asia and entry into regional politics is also examined. The paper concludes by arguing that the combination of continued Japan's security relationship with the US and its strenuous efforts to enter Asian regional politics will be the first step toward real “normalcy” of Japan.

scholarly journals US interaction with the TPSEP countries within the trade policy of the George W. Bush administration

2021 ◽  
Vol 21 (2) ◽  
pp. 225-230
Author(s):  
Viktor V. Shamardin ◽  
Keyword(s):  
Trade Liberalization ◽  
Bush Administration ◽  
The United States ◽  
Negotiation Process ◽  
Asia Pacific ◽  
Pacific Region ◽  
Asia Pacific Region ◽  
Regional Trade ◽  
Bilateral Relations ◽  
The Us

The article is devoted to the study of the formation of the US foreign trade course in the Asia-Pacific region. Special attention is paid to the factors in bilateral relations with the TPSEP countries, which had a key influence on the decision of the George W. Bush administration to join the partnership. The author comes to the conclusion that failures in the implementation of the multilateral format of regional trade liberalization contributed to the fact that the United States entered the negotiation process on the TPSEP.

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