scholarly journals Public Health and Cost Benefits of Successful Reperfusion After Thrombectomy for Stroke

Stroke ◽  
2020 ◽  
Vol 51 (3) ◽  
pp. 899-907 ◽  
Author(s):  
Wolfgang G. Kunz ◽  
Mohammed A. Almekhlafi ◽  
Bijoy K. Menon ◽  
Jeffrey L. Saver ◽  
Myriam G. Hunink ◽  
...  
Keyword(s):  
United States ◽  
Cost Savings ◽  
The United States ◽  
Reference Case ◽  
Lifetime Horizon ◽  
Endovascular Thrombectomy ◽  
Life Years ◽  
Incremental Qalys

Background and Purpose— The benefit that endovascular thrombectomy offers to patients with stroke with large vessel occlusions depends strongly on reperfusion grade as defined by the expanded Thrombolysis in Cerebral Infarction (eTICI) scale. Our aim was to determine the lifetime health and cost consequences of the quality of reperfusion for patients, healthcare systems, and society. Methods— A Markov model estimated lifetime quality-adjusted life years (QALY) and lifetime costs of endovascular thrombectomy–treated patients with stroke based on eTICI grades. The analysis was performed over a lifetime horizon in a United States setting, adopting healthcare and societal perspectives. The reference case analysis was conducted for stroke at 65 years of age. National health and cost consequences of improved eTICI 2c/3 reperfusion rates were estimated. Input parameters were based on best available evidence. Results— Lifetime QALYs increased for every grade of improved reperfusion (median QALYs for eTICI 0/1: 2.62; eTICI 2a: 3.46; eTICI 2b: 5.42; eTICI 2c: 5.99; eTICI 3: 6.73). Achieving eTICI 3 over eTICI 2b reperfusion resulted on average in 1.31 incremental QALYs as well as healthcare and societal cost savings of $10 327 and $20 224 per patient. A 10% increase in the eTICI 2c/3 reperfusion rate of all annually endovascular thrombectomy–treated patients with stroke in the United States is estimated to yield additional 3656 QALYs and save $21.0 million and $36.8 million for the healthcare system and society, respectively. Conclusions— Improved reperfusion grants patients with stroke additional QALYs and leads to long-term cost savings. Procedural strategies to achieve complete reperfusion should be assessed for safety and feasibility, even when initial reperfusion seems to be adequate.

scholarly journals Pharmacokinetic Parameter Driven Outcomes Model Predicts a Reduction in Bleeding Events Associated with BAY 81-8973 Versus Antihemophilic Factor (Recombinant) Plasma/Albumin- Free Method in a Chinese Healthcare Setting

2022 ◽  
Author(s):  
Rong Chen ◽  
Dmitry Gultyaev ◽  
Johanna Lister ◽  
Rong Han ◽  
Nan Hu ◽  
...  
Keyword(s):  
Hemophilia A ◽  
Cost Savings ◽  
Standard Of Care ◽  
Healthcare Setting ◽  
Bleeding Events ◽  
Plasma Albumin ◽  
Lifetime Horizon ◽  
Life Years ◽  
Antihemophilic Factor

Abstract Background: Long-term prophylactic therapy is considered the standard of care for hemophilia A patients. This study models the long-term clinical and cost outcomes of two factor VIII (FVIII) products using a pharmacokinetic (PK) simulation model in a Chinese population. Methods: Head-to-head PK profile data of BAY 81-8973 (KOVALTRY®) and antihemophilic factor (recombinant) plasma/albumin-free method (rAHF-PFM, ADVATE®) were applied to a two-state (alive and dead) Markov model to simulate blood FVIII concentrations at a steady state in prophylactically-treated patients with hemophilia A. Worsening of the Pettersson score was simulated and decline was associated with the probability of having orthopaedic surgery. The only difference between the compounds was FVIII concentration at a given time; each subject was treated with 25 IU/kg every 3 days. The model used a lifetime horizon, with cycle lengths of 1 year. Results: Cumulative bleeding events, joint bleeding events, and major bleeding events were reduced by 19.3%, 9.3% and 19.3%, respectively for BAY 81-8973 compared to rAHF-PFM. Hospitalizations and hospitalization days were also reduced by 19.3% for BAY 81-8973 compared to rAHF-PFM. BAY 81-8973 resulted in both cost savings and a gain in quality adjusted life years (QALYs) compared to rAHF-PFM. Conclusion: Based on modeled head-to-head comparisons, differences in PK-properties between BAY 81-8973 and rAHF-PFM result in a reduced number of bleeding events, leading to reduced costs and increased quality of life for BAY 81-8973. These results should be used to inform clinical practice in China when caring for patients with severe hemophilia A.

A Fuels Cost Comparison of Gasoline and Electric Powered Vehicles

2008 ◽  
Author(s):  
George Ford ◽  
Paul Yanik
Keyword(s):  
United States ◽  
Energy Efficiency ◽  
Fossil Fuels ◽  
Cost Savings ◽  
The United States ◽  
Cost Comparison ◽  
Environmentally Safe ◽  
Personal Transportation ◽  
Fuel Costs

Per British thermal unit (BTU), in the United States, gasoline currently costs about 7.6 times as much as coal. Due to the prevalence of coal fired electricity generating stations in the country, electrically powered vehicles may provide a fuel cost savings over similar gasoline powered vehicles. Fuel costs for electric vehicles have been reported to cost about $0.045 per mile to operate. Higher efficiency, gasoline operated automobiles such as the Toyota Corolla have reported fuel costs of about $0.093 per mile. This paper provides a first glance examination of electrically powered and gasoline powered vehicles in the United States. While gasoline costs continue to rise, a cheap, environmentally safe transportation alternative is needed to maintain the flexible lifestyle currently enjoyed by Americans. The cycle energy efficiency of coal produced electricity for personal transportation is much lower than the energy efficiency of gasoline, but the large cost differences between these two forms of fossil fuels may provide a temporary fix to a looming transportation crisis in the United States. The long-term environmental effects of an electrically powered, private transportation fleet could prove catastrophic due to increased use of coal and accompanying combustion product air pollution, but clean, renewable, electricity producing technologies may support more prolific long-term use of electrically powered transportation modes.

Thinking Like a River

1994 ◽  
Author(s):  
Donald Worster
Keyword(s):  
United States ◽  
The United States ◽  
High Tech ◽  
Natural Cycle ◽  
Soil Resource ◽  
Cooking Oil ◽  
Quality Of Water ◽  
Poor Management

When we drive by a modern farm, we still expect to see green plants sprouting from the earth, bearing the promise of food or cooking oil or a cotton shirt. Pulling up one of those plants, we are still prepared to find dirt clinging to its roots. Even in this age of high-tech euphoria, agriculture remains essentially a matter of plants growing in the soil. But another element besides soil has always been a part of the farmer’s life-water. Farming is not only growing crops on a piece of land, it is also growing crops in water. I don’t mean a hydroponics lab. I mean that the farmer and his plants inescapably are participants in the natural cycle of water on this planet. Water is a more volatile, uncertain element than soil in the agricultural equation. Soil naturally stays there on the farm, unless poor management intervenes, whereas water is by nature forever on the move, falling from the clouds, soaking down to roots, running off in streams to the sea. We must farm rivers and the flow of water as well as fields and pastures if we are to continue to thrive. But it has never been easy to extract a living from something so mobile and elusive, so relentless and yet so vulnerable as water. If there is to be a long-term, sustainable agriculture in the United States or elsewhere, farmers must think and act in accord with the flow of water over, under, through, and beyond their farms. Preserving the fertility of the soil resource is critical to sustaining it, of course, but not more so than maintaining the quality of water. In many ways, the two ideals are one. And their failure is one, as when rain erodes the topsoil and creeks and rivers suffer. But there are differences between those two resources, differences we must understand and respect. Unlike soil, water cannot be “built.” It can be lost to the farmer, or it can be diverted, polluted, misused, or over-appropriated, but it can never be deepened or enhanced as soil can be.

scholarly journals Cost-Effectiveness Analysis of Local Treatment in Oligometastatic Disease

2021 ◽  
Vol 11 ◽  
Author(s):  
Dirk Mehrens ◽  
Marcus Unterrainer ◽  
Stefanie Corradini ◽  
Maximilian Niyazi ◽  
Farkhad Manapov ◽  
...  
Keyword(s):  
United States ◽  
Cost Effectiveness ◽  
Local Treatment ◽  
Cost Effective ◽  
The United States ◽  
Trial Duration ◽  
Oligometastatic Disease ◽  
Incremental Qalys ◽  
Term Analysis

BackgroundIn certain malignancies, patients with oligometastatic disease benefit from radical ablative or surgical treatment. The SABR-COMET trial demonstrated a survival benefit for oligometastatic patients randomized to local stereotactic ablative radiation (SABR) compared to patients receiving standard care (SC) alone. Our aim was to determine the cost-effectiveness of SABR.Materials and MethodsA decision model based on partitioned survival simulations estimated costs and quality-adjusted life years (QALY) associated with both strategies in a United States setting from a health care perspective. Analyses were performed over the trial duration of six years as well as a long-term horizon of 16 years. Model input parameters were based on the SABR-COMET trial data as well as best available and most recent data provided in the published literature. An annual discount of 3% for costs was implemented in the analysis. All costs were adjusted to 2019 US Dollars according to the United States Consumer Price Index. SABR costs were reported with an average of $11,700 per treatment. Deterministic and probabilistic sensitivity analyses were performed. Incremental costs, effectiveness, and cost-effectiveness ratios (ICER) were calculated. The willingness-to-pay (WTP) threshold was set to $100,000/QALY.ResultsBased on increased overall and progression-free survival, the SABR group showed 0.78 incremental QALYs over the trial duration and 1.34 incremental QALYs over the long-term analysis. Treatment with SABR led to a marginal increase in costs compared to SC alone (SABR: $304,656; SC: $303,523 for 6 years; ICER $1,446/QALY and SABR: $402,888; SC: $350,708 for long-term analysis; ICER $38,874/QALY). Therapy with SABR remained cost-effective until treatment costs of $88,969 over the trial duration (i.e. 7.6 times the average cost). Sensitivity analysis identified a strong model impact for ongoing annual costs of oligo- and polymetastatic disease states.ConclusionOur analysis suggests that local treatment with SABR adds QALYs for patients with certain oligometastatic cancers and represents an intermediate- and long-term cost-effective treatment strategy.

scholarly journals Estimated Profitability of Thoroughbred Yearlings Sold in Auctions in the United States, 2001–2018

2020 ◽  
Vol 12 (2) ◽  
pp. 463
Author(s):  
Jenna Bryant ◽  
C. Jill Stowe
Keyword(s):  
United States ◽  
The United States ◽  
High Quality ◽  
Long Run ◽  
Thoroughbred Racehorses ◽  
Positive Return

Yearling auctions constitute the most common means of trading prospective Thoroughbred racehorses. The main objective of many equine operations is to breed yearlings to sell at these auctions, and therefore, the ability of breeders to consistently realize positive returns is paramount to their long-term participation in the market. In this article, we investigate the estimated profitability of Thoroughbred yearlings sold in auctions from 2001–2018. According to our estimates, less than 50% of transactions were profitable, with negative median profit in all years under analysis but two. In addition, the likelihood of realizing a positive return diminishes as the quality of sire decreases. Our results suggest that the long-run sustainability for many breeders, especially breeders that may lack the capital to invest in high quality stallions, is questionable.

Population Growth and United States Politics in the 1970s

1973 ◽  
Vol 3 (4) ◽  
pp. 845-853
Author(s):  
A. E. Keir Nash
Keyword(s):  
United States ◽  
Population Policy ◽  
The United States ◽  
Nixon Administration ◽  
National Population ◽  
Natural Result ◽  
Policy Problems ◽  
Population Effects

The recent drop in birth rates in the United States to a point below replacement may well take much of the wind out of the momentum which developed during the late 1960s for a comprehensive national population policy. Such at least would appear to be a “natural result” given the characteristic patterns of American politics, whereby broad and coherent policy making is rarely produced except in moments of obvious crisis. Such a result, moreover, would dovetail with the general drift of the Nixon Administration away from the domestic and foreign activism of the Johnson years. Despite its “naturalness,” however, that result would be unfortunate. The arguments for a comprehensive national population policy are best grounded in the circumstance that population effects are long-term. This article explores the reasons for instituting such a policy from the standpoint of a central concern of political science—the quality of governance. It is argued that population stabilization would, on balance, enhance the capacity of the United States governmental structure to cope with policy problems, both domestic and foreign.

scholarly journals Quality of Life (QoL) Is Reduced in Those with Severe COVID-19 Disease, Post-Acute Sequelae of COVID-19, and Hospitalization in United States Adults from Northern Colorado

2021 ◽  
Vol 18 (21) ◽  
pp. 11048
Author(s):  
Kim McFann ◽  
Baxter A. Baxter ◽  
Stephanie M. LaVergne ◽  
Sophia Stromberg ◽  
Kailey Berry ◽  
...  
Keyword(s):  
Quality Of Life ◽  
United States ◽  
Demographic Data ◽  
The United States ◽  
Sf 36 ◽  
Northern Colorado ◽  
Role Limitation ◽  
The Impact

The longitudinal quality of life (QoL) of COVID-19 survivors, especially those with post-acute sequelae (PASC) is not well described. We evaluated QoL in our COVID-19 survivor cohort over 6 months using the RAND SF-36 survey. From July 2020–March 2021 we enrolled 110 adults from the United States with a positive SARS-CoV-2 nasopharyngeal polymerase chain reaction (PCR) into the Northern Colorado Coronavirus Biobank (NoCo-COBIO). Demographic data and symptom surveillance were collected from 62 adults. In total, 42% were hospitalized, and 58% were non-hospitalized. The Rand SF-36 consists of 36 questions and 8 scales, and questions are scored 0–100. A lower-scale score indicates a lower QoL. In conclusion, hospitalization, PASC, and disease severity were associated with significantly lower scores on the RAND SF-36 in Physical Functioning, Role Limitation due to Physical Health, Energy/Fatigue, Social Functioning, and General Health. Long-term monitoring of COVID-19 survivors is needed to fully understand the impact of the disease on QoL and could have implications for interventions to alleviate suffering during recovery.

scholarly journals Evaluating the Suitability of Century-Long Gridded Meteorological Datasets for Hydrological Modeling

2020 ◽  
Vol 21 (11) ◽  
pp. 2565-2580
Author(s):  
Carolina Massmann
Keyword(s):  
United States ◽  
Time Series ◽  
Hydrological Modeling ◽  
Hydrological Model ◽  
The United States ◽  
Model Driven ◽  
Conceptual Hydrological Model ◽  
Better Than

AbstractRecent advances in climate reanalyses have led to the development of meteorological products providing information from the beginning of the last century or even before. As these data sources might be of interest to practitioners in the event of missing data from meteorological stations, it is important to assess their usefulness for different applications. The main objective of this study is to investigate the ability of two long-term reanalysis datasets (CERA-20C and 20CR) and one long-term interpolated dataset (Livneh) for supporting hydrological modeling. The precipitation and temperature data of the three datasets were first compared, downscaled, and then used as inputs to the conceptual hydrological model HBV in 168 basins in the United States. The findings suggest that the quality of all three datasets decreases the further we go back in time. Models calibrated at the beginning of the time series, where the data quality is worse, are only able to capture the general properties of the time series and thus do not show a decrease in performance as the period between calibration and validation becomes larger. The opposite is true for models calibrated at the end of the time series, which show a clear decrease in performance toward the beginning of the century. While the hydrological model driven with the interpolated datasets achieved the best performance, the results obtained with the reanalysis datasets were still informative (i.e., better than the long-term monthly mean), and they matched the performance of the interpolated dataset in a few catchments in the northwestern United States.

Speech-Language Pathology in the Peace Corps: Necessity and Sustainability

2012 ◽  
Vol 2 (1) ◽  
pp. 11-18
Author(s):  
Melissa A. Pierce
Keyword(s):  
United States ◽  
Special Education ◽  
Peace Corps ◽  
People With Disabilities ◽  
Communication Disorders ◽  
The United States ◽  
Speech Language Pathology ◽  
Speech Language Pathologists ◽  
Language Pathology

In countries other than the United States, the study and practice of speech-language pathology is little known or nonexistent. Recognition of professionals in the field is minimal. Speech-language pathologists in countries where speech-language pathology is a widely recognized and respected profession often seek to share their expertise in places where little support is available for individuals with communication disorders. The Peace Corps offers a unique, long-term volunteer opportunity to people with a variety of backgrounds, including speech-language pathologists. Though Peace Corps programs do not specifically focus on speech-language pathology, many are easily adapted to the profession because they support populations of people with disabilities. This article describes how the needs of local children with communication disorders are readily addressed by a Special Education Peace Corps volunteer.

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