Impact of Limiting Erythropoiesis-Stimulating Agent Use for Chemotherapy-Induced Anemia on the United States Blood Supply.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 2896-2896 ◽  
Author(s):  
Francis Vekeman ◽  
Brahim K. Bookhart ◽  
Mei S. Duh ◽  
Scott R. McKenzie ◽  
Patrick Lefebvre ◽  
...  
Keyword(s):  
Blood Supply ◽  
Supply And Demand ◽  
The United States ◽  
Allogeneic Blood ◽  
Sensitivity Analyses ◽  
Base Case ◽  
Sensitivity Range ◽  
The Us ◽  
Incident Cases ◽  
The Impact

Abstract Background: Between 1987–1997, the demand for allogeneic blood (whole blood and packed RBC) in the US decreased due to concerns about safety of the blood supply1. Paradoxically, these concerns also led to a decrease in the available supply. During this same period, collection of allogeneic blood declined from 13.6 million to 11.9 million units, resulting in a 48% reduction in the margin between available supply and demand.1 Although both supply and demand for blood has since increased, the margin has further declined to only 6.1% in 2004 (allogeneic collection: 14.8 million units; transfusion: 13.9 million units)2. This situation is further exacerbated by procedures used for qualifying fully screened units. In 2004, 240,000 units were rejected after screening, leaving a margin of only 648,000 units available (4.5% of the supply). Given the introduction and adoption of treatments that reduce transfusions, such as erythropoiesis-stimulating agents (ESAs) for patients (pts) with chemotherapy-induced anemia (CIA), in the past 15 years, periodic shortages in the blood supply due to this limited surplus have been moderated. Purpose: To estimate the impact of limiting the use of ESAs for CIA on the US blood supply. Methods: A modeling simulation was employed using a top-down approach to compare the number of RBC units transfused in ESA-treated pts to the number of RBC units that would be transfused if ESAs were discontinued or limited in the same population. The excess number of RBC units that would be required if ESA treatment in CIA pts was limited was contrasted with the available marginal blood supply from 2004 (latest data available). Model inputs included incident cases of CIA pts treated with ESA, transfusion rates from clinical trials, and volume of RBC units required for ESA-treated and untreated pts. Data were obtained from published literature or expert opinion where published evidence was unavailable. Estimates were developed for multiple ESA reduction scenarios, and sensitivity analyses were conducted using a range of +/–10% for each input parameter. Results: Under the base case scenario, it was estimated that 492,002 incident CIA pts received a total of 372,809 RBC units despite ESA treatment. The model predicted that up to a third of the marginal US blood supply would be required to cover the incremental demand for blood that would arise from a 25% decrease in ESA use (incremental RBC units transfused: 118,602 units, sensitivity range: 63,030–210,110 units). For ESA use reductions of 50% and 75%, the model predicted 37% (237,203 units) and 55% (355,805 units) of the marginal US blood supply would be required, respectively. In the case of total cessation of ESA use for CIA, the available US blood supply could be exceeded (incremental demand: 474,407 units, sensitivity range: 252,119–840,441 units). Conclusions: This current model of blood demand showed limiting ESA use in CIA pts imposes considerable pressure on the available US blood supply given the small margin between usable blood and transfusion demand. This added pressure on the blood supply does not consider additional exacerbations due to regional and seasonal variation in the number of available units as well as donation frequency variations.

scholarly journals Identifying silent COVID-19 infections among children is critical for controlling the pandemic

2021 ◽  
Author(s):  
Seyed M. Moghadas ◽  
Meagan C. Fitzpatrick ◽  
Affan Shoukat ◽  
Kevin Zhang ◽  
Alison P. Galvani
Keyword(s):  
Vaccination Coverage ◽  
Vaccine Efficacy ◽  
The United States ◽  
Sensitivity Analyses ◽  
Transmission Model ◽  
Base Case ◽  
Age Group ◽  
One Year ◽  
The Impact ◽  
Targeted Approach

Importance: A significant proportion of COVID-19 transmission occurs silently during the pre-symptomatic and asymptomatic stages of infection. Children, while being important drivers of silent transmission, are not included in COVID-19 vaccination campaigns given their exclusion from clinical trials thus far. Objective: To investigate the impact of a targeted approach to identifying silent infections among children as a proxy for their vaccination. Design: This study used an age-structured disease transmission model to simulate the synergistic impact of interventions in reducing attack rates over the course of one year. Setting: A synthetic population representative of the demographics of the United States (US). Participants: Six age groups of 0-4, 5-10, 11-18, 19-49, 50-64, 65+ years old, stratified for their population size based on US census data. Exposures: Vaccination of adults, self-isolation of all symptomatic cases within 24 hours of symptom onset, and detection of silent infections. Main Outcomes and Measures: Vaccination of adults was implemented to reach a 40% coverage over the course of one year with a vaccine efficacy of 95% against symptomatic and severe COVID-19. Without vaccination of children, we determined the proportion and speed that would be required for identifying silent infections among this age group to suppress future attack rates below 5%. Results: A targeted approach that identifies 20.6% and 28.6% of silent infections among children within 2 or 3 days post-infection, respectively, would be required to bring attack rates under 5% with vaccination of adults. If silent infections among children remained undetected, achieving the same attack rates would require an unrealistically high vaccination coverage (at least 82%) of this age group, in addition to the base-case 40% vaccination coverage of adults. The results were robust in sensitivity analyses with respect to vaccine efficacy against infection and reduced susceptibility of children to infection. Conclusions and Relevance: In the absence of vaccine availability for children, a targeted approach to rapid identification of silent COVID-19 infections in this age group can significantly mitigate disease burden. Without measures to interrupt transmission chains from silent infections, vaccination of adults is unlikely to contain the outbreaks in the near term.

News That Sells: Media Competition and News Content

2007 ◽  
Vol 8 (1) ◽  
pp. 7-42 ◽  
Author(s):  
JAMES T. HAMILTON
Keyword(s):  
Information Search ◽  
Information Dissemination ◽  
Market Competition ◽  
Supply And Demand ◽  
News Coverage ◽  
The United States ◽  
News Content ◽  
The Us ◽  
Media Markets ◽  
The Impact

This paper explores the economic factors that influence news coverage and discusses the difficulties of determining the impact of news content on political outcomes. Evidence from the United States clearly shows how supply and demand concepts can be used to predict content in newspapers, television, and the Internet. To demonstrate how the concept of market-driven news extends beyond the US, I trace out hypotheses about how media content in many countries should vary depending on three factors in news markets: the motivations of media outlet owners, the technologies of information dissemination available, and the property rights that govern how information is created and conveyed. I offer three different types of analyses – the measurement of product differentiation, information search patterns, and consumption patterns – to show how these ideas about competition influencing content could be tested across countries. The paper briefly discusses the degree to which market competition affects content in three Asian countries (China, Thailand, and Japan) and concludes with a section on the difficulties of designing policies to improve the operation of media markets.

scholarly journals 897 Infusion episode-related benefits of pembrolizumab Q6W dosing schedule for patients with melanoma treated in the adjuvant and metastatic settings in the United States (US)

2021 ◽  
Vol 9 (Suppl 3) ◽  
pp. A941-A941
Author(s):  
Raquel Aguiar-Ibanez ◽  
Emilie Scherrer ◽  
Dmitri Grebennik ◽  
Anvi Khandelwal ◽  
John Cook ◽  
...  
Keyword(s):  
Health Care Providers ◽  
The United States ◽  
System Capacity ◽  
Sensitivity Analyses ◽  
Care Providers ◽  
Duration Of Treatment ◽  
Dosing Schedule ◽  
Patient Capacity ◽  
The Us ◽  
The Impact

BackgroundA new dosing schedule for pembrolizumab (400 mg every six weeks (Q6W)) received accelerated FDA approval in 2020 across all approved adult indications. The Q6W dosing schedule provides an opportunity to reduce the number of infusions required over the treatment course, thereby decreasing time and costs for health care providers, patients and their caregivers. This study quantified the potential infusion episode-related benefits of pembrolizumab Q6W regimen for the treatment of patients with melanoma in the adjuvant and metastatic settings in the US.MethodsAn Excel-based tool was developed to quantify the infusion episode-related time and cost of using pembrolizumab Q6W compared to available nivolumab dosing regimens (Q4W/Q2W) to treat patients with melanoma in the adjuvant and metastatic settings from the patient, caregiver, provider, and payer perspectives. The number of infusion visits, time and costs were estimated considering a hypothetical infusion center. Time-related inputs were based on a survey of patients, physicians and nurses; cost-related inputs were obtained from published sources. Sensitivity analyses were performed to assess the robustness of results. Additional analyses assessed the impact of using alternative regimens with different frequencies of administration.ResultsBased on the tool, pembrolizumab Q6W reduced the number of infusion visits (31%), time at the infusion center (41%) and chair time (31%) in total, over one year, versus nivolumab Q4W. Because fewer visits are needed, travel time is estimated to decrease by 31%. The infusion-related direct and indirect costs borne by patients and caregivers are projected to decrease by $1,095 and $2,272, respectively over a treatment course. For a typical US infusion center treating 169 melanoma patients per week over a 1-year period, using pembrolizumab Q6W rather than nivolumab Q4W is estimated to reduce the number of infusions by 2,729 (31% reduction) for a total of 3,802 fewer hours of infusion chair time, allowing the infusion center to increase patient capacity by up to 45% using currently available resources. Time and cost savings are more prominent when comparing with nivolumab Q2W: 5,757 fewer infusion events (66% reduction) and 8,062 less hours of chair time, which would increase the patient capacity by 2.9 times.ConclusionsUtilizing pembrolizumab Q6W to treat patients with melanoma in the US is expected to substantially reduce the number of infusion visits and associated chair time required over the duration of treatment, reducing the time and monetary burden for patients and their caregivers. Additionally, it may also improve system capacity.

scholarly journals Cost-Effectiveness of Short-Course Radiation Plus Temozolomide for the Treatment of Newly Diagnosed Glioblastoma Among Elderly Patients in China and the United States

2021 ◽  
Vol 12 ◽  
Author(s):  
Jigang Chen ◽  
Xin Tong ◽  
Mingyang Han ◽  
Songfeng Zhao ◽  
Linjin Ji ◽  
...  
Keyword(s):  
United States ◽  
Cost Effectiveness ◽  
Elderly People ◽  
Cost Effective ◽  
The United States ◽  
Sensitivity Analyses ◽  
Base Case ◽  
Newly Diagnosed ◽  
Life Years ◽  
The Us

Background: Glioblastoma multiforme (GBM) is a fatal type of brain tumor with a high incidence among elderly people. Temozolomide (TMZ) has proven to be an effective chemotherapeutic agent with significant survival benefits. This study aimed to evaluate the economic outcomes of radiotherapy (RT) and TMZ for the treatment of newly diagnosed GBM in elderly people in the United States (US) and China.Methods: A partitioned survival model was constructed for RT plus TMZ and RT alone among patients with methylated and unmethylated tumor status. Base case calculations and one-way and probabilistic sensitivity analyses were performed. Life-years, quality-adjusted life-years (QALYs), costs (in 2021 US dollars [$] and Chinese Yuan Renminbi [¥]), and incremental cost-effectiveness ratios (ICERs) were calculated.Results: RT plus TMZ was found to be associated with significantly higher costs and QALYs in all groups. Only US patients with methylated status receiving RT plus TMZ had an ICER ($89358.51) less than the willingness-to-pay (WTP) threshold of $100000 per QALY gained when compared with receiving RT alone. When the WTP threshold ranged from $100000 to $150000 from the US perspective, the probability of RT plus TMZ being cost-effective increased from 80.5 to 99.8%. The cost of TMZ must be lower than ¥120 per 20 mg for RT plus TMZ to be cost-effective among patients with methylated tumor status in China.Conclusion: RT plus TMZ was not cost-effective in China, and a reduction in the TMZ price was justified. However, it is highly likely to be cost-effective for patients with methylated tumor status in the US.

scholarly journals AN INVESTIGATION OF THE UNITED STATES AIRLINE PILOT LABOUR SUPPLY

2014 ◽  
Vol 5 (2) ◽  
pp. 53-83
Author(s):  
Rebecca Lutte
Keyword(s):  
United States ◽  
Airline Industry ◽  
Supply And Demand ◽  
The United States ◽  
Airline Pilots ◽  
Airline Pilot ◽  
The Us ◽  
Future Supply ◽  
Major Airlines ◽  
The Impact

Over the next 20 years, the United States airline industry is expected to hire in excess of 95,000 pilots. This hiring will be the result of new aircraft growth, pilot retirements, and pilot attrition from the industry for reasons other than retirement. In addition, government regulations may also cause an increase in the number of new pilots required. Given this increased demand, will there be enough new pilots to ensure a long-term and continuous supply? The purpose of this research is to examine the supply and demand for US airline pilots. Several new considerations are having an impact on future supply and demand of airline pilots including cost of training, growth, retirement, regulatory changes, and slowing supply of military pilots. The methodology provides an empirical analysis of the pilot labor supply in the US. A multivariate regression model was developed to forecast demand. To explore supply, a variety of data sources have been included and a survey was implemented. The results of the study indicate that the US airline industry will experience a shortage of approximately 35,000 pilots for the 2013 to 2031 time period. The impact of the shortage on regional and major airlines is examined. Possible solutions are discussed.

The Impact of Monetary and Fiscal Policies on the Stock Market in the United States (U.S); Evidence from Linear ARDL Framework

2020 ◽  
Vol 11 (1) ◽  
pp. 132-132
Author(s):  
Aref Emamian
Keyword(s):  
United States ◽  
Stock Market ◽  
The United States ◽  
Real Effective Exchange Rate ◽  
Annual Data ◽  
Fiscal Policies ◽  
Long Run ◽  
The Us ◽  
Short Run ◽  
The Impact

This study examines the impact of monetary and fiscal policies on the stock market in the United States (US), were used. By employing the method of Autoregressive Distributed Lags (ARDL) developed by Pesaran et al. (2001). Annual data from the Federal Reserve, World Bank, and International Monetary Fund, from 1986 to 2017 pertaining to the American economy, the results show that both policies play a significant role in the stock market. We find a significant positive effect of real Gross Domestic Product and the interest rate on the US stock market in the long run and significant negative relationship effect of Consumer Price Index (CPI) and broad money on the US stock market both in the short run and long run. On the other hand, this study only could support the significant positive impact of tax revenue and significant negative impact of real effective exchange rate on the US stock market in the short run while in the long run are insignificant. Keywords: ARDL, monetary policy, fiscal policy, stock market, United States

scholarly journals Spring Freeze Damage of Pecan Bloom: A Review

Horticulturae ◽  
2020 ◽  
Vol 6 (4) ◽  
pp. 82
Author(s):  
Amandeep Kaur ◽  
Louise Ferguson ◽  
Niels Maness ◽  
Becky Carroll ◽  
William Reid ◽  
...  
Keyword(s):  
Tree Height ◽  
The United States ◽  
Reproductive Organs ◽  
Tree Age ◽  
The Us ◽  
Nut Production ◽  
Freeze Damage ◽  
Terminal Buds ◽  
And Function ◽  
The Impact

Pecan is native to the United States. The US is the world’s largest pecan producer with an average yearly production of 250 to 300 million pounds; 80 percent of the world’s supply. Georgia, New Mexico, Texas, Arizona, Oklahoma, California, Louisiana, and Florida are the major US pecan producing states. Pecan trees frequently suffer from spring freeze at bud break and bloom as the buds are quite sensitive to freeze damage. This leads to poor flower and nut production. This review focuses on the impact of spring freeze during bud differentiation and flower development. Spring freeze kills the primary terminal buds, the pecan tree has a second chance for growth and flowering through secondary buds. Unfortunately, secondary buds have less bloom potential than primary buds and nut yield is reduced. Spring freeze damage depends on severity of the freeze, bud growth stage, cultivar type and tree age, tree height and tree vigor. This review discusses the impact of temperature on structure and function of male and female reproductive organs. It also summarizes carbohydrate relations as another factor that may play an important role in spring growth and transition of primary and secondary buds to flowers.

scholarly journals Autism Tsunami: the Impact of Rising Prevalence on the Societal Cost of Autism in the United States

2021 ◽  
Author(s):  
Mark Blaxill ◽  
Toby Rogers ◽  
Cynthia Nevison
Keyword(s):  
Forecast Model ◽  
The United States ◽  
Population Projections ◽  
Base Case ◽  
Prevention Strategies ◽  
Total Base ◽  
Cost Categories ◽  
The Cost ◽  
The Impact ◽  
First Time

AbstractThe cost of ASD in the U.S. is estimated using a forecast model that for the first time accounts for the true historical increase in ASD. Model inputs include ASD prevalence, census population projections, six cost categories, ten age brackets, inflation projections, and three future prevalence scenarios. Future ASD costs increase dramatically: total base-case costs of $223 (175–271) billion/year are estimated in 2020; $589 billion/year in 2030, $1.36 trillion/year in 2040, and $5.54 (4.29–6.78) trillion/year by 2060, with substantial potential savings through ASD prevention. Rising prevalence, the shift from child to adult-dominated costs, the transfer of costs from parents onto government, and the soaring total costs raise pressing policy questions and demand an urgent focus on prevention strategies.

scholarly journals Mining Google and Apple mobility data: temporal anatomy for COVID-19 social distancing

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Corentin Cot ◽  
Giacomo Cacciapaglia ◽  
Francesco Sannino
Keyword(s):  
Infection Rate ◽  
The United States ◽  
Strong Decrease ◽  
Social Distancing ◽  
Mobility Data ◽  
Actual Measure ◽  
The Us ◽  
The Impact ◽  
Political Decisions ◽  
Mobility Reduction

AbstractWe employ the Google and Apple mobility data to identify, quantify and classify different degrees of social distancing and characterise their imprint on the first wave of the COVID-19 pandemic in Europe and in the United States. We identify the period of enacted social distancing via Google and Apple data, independently from the political decisions. Our analysis allows us to classify different shades of social distancing measures for the first wave of the pandemic. We observe a strong decrease in the infection rate occurring two to five weeks after the onset of mobility reduction. A universal time scale emerges, after which social distancing shows its impact. We further provide an actual measure of the impact of social distancing for each region, showing that the effect amounts to a reduction by 20–40% in the infection rate in Europe and 30–70% in the US.

GPTs and growth: evidence on the technological adoption of electrical and electronic technologies in the 1920s

2020 ◽  
Author(s):  
Sergio Petralia
Keyword(s):  
The United States ◽  
General Purpose ◽  
Geographical Information ◽  
General Purpose Technologies ◽  
Technological Adoption ◽  
Transformative Potential ◽  
The Us ◽  
The Impact ◽  
Electronic Technologies ◽  
Patenting Activity

Abstract The pervasive diffusion of electricity-related technologies at the beginning of the twentieth century has been studied extensively to understand the transformative potential of general purpose technologies (GPTs). Most of what we know, however, has been investigated in relation to the diffusion of their use. This article provides evidence on the county-level economic impact of the technological adoption of electrical and electronic (E&E) technologies in the 1920s in the United States (US). It focuses on measuring the impact of a GPT on technological adopters, i.e., those who are able to develop, transform, and complement it. It is shown that places with patenting activity in E&E technologies grew faster and paid higher wages than others between 1920 and 1930. This analysis required constructing a novel database identifying detailed geographical information for historical patent documents in the US since 1836, as well as developing a text-mining algorithm to identify E&E patents based on patent descriptions.

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