Sale and leaseback to market cap rate ratio in emerging markets – an empirical study in Vietnam

PurposeThis study hypothesises that sale and leaseback (SLB) cap rate is lower than the market cap rate in emerging economies, and the difference is due to institutional cost and vacancy risk. This study aims to provide a novel SLB-Cap-Rate Model to assess the performance of SLB transaction (SLBT).Design/methodology/approachSLBT data are generally not publicly available in developing countries. This study collected data from 31 SLBTs by conducting semi-structured interviews with stakeholders in Vietnam in 2019. The market cap rates were collected from consultants' reports. The hypotheses are tested by three regression models.FindingsThe results show that the SLBT cap rate is significantly less than the market cap rate in Vietnam, and most of the cap rate discount can be explained by institutional and risk factors. This suggests that SLBT helps to reduce search costs for tenants and vacancy risks. It explains why SLBTs are becoming more common in emerging countries.Practical implicationsThe study has a strong practical implication for assessing the performance of SLBT for both buyers and sellers. It introduces a novel model for analysing the cap rates and potential risks of SLBT to facilitate property investment decisions.Originality/valueThis paper is one of the studies that contains new knowledge on SLBs in a developing country specifically Vietnam.

Healthcare system conversion to a biosimilar: Trials and tribulations

Disclaimer In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose While biologic medications have transformed the care and management of millions of patients, they are a large financial strain on the healthcare system. Biosimilar medications present a great opportunity to improve care affordability. However, despite streamlined approval processes and the potential for cost savings, the acceptance and adaptation of biosimilars have been slow. This descriptive report illustrates the preparation for, challenges, and execution of an enterprise-wide biosimilar conversion within a large healthcare system. The 3 phases of biosimilar conversion utilized at our institution included selection of a biosimilar, pharmacy and therapeutics (P&T) committee approval, and implementation. Summary When selecting a biosimilar, clinical data, medication safety, cost, institutional cost savings, payer coverage, patient assistance programs, and additional patient services should be taken into consideration to ensure patient care is not affected. Understanding and endorsement of biosimilar use by physician leadership, care managers, and pharmacists are crucial before implementation. P&T committee approval with clear delineation of the patient population (naive vs experienced), disease states, and whether the biosimilar would be the preferred medication should be obtained. Transparent communication of clear expectations to patients and coordination with the information technology (IT), contracting, and supply chain departments are necessary before the go-live date. Contracting and IT implementations should ideally take potential changes in biosimilar adaptation into consideration and have enough flexibility to account for these changes. Planned evaluations of patients’ experiences with the change to the biosimilar should be incorporated as part of the implementation plan. Conclusion The barriers to biosimilar adaptation are plentiful. Careful planning, clear communication, and coordination with all affected disciplines can ensure successful biosimilar conversion.

Relevance to the Introduction of eLearning on Higher Education of Bangladesh: An Experience from the Educational Cost of COVID-19

The great lockdown of the current COVID-19 pandemic has significant consequences on the global Higher Education Studies (HES).To find the relevance of eLearning in the HES, our study calculates the economic costs of higher education during Covid-19 in Bangladesh, which includes both stu-dents’ cost and institutional cost. The study used a purposive random sample survey conducted on 105 students enrolled in higher education in different categories of institutions to identify the stu-dents’ cost during this pandemic. The institutional cost of higher education is analyzed by breaking down the budget allocated in the education sector in Bangladesh and reviewing the literature. The result indicates that the HES of Bangladesh experiences a huge economic cost due to this pandemic and the study found eLearning can reduce the economic impact of HES. In the post-COVID-19 world, higher education will never be the similar because many institutions that already had experi-ence a huge advantage from online education. The findings of the study might be helpful for the policymakers to frame effective education policies during any bizarre situation that creates huge cost in higher education sector.

Populism and Trade

Populism and Trade traces the role of populist trade policy in the increase of global protectionism and the erosion of international trade institutions. Populist anti-trade rhetoric played a major part in US President Donald Trump’s 2016 election campaign, in which he portrayed current trade agreements as elitist measures to undermine US manufacturing jobs, economic security, and the interests of the American people. Upon taking office he proceeded to implement trade restrictions that were unprecedented in the era of GATT-WTO rules. His use of national security criteria for unilateral tariffs on steel and aluminum and his trade war with China represented an abandonment of WTO trade rules and practices. In the United Kingdom, the 2016 Brexit referendum resulted in a vote to leave the European Union, thereby ending the UK trade integration arrangement that had begun in 1973. The referendum campaign drew on UK criticism of EU intrusion on UK sovereignty in presenting the issue in populist terms of elitist control from Brussels set against the interests of the victimized British people. The book develops a conceptual framework of protectionism that links behavioral factors with perceived external threats and voting behavior based on emotion. It also offers a review of trade policies of other populist governments and an assessment of their economic and institutional cost. A concluding chapter provides recommendations for addressing the populist challenge, focusing on adjustment policies, reforms of global trade institutions, and the need to protect domestic democratic processes.

Catheter-Associated Urinary Tract Infections (CAUTIs) Reduction: A Multidisciplinary Approach

Background: CAUTIs remain one of the most common hospital-acquired infections (HAIs) accounting for prolonged hospital stay and increased healthcare costs. According to the NHSN, the standardized infection ratio (SIR) at our institution was 1.6 compared to national average of 0.84 in 2018. We highlight the interventions implemented in our institution to prevent CAUTIs. These interventions have shown a reduction in the rate of CAUTIs, the SIR, Foley catheter days, and institutional cost. Methods: In addition to standard CAUTI prevention practices, we hypothesized that we could decrease CAUTIs through the daily implementation of specific practices. We developed a comprehensive interdisciplinary team which included the staff or charge registered nurse (RN), the unit manager, an infection preventionist, an advanced practice registered nurse (APRN), a pharmacist with an antimicrobial focus, and a physician from the infectious disease department who would conduct daily rounds on different units in the institution for education and assessment of catheter indications. A detailed review and analysis of the urine culture orders for patients with a Foley catheter was performed. A nurse-driven Foley catheter removal protocol before urine culture collection was initiated. We implemented a Foley catheter bundle that has guidelines for Foley insertion, best practice competency, and urinary catheter best practice algorithm and advocated alternative use of male or female external catheter. We educated physicians about ordering a reflexive urine analysis test followed by urine culture instead of testing either individually after removal of a Foley catheter. Lastly, we performed a root-cause analysis on all reported CAUTIs. These policies were implemented in a 435-bed tertiary-care center in November 2018, and we present data from 1-year before and after the interventions. Results: At our institution, we had 71 CAUTIs, with an SIR of 1.6, a standardized utilization ratio (SUR) of 0.92, 27,621 Foley days, and institutional cost of $979,303 compared to 40 CAUTIs with an SIR of 1, an SUR of 0.88, 24,193 Foley days, and institutional cost $537,927 after implementing our interventions. Conclusions: CAUTIs can be reduced by implementing specific measures that include infection control team rounds, nurse-driven protocol, and the use of Foley catheter bundles. Measures should be undertaken to prioritize these practices as part of a protocol. We advocate further studies to evaluate these measures. Education programs for healthcare professionals concerning CAUTIs and its complications can be implemented to carry out the prevention methods efficiently.Funding: NoneDisclosures: None

Evaluation of Appropriateness and Cost Savings of Pharmacist-Driven Palivizumab Ordering

OBJECTIVES Guidelines by the AAP for the use of palivizumab prophylaxis for respiratory syncytial virus (RSV) recommend administration within 72 hours prior to discharge for selected high-risk patient populations. Our institution historically administered palivizumab on a fixed-day schedule of Mondays and Thursdays, but adjusted the practice in fall 2017 to a pharmacist-driven flex-schedule based on anticipated discharge date. This review evaluated the effect of pharmacist-driven palivizumab ordering on the appropriateness of palivizumab administrations, based on AAP and institutional recommendations. Additionally, this review evaluated for effects on institutional cost. METHODS This was a retrospective single-center evaluation including patients for whom palivizumab was ordered between July 1, 2016, and June 30, 2018. Patients in the 2016–2017 RSV season were in the fixed-day group, while patients in the 2017–2018 RSV season were in the flex-schedule group. RESULTS A total of 142 palivizumab doses were evaluated. Overall, 97% of administrations were for an appropriate indication. All doses administered inappropriately (n = 4) occurred in the fixed-day group. In the fixed-day group, 48.6% of doses were given within 72 hours prior to discharge, which increased to 70.1% in the flex-schedule group (p = 0.01). The amount of drug saved by batching was 1 vial for every 4.9 patients in the fixed-day group, and 1 vial for every 4.8 patients in the flex-schedule group. CONCLUSIONS There was a statistically significant improvement in compliance with AAP recommendations following the implementation of pharmacist-driven flex-schedule for palivizumab, compared to a fixed-day batching schedule. There was no significant difference in cost.

Evaluating Adaptive Efficiency in Environmental Water Recovery: Application of a Framework for Institutional Cost-Effectiveness Analysis

The first empirical application of an established framework for evaluating the adaptive efficiency of policy and project options — the Institutional Cost-Effectiveness Analysis (ICEA) framework — is documented in this paper. The application involves cost-effectiveness comparison of six projects for environmental water recovery in the Murray-Darling Basin, Australia, managed by the New South Wales (NSW) Government under three programs: The Living Murray Initiative; the NSW Wetland Recovery Program; and the NSW Rivers Environmental Restoration Program. Focussing primarily on one of the projects — the Darling Anabranch Pipeline Project (DAPP) — allows an in-depth account to be presented of the ICEA framework’s application. Abatement and transaction costs, and public and private subsets of these costs, were accounted for in the applications. The adaptive efficiency of the DAPP (a “water-saving project”) is found provisionally — i.e., without accounting quantitatively for institutional lock-in costs — to exceed that of the five other environmental water recovery projects (including two “market-purchase projects”) evaluated. This finding is significant given a tendency for economists to presume that environmental water recovery is generally achieved more efficiently through market-purchase projects. With water management, and environmental management more broadly, exposed to increasing uncertainty, adaptive efficiency will grow in importance as a metric for economic evaluation. The application of the ICEA framework documented in this paper can guide researchers in applying this metric to evaluations of projects and policies implemented in, or proposed for, this domain.

Analysis of Direct Private Investment: The Case of Bachelor’s Level in Community College

The costs spent by students or parents while attaining education are called the direct private costs which are usually placed outside and inside the domain of educational institutions. The present study is a quantitative survey that aims to conduct a comparative analysis of institutional and non-institutional direct private costs. Furthermore, it tries to find the size of institutional and non-institutional direct private costs at Bachelor’s level education in Nepal. For these purposes, I have selected a community based college from Kathmandu valley purposively and 90 students of Bachelor’s level (30 each from the faculty of humanities, education and management) were selected using simple random sampling technique. The findings of the study reveal that the average college related institutional unit cost per student was Rs. 24730.57, university related institutional cost was Rs. 5982.23; and total annual institutional unit cost was Rs. 30712.80. Likewise, it was found that a student has expensed Rs. 46411.63 as non-institutional direct private cost in a year. Total annual average direct private cost of education (institutional plus non-institutional) was Rs. 77124.43 at Bachelor’s level of community based college in the capital city of Nepal.

Clinical Care Redesign to Improve Value for Trigger Finger Release: A Before-and-After Quality Improvement Study

Background: Trigger finger release (TFR) is a commonly performed procedure. However, there is great variation in the setting, care pathway, anesthetic, and cost. We compared the institutional cost for isolated TFR before and after redesigning our clinical care pathway. Methods: Total direct cost to the health system (excluding the surgeon and anesthesiology costs) and time spent by the patient at the surgery center were collected for 1 hand surgeon’s procedures at an ambulatory surgery center over a 3-year period. We implemented a redesigned pathway that altered phases of care and anesthetic use by transitioning from intravenous (IV) sedation to wide awake local anesthesia with no tourniquet. Cost data were reported as percentage change in the median and compared both pre- to post-implementation and with 2 control surgeons using the traditional pathway within the same center. Power analysis was based on prior work on a carpal tunnel pathway. Significance was defined by a P-value < .05. Results: Ten TFRs (90% local with IV sedation) and 44 TFRs (89% local alone) were performed pre- and post-implementation, respectively. From pre- to post-implementation, the study surgeon’s total direct cost decreased by 18%, while the control surgeons decreased by 2%. Median time spent at the surgery center decreased by 41 minutes post-implementation with significantly shorter setup time in the operating room (OR), total time in the OR, and time spent in recovery prior to discharge. Conclusions: Redesigning the care pathway for TFR led to a decrease in institutional cost and patient time spent at the surgery center.