Estimation of lung cancer diagnosis and treatment costs based on a patient-level analysis in Catalonia (Spain)

Background: Assessing of the costs of treating disease is necessary to demonstrate cost-effectiveness and to estimate the budget impact of new interventions and therapeutic innovations. However, there are few comprehensive studies on resource use and costs associated with lung cancer patients in clinical practice in Spain or internationally. The aim of this paper was to assess the hospital cost associated with lung cancer diagnosis and treatment by histology, type of cost and stage at diagnosis in the Spanish National Health Service. Methods: A retrospective, descriptive analysis on resource use and a direct medical cost analysis were performed. Resource utilisation data were collected by means of patient files from nine teaching hospitals. From a hospital budget impact perspective, the aggregate and mean costs per patient were calculated over the first three years following diagnosis or up to death. Both aggregate and mean costs per patient were analysed by histology, stage at diagnosis and cost type. Results: A total of 232 cases of lung cancer were analysed, of which 74.1% corresponded to non-small cell lung cancer (NSCLC) and 11.2% to small cell lung cancer (SCLC); 14.7% had no cytohistologic confirmation. The mean cost per patient in NSCLC ranged from 13,218 Euros in Stage III to 16,120 Euros in Stage II. The main cost components were chemotherapy (29.5%) and surgery (22.8%). Advanced disease stages were associated with a decrease in the relative weight of surgical and inpatient care costs but an increase in chemotherapy costs. In SCLC patients, the mean cost per patient was 15,418 Euros for limited disease and 12,482 Euros for extensive disease. The main cost components were chemotherapy (36.1%) and other inpatient costs (28.7%). In both groups, the Kruskall-Wallis test did not show statistically significant differences in mean cost per patient between stages. Conclusions: This study provides the costs of lung cancer treatment based on patient file reviews, with chemotherapy and surgery accounting for the major components of costs. This cost analysis is a baseline study that will provide a useful source of information for future studies on cost-effectiveness and on the budget impact of different therapeutic innovations in Spain.

Response of fine root respiration to variations in biotic and abiotic factors in a mixed Mediterranean forest affected by drought-induced secondary succession

Understanding the factors controlling fine root respiration (FRR) at different temporal scales will help to improve our knowledge about the spatial and temporal variability of soil respiration (SR) and to improve future predictions of CO2 effluxes to the atmosphere. Here we present a comparative study of how FRR respond to variability in soil temperature and moisture in two widely spread species, Scots pines (Pinus sylvestris L.) and Holm-oaks (HO; Quercus ilex L.). Those two species show contrasting water use strategies during the extreme summer-drought conditions that characterize the Mediterranean climate. The study was carried out on a mixed Mediterranean forest where Scots pines affected by drought induced die-back are slowly being replaced by the more drought resistant HO. FRR was measured in spring and early fall 2013 in excised roots freshly removed from the soil and collected under HO and under Scots pines at three different health stages: dead (D), defoliated (DP) and non-defoliated (NDP). Variations in soil temperature, soil water content and daily mean assimilation per tree were also recorded to evaluate FRR sensibility to abiotic and biotic environmental variations. Our results show that values of FRR were substantially lower under HO (1.26 ± 0.16 microgram CO2 /groot·min) than under living pines (1.89 ± 0.19 microgram CO2 /groot·min) which disagrees with the similar rates of soil respiration previously observed under both canopies and suggest that FRR contribution to total SR varies under different tree species. The similarity of FRR rates under HO and DP furthermore confirms other previous studies suggesting a recent Holm-oak root colonization of the gaps under dead trees. A linear mixed effect model approach indicated that seasonal variations in FRR were best explained by soil temperature (p<0.05) while soil moisture was not exerting any direct control over FRR, despite the low soil moisture values during the summer sampling. Plant assimilation rates were positively related to FRR explaining part of the observed variability (p<0.01). However the positive relations of FRR with plant assimilation occurred mainly during spring, when both soil moisture and plant assimilation rates were higher. Our results finally suggest that plants might be able to maintain relatively high rates of FRR during the sub-optimal abiotic and biotic summer conditions probably thanks to their capacity to re-mobilize carbon reserves and their capacity to passively move water from moister layers to upper layers with lower water potentials (where the FR were collected) by hydraulic lift.

Firm Size and Geographical Aggregation: An Empirical Appraisal in Industrial Location

This paper assesses empirically the importance of size discrimination and disaggregate data for deciding where to locate a start-up concern. We compare three econometric specifications using Catalan data: a multinomial logit with 4 and 41 alternatives (provinces and comarques, respectively) in which firm size is the main covariate; a conditional logit with 4 and 41 alternatives including attributes of the sites as well as size-site interactions; and a Poisson model on the comarques and the full spatial choice set (942 municipalities) with site-specific variables. Our results suggest that if these two issues are ignored, conclusions may be misleading. We provide evidence that large and small firms behave differently and conclude that Catalan firms tend to choose between comarques rather than between municipalities. Moreover, labour-intensive firms seem more likely to be located in the city of Barcelona. Keywords: Catalonia, industrial location, multinomial response model. JEL: C250, E30, R00, R12

Technological trampolines for new venture creation in Catalonia: the case of the University of Girona

Recent trends in technology transfer show an intensification of spin-off creation as a modality of university research commercialisation, complementary to the conventional ones, contract research and licensing. In this paper we analyse the evolution, objectives, resources and activities of a specialised unit –Technological Trampoline (TT) - in charge of new venture creation at the University of Girona (Catalonia-Spain). Based on two theoretical frameworks, Resource-based-view and Institutional Theory, we adopt a multi-dimensional approach to study the strategy of spinning-off new ventures at the University of Girona in terms of resources and activities, how this process is organised and if the outputs fit with this UdG’s objectives and the local environment. Our main contribution is an in-depth analysis of the spin-off creation unit with special emphasis on its variety of resources and activities. The results have a series of implications and recommendations at both university and TT level.

Use and users of electronic journals at Catalan universities: the results of a survey

Es presenten els resultats d’una enquesta sobre l’ús de revistes electròniques realitzada al professorat de les universitats que formen el Consorci de Biblioteques Universitàries de Catalunya (CBUC). Els resultats mostren un elevat grau de coneixement de la col·lecció de revistes electròniques entre el personal docent i investigador i una creixent preferència pel format electrònic en detriment de l’imprès. L’alt grau de coneixement i d’ús dels títols electrònics, i la preferència per aquest suport, comporten una elevada valoració de la col·lecció de revistes electròniques. Al mateix temps, la major part dels usuaris preveu un increment de l’ús dels títols electrònics durant els propers anys. Els resultats també confirmen la importància de la disciplina i de l’edat com a factors explicatius de l’ús de les revistes electròniques.

Testing of stair climbing point-of-choice prompts in Barcelona at an outdoor set of stairs and scalators on the Montjuïc site

Regular stair climbing has well-documented health dividends, such as increased fitness and strength, weight loss and reduced body fat, improved lipid profiles and reduced risk of osteoporosis. The general absence of barriers to participation makes stair climbing an ideal physical activity (PA) for health promotion. Studies in the US and the UK have consistently shown that interventions to increase the accumulation of lifestyle PA by climbing stairs rather than using the escalators are effective. However, there are no previous in Catalonia. This project tested one message for their ability to prompt travelers on the Montjuïc site to choose the stairs rather than the escalator when climbing up the Monjuïc hill. One standard message, " Take the stairs! 7 minutes of stair climbing a day protects your heart" provided a comparison with previous research done in the UK. Translated into Catalan and Spanish, it was presented on a poster positioned at the point of choice between the stairs and the escalator. The study used a quasi-experimental, interrupted time series design. Travelers, during several and specific hours on two days of the week, were coded for stair or escalator use, gender, age, ethnic status, presence of accompanying children or bags by one observer. Overall, the intervention resulted in a 81% increase in stair climbing. In the follow-up period without messages, stair climbing dropped out to baseline levels. This preliminary study showed a significant effect on stair use. However, caution is needed since results are based on a small sample and, only a low percentage of the sample took the stairs at baseline or the intervention phase . Future research on stair use in Catalonia should focus on using bigger samples, different sites (metro stations, airports, shopping centers, etc) , different messages and techniques to promote stair climbing.

Milk, from medicine to food Mediterranean Europe: Catalonia, 19th-20th centuries

The spread of milk consumption was a significant change in the diet of Europeans, however it is one that has not been greatly studied with regard to the populations of Mediterranean Europe. In this article we shall analyse the ain circumstances that conditioned that process in Catalonia between the middle of the 19th century and 1936. In our study we shall argue that the consumption of milk in this area was only relevant in the 19th century in situations of illness or old age, and that it subsequently increased and acquired a new significance as a result of various factors. In particular, we shall emphasise: (a) the scientific advances in microbiology and nutrition, (b) the activities carried out by doctors and various public institutions to promote the consumption of fresh milk, and (c) the technological innovations in the milk producing sector. In Appendix 1 we show two maps representing the main territorial references that we shall mention.

Agglomeration and location: a nonparametric approach

The aim of this article is to assess the effects of several territorial characteristics, specifically agglomeration economies, on industrial location processes in the Spanish region of Catalonia. Theoretically, the level of agglomeration causes economies which favour the location of new establishments, but an excessive level of agglomeration might cause diseconomies, since congestion effects arise. The empirical evidence on this matter is inconclusive, probably because the models used so far are not suitable enough. We use a more flexible semiparametric specification, which allows us to study the nonlinear relationship between the different types of agglomeration levels and location processes. Our main statistical source is the REIC (Catalan Manufacturing Establishments Register), which has plant-level microdata on location of new industrial establishments. Keywords: agglomeration economies, industrial location, Generalized Additive Models, nonparametric estimation, count data models.

The Total fiscal cost of indirect taxation: an approximation using Catalonia's recent input-output table

In this note we quantify to what extent indirect taxation influences and distorts prices. To do so we use the networked accounting structure of the most recent input-output table of Catalonia, an autonomous region of Spain, to model price formation. The role of indirect taxation is considered both from a classical value perspective and a more neoclassical flavoured one. We show that they would yield equivalent results under some basic premises. The neoclassical perspective, however, offers a bit more flexibility to distinguish among different tax figures and hence provide a clearer disaggregate picture of how an indirect tax ends up affecting, and by how much, the cost structure.

Dealing with Tyranny: International Sanctions and Autocrats’ Duration

This paper enquires into whether economic sanctions are effective in destabilizing authoritarian rulers. We argue that this effect is mediated by the type of authoritarian regime against which sanctions are imposed. Thus, personalist regimes and monarchies, which are more dependent on aid and resource rents to maintain their patronage networks, are more likely to be affected by sanctions. In contrast, single-party and military regimes are able to maintain (and even increase) their tax revenues and to reallocate their expenditures and so increase their levels of cooptation. Data on sanction episodes, authoritarian rulers and regimes covering the period 1946–2000 have allowed us to test our hypotheses. To do so, duration models have been run, and the results confirm that personalist autocrats are more vulnerable to foreign pressure. Concretely, the analysis of the modes of exit reveals that sanctions increase the likelihood of an irregular change of ruler, such as a coup. Sanctions are basically ineffective when targeting single-party or military regimes.

Patrimoni Digital de Catalunya, a year and a half experience

E-repositories are part of the e-science, and they are based on the e-infrastructure. The Centre de Supercomputació de Catalunya (CESCA) together with the Consorci de Biblioteques Universitàries de Catalunya (CBUC) started in 1999 a cooperative repository, named TDR, to file, in digital format, the full-text of the read thesis at the universities of our country in order to spread them worldwide in open access, while at the same time, preserving the intellectual copyright of the authors. Since then, four additional cooperative repositories have been created: RECERCAT for research papers; RACO for scientific, cultural and erudite Catalan magazines; MDC for Catalan digital collections of pictures, maps, posters and old magazines; and PADICAT for archiving Catalan digital web content; The main objective of the latter is to archive Catalan web sites. That is, PADICAT collects, processes and provides permanent access to the entire cultural, scientific and general output of Catalonia in digital format. The repository manager is the Biblioteca de Catalunya, as the institution responsible for compiling, processing and distributing the bibliographic heritage of Catalonia, while CESCA is the technology partner. On September 11th, 2006 the repository went into operation for the general public, with some thirty websites archived. After one year and a half, it has 2.720 captures of more than 1.000 websites. This includes 34 million files (HTML, images...) and two terabytes of data. The objective of this paper is to present PADICAT and our experience developing and managing it.We describe the repository briefly, we explain the technology used to implement it and we comment our experiences during its first year and a half.

Innovation sources and productivity in Catalonian firms: a quantile regression analysis

This paper explores the effects of two main sources of innovation -intramural and external R&D- on the productivity level in a sample of 3,267 Catalonian firms. The data set used is based on the official innovation survey of Catalonia which was a part of the Spanish sample of CIS4, covering the years 2002-2004. We compare empirical results by applying usual OLS and quantile regression techniques both in manufacturing and services industries. In quantile regression, results suggest different patterns at both innovation sources as we move across conditional quantiles. The elasticity of intramural R&D activities on productivity decreased when we move up the high productivity levels both in manufacturing and services sectors, while the effects of external R&D rise in high-technology industries but are more ambiguous in low-technology and knowledge-intensive services. JEL codes: O300, C100, O140. Keywords: Innovation sources, R&D, Productivity, Quantile regression

Why Catalonia will see its energy metabolism increase in the near future: an application of MuSIASEM

This paper applies the so-called Multi-Scale Integrated Analysis of Societal and Ecosystem Metabolism (MuSIASEM) to the economy of the Spanish region of Catalonia. By applying Georgescu-Roegen's fund-flow model, it arrives at the conclusion that within a context of the end of cheap oil, the current development model based on the growth of low productivity sectors such as services and construction must change. The change is needed not only because of the increasing scarcity of affordable energy carriers, or because of the increasing environmental impact that the present development represents, but also because of an ageing population that demands labour productivity gains. This will imply industry requiring more energy consumption per worker in order to increase its productivity, and therefore its competitiveness. Thus, we conclude that energy intensity, and exosomatic energy metabolism of Catalonia will increase dramatically in the near future unless major conservation efforts are implemented in both the household and transport sectors.

Innovation, R&D spillovers and productivity: the role of knowledge-intensive services

This paper analyses the performance of companies’ R&D and innovation and the effects of intra- and inter-industry R&D spillover on firms’ productivity in Catalonia. The paper deals simultaneously with the performance of manufacturing and service firms, with the aim of highlighting the growing role of knowledge-intensive services in promoting innovation and productivity gains. We find that intra-industry R&D spillovers have an important effect on the productivity level of manufacturing firms, and the inter-industrial R&D spillovers related to computer and software services also play an important role, especially in high-tech manufacturing industries. The main conclusion is that the traditional classification of manufactured goods and services no longer makes sense in the ‘knowledge economy’ and in Catalonia the regional policy makers will have to design policies that favour inter-industrial R&D flows, especially from high-tech services.

Innovation sources and productivity: a quantile regression analysis

This paper explores the effects of two main sources of innovation —intramural and external R&D— on the productivity level in a sample of 3,267 Catalan firms. The data set used is based on the official innovation survey of Catalonia which was a part of the Spanish sample of CIS4, covering the years 2002-2004. We compare empirical results by applying usual OLS and quantile regression techniques both in manufacturing and services industries. In quantile regression, results suggest different patterns at both innovation sources as we move across conditional quantiles. The elasticity of intramural R&D activities on productivity decreased when we move up the high productivity levels both in manufacturing and services sectors, while the effects of external R&D rise in high-technology industries but are more ambiguous in low-technology and services industries.