Clinical and economic burden of emergency department presentations for neutropenia following outpatient chemotherapy for cancer in Victoria, Australia

Objective. To examine the clinical characteristics and financial charges associated with treating adult cancer patients receiving chemotherapy in outpatient clinics who presented to the emergency department (ED) with neutropenia.
Design and Setting. A retrospective audit was conducted across two health services involving ED episodes and subsequent hospital admissions of patients who received chemotherapy through day oncology from January 1 to December 31, 2007 and presented to the ED with neutropenia. ED data were collected from the Victorian Emergency Minimum Dataset and charges were collected from Health Information Services. Descriptive and bivariate statistics were used to describe the patient and clinical characteristics and financial outcomes, and to explore associations between these factors.
Results. In total, 200 neutropenic episodes in 159 outpatients were seen in the ED over the survey period. The mean patient age was 56.6 years (standard deviation, 13.2 years) and 47.2% were male. Overall, 70.0% of ED episodes were triaged as Australasian Triage Scale 2 (emergency). The median ED wait time was 10 minutes and the median ED length of stay was 6.8 hours. The median charge for each ED episode was $764.08 Australian dollars. The total combined ED and inpatient charge per episode was in the range of $144.27-$174,732.68, with a median charge of $5,640.87.
Conclusions. This study provides important insights into the clinical and economic burden of neutropenia from both the ED and inpatient perspectives. Alternative treatment models, such as outpatient treatment, early discharge programs or prophylactic interventions to reduce the clinical and economic burden of neutropenia on our health system, must be explored.

Economic implications of obesity among people with atherothrombotic disease

Objective: The purpose of this study was to ascertain the impact of obesity on the cost of disease management in people with or at high risk of atherothrombotic disease from a governmental perspective using a bottom-up approach to cost estimation. In addition, the aim was also to explore the causes of any differences found.

Method: The health-care costs of obesity were estimated from 2819 participants recruited into the nationwide Australian REACH Registry with established atherothrombotic disease or at least three risk factors for atherothrombosis. Enrollment was in 2004, through primary care general practices. Information was collected on the use of cardiovascular drugs, hospitalizations and ambulatory care services. Bottom-up costing was undertaken by assigning unit costs to each health-care item, based on Australian Government-reimbursed figures 2006-2007. Linear-mixed models were used to estimate associations between direct medical costs and body mass index (BMI) categories.

Results: Annual pharmaceutical costs per person increased with increasing BMI category, even after adjusting for gender, age, living place, formal education, smoking status, hypertension and diabetes. Adjusted annual pharmaceutical costs of overweight and obese participants were higher (7 (P0.004) and 144 (0.001), respectively) than those of the normal weight participants. This was due to participants in higher BMI categories receiving more pharmaceuticals than normal weight participants. There was no significant change across the BMI categories in annual ambulatory care costs and annual hospital costs.

Conclusion: In these participants with or at high risk of atherothrombotic disease, annual pharmaceutical costs were greater in participants of higher BMI category, but there was not such a gradient in the annual hospital or ambulatory care costs. The greater cardiovascular pharmaceutical costs for participants of higher BMI categories remained even after adjusting for a range of demographic factors and comorbidities. Our results suggest that these costs are explained by the higher number of drugs used among people with atherothrombotic disease. Further investigation is needed to understand the reasons for this level of drug use.

Microeconomic models of intra-household activity time allocation

The primary purpose of this research is to analyze theoretically the group decisionmaking process leading to the allocation of activity time and the consumption of goods, with particular emphasis in the households. Each household is characterized as a group of individuals making joint decisions about their activity participations, alternative activity time allocations and consumption of various goods, such as independent and joint activity time allocations as well as private and shared consumption patterns. We firstly explore why individual-based models are not realistic in multi-person households, and secondly, we summarize various intra-household activity time allocation models based on different decision-making processes. All models are presented under microeconomic principle of utility maximization to represent the economic behavior of the households.

The clinical effectiveness and cost-effectiveness of bariatric (weight loss) surgery for obesity: a systematic review and economic evaluation

To assess the clinical effectiveness and cost-effectiveness of bariatric surgery for obesity. Seventeen electronic databases were searched [MEDLINE; EMBASE; PreMedline In-Process & Other Non-Indexed Citations; The Cochrane Library including the Cochrane Systematic Reviews Database, Cochrane Controlled Trials Register, DARE, NHS EED and HTA databases; Web of Knowledge Science Citation Index (SCI); Web of Knowledge ISI Proceedings; PsycInfo; CRD databases; BIOSIS; and databases listing ongoing clinical trials] from inception to August 2008. Bibliographies of related papers were assessed and experts were contacted to identify additional published and unpublished references. Two reviewers independently screened titles and abstracts for eligibility. Inclusion criteria were applied to the full text using a standard form. Interventions investigated were open and laparoscopic bariatric surgical procedures in widespread current use compared with one another and with non-surgical interventions. Population comprised adult patients with body mass index (BMI) > or = 30 and young obese people. Main outcomes were at least one of the following after at least 12 months follow-up: measures of weight change; quality of life (QoL); perioperative and postoperative mortality and morbidity; change in obesity-related comorbidities; cost-effectiveness. Studies eligible for inclusion in the systematic review for comparisons of Surgery versus Surgery were RCTs. For comparisons of Surgery versus Non-surgical procedures eligible studies were RCTs, controlled clinical trials and prospective cohort studies (with a control cohort). Studies eligible for inclusion in the systematic review of cost-effectiveness were full cost-effectiveness analyses, cost-utility analyses, cost-benefit analyses and cost-consequence analyses. One reviewer performed data extraction, which was checked by two reviewers independently. Two reviewers independently applied quality assessment criteria and differences in opinion were resolved at each stage. Studies were synthesised through a narrative review with full tabulation of the results of all included studies. In the economic model the analysis was developed for three patient populations, those with BMI > or = 40; BMI > or = 30 and < 40 with Type 2 diabetes at baseline; and BMI > or = 30 and < 35. Models were applied with assumptions on costs and comorbidity.

Market effects on forecasting construction prices using vector error correction models

Construction price forecasting is an essential component to facilitate decision-making for construction contractors, investors and related financial institutions. Construction economists are increasingly interested in seeking a more analytical method to forecast construction prices. Although many studies have focused on construction price modelling and forecasting, few have considered the impacts of large-scale economic events and seasonality. In this study, an advanced multivariate modelling technique, namely the vector correction (VEC) model with dummy variables, was employed. The impacts of global economic events and seasonality are factored into the model to forecast the construction price in the Australian construction market. Research findings suggest that both long-run and dynamic short-term causal relationships exist among the price and levels of supply and demand in the construction market. These relationships drive the construction price and supply and demand, which interact with one another as a loop system. The reliability of forecasting models was examined by the mean absolute percentage error (MAPE) and the Theil's inequality coefficient U tests. The test results suggest that the conventional VEC model and the VEC model with dummy variable are both acceptable for forecasting the construction price, while the VEC model considering external impacts achieves higher prediction accuracy than the conventional VEC model. © 2014 © 2014 Taylor & Francis.

Coal - the black gold of economic growth in China: empirical evidence and the role of cleaner coal technologies in recent time

Coal comprises 70 per cent of China’s primary energy source and 80 per cent of China's electricity generation. This study investigates the long-run relationship between coal consumption-economic growth nexus considering both supply and demand side models in a multivariate framework over the period of 1978 and 2010. Our innovation in this paper is to include a coal-to-electricity efficiency indicator into the economic growth model ; and trade exposure in coal demand. Using Autoregressive Distributed Lag bounds testing approach, we find improvement in coal-to-efficiency indicator causes almost 35 per cent increase in real GDP in the long-run. The Toda-Yamamoto approach of causality test indicates unidirectional causality from coal consumption to economic growth; feedback effect both for coal-to-electricity efficiency indicator to economic growth and openness to coal consumption. For robustness check, using the generalised forecast error variance decomposition method we forecast the validity of causal relationships beyond the sample horizon. The paper suggests the role of advanced coal technologies will play a significant role along with other environmental and energy policies in maintaining sustainable economic growth in China .

A nonparametric model of financial system and economic growth

In this paper, we show that in the proposed models for economic growth, the financial system variables are generally nonparametric. We, thus, use a nonparametric panel data model to estimate the financial system-economic growth relationship. Our results suggest that as long as a country's domestic credit and private credit are above their cross-sectional mean they have a positive effect on GDP growth. We also discover that market capitalisation positively and significantly impacts GDP growth, while stocks traded (with the exception of OECD countries) has a statistically insignificant effect on GDP growth.

The health and economic benefits of reducing intimate partner violence: an Australian example.

BACKGROUND: Intimate partner violence (IPV) has important impacts on the health of women in society. Our aim was to estimate the health and economic benefits of reducing the prevalence of IPV in the 2008 Australian female adult population. METHODS: Simulation models were developed to show the effect of a 5 percentage point absolute feasible reduction target in the prevalence of IPV from current Australian levels (27%). IPV is not measured in national surveys. Levels of psychological distress were used as a proxy for exposure to IPV since psychological conditions represent three-quarters of the disease burden from IPV. Lifetime cohort health benefits for females were estimated as fewer incident cases of violence-related disease and injury; deaths; and Disability Adjusted Life Years (DALYs). Opportunity cost savings were estimated for the health sector, paid and unpaid production and leisure from reduced incidence of IPV-related disease and deaths. Workforce production gains were estimated by comparing surveyed participation and absenteeism rates of females with moderate psychological distress (lifetime IPV exposure) against high or very high distress (current IPV exposure), and valued using the friction cost approach (FCA). The impact of improved health status on unpaid household production and leisure time were modelled from time use survey data. Potential costs associated with interventions to reduce IPV were not considered. Multivariable uncertainty analyses and univariable sensitivity analyses were undertaken. RESULTS: A 5 percentage point absolute reduction in the lifetime prevalence of IPV in the 2008 Australian female population was estimated to produce 6000 fewer incident cases of disease/injury, 74 fewer deaths, 5000 fewer DALYs lost and provide gains of 926,000 working days, 371,000 days of home-based production and 428,000 leisure days. Overall, AUD371 million in opportunity cost savings could be achievable. The greatest economic savings would be home-based production (AUD147 million), followed by leisure time (AUD98 million), workforce production (AUD94 million) and reduced health sector costs (AUD38 million). CONCLUSIONS: This study contributes new knowledge about the economic impact of IPV in females. The findings provide evidence of large potential opportunity cost savings from reducing the prevalence of IPV and reinforce the need to reduce IPV in Australia, and elsewhere.

Assessing the economic benefits of starling detection and control to Western Australia

The common starling (Sturnus vulgaris) has a proven invasion history in many countries, and at a continental scale in North America and Australasia. In Australia, starlings are firmly established throughout the eastern states and Tasmania. Incursions of starlings into Western Australia (WA) represent a significant threat to this State’s agricultural, public amenity and biodiversity assets. We present models of starling population dynamics that incorporate environmental and control effort variability. We incorporate knowledge of starling ecology with economic data to assess the potential economic cost of starlings establishing in WA, evaluating the cost–benefits for each management scenario. We calculated starling population size will approach carrying capacity in WA within as little as 30 years if left unchecked. A population of this size could cost the WA economy up to $43.7 million annually in 2011/2012 dollars. Over a 50 year horizon, the conservative benefit–cost ratio for ongoing detection and control at the current level of expenditure is 6.03:1. However, even under current levels of control, starling numbers are projected to increase to almost 11 million by 2061. Further improvements in the efficiency of starling detection and control and/or an increased level of expenditure on detection and control are required.

Online distance education models and research implications

As a form of education, distance education is influenced by educationaltheories and ideologies. Hence, over time its various theoretical modelshave reflected varying emphases on students, both individually and ingroups, on content and process, and on administration and costs, and itsguiding philosophies have ranged from knowledge replication to knowledge creation, and from teacher direction to learner engagement. Its founding purpose was the provision of education to populations who were not able to access available residential education. The reasons were not only based on the individual situation, such as, geographic location, family commitments,work commitments, or cost factors, but also included state issues such as insufficient institutions or a lack of enrolment places, full-time funding, or sufficient staff. These factors have contributed in various ways to the growth of distance education, both historically as when distance education was a major focus in many European countries after WWII, and as a current imperative in many countries where the need and desire for education outstrips the supply through residential institutions, regardless of their fiscal capacities. Education is seen by both individuals and states as essential for the development of a better socio-economic environment, hence, distance education has become the cost-affordable means of provision for millions worldwide.Distance education, then, is framed within larger socio-economic andpolitical contexts. These are not only reflective of societal characteristics like those identified by Keegan (2000): immediacy, globalization, privatization, and industrialization, to which we added professional learning, but also reflective of current social, political, and economic circumstances, such as the sequence of global economic crises this century.Within these contexts then, the provision of distance education seldomarises from the desire of an institution alone; rather there are likely to becomplex national, local, and individual aspirations where distance education is seen as the best solution. The realization of this provision depends on the issues being addressed and the various influences on the particular configuration of design and provision. It may be publicly or privately funded; it may seek to emulate or extend educational provision in residential institutions; its focus may be on increasing access or openness or convenience.Models or designs for distance education, then, have generally arisen from consideration of these instances, in part to provide a framework for researchers and in part to provide a means to reflect on issues that the models themselves have tried to resolve and sometimes inadvertently create.

Managing undesirable outputs in the Australian construction industry using Data Envelopment Analysis models

Carbon reduction has become one of the most significant challenges for economic growth. This paper presents the preliminary analysis of undesirable output reduction targets and emission schedules in temporal-spatial comparisons based on Data Envelopment Analysis. The reduction targets of undesirable outputs are investigated, including the maximum, input, technical and ideal reduction targets. Four Data Envelopment Analysis models that are based on a sequential benchmark technology and variable returns to scale are introduced to measure these reduction percentages. In order to formulate the optimal emission schedule of undesirable outputs, an optimal model is provided without inflation. Data from the Australian construction industry from 2000 to 2010 are employed to develop the models. The results of the analysis indicate that the Australian Government could achieve its promised carbon reduction targets in the construction industry. Most Australian regions' construction industries possess carbon mitigation potential and some of them could increase their desirable outputs if carbon were decreased. This paper suggests that policymakers can benefit from formulating various suitable undesirable output reduction objectives and schedules through the models developed. The research method can be replicated for other sectors and regions focussing on undesirable output reduction.

An investigation of neighborhood-level social, economic and physical factors for railway suicide in Victoria, Australia

BACKGROUND: This study investigates the associations between railway suicide and neighborhood social, economic, and physical determinants using postcode-level data. It also examines whether the associations are influenced by having high concentration of high-risk individuals in a neighborhood area. METHODS: Railway suicide cases from Victoria, Australia for the period of 2001-2012, their age, sex, year of death, usual residential address and suicide location were obtained from the National Coronial Information System. Univariate negative binomial regression models were used to estimate the association between railway suicide and neighborhood-level social, economic and physical factors. Variables which were significant in these univariate models were then assessed in a multivariate model, controlling for age and sex of the deceased and other known confounders. RESULTS: Findings from the multivariate analysis indicate that an elevated rate of railway suicide was strongly associated with neighborhood exposure of higher number of railway stations (IRR=1.30 95% CI=1.16-1.46). Other significant neighborhood risk factors included patronage volume (IRR=1.06, 95% CI=1.02-1.11) and train frequency (IRR=1.02, 95% CI=1.01-1.04). An increased number of video surveillance systems at railway stations and carparks was significantly associated with a modest reduction in railway suicide risk (IRR=0.93, 95% CI=0.88-0.98). These associations were independent of concentration of high-risk individuals. LIMITATIONS: Railway suicide may be under-reported in Australia. CONCLUSIONS: Interventions to prevent railway suicide should target vulnerable individuals residing in areas characterized by high station density, patronage volume and train frequency.

Returns to scale, market power, and the nature of price rigidity in new keynesian models with self-fulfilling expectations

Increasing returns to scale and firms' market power are two potential sources of sunspot expectations in neoclassical models. We show that in New Keynesian models, returns to scale and market power can have fundamentally different implications for broad macroeconomic issues, including self-fulfilling expectations, depending on the nature of price rigidity. Our findings suggest that the design of stabilization monetary policy can depend on precise knowledge about the economy's real and nominal features. Therefore, a clear understanding of the specific economic environment and its relevance to monetary policymaking for ensuring macroeconomic stability can be an integrated part of monetary policy practice.