Please scroll down for article-it is on subsequent pages With 12,500 members from nearly 90 countries, INFORMS is the largest international association of operations research (O.R.) and analytics professionals and students. INFORMS provides unique networking and learning opportunities for individual professionals, and organizations of all types and sizes, to better understand and use O.R. and analytics tools and methods to transform strategic visions and achieve better outcomes. For more information on INFORMS, its publications, membership, or meetings visit http://www.informs.org
The complete hospital and community records of 77 women were randomly selected from 232 women who had relapsed breast cancer between 2000 and 2005. Scrutiny of all management activities revealed a total cost of d1 939 329 (mean per patient of d25 186, 95% CI d13 705 -d33 821). The median survival from time of relapse was 40.07 months and the median total cost per patient was d31 402.62. Including the community cost of a relapse provides a more realistic figure for future cost-effectiveness analysis of adjuvant breast cancer therapies. et al, 2006). To decide whether the benefits are cost-effective, budget holders require an accurate knowledge of how much it costs to treat patients with relapse. Most earlier estimates have used predictive modelling or interviews with clinicians (Mansel et al, 2007). A UK trial, now 6 years old, estimated hospital costs of relapsed breast cancer by sending questionnaires to UK oncologists and produced a figure of d12 500 per patient (Remak and Brazil, 2004). A study from Edinburgh, collecting hospital data from node-positive women, gave a figure of d13 533 for locoregional relapse and d13 193 for distant relapse (Karnon et al, 2007). We report the first analysis of the total hospital and community cost of managing patients with relapsed breast cancer from a typical UK breast cancer practice. METHODSThe Bedford Breast Cancer database identified 232 women who had relapsed between March 2000 and March 2005 with locoregional or distant disease. The identification codes were placed in separate sealed envelopes and one-third (77) randomly selected for data collection until their death or the predetermined end of the study in January 2007. The average age of the cohort was 62.3 years (33 -95) and 44% were originally node positive; 67% postmenopausal, 48% stage 1 (T1), 33% T2, 16% T3 -4; 55% oestrogen receptor (ER) þ ve , 25% ER Àve (25% unknown) and 21% overexpressed human epithelial growth factor receptor (HER)2 (17% unknown). The demographics of the entire group and selected cohort were similar, indicating that the randomisation process was balanced. The specific cancer-related activities were derived from written and electronic hospital records (Table 1). For each patient, a member of the research team visited all GP practices, hospices and community offices to collect all the relapse-related management and drug activities, which ensured there was no missing data. Once complete, the data set was locked and analysed in liaison with the Health Economics Department of Cranfield University. The predetermined subgroups chosen were menopausal status, ER status and HER2 expression, as these influence drug strategies on relapse. Whether patients suffered local or distant relapse was not included, as an earlier analysis did not demonstrate a cost difference (Karnon et al, 2007).The NHS tariffs for outpatient visits, procedures, nights in hospital and investigations were derived from the existing NHS Trust Reference Cost Index 2004 (DoH, 2004). Radiotherapy was costed per fraction taken from t...
The UK economy has enjoyed an unprecedented period of positive economic growth since the early 1990s. The absence of recession for more than a decade has been accompanied by a sustained decline in the level of mortgage arrears, as reported by major lenders. This paper seeks to examine the factors which have driven the reduction in mortgage arrears and, in doing so, identify those factors which are most likely to cause arrears to increase in the future, should economic conditions deteriorate. The paper employs the Johansen methodology to test for the presence of multiple cointegrating vectors. An error correction model is estimated in order to examine long-run and short-run dynamics in mortgage arrears. In line with previous research concerning the causes of mortgage arrears, the results presented here emphasise the importance of changes in the rate of unemployment, loan-income and debt-service ratios. More importantly, our results highlight the statistical significance of unwithdrawn housing equity as an explanatory variable with respect to mortgage arrears.
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