Recent Trends in the Economic Status of Boston\u27s Aged: Determinants and Policy Implications

The economic status of the older population has improved significantly since the early 1970s. Yet poverty rates among certain groups of elderly, especially older minorities, have declined very little. To understand the reasons for these seemingly contradictory trends, changes in the income composition of the elderly in Boston are compared to changes in income for the elderly in the United States. This analysis suggests that low-income older persons were largely bypassed by one of the major factors in income growth among the older population — growth in pension income. Despite the persistence of poverty among significant segments of the older population, it does not appear likely that federal programs for the aged poor will be expanded in the near future (given the current political environment engendered by large federal deficits). If this is the case, it suggests an increased role for state and local policy initiatives to improve the economic status of the aged poor. The number of such state and local policy options is limited, however. Employment programs might be helpful for improving the incomes of some older persons, but labor force participation rates among the aged poor are already very high. Many of the remaining elderly in poverty have health limitations or lack the necessary job skills for employment, even if training were more readily available. The most promising option for improving the cash incomes of the elderly living in poverty is to increase the state supplementation of SSI benefits, especially for older persons living alone

Aggregation bias, information loss, and trade-coefficient stability in the multiregional input-output model

Thesis (Ph.D.)--Massachusetts Institute of Technology, Dept. of Urban Studies and Planning, 1982.MICROFICHE COPY AVAILABLE IN ARCHIVES AND ROTCH.Bibliography: leaves 174-180.by William H. Crown.Ph.D

Benefit Plan Design and Prescription Drug Utilization Among Asthmatics: Do Patient Copayments Matter?

Objective: The ratio of controller to reliever medication use has been proposed as a measure of treatment quality for asthma patients. In this study we examine the effects of plan level mean out-of-pocket asthma medication patient copayments and other features of benefit plan design on the use of controller medications alone, controller and reliever medications (combination therapy), and reliever medications alone. Methods: 1995-2000 MarketScan claims data were used to construct plan-level out-of-pocket copayment and physician/practice prescriber preference variables for asthma medications. Separate multinomial logit models were estimated for patients in fee-for-service (FFS) and non-FFS plans relating benefit plan design features, physician/practice prescribing preferences, patient demographics, patient comorbidities and county-level income variables to patient-level asthma treatment patterns. Results: We find that the controller reliever ratio rose steadily over 1995-2000, along with out-of-pocket payments for asthma medications, which rose more for controllers than for relievers. However, after controlling for other variables, plan level mean out-of-pocket copayments were not found to have a statistically significant influence upon patient-level asthma treatment patterns. On the other hand, physician practice prescribing patterns strongly influenced patient level treatment patterns. Conclusions: There is no strong statistical evidence that higher levels of out-of-pocket copayments for prescription drugs influence asthma treatment patterns. However, physician/practice prescribing preferences influence patient treatment.

Seasonal versus Perennial Allergic Rhinitis: Drug and Medical Resource Use Patterns

AbstractBackgroundThere are no published studies that have compared the medical costs of patients with seasonal and perennial allergic rhinitis symptomatology.ObjectivesThe objectives of this study were to develop an algorithm for classifying patients into seasonal and perennial groups based on their patterns of allergy medication use and then compare the epidemiology and economics of the two groups.MethodsData for the study were obtained from the 1996 to 1998 MarketScan databases containing linked inpatient, outpatient, and pharmaceutical claims for approximately 2 million covered lives annually. Patients were classified into seasonal allergic rhinitis (SAR) or perennial allergic rhinitis (PAR) groups based on their pattern of allergy medication use over the course of 1 year and then compared using descriptive methods.ResultsSeventy-nine percent of the total study sample (80,534 allergy patients) was classified as SAR and 21% as PAR. PAR patients were found to have higher mean levels of allergy-related outpatient payments ($568 vs.$471) and higher mean costs for second-generation antihistamines ($552 vs.$162). PAR patients also had higher levels of comorbidities (asthma, sinusitis, depression, and migraine), higher numbers of concomitant medications (multiple second-generation antihistamines, nasal steroids, other antihistamines, asthma medications, and ophthalmic decongestants), and more immunization encounters.ConclusionsApproximately 21% of allergic rhinitis patients have perennial symptoms as reflected in their patterns of medication use. Perennial patients have significantly higher allergy-related health-care costs and rates of comorbidities and greater use of concomitant medications. These distinct clinical and resource use profiles may have implications for therapy choices in the cost-effective management of perennial allergic rhinitis patients

An Economic Framework for Evaluating Personalized Medicine

Individual variation accounts for a wide range of medical and economic consequences, from inefficiencies in drug discovery and development to ineffectiveness of drug treatment to drug-induced morbidity and mortality. Addressing these consequences could benefit patients, health care providers and payers, and the pharmaceutical industry. When appropriate markers are known, diagnostic tests allow precise diagnosis and dosing, prediction of disease progression, prediction of treatment response and prediction of adverse drug reactions for individual patients. There may also be substantial savings realized by eliminating costs associated with failed treatment. We developed an analytical framework for analyzing the potential value of using a diagnostic test in clinical practice. Our framework determines the economic consequences of implementing pharmacogenomics in the clinic using a diagnostic test to predict drug response. We offer an empirical test of these ideas: we calculated the cost offset realized by predicting the likelihood of response to an alternative existing treatment using a hypothetical pharmacogenomic test in an asthma population. Because the diagnostic test is hypothetical, our framework is general and could be applied to other indications where diagnostic tests have not been developed. Our results could potentially guide future economic evaluation of new diagnostic tests. Importantly, they may also influence biomarker discovery strategies to ensure consistency between market priorities and the future stream of product introductions

Multiple pathways of SARS-CoV-2 nosocomial transmission uncovered by integrated genomic and epidemiological analyses during the second wave of the COVID-19 pandemic in the UK

INTRODUCTION: Throughout the global COVID-19 pandemic, nosocomial transmission has represented a major concern for healthcare settings and has accounted for many infections diagnosed within hospitals. As restrictions ease and novel variants continue to spread, it is important to uncover the specific pathways by which nosocomial outbreaks occur to understand the most suitable transmission control strategies for the future. METHODS: In this investigation, SARS-CoV-2 genome sequences obtained from 694 healthcare workers and 1,181 patients were analyzed at a large acute NHS hospital in the UK between September 2020 and May 2021. These viral genomic data were combined with epidemiological data to uncover transmission routes within the hospital. We also investigated the effects of the introduction of the highly transmissible variant of concern (VOC), Alpha, over this period, as well as the effects of the national vaccination program on SARS-CoV-2 infection in the hospital. RESULTS: Our results show that infections of all variants within the hospital increased as community prevalence of Alpha increased, resulting in several outbreaks and super-spreader events. Nosocomial infections were enriched amongst older and more vulnerable patients more likely to be in hospital for longer periods but had no impact on disease severity. Infections appeared to be transmitted most regularly from patient to patient and from patients to HCWs. In contrast, infections from HCWs to patients appeared rare, highlighting the benefits of PPE in infection control. The introduction of the vaccine at this time also reduced infections amongst HCWs by over four-times. DISCUSSION: These analyses have highlighted the importance of control measures such as regular testing, rapid lateral flow testing alongside polymerase chain reaction (PCR) testing, isolation of positive patients in the emergency department (where possible), and physical distancing of patient beds on hospital wards to minimize nosocomial transmission of infectious diseases such as COVID-19

Publisher Correction: SARS-CoV-2 Omicron is an immune escape variant with an altered cell entry pathway (Nature Microbiology, (2022), 7, 8, (1161-1179), 10.1038/s41564-022-01143-7)

In the version of this article initially published, the author affiliation information was incomplete, neglecting to note that Brian J. Willett, Joe Grove, Oscar A. MacLean, Craig Wilkie, Giuditta De Lorenzo, Wilhelm Furnon, Diego Cantoni, Sam Scott, Nicola Logan and Shirin Ashraf contributed equally and that John Haughney, David L. Robertson, Massimo Palmarini, Surajit Ray and Emma C. Thomson jointly supervised the work, as now indicated in the HTML and PDF versions of the article

SARS-CoV-2 Omicron is an immune escape variant with an altered cell entry pathway

Vaccines based on the spike protein of SARS-CoV-2 are a cornerstone of the public health response to COVID-19. The emergence of hypermutated, increasingly transmissible variants of concern (VOCs) threaten this strategy. Omicron (B.1.1.529), the fifth VOC to be described, harbours multiple amino acid mutations in spike, half of which lie within the receptor-binding domain. Here we demonstrate substantial evasion of neutralization by Omicron BA.1 and BA.2 variants in vitro using sera from individuals vaccinated with ChAdOx1, BNT162b2 and mRNA-1273. These data were mirrored by a substantial reduction in real-world vaccine effectiveness that was partially restored by booster vaccination. The Omicron variants BA.1 and BA.2 did not induce cell syncytia in vitro and favoured a TMPRSS2-independent endosomal entry pathway, these phenotypes mapping to distinct regions of the spike protein. Impaired cell fusion was determined by the receptor-binding domain, while endosomal entry mapped to the S2 domain. Such marked changes in antigenicity and replicative biology may underlie the rapid global spread and altered pathogenicity of the Omicron variant

Investigation of hospital discharge cases and SARS-CoV-2 introduction into Lothian care homes

Background The first epidemic wave of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) in Scotland resulted in high case numbers and mortality in care homes. In Lothian, over one-third of care homes reported an outbreak, while there was limited testing of hospital patients discharged to care homes. Aim To investigate patients discharged from hospitals as a source of SARS-CoV-2 introduction into care homes during the first epidemic wave. Methods A clinical review was performed for all patients discharges from hospitals to care homes from 1st March 2020 to 31st May 2020. Episodes were ruled out based on coronavirus disease 2019 (COVID-19) test history, clinical assessment at discharge, whole-genome sequencing (WGS) data and an infectious period of 14 days. Clinical samples were processed for WGS, and consensus genomes generated were used for analysis using Cluster Investigation and Virus Epidemiological Tool software. Patient timelines were obtained using electronic hospital records. Findings In total, 787 patients discharged from hospitals to care homes were identified. Of these, 776 (99%) were ruled out for subsequent introduction of SARS-CoV-2 into care homes. However, for 10 episodes, the results were inconclusive as there was low genomic diversity in consensus genomes or no sequencing data were available. Only one discharge episode had a genomic, time and location link to positive cases during hospital admission, leading to 10 positive cases in their care home. Conclusion The majority of patients discharged from hospitals were ruled out for introduction of SARS-CoV-2 into care homes, highlighting the importance of screening all new admissions when faced with a novel emerging virus and no available vaccine