Economic burden of Cardiac Arrest in Spain: analyzing healthcare costs drivers and treatment strategies cost-effectiveness

Carga económica; Parada cardíaca; RentabilidadEconomic burden; Cardiac arrest; Cost-effectivenessCàrrega econòmica; Aturada cardíaca; RendibilitatBackground Cardiac arrest is a major public health issue in Europe. Cardiac arrest seems to be associated with a large socioeconomic burden in terms of resource utilization and health care costs. The aim of this study is the analysis of the economic burden of cardiac arrest in Spain and a cost-effectiveness analysis of the key intervention identified, especially in relation to neurological outcome at discharge. Methods The data comes from the information provided by 115 intensive care and cardiology units from Spain, including information on the care of patients with out-of-hospital cardiac arrest who had a return of spontaneous circulation. The information reported by theses 115 units was collected by a nationwide survey conducted between March and September 2020. Along with number of patients (2631), we also collect information about the structure of the units, temperature management, and prognostication assessments. In this study we analyze the potential association of several factors with neurological outcome at discharge, and the cost associated with the different factors. The cost-effectiveness of using servo-control for temperature management is analyzed by means of a decision model, based on the results of the survey and data collected in the literature, for a one-year and a lifetime time horizon. Results A total of 109 cardiology units provided results on neurological outcome at discharge as evaluated with the cerebral performance category (CPC). The most relevant factor associated with neurological outcome at discharge was ‘servo-control use’, showing a 12.8% decrease in patients with unfavorable neurological outcomes (i.e., CPC3-4 vs. CPC1-2). The total cost per patient (2020 Euros) was €73,502. Only “servo-control use” was associated with an increased mean total cost per hospital. Patients treated with servo-control for temperature management gained in the short term (1 year) an average of 0.039 QALYs over those who were treated with other methods at an increased cost of €70.8, leading to an incremental cost-effectiveness ratio of 1,808 euros. For a lifetime time horizon, the use of servo-control is both more effective and less costly than the alternative. Conclusions Our results suggest the implementation of servo-control techniques in all the units that are involved in managing the cardiac arrest patient from admission until discharge from hospital to minimize the neurological damage to patients and to reduce costs to the health and social security system

Are trading rules based on genetic algorithms profitable?

In this letter the profitability of a simple trading rule based upon genetic algorithms has been investigated. The referred technical trading rule has been contrasted in four different sample periods of the Spanish stock market index known as IBEX-35. Results suggest that in general the profitability of the simple trading rule is superior to the buy-and-hold strategy. This conclusion is clearer in 'bull', 'bear' and 'volatile' market episodes. These results can be compared with those that apply artificial neural networks as simple trading strategies to the general index of Madrid.

A SVAR model for estimating core inflation in the Euro zone

A traditional role of central banks has been to protect the purchasing power of money by keeping a roof on inflation. Recently, several central banks have explicitly assumed an inflation control target. This is the case, among others, of the European Central Bank (ECB) whose monetary policy goal is to keep an annual inflation rate below 2% over a medium-term horizon (ECB, 2001). In practice, inflation is often measured in terms of the Consumer Price Index (CPI). However, the headline inflation rate is not totally under the control of the ECB. In this study core inflation is measured by means of the structural VAR approach, in particular it is based on long-run restrictions over crucial macroeconomic variables: inflation, money and output. Core inflation is estimated and compared with the standard measured inflation.

A note on cointegrated relationships estimated with genetic algorithms

Estimation techniques based on Genetic Algorithms (GA) have been studied in the presence of cointegrated variables. Several applications of GA to time-series have ignored the fact that the equation estimated by GA might be spurious. In this line, in this study it is shown that: (1) GA robustly detects this kind of relationship when the process contains a linear cointegrated relationship, (2) estimated models provide real fitness instead of spurious fitness. The well known cointegrated relation between income and consumption is estimated using GA.

A hybrid approach based on neural networks and genetic algorithms to the study of profitability in the Spanish Stock Market

This paper studies predictability and profitability of using neural networks (NN) in the Spanish security market. This is carried out through a hybrid approximation which entails evolving a genetic algorithm in order to obtain an optimal NN's architecture. To that end, (NNs) forecasts are transformed into a simple trading strategy, whose profitability is evaluated against a simple buy-and-hold strategy.

The BDS test and delay time

One of the most popular tests for detecting non-linear structure is the BDS test. This test is based on the correlation integral, and some studies have proved the sensitivity of this concept in relation to the choice of one particular parameter: delay time. However, the BDS test considers fixed delay time equal to one. In this paper it is investigated whether a flexible choice of delay time might improve the capacity of the BDS test. It is shown that the BDS-G test (generalized BDS test, including delay time choice) can capture non-linearities that are undetected by the classical BDS test. Finally, the robustness of the BDS-G test in the presence of noise is analysed.

Spatial partial causality

This paper, on the one hand, proposes a statistical technique to detect potential causal relationships when the researcher has georeferenced data but not time dimension, and, on the other, applies this new methodology to the analysis of potential partial causal determinants of home prices. In particular, we find that the direction of causality for home prices in California goes from the income level to prices

Complex networks and dynamics: Social and Economic Interactions

This volume sheds light on the current state of complex networks and nonlinear dynamics applied to the understanding of economic and social phenomena ranging from geographical economics to macroeconomics and finance, and its purpose is to give readers an overview of several interesting topics for research at an intermediate level. Three different and interdisciplinary, but complementary, aspects of networks are put together in a single piece, namely: (i) complex networks theory, (ii) applied network analysis to social and economic interrelations, and (iii) dynamical evolution of systems and networks. The volume includes contributions from excellent scholars in economics and social sciences as well as leading experts in the fields of complex networks and nonlinear dynamics

Surgical treatment of low and intermediate grade lung net

Background: Carcinoids now constitute complex tumours which require a multidisciplinary approach and long-term follow-up. Surgical intervention is nowadays confirmed as the mainstay of treatment.Methods: From 1980 to 2015, EMETNE-SEPAR collected 1,339 patients treated surgically for bronchial carcinoid (1,154 typical and 185 atypical carcinoids). Standard and conservative procedures were considered with regard to surgical approach. All the patients with carcinoid were pathologically coded following the standards of the 7th edition 2009 TNM lung cancer staging. Statistical analyses were performed in order to determine whether histology, nodal affectation and surgical technique were associated with significant differences in survival, presence of metastases and local recurrence.Results: The influence of the surgical procedure on overall survival, the presence of metastases and local recurrence were demonstrated as no significant in our sample in central tumours (P>0.05). Sublobar resections in peripheral tumours are related to a decrease in survival in typical carcinoids (P=0.008) with nodal involvement and an increased number of recurrences in atypical carcinoids without nodal involvement (P=0.018).Conclusions: In central typical carcinoid, the use of lung-sparing bronchoplastic techniques could influence local recurrence in some cases. This observation demands the intraoperative pathologic verification of an adequate surgical margin by frozen section. Peripheral typical carcinoids have been surgically treated, occasionally, by sublobar resection. However, in peripheral atypical carcinoid after a limited sublobar resection the observed increase of the probability of local recurrence makes it, in our opinion, not advisable