Ökonomische Folgen der Ausbreitung von Neobiota : Forschungsbericht 20186211

The European Strategy on Invasive Alien Species T-PWS(2002) 8 mandates intensified research by member nations on invasive species. This research will not be restricted solely to the biology and remediation of invasive species, but will also evaluate their adverse health effects and economic impact. Previous studies of these issues have only been carried out in the Unites States of America, or in a limited, regional manner. Consequently, 20 plant and animal species from various problem areas (species which pose a threat to public health; losses to agriculture, fisheries, and forestry; damage to public roads and waterways; costs associated with the protection of native species threatened by non-native species as mandated by Recommendation 77 of the Bern Convention were assessed in Germany nation-wide. The accruing costs were sorted into 3 categories: a) direct economic losses, such as those caused by destructive pest species; b) ecological costs, in the form of extra care and protection of native taxa, biotopes, or ecosystems threatened by invasive species; c) costs of measures to combat invasive species. Because of the nature of available data, as well as the different biology and ecology of the invasive species, each had to be treated individually, and the associated costs vary greatly from species to species. Moreover, not all of the species investigated cause economic losses. Accordingly, a nuanced approach to alien species is essential. Cost assessment of losses deriving from ecological damage was only possible in a few cases. Ongoing, multi-year studies incorporating cost/benefit analysis will be necessary to resolve remaining issues.In dem Entwurf einer European Strategy on Invasive Alien Species T-PVS (2002) 8 werden verstärkte Forschungsaktivitäten der Mitgliedstaaten angeregt, die nicht nur auf den biologischen Bereich oder Bekämpfung invasiver Arten beschränkt bleiben, sondern auch die Bewertung der Auswirkungen auf Gesundheitswesen und Volkswirtschaft untersuchen sollen. Derartige Studien wurden bisher nur für die Vereinigten Staaten von Amerika oder mit eher regionalen Charakter durchgeführt. Aus diesem Grunde wurden 20 Tiere und Pflanzen aus verschiedenen Problemgebieten (Gesundheitsgefährdende Arten, Schäden in Forst-, Land-, und Fischereiwirtschaft, im kommunalen Bereich, an aquatischen und terrestrischen Verkehrswegen sowie Kosten von Arten, die einheimische Spezies gefährden oder in der Empfehlung 77 der Berner Konvention aufgeführt sind) ausgewählt und beispielhaft für das Gebiet Deutschlands bearbeitet. Die entstehenden Kosten wurden in drei Kategorien aufgeschlüsselt: a) direkte ökonomische Schäden, beispielsweise durch Vorratsschädlinge, b) ökologische Schäden, verursacht durch Pflege und Schutz gefährdeter heimischer Arten, Biozönosen oder Ökosysteme und c) Kosten für Maßnahmen zur Bekämpfung invasiver Arten. Es zeigte sich, dass auf Grund der Datenlage sowie der unterschiedlichen Biologie und Ökologie der invasiven Arten jeweils individuelle Ansätze notwendig waren. Die hier ermittelten Kosten unterscheiden sich stark von Art zu Art. Nicht alle untersuchten Arten verursachen ökonomische Schäden. Eine differenzierte Betrachtung von Neobiota ist nach dem Prinzip der Einzelfallbewertung erforderlich. Die Monetisierung von ökologischen Schäden gelang hierbei nur in wenigen Fällen. Weitergehende, mehrjährige Studien sollten willingness to pay-Analysen einbeziehen, um offen gebliebene Fragen zu beantworten

Economic impact of the spread of alien species in Germany

In dem Entwurf einer European Strategy on Invasive Alien Species T-PVS (2002) 8 werden verstärkte Forschungsaktivitäten der Mitgliedstaaten angeregt, die nicht nur auf den biologischen Bereich oder Bekämpfung invasiver Arten beschränkt bleiben, sondern auch die Bewertung der Auswirkungen auf Gesundheitswesen und Volkswirtschaft untersuchen sollen. Derartige Studien wurden bisher nur für die Vereinigten Staaten von Amerika oder mit eher regionalen Charakter durchgeführt. Aus diesem Grunde wurden 20 Tiere und Pflanzen aus verschiedenen Problemgebieten (Gesundheitsgefährdende Arten, Schäden in Forst-, Land-, und Fischereiwirtschaft, im kommunalen Bereich, an aquatischen und terrestrischen Verkehrswegen sowie Kosten von Arten, die einheimische Spezies gefährden oder in der Empfehlung 77 der Berner Konvention aufgeführt sind) ausgewählt und beispielhaft für das Gebiet Deutschlands bearbeitet. Die entstehenden Kosten wurden in drei Kategorien aufgeschlüsselt: a) direkte ökonomische Schäden, beispielsweise durch Vorratsschädlinge, b) ökologische Schäden, verursacht durch Pflege und Schutz gefährdeter heimischer Arten, Biozönosen oder Ökosysteme und c) Kosten für Maßnahmen zur Bekämpfung invasiver Arten. Es zeigte sich, dass auf Grund der Datenlage sowie der unterschiedlichen Biologie und Ökologie der invasiven Arten jeweils individuelle Ansätze notwendig waren. Die hier ermittelten Kosten unterscheiden sich stark von Art zu Art. Nicht alle untersuchten Arten verursachen ökonomische Schäden. Eine differenzierte Betrachtung von Neobiota ist nach dem Prinzip der Einzelfallbewertung erforderlich. Die Monetisierung von ökologischen Schäden gelang hierbei nur in wenigen Fällen. Weitergehende, mehrjährige Studien sollten willingness to pay-Analysen einbeziehen, um offen gebliebene Fragen zu beantworten.The European Strategy on Invasive Alien Species T-PWS(2002) 8 mandates intensified research by member nations on invasive species. This research will not be restricted solely to the biology and remediation of invasive species, but will also evaluate their adverse health effects and economic impact. Previous studies of these issues have only been carried out in the Unites States of America, or in a limited, regional manner. Consequently, 20 plant and animal species from various problem areas (species which pose a threat to public health; losses to agriculture, fisheries, and forestry; damage to public roads and waterways; costs associated with the protection of native species threatened by non-native species as mandated by Recommendation 77 of the Bern Convention were assessed in Germany nation-wide. The accruing costs were sorted into 3 categories: a) direct economic losses, such as those caused by destructive pest species; b) ecological costs, in the form of extra care and protection of native taxa, biotopes, or ecosystems threatened by invasive species; c) costs of measures to combat invasive species. Because of the nature of available data, as well as the different biology and ecology of the invasive species, each had to be treated individually, and the associated costs vary greatly from species to species. Moreover, not all of the species investigated cause economic losses. Accordingly, a nuanced approach to alien species is essential. Cost assessment of losses deriving from ecological damage was only possible in a few cases. Ongoing, multi-year studies incorporating cost/benefit analysis will be necessary to resolve remaining issues

Management and outcomes in critically ill nonagenarian versus octogenarian patients.

BACKGROUND: Intensive care unit (ICU) patients age 90 years or older represent a growing subgroup and place a huge financial burden on health care resources despite the benefit being unclear. This leads to ethical problems. The present investigation assessed the differences in outcome between nonagenarian and octogenarian ICU patients. METHODS: We included 7900 acutely admitted older critically ill patients from two large, multinational studies. The primary outcome was 30-day-mortality, and the secondary outcome was ICU-mortality. Baseline characteristics consisted of frailty assessed by the Clinical Frailty Scale (CFS), ICU-management, and outcomes were compared between octogenarian (80-89.9 years) and nonagenarian (> 90 years) patients. We used multilevel logistic regression to evaluate differences between octogenarians and nonagenarians. RESULTS: The nonagenarians were 10% of the entire cohort. They experienced a higher percentage of frailty (58% vs 42%; p < 0.001), but lower SOFA scores at admission (6 + 5 vs. 7 + 6; p < 0.001). ICU-management strategies were different. Octogenarians required higher rates of organ support and nonagenarians received higher rates of life-sustaining treatment limitations (40% vs. 33%; p < 0.001). ICU mortality was comparable (27% vs. 27%; p = 0.973) but a higher 30-day-mortality (45% vs. 40%; p = 0.029) was seen in the nonagenarians. After multivariable adjustment nonagenarians had no significantly increased risk for 30-day-mortality (aOR 1.25 (95% CI 0.90-1.74; p = 0.19)). CONCLUSION: After adjustment for confounders, nonagenarians demonstrated no higher 30-day mortality than octogenarian patients. In this study, being age 90 years or more is no particular risk factor for an adverse outcome. This should be considered- together with illness severity and pre-existing functional capacity - to effectively guide triage decisions. TRIAL REGISTRATION: NCT03134807 and NCT03370692

Relationship between the Clinical Frailty Scale and short-term mortality in patients ≥ 80 years old acutely admitted to the ICU: a prospective cohort study.

BACKGROUND: The Clinical Frailty Scale (CFS) is frequently used to measure frailty in critically ill adults. There is wide variation in the approach to analysing the relationship between the CFS score and mortality after admission to the ICU. This study aimed to evaluate the influence of modelling approach on the association between the CFS score and short-term mortality and quantify the prognostic value of frailty in this context. METHODS: We analysed data from two multicentre prospective cohort studies which enrolled intensive care unit patients ≥ 80 years old in 26 countries. The primary outcome was mortality within 30-days from admission to the ICU. Logistic regression models for both ICU and 30-day mortality included the CFS score as either a categorical, continuous or dichotomous variable and were adjusted for patient's age, sex, reason for admission to the ICU, and admission Sequential Organ Failure Assessment score. RESULTS: The median age in the sample of 7487 consecutive patients was 84 years (IQR 81-87). The highest fraction of new prognostic information from frailty in the context of 30-day mortality was observed when the CFS score was treated as either a categorical variable using all original levels of frailty or a nonlinear continuous variable and was equal to 9% using these modelling approaches (p < 0.001). The relationship between the CFS score and mortality was nonlinear (p < 0.01). CONCLUSION: Knowledge about a patient's frailty status adds a substantial amount of new prognostic information at the moment of admission to the ICU. Arbitrary simplification of the CFS score into fewer groups than originally intended leads to a loss of information and should be avoided. Trial registration NCT03134807 (VIP1), NCT03370692 (VIP2)

Management and outcomes in critically ill nonagenarian versus octogenarian patients

Background: Intensive care unit (ICU) patients age 90 years or older represent a growing subgroup and place a huge financial burden on health care resources despite the benefit being unclear. This leads to ethical problems. The present investigation assessed the differences in outcome between nonagenarian and octogenarian ICU patients. Methods: We included 7900 acutely admitted older critically ill patients from two large, multinational studies. The primary outcome was 30-day-mortality, and the secondary outcome was ICU-mortality. Baseline characteristics consisted of frailty assessed by the Clinical Frailty Scale (CFS), ICU-management, and outcomes were compared between octogenarian (80-89.9 years) and nonagenarian (>= 90 years) patients. We used multilevel logistic regression to evaluate differences between octogenarians and nonagenarians. Results: The nonagenarians were 10% of the entire cohort. They experienced a higher percentage of frailty (58% vs 42%; p < 0.001), but lower SOFA scores at admission (6 +/- 5 vs. 7 +/- 6; p < 0.001). ICU-management strategies were different. Octogenarians required higher rates of organ support and nonagenarians received higher rates of life-sustaining treatment limitations (40% vs. 33%; p < 0.001). ICU mortality was comparable (27% vs. 27%; p = 0.973) but a higher 30-day-mortality (45% vs. 40%; p = 0.029) was seen in the nonagenarians. After multivariable adjustment nonagenarians had no significantly increased risk for 30-day-mortality (aOR 1.25 (95% CI 0.90-1.74; p = 0.19)). Conclusion: After adjustment for confounders, nonagenarians demonstrated no higher 30-day mortality than octogenarian patients. In this study, being age 90 years or more is no particular risk factor for an adverse outcome. This should be considered- together with illness severity and pre-existing functional capacity - to effectively guide triage decisions