Cost-Effectiveness of Pertussis Vaccination Schedule in Israel.

Pertussis is a highly contagious bacterial disease that primarily affects infants. To optimize the pertussis vaccination schedule in Israel and evaluate the cost-effectiveness of alternative strategies that add or remove booster doses, we developed an age-structured model for pertussis transmission. Our model was calibrated using 16 years of data from laboratory-confirmed pertussis cases in Israel. Costs and quality-adjusted life years (QALYs) projected by the model within 12 years from the implementation of the considered interventions were compared with the current vaccination schedule. We found that by using the same number of vaccines administered today, the targeting of children at the age of six instead of seven would be predicted to be the optimal schedule to decrease both outpatient visits and hospitalizations. We also found that any increase in maternal vaccination coverage is likely to be cost-effective, with an incremental cost-effectiveness ratio of $77,000-$97,000 per QALY. By contrast, the contribution of the second booster dose is limited, with a probability of only 0.6 to be cost-effective at $110,000/QALY saved. Additional effort should be invested to encourage maternal vaccination against pertussis. We recommend moving the first booster to age six and prudently considering the necessity of the second booster dose.

Network Dynamics of a Financial Ecosystem.

Global financial crises have led to the understanding that classical econometric models are limited in comprehending financial markets in extreme conditions, partially since they disregarded complex interactions within the system. Consequently, in recent years research efforts have been directed towards modeling the structure and dynamics of the underlying networks of financial ecosystems. However, difficulties in acquiring fine-grained empirical financial data, due to regulatory limitations, intellectual property and privacy control, still hinder the application of network analysis to financial markets. In this paper we study the trading of cryptocurrency tokens on top of the Ethereum Blockchain, which is the largest publicly available financial data source that has a granularity of individual trades and users, and which provides a rare opportunity to analyze and model financial behavior in an evolving market from its inception. This quickly developing economy is comprised of tens of thousands of different financial assets with an aggregated valuation of more than 500 Billion USD and typical daily volume of 30 Billion USD, and manifests highly volatile dynamics when viewed using classic market measures. However, by applying network theory methods we demonstrate clear structural properties and converging dynamics, indicating that this ecosystem functions as a single coherent financial market. These results suggest that a better understanding of traditional markets could become possible through the analysis of fine-grained, abundant and publicly available data of cryptomarkets.

Structural Entropy: Monitoring Correlation-Based Networks Over Time With Application To Financial Markets.

The concept of "Structural Diversity" of a network refers to the level of dissimilarity between the various agents acting in the system, and it is typically interpreted as the number of connected components in the network. This key property of networks has been studied in multiple settings, including diffusion of ideas in social networks and functional diversity of regions in brain networks. Here, we propose a new measure, "Structural Entropy", as a revised interpretation to "Structural Diversity". The proposed measure relies on the finer-grained network communities (in contrast to the network's connected components), and takes into consideration both the number of communities and their sizes, generating a single representative value. We then propose an approach for monitoring the structure of correlation-based networks over time, which relies on the newly suggested measure. Finally, we illustrate the usefulness of the new approach, by applying it to the particular case of emergent organization of financial markets. This provides us a way to explore their underlying structural changes, revealing a remarkably high linear correlation between the new measure and the volatility of the assets' prices over time.

Second opinion utilization by healthcare insurance type in a mixed private-public healthcare system: a population-based study.

OBJECTIVES: To evaluate the utilisation (overall and by specialty) and the characteristics of second-opinion seekers by insurance type (either health fund or supplementary insurance) in a mixed private-public healthcare. DESIGN: An observational study. SETTING: Secondary care visits provided by a large public health fund and a large supplementary health insurance in Israel. PARTICIPANTS: The entire sample included 1 392 907 patients aged 21 years and above who visited at least one specialist over an 18 months period, either in the secondary care or privately via the supplementary insurance. OUTCOMES MEASURES: An algorithm was developed to identify potential second-opinion instances in the dataset using visits and claims data. Multivariate logistic regression was used to identify characteristics of second-opinion seekers by the type of insurance they used. RESULTS: 143 371 (13%) out of 1 080 892 patients who had supplementary insurance sought a single second opinion, mostly from orthopaedic surgeons. Relatively to patients who sought second opinion via the supplementary insurance, second-opinion seekers via the health fund tended to be females (OR=1.2, 95% CI 1.17 to 1.23), of age 40-59 years (OR=1.36, 95% CI 1.31 to 1.42) and with chronic conditions (OR=1.13, 95% CI 1.08 to 1.18). In contrast, second-opinion seekers via the supplementary insurance tended to be native-born and established immigrants (OR=0.79, 95% CI 0.76 to 0.84), in a high socioeconomic level (OR=0.39, 95% CI 0.37 to 0. 4) and living in central areas (OR=0.88, 95% CI 0.85 to 0.9). CONCLUSIONS: Certain patient profiles tended to seek second opinions via the supplementary insurance more than others. People from the centre of the country and with a high socioeconomic status tended to do so, as medical specialists tend to reside in central urban areas. Further research is recommended to examine the availability of medical specialists by specialty and residence.