Measuring the Direct Medical Costs of Hospital-Onset Infections Using an Analogy Costing Framework.

BACKGROUND: The majority of recent estimates on the direct medical cost attributable to hospital-onset infections (HOIs) has focused on device- or procedure-associated HOIs. The attributable costs of HOIs that are not associated with device use or procedures have not been extensively studied. OBJECTIVE: We developed simulation models of attributable cost for 16 HOIs and estimated the total direct medical cost, including nondevice-related HOIs in the USA for 2011 and 2015. DATA AND METHODS: We used total discharge costs associated with HOI-related hospitalization from the National Inpatient Sample and applied an analogy costing methodology to develop simulation models of the costs attributable to HOIs. The mean attributable cost estimate from the simulation analysis was then multiplied by previously published estimates of the number of HOIs for 2011 and 2015 to generate national estimates of direct medical costs. RESULTS: After adjusting all estimates to 2017 US dollars, attributable cost estimates for select nondevice-related infections attributable cost estimates ranged from $7661 for ear, eye, nose, throat, and mouth (EENTM) infections to $27,709 for cardiovascular system infections in 2011; and from $8394 for EENTM to $26,445 for central nervous system infections in 2016 (based on 2015 incidence data). The national direct medical costs for all HOIs were $14.6 billion in 2011 and $12.1 billion in 2016. Nondevice- and nonprocedure-associated HOIs comprise approximately 26-28% of total HOI costs. CONCLUSION: Results suggest that nondevice- and nonprocedure-related HOIs result in considerable costs to the healthcare system.

Leaving the labor market: Exit routes, personality traits and well-being.

In this paper we examine the buffering effects of personality traits when people leave their work in later life. Using large-scale panel data for the UK, we show that depending on the exit route and satisfaction related to overall life and the domains of income and leisure, different personality traits act as moderators. Besides augmenting leisure satisfaction for those who hit mandatory retirement, conscientiousness augments life satisfaction for those becoming unemployed. On the contrary, extraversion mitigates satisfaction with life, income, and leisure for those who retire early. This may be an indication that extraverted individuals who tend to be sociable and outgoing may suffer when losing social relationships from their work. At the same time, extraversion may be helpful in augmenting leisure satisfaction for those who stop working for reasons related to ill health or family care. Neuroticism augments income satisfaction for those who become unemployed, which may reflect that people high in neuroticism had a lower "baseline level" of income satisfaction relative to typical individuals so they were not affected as much. Finally, agreeableness mitigates life and leisure satisfaction for those hitting mandatory retirement, as is also the case with openness in terms of income satisfaction.

GEOGRAPHICAL ACCESS TO RECREATIONAL MARIJUANA.

We investigate whether adult marijuana use in Washington responds to increased local access as measured by drive time to the nearest legal marijuana retailer as well as measures of retail density. Using survey data from the Behavioral Risk Factor Surveillance System, we find that as retailers open closer to where they live, more individuals use marijuana and more frequently. These effects are concentrated among young adults (ages 18-26), women, and rural residents. Controlling for distance to the nearest retailer, we find that whether retail density affects marijuana use depends on how it is measured.