Mihail Samnaliev

Background Social science theories suggest that the legalization of same-sex marriage may lead to improved economic opportunities among sexual minorities. However, empirical evidence pertaining to this issue is scarce. We examined the association between state-level same-sex marriage legalization between 2004 and 2014 and employment outcomes among sexual minority men and women aged 18 years or older (N = 274) in 2015 using the U.S. Medical Expenditures Panel Survey. Results Legalization of same-sex marriage in the U.S. was associated with increased odds of employment among sexual minorities in regression models adjusting for individual-level sociodemographic factors, household–level characteristics, county-level economic and demographic factors, and state-level public attitudes towards sexual minorities. In addition, there was some evidence that the legalization of same-sex marriage may be associated with greater earnings and income among sexual minorities. There were no significant positive associations between same-sex legalization and any of the outcomes when the same analyses were repeated among heterosexual individuals (N = 10,330). Conclusions Our findings provide partial evidence that the legalization of same-sex marriage may have improved socioeconomic outcomes among U.S. sexual minorities.

Purpose: To compare rates of persistent postoperative pain (PPP) after lumbar spine surgery—commonly known as Failed Back Surgery Syndrome—and healthcare costs for instrumented lumbar spinal fusion versus decompression/discectomy. Methods: The UK population-based healthcare data from the Hospital Episode Statistics (HES) database from NHS Digital and the Clinical Practice Research Datalink (CPRD) were queried to identify patients with PPP following lumbar spinal surgery. Rates of PPP were calculated by type of surgery (instrumented and non-instrumented). Total healthcare costs associated with the surgery and covering the 24-month period after index hospital discharge were estimated using standard methods for classifying health care encounters into major categories of health care resource utilization (i.e., inpatient hospital stays, outpatient clinic visits, accident and emergency attendances, primary care encounters, and medications prescribed in primary care) and applying the appropriate unit costs (expressed in 2013 GBP). Results: Increasing the complexity of surgery with instrumentation was not associated with an increased rate of PPP. However, 2-year healthcare costs following discharge after surgery are significantly higher among patients who underwent instrumented surgery compared with decompression/discectomy. Conclusions: Although there is a not insubstantial risk of ongoing pain following spine surgery, with 1-in-5 patients experiencing PPP within 2 years of surgery, the underlying indications for surgical modality and related choice of surgical procedure do not, by itself, appear to be a driving factor.

To assess the likelihood of persistent postoperative pain (PPP) following reoperation after lumbar surgery and to estimate associated healthcare costs.

Objectives: To assess the cost‐effectiveness of a pilot disease management (DM) program aimed at preventing early childhood caries among children younger than 5 years.Methods: TheDMprogram was implemented in theBostonChildren'sHospital‐based dental practice in 2008. Health care costs were obtained from the hospital finance department and non‐health care costs were estimated through a parent survey. The measure of effectiveness was avoided hospital‐based visits for restorative treatment or extractions. Incremental costs (2011US$) and effectiveness were estimated from a health care system, societal, and public payer perspectives over 3, 6, and 12 months, by comparingDMparticipants (n = 395) to a historical comparison group (n = 123) using generalized linear models. Bootstrapping and other sensitivity analyses were used to incorporate uncertainty in the analyses.Results: The DM program was associated with a reduction in societal costs of $20 (p= 0.85), $215 (p= 0.24), and $669 (p< 0.01) per patient and a reduction in the number of hospital‐based visits for restorative treatment or extractions by 0.44 (p< 0.01), 0.42 (p< 0.01), and 0.45 (p< 0.01) per patient over 3, 6, and 12 months, respectively. The probability of it being less costly and more effective was 61.5 percent, 81.9 percent, and 98.6 percent over 3, 6, and 12 months, respectively. Consistent results were observed from a health care system and public payer perspectives.Conclusions: TheDMprogram appears cost‐effective and has the potential to reduce health care costs. Our results justify a multicenter trial to evaluate theDMprogram on a larger scale.

Background: Red blood cells are a scarce resource with demand outstripping supply. Use of intraoperative red cell salvage (CS) – the process of collecting shed blood during surgery and reinfusing it to patients – is often used as an effective blood conservation strategy. However, little is known about the economic impact of CS during pediatric surgery.Methods: A decision tree model was used to estimate the transfusion‐related costs per patient (2010 USD) from a healthcare system perspective of four transfusion strategies among children undergoing elective orthopedic or cardiac surgery: (i) CS followed by allogeneic transfusion, (ii) CS followed by autologous transfusion, (iii) allogeneic transfusion alone, and (iv) autologous transfusion alone.Results: Cell salvage and allogeneic transfusion was the least expensive strategy (USD 883.3) followed by CS and autologous blood transfusion (USD 1,269.7), allogeneic transfusion alone (USD 1,443.0), and autologous transfusion alone (USD 1,824.7). Savings associated with CS use persisted in separate analyses of orthopedic and cardiac surgery, as well as in one‐way and probabilistic sensitivity analyses.Conclusions: Use of CS, particularly along with allogeneic blood transfusion, appears cost‐saving and cost‐effective in pediatric surgery.