Budget impact of everolimus for the treatment of progressive,well-differentiated,non-functional neuroendocrine tumors of gastrointestinal or lung origin that are advanced or metastatic

Background: Advanced neuroendocrine tumors (NETs) are a rare malignancy with considerable need for effective therapies. Everolimus is a mammalian target of rapamycin (mTOR) inhibitor approved by the US Food and Drug Administration (FDA) and European Medicines Agency (EMA) in 2016 for treatment of adults with progressive, well-differentiated, non-functional NETs of gastrointestinal (GI) or lung origin that are unresectable, locally advanced, or metastatic.

Objective: To assess the 3-year budget impact for a typical US health plan following availability of everolimus for treatment of GI and lung NETs.

Methods An economic model was developed that considered two perspectives: an entire health plan and a pharmacy budget. The total budget impact included costs of drug therapies, administration, hospitalizations, physician visits, monitoring, and adverse events (AEs). The pharmacy model only considered drug costs.

Results: In a US health plan with 1 million members, the model estimated 66 patients with well-differentiated, non-functional, and advanced or metastatic GI NETs and 20 with lung NETs undergoing treatment each year. Total budget impact in the first through third year after FDA approval ranged from $0.0568–$0.1443 per member per month (PMPM) for GI NETs and from $0.0181–$0.0355 PMPM for lung NETs. The total budget impact was lower than the pharmacy budget impact because it included cost offsets from administration and AE management for everolimus compared with alternative therapies (e.g. chemotherapies).

Limitations: Because GI and lung NETs are rare diseases with limited published data, several assumptions were made that may influence interpretation of results.

Conclusions: The budget impact for everolimus was minimal in this rare disease area with a high unmet need, largely due to low disease prevalence. These results should be considered in the context of significant clinical benefits potentially provided by everolimus, including significantly longer progression-free survival (PFS) for advanced GI and lung NET patients.     

HR professional development: creating the future creators at the University of Michigan Business School

This article focuses on the development of mid‐ to senior‐level HR professionals through a public program offered at the University of Michigan Business School. We suggest that developing HR professionals requires a theory of competencies about what HR professionals must know and do and a development experience based on those competencies. We highlight how we have created a competency model over the last decade and designed our HR executive programs to deliver against this model. We also show the pedagogical techniques used to deliver these competencies. © 1999 John Wiley & Sons, Inc.     

Can smallholder farmers adapt to climate variability,and how effective are policy interventions? Agent‐based simulation results for Ethiopia

Climate variability with unexpected droughts and floods causes serious production losses and worsens food security, especially in Sub‐Saharan Africa. This study applies stochastic bioeconomic modeling to analyze smallholder adaptation to climate and price variability in Ethiopia. It uses the agent‐based simulation package Mathematical Programming‐based Multi‐Agent Systems (MPMAS) to capture nonseparable production and consumption decisions at household level, considering livestock and eucalyptus sales for consumption smoothing, as well as farmer responses to policy interventions. We find the promotion of new maize and wheat varieties to be an effective adaptation option, on average, especially when accompanied by policy interventions such as credit and fertilizer subsidy. We also find that the effectiveness of available adaptation options is quite different across the heterogeneous smallholder population in Ethiopia. This implies that policy assessments based on average farm households may mislead policy makers to adhere to interventions that are beneficial on average albeit ineffective in addressing the particular needs of poor and food insecure farmers.     

什么因素促使国际油价长期居高不下?

在未来5～10年里,世界大多数人不能够就近并尽其所能地购买和消费包括石油在内的大宗商品,所以牛市将会持续.维持国际油价长期居高不下的主要因素包括:1)世界经济发展形势良好;2)通货膨胀得到有效控制;3)美元大幅贬值;4)石油输出国组织控制石油供应量;5)原油库存减少;6)全球炼油能力无法满足需求;7)石油生产国和消费国对全球石油供需的预测值差异较大,供应无法满足需求.虽然石油价格很高,但需求仍在增长,整个供应链的产能仍然很紧张,石油和天然气在能源中的主导地位并没有面临很大的挑战,这可能就是问题的根本所在.     

Bayesian estimation of manufacturing effects in a fuel economy model

The analysis of fuel economy data results in estimates of the technology utilization by manufacturer and vehicle line. The analysis employs a hierarchical Bayesian regression model with random components representing vehicle lines and manufacturers. The model includes predictor variables which describe vehicle features, such as type of transmission, and vehicle line specific measurements, such as compression ratio. Non-informative priors with novel modifications are used and the Bayes estimates are obtained by use of Gibbs sampling. The results show there is substantial variability among manufacturers in efficiently utilizing technology for fuel economy.