Economic modeling for the US of the cost-efficiency and associated expanded treatment access of conversion to biosimilar pegfilgrastim-bmez from reference pegfilgrastim

Abstract

Aims: For this economic analysis, we aimed to model: (1) the cost-efficiency of prophylaxis with biosimilar pegfilgrastim-bmez for chemotherapy-induced (febrile) neutropenia (CIN/FN) compared to reference pegfilgrastim, and (2) the expanded access to CIN/FN prophylaxis and anti-neoplastic treatment that could be achieved with biosimilar cost-savings on a budget-neutral basis.

Methods: In a hypothetical panel of 20,000 cancer patients receiving CIN/FN prophylaxis and using the average sales price (ASP) for the second quarter of 2019 for reference pegfilgrastim, we: conducted an ex ante simulation from the payer perspective of the cost-savings of 10–100% conversion from reference to biosimilar pegfilgrastim-bmez using drug price discounting ranging from 10–35%; estimated the budget-neutral expanded access to biosimilar pegfilgrastim-bmez enabled by these cost-savings; and estimated the budget-neutral expanded access to anti-neoplastic treatment with pembrolizumab. The simulations were replicated using fourth quarter 2019 wholesale acquisition cost (WAC) for reference pegfilgrastim and biosimilar pegfilgrastim-bmez in a post facto analysis.

Results: In ASP simulations, cost-savings of using pegfilgrastim-bmez over reference pegfilgrastim in a 20,000 patient panel range from $1.3?M (at 15% price discount) to $3?M (35%) at 10% conversion rate and from $6.4?M to $14.9?M, respectively, at 50% conversion. These savings could provide prophylaxis with pegfilgrastim-bmez to an additional 352 (15% discount) to 1,076 patients (35%) at 10% conversion or 1,764–5,384, respectively, at 50% conversion. Alternatively, savings could be reallocated for anti-neoplastic treatment with pembrolizumab to 3 (15% discount) to 9 (35%) patients at 10% conversion or 19–45, respectively, at 50% conversion. When utilizing WAC, cost-savings range from $4.6?M (10% conversion) to $23.1?M (50%) which could provide pegfilgrastim-bmez to an additional 1,174 (10% conversion) to 5,873 patients (50%).

Conclusions: Prophylaxis with biosimilar pegfilgrastim-bmez increases the value of cancer care by generating significant cost-savings that could be reallocated to provide expanded access to CIN/FN prevention and anti-neoplastic therapy on a budget-neutral basis.     

Learning and development opportunities as a tool for the retention of volunteers: a motivational perspective

The growing reliance on volunteers in Australia has heightened the need for non‐profit organisations to retain these valuable resources. However, the current literature on volunteer retention is limited. One potential way volunteers can be retained is by providing learning and development opportunities (LDOs). This study investigates the relationship between volunteer perceptions of LDOs, their motivations for volunteering, and retention. Analyses revealed significant main effects for LDOs and volunteer motivations on retention and several interactive effects demonstrating that LDOs can have differential effects on retention depending on the reasons for volunteering.     

E-Shopping Patterns of Chinese and US Millennials

A conceptually based taxonomy of 22 distinct forms of e-shopping vehicles is proposed. A modification of the UTAUT and UTAUT2 models is introduced to explain how vehicles are interrelated in regard to consumer reliance upon them for their e-purchasing. A survey of over 1,000 millennial university students, 697 Chinese and 306 US, revealed strong support in both samples for the hypothesized six dimensional pattern underlying consumer vehicular reliance. Further, differences between Chinese and US samples lay not in the nature of the dimensions, but rather in the strength of reliance upon each dimension. Thus, the study demonstrates the utility of the concept/measure of shopper vehicular reliance, VPR (Vehicle Purchasing Reliance) for both practitioners and scientists. In cross-national comparisons, observed differences between samples in strength of reliance supported four of five hypotheses predicated on previously established national distinctions a) in trust and b) in the cultural value of individualism-collectivism.     

An alternative interpretation of the discontinuity in earnings distributions

We show that the asymmetric effects of income taxes and special items for profit and loss firms contribute to a discontinuity at zero in the distribution of earnings. Income taxes draw profit observations towards zero while negative special items pull loss observations away from zero. These earnings components are thus expected to contribute to a discontinuity even in the absence of discretion. We show our results are not an artifact of deflation and that other common components of earnings do not have similar effects on the earnings distribution around zero.

Supply structure: The pendulum in action

Using an in-depth longitudinal case study based on an “historical retrospective”, this article focuses on how some factors (“drivers”) set into motion the pendulum of change in supply structures, a research theme neglected in the supply field. It examines, over a 20-year period, the changes made to the supply structure of a well-known organization. The data comes mainly from: (a) semi-structured interviews with 21 managers and professionals within eight operating units, and (b) documentary analyses of the archives. This article shows how to map structural changes of the supply function, while explaining the nature and the causes of these changes. Understanding the pendulum movement from one supply structure to another can be very valuable, as well for academics as for managers.     

Property rights imperfections and asset allocation: Co-ownership in Bulgaria

This paper analyzes how imperfections of property rights affect households’ allocation of assets using micro-survey data from Bulgaria. Co-ownership of assets is widespread in many countries due to inheritance. Central and Eastern Europe offers an interesting natural experiment to assess the effects of this type of property rights imperfection because of the asset restitution process in the 1990s. In Bulgaria, where co-ownership is very prominent and land is strongly fragmented, the land reform and inheritance legislation allows identifying the impact of co-ownership by taking advantage of a discontinuity created by a minimum plot size law. We find that land in co-ownership is more likely to be used by less efficient farm organizations or to be left abandoned, and that it is related to significant welfare losses. The paper hence provides evidence of sub-optimal land allocation following a privatization that established formal but imperfect property rights.