Economic burden of sarcoidosis in a commercially-insured population in the United States

Background: Sarcoidosis is a multi-system inflammatory disorder characterized by the presence of non-caseating granulomas in involved organs. Patients with sarcoidosis have a reduced quality-of-life and are at an increased risk for several comorbidities. Little is known about the direct and indirect cost of sarcoidosis following the initial diagnosis.

Aims: To provide an estimate of the healthcare resource utilization (HCRU) and costs borne by commercial payers for sarcoidosis patients in the US.

Methods: Patients with a first diagnosis of sarcoidosis between January 1, 1998 and March 31, 2015 (“index date”) were selected from a de-identified privately-insured administrative claims database. Sarcoidosis patients were required to have continuous health plan enrollment 12 months prior to and following their index dates. Propensity-score (1:1) matching of sarcoidosis patients with non-sarcoidosis controls was carried out based on a logistic regression of baseline characteristics. Burden of HCRU and work loss (disability days and medically-related absenteeism) were compared between the matched groups over the 12-month period following the index date (“outcome period”).

Results: A total of 7,119 sarcoidosis patients who met the selection criteria were matched with a control. Overall, commercial payers incurred $19,714 in mean total annual healthcare costs per sarcoidosis patient. The principle cost drivers were outpatient visits ($9,050 2015 USD, 46%) and inpatient admissions ($6,398, 32%). Relative to controls, sarcoidosis patients had $5,190 (36%) higher total healthcare costs ($19,714 vs $14,524; p?p?p?Background: Sarcoidosis is a multi-system inflammatory disorder characterized by the presence of non-caseating granulomas in involved organs. Patients with sarcoidosis have a reduced quality-of-life and are at an increased risk for several comorbidities. Little is known about the direct and indirect cost of sarcoidosis following the initial diagnosis.

Aims: To provide an estimate of the healthcare resource utilization (HCRU) and costs borne by commercial payers for sarcoidosis patients in the US.

Methods: Patients with a first diagnosis of sarcoidosis between January 1, 1998 and March 31, 2015 (“index date”) were selected from a de-identified privately-insured administrative claims database. Sarcoidosis patients were required to have continuous health plan enrollment 12 months prior to and following their index dates. Propensity-score (1:1) matching of sarcoidosis patients with non-sarcoidosis controls was carried out based on a logistic regression of baseline characteristics. Burden of HCRU and work loss (disability days and medically-related absenteeism) were compared between the matched groups over the 12-month period following the index date (“outcome period”).

Results: A total of 7,119 sarcoidosis patients who met the selection criteria were matched with a control. Overall, commercial payers incurred $19,714 in mean total annual healthcare costs per sarcoidosis patient. The principle cost drivers were outpatient visits ($9,050 2015 USD, 46%) and inpatient admissions ($6,398, 32%). Relative to controls, sarcoidosis patients had $5,190 (36%) higher total healthcare costs ($19,714 vs $14,524; p?<?0.001). Sarcoidosis patients also had significantly more work loss days (15.9 vs 11.3; p?<?0.001) and work loss costs ($3,288 vs $2,527; p?<?0.001) than matched controls. Sarcoidosis imposes an estimated total direct medical cost of $1.3–$8.7 billion to commercial payers, and an indirect cost of $0.2–$1.5 billion to commercial payers in work loss.

Conclusions: Sarcoidosis imposes a significant economic burden to payers in the first year following diagnosis.     

Buyer‐Induced Exclusive Dealing

Large retailers may exercise buyer power in their interactions with manufacturers. This article explores the use of exclusive dealing arrangements by a monopoly retailer when purchasing a differentiated product from competing manufacturers. Interactions among the firms are modeled as a bargaining game. When consumers' brand preferences are weak and/or when one brand is preferred by a significant majority of consumers, it is more profitable for the retailer to negotiate an exclusive dealing arrangement with one of the manufacturers than to distribute both products. Also, it is more profitable for the retailer to induce exclusive dealing if the manufacturer of the excluded brand has a lot of bargaining power when negotiating with the retailer. If buyer‐induced exclusive dealing reduces the retail price of the exclusive brand in order to encourage “brand switching” by consumers who favor the excluded brand, the practice may increase consumer welfare and even total welfare.     

Countervailing Power and Chain Stores

The countervailing power of large buyers subdues the market power of sellers, but price concessions won by large buyers in upstream markets may or may not translate into lower prices downstream as Galbraith (American capitalism: The concept of countervailing power. Houghton Mifflin, Boston, 1952, Am Econ Rev 44:1–6, 1954) once contended. This paper presents a model that formalizes certain previously neglected elements of Galbraith’s argument, and shows that upstream price concessions may lead to lower downstream prices. In this model, a large retail chain store with countervailing power plays one large supplier off against another to win lower prices. An indirect effect of these interactions is that small retailers also pay lower prices, although not as low as the chain. Finally, competition among the retailers drives retail prices lower. The retail-price-restraining effect of the chain is stronger than the effect that is produced by the entry of an additional supplier.     

The behaviour of expected short-term real interest rates in the UK

The existence of persistent technical inefficiency offers the opportunity for a ‘free lunch’ not typically implied by the neoclassical theory of the firm. When external effects are related to the use of particular inputs, reduction of persistent technically inefficient levels of input use represents a means of reducing external impacts. An important example is found in agriculture where substantial environmental impacts are generated by particular inputs. Within this context, this paper considers the usefulness of data envelopment analysis (DEA) for estimation of potential input reductions and assessment of potential reductions of environmental impacts of agricultural inputs. An application for French cereal production provides estimates that indicate that substantial potential exists for reduction of input use and environmental impacts.     

Assessing information provision and respondent involvement effects on preferences

We develop a test of the effect of information and respondent involvement on preferences for passive-use values using three treatments. Individuals from a rural community participated in one of three groups, each with a different level of involvement in the valuation assessment. The first group was highly involved, attending three meetings which allowed for information acquisition and preference construction. The second group was involved in a single meeting, and the third group was minimally involved through telephone contact and the completion of a mail administered survey. The hypothesis examined was that the degree of involvement in the exercise would affect the magnitude and consistency of preferences across the groups. The hypothesis that the preferences differ was not accepted. Furthermore, the hypothesis that variances in preferences would be higher in less involved groups was also rejected. While the analysis is based on relatively small samples the findings suggest caution in claiming that increasing degrees of respondent involvement improve economic measures of trade-offs.     

Social Pressure at the Plate: Inequality Aversion,Status, and Mere Exposure

This paper uses professional baseball data to evaluate the impact of social pressures on subjective decisions made by officials. Umpires show tendencies consistent with both centrality bias and favoritism toward players with higher status in the league. Results also indicate that the odds of a strike are lower for batters in close proximity to the official throughout the game. Implications extend beyond sport to issues regarding closeness of contact in employee–manager relationships and pay and promotions decisions in the workplace. Given the persistent monitoring of officials in professional baseball, this phenomenon could be more prevalent in less scrutinized positions in other industries. Copyright © 2013 John Wiley & Sons, Ltd.     

Trade in High-Tech Services

This paper examines the size, scope, and potential implications of trade in high-tech services in the U.S. The results suggest that many service activities are tradable, tradable service activities tend to employ more educated workers and pay higher wages, and high-tech services account for a large share of service activities that are tradable. Service exporters are more prevalent in high-tech industries with larger establishments and higher wages. Within industries, service exporters tend to be larger, pay higher wages, and are more productive. Tradable service activities seem consistent with U.S. comparative advantage and, as a result, less likely to be vulnerable to offshoring. Consistent with this, recent employment growth in tradable service industries is not significantly different than employment growth in non-tradable service industries.     

Athlete Pay and Competitive Balance in College Athletics

In this paper we analyze the argument—which has been used by both the National Labor Relations Board and the National Collegiate Athletic Association—that unionization and/or player pay will hurt competitive balance in college sports. We present a theoretical analysis of universities that recruit athletes and examine the assumptions that are needed for player compensation to decrease competitive balance. We also empirically illustrate the differences in balance between professional and college sports. Given the theoretical and empirical analysis, we argue that unionization and/or player pay is unlikely to hurt competitive balance.     

Exporting and Productivity in the USA

Exporting is often touted as a way to increase economic growth.This paper examines the interaction between exporting and productivitygrowth in US manufacturing. While exporting plants have substantiallyhigher productivity levels, there is no evidence that exportingincreases plant productivity growth rates. The higher productivityof exporters largely predates their entry into exporting. However,within the same industry, exporters do grow faster than non-exportersin terms of both shipments and employment. Exporting is associatedwith the reallocation of resources from less efficient to moreefficient plants. In the aggregate, these reallocation effectsare quite large, making up over 40 per cent of total factorproductivity growth in the manufacturing sector. Half of thisreallocation to more productive plants occurs within industriesand the direction of the reallocation is towards exporting plants.