The impact of recent mental health changes on employment: new evidence from longitudinal data

This study uses longitudinal data and four different measures of mental health to tease out the impact of psychiatric disorder onsets and recoveries on employment outcomes. Results suggest that developing a mental health problem leads to a significant increase in the probability of transitioning to non-employment, while a recovery increases the probability of return to work among the not employed with a mental health problem. No consistent effect was found on hours worked and earnings. Research and policy attention is needed with respect to early interventions such as job retention programmes to help workers with mental health problems remain employed as well as interventions that may lead to recovery and return to work. More research is needed especially with data and models that can differentiate between the effects of mental health onsets and recoveries on employment exit and return to work transitions.     

Conditional Cash Transfer and School Outcomes: An Evaluation of the Pantawid Pamilyang Pilipino Program in Davao Oriental,Philippines

The present study adds to the empirical literature examining the effects of conditional cash transfers on school outcomes. Using school‐level and student‐level enrolment data from Davao Oriental Philippines, we evaluate the influence of the Pantawid Pamilyang Pilipino Program (also known as 4Ps), a social development policy program, on the growth rates in school enrolment outcomes. The findings show that 4Ps, on average, increased school enrolment of children by 1.12 percent. It was also apparent that using student‐level data as opposed to school‐level data revealed a more robust effect of 4Ps on school outcomes. We also found some school and socioeconomic characteristics influencing the change in school enrolments. Finally, this study highlights the role of government intervention programs in improving access to education in the poorest sector of the economy.     

The economic burden of common adverse events associated with metastatic colorectal cancer treatment in the United States

Aims: Adverse events (AEs) associated with treatments for metastatic colorectal cancer (mCRC) may compromise the course of treatment, impact quality-of-life, and increase healthcare resource utilization. This study assessed the direct healthcare costs of common AEs among mCRC patients in the US.

Methods: Adult mCRC patients treated with chemotherapy or targeted therapies were identified from administrative claims databases (2009–2014). Up to the first three mCRC treatment episodes per patient were considered and categorized as with or without the AE system/organ category during the episode. Total healthcare costs (2014 USD) were measured by treatment episode and reported on a monthly basis. Treatment episodes with the AE category were matched by treatment type and line of treatment to those without the AE category. Adjusted total cost differences were estimated by comparing costs during treatment episodes with vs without the AE category using multivariate regression models; p-values were estimated with bootstrap.

Results: A total of 4158 patients with ≥1 mCRC treatment episode were included (mean age?=?59 years; 58% male; 60% with liver and 14% with lung metastases; 2,261 [54%] with a second and 1,115 [27%] with a third episode). On average, two treatment episodes were observed per patient with an average length of 166 days per episode. Adjusted monthly total cost difference by AE category included hematologic ($1,480), respiratory ($1,253), endocrine/metabolic ($1,213), central nervous system (CNS; $1,136), and cardiovascular ($1,036; all p?Limitations: Claims do not include information on the cause of AEs, and potentially less severe AEs may not have been reported by the physician when billing the medical service. This study aimed to assess the association between costs and AEs and not the causation of AEs by treatment.

Conclusions: The most costly AEs among mCRC patients were hematologic, followed by respiratory, endocrine/metabolic, CNS, and cardiovascular.     

Mapping EORTC-QLQ-C30 to EQ-5D-3L in patients with colorectal cancer

Aims: The primary aim of this study was to perform a mapping of the EORTC-QLQ-C30 scores to EQ-5D-3L for the SIRFLOX study; a large dataset of patients with previously untreated liver-only or liver-dominant metastatic colorectal cancer (mCRC). A secondary aim was to compare the predictive validity of existing mappings from EORTC-QLQ-C30 to EQ-5D-3L conducted in other cancers.

Methods and materials: Questionnaires (completed within 529 patients) were used in a linear mixed regression to model EQ-5D-3L utility values (scored using the UK tariff) as a function of the five function scores, nine symptom scores, and the global score from the EORTC-QLQ-C30 questionnaire. A Tobit regression was also performed. The mean EQ-5D-3L values for the SIRFLOX trial were calculated and compared with predicted EQ-5D-3L values derived using published mapping algorithms.

Results: The linear mixed regression model provided a satisfactory mapping between the EORTC-QLQ-C30 and the EQ-5D-3L, whilst the Tobit model did not perform as well. When utilities from the SIRFLOX data were calculated with previously published mapping studies, three out of five studies performed well (< 10% mean difference).

Limitations: The main limitation of the study was the lack of meaningful observations post-progression (67 paired observations). For this reason, this study was unable to test whether the mapping holds by disease stage. Additionally, although the study adds to the literature of mappings to the EQ-5D-3L, it is not known how results would differ using the EQ-5D-5L.

Conclusion: This study is the first of its kind in liver-only or liver-dominant mCRC, and mCRC in general. The mapping constructed showed a good fit to the data and provides practitioners with an additional mapping between EORTC-QLQ-C30 to EQ-5D-3L using a large dataset (529 patients, 707 paired observations). The study also confirmed the generalizability of mappings published by Proskorovsky, Kontodimopoulos, and Longworth to liver-only or liver-dominant mCRC.     

Costs of providing infusion therapy for patients with inflammatory bowel disease in a hospital-based infusion center setting

Aims: Inflammatory bowel disease (IBD) (e.g. ulcerative colitis [UC] and Crohn’s disease [CD]) severely impacts patient quality-of-life. Moderate-to-severe disease is often treated with biologics requiring infusion therapy, adding incremental costs beyond drug costs. This study evaluates US hospital-based infusion services costs for treatment of UC or CD patients receiving infliximab or vedolizumab therapy.

Materials and methods: A model was developed, estimating annual costs of providing monitored infusions using an activity-based costing framework approach. Multiple sources (published literature, treatment product inserts) informed base-case model input estimates.

Results: The total modeled per patient infusion therapy costs in Year 1 with infliximab and vedolizumab was $38,782 and $41,320, respectively, and Year 2+, $49,897 and $36,197, respectively. Drug acquisition cost was the largest total costs driver (90–93%), followed by costs associated with hospital-based infusion provision: labor (53–56%, non-drug costs), allocated overhead (23%, non-drug costs), non-labor (23%, non-drug costs), and laboratory (7–10%, non-drug costs).

Limitations: Limitations included reliance on published estimates, base-case cost estimates infusion drug, and supplies, not accounting for volume pricing, assumption of a small hospital infusion center, and that, given the model adopts the hospital perspective, costs to the patient were not included in infusion administration cost base-case estimates.

Conclusions: This model is an early step towards a framework to fully analyze infusion therapies’ associated costs. Given the lack of published data, it would be beneficial for hospital administrators to assess total costs and trade-offs with alternative means of providing biologic therapies. This analysis highlights the value to hospital administrators of assessing cost associated with infusion patient mix to make more informed resource allocation decisions. As the landscape for reimbursement changes, tools for evaluating the costs of infusion therapy may help hospital administrators make informed choices and weigh trade-offs associated with providing infusion services for IBD patients.     

Similar patient outcomes yet different hospital costs between flowable hemostatic agents

Abstract

Introduction:

SURGIFLO? and FLOSEAL® are absorbable gelatin-based products that form hemostatic matrices. These products are indicated as adjuncts to hemostasis when control of bleeding by conventional surgical techniques (such as suture, ligature or cautery) is ineffective or impractical. This study analyzed the effect of surgery time and the choice of product on cost to the hospital and patient outcomes.     

The Relationships among Theatrical Components,Experiential Value,Relationship Quality,and Relationship Marketing Outcomes

Both marketing practitioners and academic researchers have traditionally recognized the major influence that relationship quality (RQ) has on relationship marketing outcomes. Differing from previous studies, this study proposes a more integrated model by including theatrical components and experiential value in the “RQ-relationship marketing outcomes” paradigm. The structural relationships among the variables are examined by adopting a structural equation modeling (SEM) approach in the context of a theme park. The results confirm the existence of the path “theatrical components → experiential value → RQ → relationship marketing outcomes”.     

The effect of prior outcomes on gender risk-taking differences

This study proposed that men are more likely to take greater risk after a win (‘house money’ effect), while women are more likely to take greater risk after a loss (‘escalation of commitment’ effect). These effects are, however, moderated by prior experiences in risk-taking and role characteristics. Three distinct groups of 30 subjects (total?=?90) each were solicited to play an experimental betting game. The subjects were categorized into risk providers (RP), risk customers (RC), and non-risk customers (NRC). RP are represented by casino executives, RC by leisure life-time casino gamblers, and NRC by non-casino gamblers. On average, RC group was found to take most betting risk. Male RCs were more likely to bet more after a win, while female RCs were more likely to bet more after a loss. NRCs, irrespective of gender, were more likely to bet more after a loss. There were no gender risk-taking differences in prior outcomes in the RP group.     

An analysis of irrigated agricultural outcomes under the prior appropriation doctrine: hypotheses and applications

This article measures irrigated agricultural outcomes under the prior appropriation doctrine by developing a model of farmers’ land allocations in response to water supply change. The modelling approach considers the institutional factors of water rights and permits the inclusive determination of water and land allocations. We utilize farm-level data of irrigated agriculture in Water District #1 in Idaho to examine the predictions from our theoretical model. The water rights priority date is consolidated at the farm level and used to differentiate farmers’ responses. We test a set of hypotheses that relate to water supply and crop revenue. Our results suggest that the water rights priority has a profound impact on agricultural outcomes, indicating strong institutional effects and weak influence of market-based approaches. Farmers respond to both long-term and seasonal water supply change and variation, and they respond to seasonal water supply forecasts in varied ways depending on their water rights portfolios, thus signalling a disproportionate distribution of potential impacts of water supply change.     

New development: The paradox of outcomes—the more we measure,the less we understand

The use of ‘outcomes’ as a concept to measure the effectiveness of social policy interventions is inherently flawed and creates unwelcome paradoxes. This article explains why, instead of improving the lives of those who receive support, a focus on outcome information distorts both the priorities and practice of organizations who deliver such support, resulting in poorer results for those most in need. It provides an important first stage towards the evolution of new ways of conceptualizing ways to create improvements in social policy delivery.