Aims: To develop a budget impact model (BIM) for estimating the financial impact of formulary adoption and uptake of calcipotriene and betamethasone dipropionate (C/BD) foam (0.005%/0.064%) on the costs of biologics for treating moderate-to-severe psoriasis vulgaris in a hypothetical US healthcare plan with 1 million members.
Methods: This BIM incorporated epidemiologic data, market uptake assumptions, and drug utilization costs, simulating the treatment mix for patients who are candidates for biologics before (Scenario #1) and after (Scenario #2) the introduction of C/BD foam. Predicted outcomes were expressed in terms of the annual cost of treatment (COT) and the COT per member per month (PMPM).
Results: At year 1, C/BD foam had the lowest per-patient cost ($9,913) necessary to achieve a Psoriasis Area and Severity Index (PASI)-75 response compared with etanercept ($73,773), adalimumab ($92,871), infliximab ($34,048), ustekinumab ($83,975), secukinumab ($113,858), apremilast ($47,960), and ixekizumab ($62,707). Following addition of C/BD foam to the formulary, the annual COT for moderate-to-severe psoriasis would decrease by $36,112,572 (17.91%, from $201,621,219 to $165,508,647). The COT PMPM is expected to decrease by $3.00 (17.86%, from $16.80 to $13.80).
Limitations: Drug costs were based on Medi-Span reference pricing (January 21, 2016); differences in treatment costs for drug administration, laboratory monitoring, or adverse events were not accounted for. Potentially confounding were the definition of “moderate-to-severe” and the heterogeneous efficacy data. The per-patient cost for PASI-75 response at year 1 was estimated from short-term efficacy data for C/BD foam and apremilast only.
Conclusions: The introduction of C/BD foam is expected to decrease the annual COT for moderate-to-severe psoriasis treatable with biologics by $36,112,572 for a hypothetical US healthcare plan with 1 million plan members, and to lower the COT PMPM by $3.00. 相似文献
Upon differentiating the Thiele differential equations and the equivalence condition with respect to some parameter appearing in the equations, one obtains differential equations for the derivatives of the state-wise reserves and the premium level with respect to the parameter. The solution to these equations measures the impact on premiums and reserves of a change in the parameter. Typically only numerical results can be obtained, but the method applies quite generally to multi-state policies and to virtually any parameter, and so represents a panacea in (the vast majority of) situations where analytical results are out of reach. Extensions to higher order derivatives and higher order conditional moments are straightforward. A difference method for computation is devised, and numerical results are reported for some practical cases. 相似文献
The submitted paper proposes the possible use of integrated semi-quantitative risk assessment of groundwater resources. There are risks resulting from both natural and anthropogenic hazard sources. Activation of these types of hazard sources can cause damage to, or destruction of, particular hydrogeological structures and technological equipment of selected groundwater resources suitable for the emergency drinking water supply of the population. The process of risk assessment is based on the described register of hazards, including semi-quantitative assessment of the frequency with which the assessed sources of hazards are activated, the register of sensitivity together with the semi-quantitative sensitivity assessment of selected threatened elements of the assessed water resource and the determination of their criticality. The semi-quantitative risk assessment should become one of the important criteria for classifying groundwater resources which have been proposed for emergency water supply. The classification carried out on the basis of the above-mentioned principle can contribute to faster selection and effective use of groundwater resources, as well as to the enhancement of emergency and crisis planning systems when the public system is either damaged or destroyed. 相似文献
The strategies of multinational firms increasingly rely in Asia Pacific Region on processes of socialising their employees, who are seeking to develop and reinforce a “global” company culture, without endangering the cultures of local subsidiaries. Specialists have coined the term “cross-cultural management”. A role of “company ambassador” is allocated to a new generation of international executives in Asia whose mission will be to play an effective role as interface between head office its the subsidiaries – and between the subsidiaries themselves – once they have been suitably “impregnated” with the company culture and the particular features of different markets. The repeated experience of international mobility that executives live through means that the individual may well be living in conflict with previous identities. It is true to say that nobody stays long in an internationally mobile situation without running the risk of there being strong divergence between the domestic and residential worlds, the life of the community and the world of the company. This article has been written as a result of in-depth research into the way executives of a large French oil company built up their identities and as a result of a study examines intercultural learning based on French expatriates' experience in China. We consider how French expatriates experience China and what imaginary underlies their perception. Analysis of daily socialization and interaction processes shows intercultural competence develops along distinct immersion stages: immersion–adjustment, immersion–comprehension, and immersion–integration. Individually, adjustment and comprehension support intercultural practice. The ultimate immersion stage leads to enlightened pragmatism stemming from “nomadic intelligence”. Where a researcher in the social sciences or a business man might have expected to have found an homogenous international elite, international executives building an “international system”, the heterogeneous nature of the identity strategies of international executives give the lie to the myth of the large company as a space for the irreversible assimilation of its members. At an individual level, being an international executive is a unique way of living the experience abroad, or rather, several different ways of experiencing identity strategies linked to the manipulation of one's ethnicity in a context of significant geographical and functional mobility. 相似文献
We examine whether Italian household consumption exhibits excess sensitivity to “severance pay”, a sizable lump-sum that workers receive at job termination. We find no evidence of excess sensitivity of non-durable expenditure to this anticipated cash-in-hand change. 相似文献