Budget impact of netupitant/palonosetron for the prevention of chemotherapy-induced nausea and vomiting

Background: Chemotherapy-induced nausea and vomiting (CINV) are among the most common and debilitating side-effects patients experience during chemotherapy, and are associated with considerable acute care use and healthcare cost. It is estimated that 70–80% of CINV could be prevented through appropriate use of CINV prophylaxis; however, suboptimal CINV compliance and control remains an issue in clinical practice. Netupitant/palonosetron (NEPA) is a fixed combination of serotonin-3 (5-HT₃) and neurokinin-1 (NK₁) receptor antagonists (RAs), respectively, indicated for the prevention of acute and delayed nausea and vomiting associated with highly emetogenic chemotherapy (HEC) and moderately emetogenic chemotherapy (MEC). Phase 3 clinical trials showed a significantly higher complete response rate in both acute and delayed CINV in chemotherapy-naïve patients receiving NEPA compared to patients receiving palonosetron.

Objective: The objective of this study was to estimate the budgetary impact of adding NEPA to a US payer or practice formulary for CINV prophylaxis.

Methods: A model was developed to estimate the impact of adding NEPA to the formulary of a hypothetical US payer with 1.15 million members, including 150,000 (13%) Medicare beneficiaries. The model compared the annual total costs of CINV-related events and CINV prophylaxis in two scenarios: base year (no NEPA) and comparator year (10% and 5% NEPA usage in HEC and MEC patients, respectively). A univariate sensitivity analysis was conducted to explore the effect of variability in model parameters on the budget impact.

Results: A total of 2,021 patients were eligible to receive CINV prophylaxis. With NEPA, CINV prophylaxis costs increased by 0.7% ($3,493,630 vs $3,518,760) while medical costs associated with CINV events decreased by 3.9% ($15,118,639 vs $14,532,442), resulting in a net cost saving of $561,067 (3.0%) for the health plan ($18,612,269 vs $18,051,202), or Background: Chemotherapy-induced nausea and vomiting (CINV) are among the most common and debilitating side-effects patients experience during chemotherapy, and are associated with considerable acute care use and healthcare cost. It is estimated that 70–80% of CINV could be prevented through appropriate use of CINV prophylaxis; however, suboptimal CINV compliance and control remains an issue in clinical practice. Netupitant/palonosetron (NEPA) is a fixed combination of serotonin-3 (5-HT₃) and neurokinin-1 (NK₁) receptor antagonists (RAs), respectively, indicated for the prevention of acute and delayed nausea and vomiting associated with highly emetogenic chemotherapy (HEC) and moderately emetogenic chemotherapy (MEC). Phase 3 clinical trials showed a significantly higher complete response rate in both acute and delayed CINV in chemotherapy-naïve patients receiving NEPA compared to patients receiving palonosetron.

Objective: The objective of this study was to estimate the budgetary impact of adding NEPA to a US payer or practice formulary for CINV prophylaxis.

Methods: A model was developed to estimate the impact of adding NEPA to the formulary of a hypothetical US payer with 1.15 million members, including 150,000 (13%) Medicare beneficiaries. The model compared the annual total costs of CINV-related events and CINV prophylaxis in two scenarios: base year (no NEPA) and comparator year (10% and 5% NEPA usage in HEC and MEC patients, respectively). A univariate sensitivity analysis was conducted to explore the effect of variability in model parameters on the budget impact.

Results: A total of 2,021 patients were eligible to receive CINV prophylaxis. With NEPA, CINV prophylaxis costs increased by 0.7% ($3,493,630 vs $3,518,760) while medical costs associated with CINV events decreased by 3.9% ($15,118,639 vs $14,532,442), resulting in a net cost saving of $561,067 (3.0%) for the health plan ($18,612,269 vs $18,051,202), or $0.04 per member per month. This was equivalent to saving $5,011 per patient moved to NEPA. Among all 5-HT₃ RA?+?NK₁ RA regimens, NEPA was associated with the lowest CINV-related costs, leading to the lowest total cost of care.

Conclusions: Adding NEPA to a payer or practice formulary results in a net decrease in the total budget due to a substantial reduction in CINV event-related resource utilization and medical costs, and an increase in pharmacy costs <1%, saving over $5,000 per patient.     

Evaluating Instream Flows for Recreation: Applying the Structural Norm Approach to Biophysical Conditions

Instream flow can affect recreation quality and is a major issue on rivers where humans manage flows through dams and diversions. The structural norm approach offers a theoretical and methodological model for collecting, organizing, and analyzing evaluative information that relates flow and recreation quality. This article reviews work from several flow-recreation studies that have used this approach, extending it beyond social impact contexts and illustrating its adaptability to other natural resource issues. The article reviews the general structural norm approach and how it has been adapted to examine instream flows for recreation, and provides a list of studies that have utilized it. A review of methods issues describes study types, question formats, and purposive sampling. A review of key findings focuses on incremental relationships between flows and recreation quality, differences in evaluations by craft, skill level, or type of opportunity, the concept that recreation opportunities occupy niches in the flow regime, and emerging hypotheses about relationships between flows and aesthetics.     

Interimistic relational exchange: Conceptualization and propositional development

Research on relational exchange has focused primarily on long-term, or “enduring,” relational exchange. The evolutionary model of relationship development that is the foundation for much of the research on enduring relational exchange lacks applicability for short-term, or “interimitic,” relational exchange. Interimistic relational exchange is defined as a close, collaborative, fast-developing, short-lived exchange relationship in which companies pool their skills and/or resources to address a transient, albeit important, business opportunity and/or threat. Because interimistic exchange relationships must quickly become functional and have a short life, these relationships have less time to fully develop the relational governance mechanisms assumed in the evolutionary model. There-fore, interimistic relational exchange appears to relymore on nonrelational mechanisms than does enduring relational exchange. This article (1) examines how interimistic relational exchange governance differs from that of enduring relational exchange and (2) develops propositions for further research on interimistic relational exchange. C. Jay Lambe received his doctorate from the Darden School at the University of Virginia. He is an assistant professor of marketing at Texas Tech University. Prior to entering academe, he was engaged in business-to-business marketing for both Xerox and AT&T. His research interests include business-to-business marketing, relationship marketing, marketing strategy, and sales management. He has publications in theJournal of Product Innovation Management, theEuropean Journal of Marketing, theJournal of Personal Selling and Sales Management, and theInternational Journal of Management Reviews. In 1999, he was one of five Texas Tech University faculty members chosen by the students for the annual Outstanding Faculty Member Award. Robert E. Spekman is the Tayloe Murphy Professor of Business Administration at the Darden School. He was formerly a professor of marketing and associate director of the Center for Telecommunications at the University of Southern California (USC). He is a recognized authority on business-to-business marketing and strategic alliances. His consulting experiences range from marketing research and competitive analysis to strategic market planning, supply chain management, channels of distribution design and implementation, and strategic partnering. He has taught in a number of executive programs in the United States, Canada, Latin America, Asia, and Europe. He has edited/written seven books and has authored (coauthored) more than 80 articles and papers. He also serves as a reviewer for a number of marketing and management journals as well as for the National Science Foundation. Prior to joining the faculty at USC, he taught in the College of Business at the University of Maryland, College Park. During his tenure at Maryland, he was granted the Most Distinguished Faculty Award by the MBA students on three separate occasions. Shelby D. Hunt is the J. B. Hoskins and P. W. Horn Professor of Marketing at Texas Tech University, Lubbock, Texas. A past editor of theJournal of Marketing (1985–1987) and author ofModern Marketing Theory: Critical Issues in the Philosophy of Marketing Science (South-Western, 1991), he has written numerous articles on competitive theory, macro marketing, ethics, channels of distribution, and marketing theory. Three of hisJournal of Marketing articles, “The Nature and Scope of Marketing” (1976), “General Theories and the Fundamental Explananda of Marketing” (1983), and “The Comparative Advantage Theory of Competition” (1995) won the Harold H. Maynard Award for the “best article on marketing theory”. He received the 1986 Paul D. Converse Award from the American Marketing Association for his “outstanding contributions to theory and science in marketing”. He received the 1987 Outstanding Marketing Educator Award from the Academy of Marketing Science and the 1992 American Marketing Association/Richard D. Irwin Distinguished Marketing Educator Award. His new and provocative book is titledA General Theory of Competition: Resources, Competences, Productivity, Economic Growth (Sage, 2000).     

Comparing two approaches for identifying recreation activity substitutes

Abstract

Previous research has utilized at least two distinct methodological approaches to identify substitutable recreation activities: (1) the activity type method, which constructs typologies of substitutable activities based on similarities in reported participation rates or preference patterns and (2) the direct‐question method of asking individuals to specify their substitutes for a particular activity. The present study compares the theoretical assumptions of and predictions made by each method using a sample of hunters in Maryland. Based on differences in the assumptions and specificity of the two approaches, it was hypothesized that the predicted substitutes would vary. Findings indicate that the approaches result in different predictions about substitute activities and that the activity type method is probably not well‐suited for understanding or predicting the choice of specific activity substitutes. The implications of these findings for resource management and future research are discussed.     

Possibilities for the exportation of production taxes: A general equilibrium analysis

This paper re-evaluates previous discussions of inter-regional tax incidence and tax exportation. A two region general equilibrium model is developed that allows for inter-regional capital mobility and explicit commodity price determination, where one of the two regions is incompletely specialized. Conditions are determined under which either region will be able to export a production tax. Also, the link between tax exportation and the welfare of the taxing region is analyzed. In the case where taxes are not equal to zero initially, tax exportation may be inadvisable even when it is possible.     

Ethical problems in public accounting: The view from the top

The authors empirically examine the nature and extent of ethical problems confronting senior level AICPA members (CPAs) and examine the effectiveness of partner actions and codes of ethics in reducing ethical problems. The results indicate that the most difficult ethical problems (frequency reported) were: client requests to alter tax returns and commit tax fraud, conflict of interest and independence, client requests to alter financial statements, personal-professional problems, and fee problems. Analysis of attitudes toward ethics in the accounting profession indicated that (1) CPAs perceive that opportunities exist in the accounting profession to engage in unethical behavior, (2) CPAs, in general, do not believe that unethical behavior leads to success, and (3) when top management (partners) reprimand unethical behavior, the ethical problems perceived by CPAs seem to be reduced. Don W. Finn is Associate Professor of Accounting at Texas Tech University in Lubbock, Texas. Professor Finn has published over twenty articles on business, accounting, and budgeting topics which have appeared in professional publications such as The Accounting Review, Omega, Oil & Gas Tax Quarterly, Cost and Management, and Managerial Planning. Dr. Finn also has co-authored two monographs on accounting topics. He is also active in the American Accounting Association and the National Association of Accountants. Professor Shelby Hunt is currently Distinguished Professor and Horn Professor of Research in the Marketing Department at Texas Tech University. He has published extensively in Journal of Marketing Research, Journal of Marketing, and many other prestigious journals. Recently, he was editor-in-chief for the Journal of Marketing. Professor Chonko has published in Journal of Marketing Research and other prestigious marketing journals. He is currently director of consumer research at Baylor University.     

Social responsibility and personal success: A research note

Views of corporate social responsibility recognize thatindividual decision makers are key to implementing socially responsible programs and that it is difficult to ask executives to act in a socially responsible manner if such actions have a negative impact on personal success. Using a sample of more than 300 advertising executives, the compatibility of social responsibility and personal success are explored by examining the relationship between social responsibility and advertising executives’ incomes and titles. Findings indicate that neither penalties nor rewards accrue to advertising executives for socially responsible actions. Implications for executives wanting their organizations to be viewed as socially responsible are discussed.