Economic burden of chemotherapy-treated recurrent and/or metastatic squamous cell carcinoma of the head and neck in France: real-world data from the permanent sample of national health insurance beneficiaries

Aims: Overall survival (OS) of patients with recurrent or metastatic (R/M) squamous cell carcinoma of the head and neck (SCCHN) is extremely poor. New therapeutic options emerge but need to establish their economic value. The objective was to describe the direct and related costs of R/M SCCHN in France.

Materials and methods: We selected all adult patients treated with chemotherapy for R/M SCCHN between 1 January 2009 and 31 December 2014 from the permanent sample of the French national health insurance database (EGB). Data were analyzed from the index date (first chemotherapy) until patients’ death or 31 December 2015. “Treatment period” and “end-of-life” (EoL) (from last chemotherapy until death) were distinguished. Costs included all hospitalizations for SCCHN and ambulatory care. Costs of hospitalized and non-hospitalized adverse events (AEs) were estimated.

Results: Among 267 patients identified, 85% were men, 44% had metastases at the index date and the mean age was 62.0 years (±9.9). The most common tumor location was oropharynx (29%) but 39% of patients had multiple locations. Median OS was 9.3 (95% CI: 7.9–11.8) months for the overall population. The average total direct cost per patient was €49,954, broken down into €32,908 (95% CI: 29,525–36,290) for hospitalizations and €17,047 (14,941–19,152) for ambulatory care. Main cost drivers were drug acquisition and administration (€14,538) during the treatment period (209?days on average) and palliative care (€3,750) during the EoL period (125?days). Regarding related costs, around 12% of patients received disability pensions (€1,397 per patient [624–2,171]) and sick leave payments (€1,592 [888–2,297]). “Metabolism and nutrition disorders” and “Infections and infestations” were the most expensive hospitalized AEs (€1,513 and €1,180 per patient, respectively). Febrile neutropenia was the most expensive non-hospitalized AE (€766 per patient).

Conclusions: This analysis of real-world data confirms the poor prognosis of patients with R/M SCCHN and provides cost data for future economic evaluations.     

Correction note for ��The large-maturity smile for the Heston model��

The papers (Forde and Jacquier in Finance Stoch. 15:755?C780, 2011; Forde et al. in Finance Stoch. 15:781?C784, 2011) study large-time behaviour of the price process in the Heston model. This note corrects typos in Forde and Jacquier (Finance Stoch. 15:755?C780, 2011), Forde et al. (Finance Stoch. 15:781?C784, 2011) and clarifies the proof of Forde et al. (Finance Stoch. 15:781?C784, 2011, Proposition 2.3).     

Coordination Costs and the Geography of Production

In a model à la Venables of 1996 Venables, A. J. (1996) Equilibrium locations of vertically linked industries, International Economic review, 37, 341–359. doi: 10.2307/2527327[Crossref], [Web of Science ®] , [Google Scholar], we distinguish two kinds of intermediate goods: complex goods that entail endogenous coordination costs, and simple goods that do not. Coordination costs depend on geographical distance and the number of intermediate goods used in the production process. In the final stage of integration, there are two possible spatial configurations: (1) a symmetric configuration and (2) a partial core–periphery equilibrium, comprised of a core region that produces the final and complex intermediate goods, and a periphery that produces simple intermediate goods. We discuss some policy implications of this multiple-equilibria outcome.

Les coûts de coordination et la géographie de la production     

Scientist and public responses to BSE‐related risk: A comparative study

Social studies of risk repeatedly have found substantial divergences in the way that experts/scientists and members of the general public appraise risks associated with health and environmental hazards. However, empirical evidence for these differences remains controversial. A recent review of literature suggests in particular that divergences between experts and lay people may potentially result from confounding socio‐demographic factors. The purpose of the present article is to investigate and to compare how medical scientists and members of the general population reacted to BSE (“mad cow disease”) in France. A sample of 401 scientists belonging to the French Institute of Health and Medical Research (INSERM) and a representative sample of 902 French citizens were asked about their cognitive, affective and behavioural responses to BSE. Results show that non‐scientists tended to express much more concern about BSE‐related risk than scientists, even when socio‐demographic variables were controlled. However, (1) no significant differences were found between these two groups concerning subjective epidemiological predictions, and (2) scientists manifested greater avoidance of beef or beef by‐products avoidance following the BSE epidemic than lay respondents did. The implications of these paradoxical results are discussed.     

Who do we tip and why? An empirical investigation

An important question about social norms is whether they are created to increase welfare. This is addressed by examining the characteristics of tipped and non-tipped occupations. Tipping prevalence is negatively correlated with worker's income and consumer's monitoring ability and positively with consumer's income and closeness between the worker and the consumer. The results refute a common belief that tipping exists to improve economic efficiency by lowering monitoring costs. Tipping, however, is more prevalent when consumers feel empathy and compassion for workers and want to show gratitude for good service, suggesting that tipping might increase welfare if welfare includes psychological utility.     

KNOWLEDGE ACCUMULATION WITHIN AN ORGANIZATION

In this article, we consider a knowledge accumulation problem within an organization that cannot prevent the worker from quitting and using the knowledge outside the organization. We show that knowledge accumulation is delayed: The fraction of working time allocated to knowledge creation is highest at the early career stage, falls gradually, then rises again, before falling finally toward zero. We determine the effect of a change in the severity of the enforcement problem (or the specificity of knowledge). We also discuss the form of the optimal life‐cycle wage profiles, the role of the initial knowledge level, and the role of discounting.     

Consumers’ willingness to pay for eco-friendly apples under different labels: Evidences from a lab experiment

An experiment was conducted in France to evaluate the impact of health and environmental information on consumers’ choices between conventional and organic apples. Results show that additional and precise messages about both pesticides use and pesticides residues significantly impact consumers’ choices between both products. The experiment also studied the effect of a new label signaling apples that only use few pesticides compared to conventional apples. With elicited willingness-to-pay, we show that the introduction of this new label increases the average participants’ surplus whatever the information context for participants, because of a higher quality compared to conventional apples and a lower price compared to organic products. In order to complement this label, a minimum-quality standard imposing the use of few pesticides is socially optimal when initial participants’ knowledge is limited.     

Novel versus familiar brands: An analysis of neurophysiology, response latency, and choice

Two experiments were conducted to analyze neurophysiological activation, response latency, and actual brand choice concerning novel and familiar brands. The results show that (1) the choice of novel brands (compared to the choice of familiar brands) is preceded by increased activation of both the cingulate gyrus and the ventromedial prefrontal cortex, as measured by a functional magnetic resonance imaging (fMRI) study; (2) novel brands are associated with longer choice response latency than familiar brands; and (3) positive mood enhances response latency of choosing novel brands compared to familiar brands.