Japanese sogo shosha and the U.S. export trading companies

Recent legislation in the U.S. concerning export trading companies has drawn attention to the Japanese general trading companies. While the intent of the ETC Act was not to replicate the sogo shosha model in the U.S., there are some parallels which we can identify. In this paper we examine the evolving forms of the sogo shosha and ETCs, and show how they compete directly in some areas of international trade. Although early performance results for U.S. ETCs are not encouraging, longer term results are expected to improve. To support this expectation, we identify current problems and offer recommendations for improvement. These recommendations are framed in the context of the U.S. business environment, and implications for public policy are assessed.     

Primary vs secondary prophylaxis with pegfilgrastim for the reduction of febrile neutropenia risk in patients receiving chemotherapy for non-Hodgkin’s lymphoma: cost-effectiveness analyses

Objective:

Evaluate the cost-effectiveness of primary vs secondary prophylaxis (PP vs SP) with pegfilgrastim to reduce the risk of febrile neutropenia (FN) in Non-Hodgkin’s Lymphoma (NHL) patients receiving myelosuppressive chemotherapy from a US payer perspective.

Methods:

A Markov model was used to compare PP vs SP with pegfilgrastim in a cohort of patients receiving six cycles of cyclophosphamide, vincristine, doxorubicin, and prednisone (CHOP) or CHOP plus rituximab (CHOP-R) chemotherapy. Model inputs, including efficacy of pegfilgrastim in reducing risk of FN and costs, were estimated from publicly available sources and peer-reviewed publications. Incremental cost-effectiveness was evaluated in terms of net cost per life-year saved (LYS), per quality-adjusted life-year (QALY) gained, and per FN event avoided over a lifetime horizon. Deterministic and probabilistic analyses were performed to assess sensitivity and robustness of results.

Results:

Lifetime costs for PP were $5000 greater than for SP; however, PP was associated with fewer FN events and more LYs and QALYs gained vs SP. Incremental cost-effectiveness ratios (ICERs) for PP vs SP for CHOP were $13,400 per FN event avoided, $29,500 per QALY gained, and $25,800 per LYS. CHOP-R results were similar ($15,000 per FN event avoided, $33,000 per QALY gained, and $28,900 per LYS). Results were most sensitive to baseline FN risk, cost per FN episode, and odds ratio for reduced relative dose intensity due to prior FN event. PP was cost-effective vs SP in 85% of simulations at a $50,000 per QALY threshold.

Limitations:

In the absence of NHL-specific data, estimates for pegfilgrastim efficacy and relative risk reduction of FN were based on available data for neoadjuvant TAC in patients with breast cancer. Baseline risks of FN for CHOP and CHOP-R were assumed to be equivalent.

Conclusions:

PP with pegfilgrastim is cost-effective compared to SP with pegfilgrastim in NHL patients receiving CHOP or CHOP-R.     

Medicare in the 21st century.

The authors provide an overview of the Medicare program in terms of how the current program operates, the current issues it faces that may shape possible options for reform, and the implications of these features and issues for employment-based health plans. Current issues include adoption of a premium support model, changes in the eligibility age for Medicare benefits, Medigap insurance, benefits covered and customer service.     

How libraries can enhance customer service by implementing a customer value mindset

Libraries have a rich tradition of solid customer service. Good service today, however, is often not good enough. Libraries can improve the customer experience by understanding what it means to truly deliver outstanding value. Implementing customer‐centric marketing and the latest technology can increase the perceived value of library usage before, during, and after service delivery. The evolving library experience framework explains how library administrators can prepare for current challenges and future changes to enhance customer service. A customer value‐based services perspective will help libraries strengthen overall user experiences to keep a larger “share of customer” from formidable information rivals such as search engines, online databases, news sources, video sharing sites, internet service providers, and content creators.