Cost analysis of plasma-derived factor VIII/von Willebrand factor versus recombinant factor VIII for treatment of previously untreated patients with severe hemophilia A in the United States

Background: Inhibitor development to factor VIII (FVIII) hemophilia therapy results in increased complications and substantial economic costs. The SIPPET study, the first randomized controlled trial to compare the immunogenicity of plasma-derived FVIII (pdFVIII)/von Willebrand factor (VWF) and recombinant-DNA-derived FVIII (rFVIII), demonstrated higher inhibitor rates in previously untreated patients (PUPs) treated with rFVIII than in PUPs treated with pdFVIII/VWF.

Objective: To quantify the economic impact of treating PUPs with pdFVIII/VWF vs rFVIII.

Methods: An Excel-based clinical and economic model was developed from a US healthcare payer perspective and run over a 5-year period. The analysis utilized a cohort approach to model patient treatment and outcomes over a monthly cycle to quantify differences in costs of FVIII, bypassing agents, and hospitalizations for serious bleeds. Rates of high-titer inhibitor development were obtained from the SIPPET study. Patients developing high-titer inhibitors were treated with immune tolerance induction (ITI). Patients who developed low-titer inhibitors and those who did not develop inhibitors continued their usual FVIII treatment. Patients who were successfully treated with ITI returned to FVIII treatment, while unsuccessfully treated patients received bypassing agents. Total costs per treated patient were estimated and a one-way sensitivity analysis was conducted to quantify the impact of parameter uncertainty on the model outcomes.

Results: Total cumulative costs per patient over 5 years were $834,621 for pdFVIII/VWF patients and $1,237,163 for rFVIII patients, representing a total saving of $402,542 per patient over the 5-year period, for an average annual saving of $80,508 per patient.

Conclusions: Based on data from the SIPPET study, this analysis found that initiating FVIII treatment in severe hemophilia A PUPs with pdFVIII/VWF has the potential to offer substantial cost savings to healthcare payers, amounting to a one-third reduction in costs.     

Asymmetric effects of housing wealth on college enrolment

We investigate the impact of housing wealth, credit availability and financial distress on college enrolment decisions. We find that housing wealth is negatively related to enrolment in public schools and positively related to enrolment in private schools. This evidence suggests that, on average, students substituted away from private schools towards public institutions during the recent financial crisis.     

Input use under cost-of-production crop insurance: Theory and evidence

There have been a number of previous studies that examined the effects of yield- or revenue-based crop insurance products on input use of farmers. However, no study has specifically investigated the input use impacts of a cost-of-production (COP) crop insurance policy, even though this type of crop insurance is the predominant one used in several other countries outside of the United States (such as the Philippines and China). This article aims to theoretically and empirically examine the effect of a COP crop insurance product on farmers’ chemical input use. Our theoretical model suggests that the effect of COP insurance on input use can either be positive or negative, with the resulting impact depending on the strengths of (a) the traditional moral hazard effect of insurance (i.e., an input use decreasing effect); versus (b) the marginal incentives to apply more inputs due to input levels being the main determinant for expected indemnity amounts in this type of insurance (i.e., an input use increasing effect). A survey data set from corn farmers in the Philippines is then used to empirically illustrate how a particular COP insurance product influences input use in a real-life context. In this case, we find that COP insurance increases the use of chemical inputs (e.g., fertilizers and total chemical expenditure), implying that the positive marginal incentive to apply more inputs dominates the negative moral hazard effect.     

Effects of consumer cohorts and age on meat expenditures in the United States

Meat demand is likely influenced by the birth cohort and age of the individual. In this study, we examine the demand for beef, pork, poultry, and other meat in the United States using the 1984–2012 Consumer Expenditure Survey and the almost ideal demand system with the incorporation of age, period, and cohort (APC) effects. We find that the model with APC effects performs better than the models without APC effects. The results indicate that cohorts born in earlier time periods are expected to purchase significantly less poultry compared to cohorts born in later time periods, when they are measured at the same age. Over the life cycle, purchase of poultry is expected to increase with age while the opposite is true for red meat. We also find that the own-price elasticity for beef is highest among the products examined, while the own-price elasticity for other meat is lowest and the inclusion of APC effects increases the absolute value of the own-price elasticities for beef, pork, and poultry, but reduces the own-price elasticity for other meat. Our forecasts indicate that the aggregate poultry purchase will continue to increase until 2022, while the aggregate purchase of red meat will slightly increase until 2017, but will either decrease or stay at same level from year 2017 to 2022.     

Advertising effects on consumer welfare: Prices paid and liking for brands selected

The effect of advertising on consumer welfare has been the subject of dispute among economists, arising largely from disagreement among scholars regarding the persuasive versus the informative role of advertising. This paper reports two experiments that explore the welfare implications of advertising effects. Experiment 1 shows that the same advertisements can either increase or decrease prices paid for selected brands, depending on the degree to which the choice situation requires brands to be recalled in order to be considered. However, an increase in prices paid caused by advertising does not necessarily imply detrimental effects on consumer welfare. Experiment 2 shows that, even under circumstances in which differentiating advertising leads consumers to select brands with higher average prices, it can provide useful information to consumers that allows them to make purchases that are more in line with their personal tastes than are the choices of consumers not exposed to the advertisements.     

The Ethics of Professorial Book Selling: Morality, Money and "Black Market" Books

This study used experimental and correlational techniques to examine perceptions that university faculty hold regarding the practice of professorial selling of examination textbooks to wholesalers. Faculty members (n = 236) from 14 universities and community colleges and a wide variety of academic disciplines responded to a web-based survey. We presented hypothetical selling situations to respondents with manipulated variables consisting of solicitation status (unsolicited versus solicited) and use of money (for faculty or for student activities). Both main effects and the interaction effect were significant such that respondents perceived it to be more ethical to sell an examination book when the book was unsolicited and when the money was being used to fund student activities. The variable most correlated with faculty members' beliefs that book selling is ethical and the faculty members' self-reports of whether or not they have engaged in bookselling was how widespread the practice appeared to be on campus. About 30 percent of faculty members sold textbooks over the past year at a dollar value of about $80 per professor. About 38 percent of respondents reported they believed the practice to be generally ethical. Implications for business ethics theory, students' moral development, and advancement of on-campus codes of ethics policies are discussed along with avenues for future research.     

Removing the contextual lens: A multinational, multi-setting comparison of service evaluation models

Four service evaluation models are identified from the literature that are commonly offered to depict the relationships amongst the primary service evaluation constructs of sacrifice, service quality, service value, satisfaction, and behavioral intentions. We comparatively test the models using samples of service consumers in Australia, Hong Kong, Morocco, the Netherlands, and the United States, as well as across varied temporal and service settings. The results of the comparative analyses reveal that one conceptualization, the “comprehensive” model, best captures the identified relationships. This model is the best fitting across all countries and settings, which indicates it has the greatest external validity. These findings are discussed relative to the limitations associated with the use of less generalizable models.     

The Influence of Entrepreneurial Risk Assessment on Venture Launch or Growth Decisions

Entrepreneurs are thought to engage in riskier behavior than nonentrepreneurs, yet little empirical evidence supports that intuitively appealing notion. We argue instead that differences in information, not risk aversion, may explain the decision to launch or grow a venture. We separately test risk taking propensity and risk assessment. We hypothesize that entrepreneurs will not differ from nonentrepreneurs on risk taking propensity. Additionally, we propose and test a model of risk assessment. The sample size for this exploratory study is n=53 with 30 respondents declaring themselves as entrepreneurs and 23 declaring themselves as nonentrepreneurs. The study’s design is a simulation. Each respondent is provided with data on a potential acquisition that would result in either the launch of a new venture or significant growth for an existing firm. Consistent with the hypotheses, the results show no difference between entrepreneurs and nonentrepreneurs on the risk taking measure. We also find that we can predict entrepreneurial behavior based on risk assessment. We close with a discussion of limitations and directions for future research.