Subcutaneous vs intravenous rituximab in patients with non-Hodgkin lymphoma: a time and motion study in the United Kingdom

Objective:

Rituximab is part of standard therapy for many non-Hodgkin lymphoma (NHL) patients, and is usually administered as an intravenous (IV) infusion. A formulation for subcutaneous (SC) injection will be available from June 2014. A time and motion study was conducted to investigate the staff time and costs associated with administration of SC and IV rituximab.

Research design and methods:

The time and motion study was conducted in three UK centers alongside a phase III trial of SC rituximab in patients with NHL (ClinicalTrials.gov identifier NCT01461928). Active healthcare professional (HCP) time spent on the preparation and administration of IV and SC rituximab was recorded and used to calculate the associated costs.

Results:

Total active HCP time associated with administration of IV rituximab was 223.3?min (95% CI?=?218.0–228.7), vs 48.5?min (95% CI?=?45.5–51.6) for SC rituximab, a saving of 174.8?min (95% CI?=?172.5–177.1) per session. Patient time in the treatment room was 263.8?min (95% CI?=?236.6–294.3) for IV rituximab and 70.0?min (95% CI?=?57.1–87.2) for SC rituximab, per session. The SC formulation reduced total mean staff costs by £115.17 (95% CI?=?98.95–136.93) per session. Differing monitoring scenarios during infusion consistently showed time and cost savings for SC rituximab.

Limitations:

Study limitations include the non-interventional design and lack of statistical power, and the investigational nature of SC rituximab. The data collected did not account for patient and center characteristics and variability on active HCP time.

Conclusions:

SC rituximab was associated with reduced active HCP time and costs vs IV rituximab, as well as reduced patient time in the treatment room. Switching from IV to SC rituximab could increase treatment room capacity and patient throughput, as well as improving the patient experience.     

Time spent on erythropoietin stimulating agents administration in hemodialysis centers in Panama: a time and motion study

Objectives: There is a lack of data in Panama on the potential differences in total healthcare professional (HCP) time between routine administrations of short-acting erythropoietin simulating agents (ESAs) (i.e. epoetin alfa) and continuous erythropoietin receptor activator (CERA) (i.e. methoxy polyethylene glycol–epoetin beta). This study aimed to quantify the HCP time associated with a single administration of epoetin alfa and CERA for the treatment of anemic patients with chronic kidney disease (CKD) on hemodialysis.

Methods: This was a multi-center, cross-sectional study, using a time-and-motion methodology. Costs related to HCP time and consumables usage associated with administration of epoetin alfa and CERA were estimated.

Results: Based on 60 administrations of either CERA or epoetin alfa, the estimated savings in mean total active HCP time were 2.34 (95% confidence interval?=?1.87–2.81) min (–30%) per administration. When extrapolating to a full year’s treatment with intravenous ESA, it would require a total of 20.3 (95% CI?=?19.90–20.71) h of HCP time for epoetin alfa vs 1.1 (95% CI?=?1.01–1.19) h for CERA per patient per year. Estimated savings in active HCP time per patient per year were 19.20 (95% CI?=?19.20–19.21) h (–95%). This, in turn, translates into staff cost efficiency that favors Mircera with an estimated annual saving of $78.24 (95% CI?=?78.24–78.28) (–95%) per patient.

Conclusions: Data from a real-world setting showed that the adoption of CERA could potentially lead to a reduction in active HCP time.

• Highlights

• Few comparative data have explored the costs and potential savings of using long-acting erythropoietin–stimulating agents (ESA) instead of short-acting ESAs to treat anemia in CKD patients on hemodialysis.

• This time-and-motion study shows that use of CERA reduces total healthcare professional time and could represent a save for an institution in a real-world setting in Panama.

     

Estimating the wetland rental fee: a case study involving a Taiwan wetland

Wetlands provide many functions that are both economic and recreational and are valuable in terms of their ecological diversity, while at the same time being nonmarket value products. The purpose of this study is to estimate the optimal wetland rental through estimations of both the demand and supply functions in relation to wetland. The wetland supply function is directly estimated based on the data provided by the owners of the wetland, while the estimation of the wetland input demand function involves using the bootstrapping and contingent visitation approaches. Such estimation approaches could also be applied to other nonmarket value products that give rise to environmental externalities. The estimation of rental fee could provide a long-term leasing contract that gives the landlord with a particular rent to lease their lands to support a wetland eco-tourism park to maintain wetland for substantial management. Several environmental management policy implications are also addressed.     

Estimating a continuous time portfolio selection model: An application with UK data

An empirical assessment of a continuous time portfolio selection model is studied for the UK economy between 1970 and 1996. The estimates obtained from this study are both statistically significant and consistent with the model's predictions. The estimate of risk aversion parameter refers to low risk aversion which is consistent with the optimal risky asset holding parameter. Furthermore, the estimated parameters of the asset pricing relationship are also found to be consistent with the historical values of the stock prices. First version received: February 1998/final version received: March 1999     

Estimating DSGE models across time and frequency

Using a wavelet-based decomposition, this paper exploits the information in the data usually employed in the estimation of DSGE models. A simple New Keynesian model featuring price and wage rigidities is estimated for the United States across different frequencies. The estimations indicate that most structural parameters exhibit a frequency-dependent behavior. The impulse response functions also indicate frequency-dependent responses of output to the exogenous shocks. For lower frequencies, there are more persistent effects, especially for preference and technology shocks.     

Estimating labour supply elasticities under rationing: a structural model of time allocation behaviour

Abstract .  This paper presents a structural model of the allocation of time to various non-market activities and market work by couples and single men and women. Parameters are estimated using a sample taken from the UK 2000 Time Use Survey. Own-wage effects are found to be positive for both men and women and are larger for cohabiting individuals than for singles. The presence of young children leads to a much larger increase in the time spent in home production by women than by men. However, the presence of young children causes men to increase their total time spent working by more than women.     

Estimating fundamental and affordable housing price trends: a study based on Singapore

Policy-makers often impose some cooling measures on the housing market when housing prices rise fast. Such policies yield limited success if housing prices are driven up by fundamentals. Estimating a fundamental price trend from observed price data is a challenge. We present an empirical methodology to separate housing price trends into fundamental and affordable components. Deviating from the common practice, we replace current income by a long-run income measure constructed from household incomes at different quantiles. This income measure provides a more suitable basis for constructing affordable house price levels. It also serves as a better fundamental variable, especially for segmented housing markets like that of Singapore. These price trends provide policy-makers with useful information to intervene into property markets to achieve desirable outcomes. Analysing Singapore data using this methodology shows the magnitudes of the price gaps between actual and fundamental prices and how housing affordability fluctuates over price cycles.     

Estimating technology in the postal sector: a Bayesian approach

The aim of this article is to study the technology of the sector represented by the Spanish national post-office and telegraph service, Sociedad Estatal Correos y Telégrafos, S.A. trading as Correos, and denominated as such hereafter. Concretely, we analyse economic efficiency (technical and allocative) and scale economies of the production units (cost centres) of Correos. To do this, we employ a methodology based on an input distance function which is the dual of the cost function. Moreover, and applying duality theory, we develop an economic model to assess the effect of postal infrastructures on the operators’ costs. In order to carry out the empirical model, Bayesian econometrics is applied to estimate the parameters in the input distance function and the technical and allocative efficiency terms.     

Estimating export equations: a survey of the literature

Export is an important component of national income. It is one of the main determinants of the development level of countries. Both developed and developing countries formulate policies to increase their exports, to increase quality, technology and value added of exported products and to gain competitive advantage in world markets. Export equations provide valuable information regarding this decision making process. Aim of this study was to conduct a survey on extensive literature on estimation of export equations. The literature on export equations can be grouped mainly into four levels of analysis from macro to micro: aggregated level exports, country-level, sector-level and firm-level analyses. In this study, we have surveyed the literature on each level. In the last part, a survey of econometric techniques used in estimation of export equations has been provided, as well.     

Intra-unit patient transports: time, motion, and cost impact on hospital efficiency

The costly and inefficient movement of patients within the hospital challenges health systems across the country as they strive to simultaneously contain rising costs and provide high-quality patient care. Solid evidence to support the improvement of hospital and patient care efficiency through the identification and suggested elimination of waste patterns within the transport process is presented.     

Estimating and communicating food system impacts: A case study in Montreal, Quebec

Modern food systems are characterized by a range of resource use, environmental, and socioeconomic impacts, resulting from choices made by various actors, including the public, who are “distanced” from these impacts, with important implications for sustainability. In order to make ecologically responsible food choices, the public will need information that is reliable, easily comprehensible, and that allows them to discriminate between these choices in terms of the range of impacts, and their trade-offs with factors such as market price.We illustrate, by means of a case study involving nine variations of two meals of similar nutritional energy content, some challenges and issues associated with estimating and integrating the diverse impacts of food systems, and explore the implications of our results for communicating these impacts in a manner that balances epistemic adequacy with heuristic usefulness in enabling ecologically responsible food choices.     

Estimating short and long-run relationships: a guide for the applied economist

Many applied economists face problems in selecting an appropriate technique to estimate short and long-run relationships with the time series methods. This article reviews three alternative approaches viz., general to specific, vector autoregressions and the vector error correction models. As in other methodological controversies, definite answers are difficult. It is suggested that if these techniques are seen as tools to summarize data, as in Smith (2000 Smith, RP. 2000. “Unit Roots and all that: the impact of time-series methods on macroeconomics”. In Macroeconomics and the Real World, Edited by: Backhouse, RE. and Salanti, A. 199–215. Oxford: Oxford University Press.  [Google Scholar]), often there maybe only minor differences in their estimates. Therefore a computationally attractive technique is likely to be popular.     

Estimating technical change in aggregate production functions: a critique

This paper extends the approach of Simon and Shaikh and demonstrates that the estimates of aggregate production functions can provide no independent evidence of the underlying technology of the economy. It is further shown that estimates of labour and capital augmenting technical progress will merely be equal, by definition, to the growth rates of real wages and of the real rental price of capital respectively. This is illustrated by reference to recent studies that estimate technical progress for the Australian manufacturing industries.     

Save a Tree and Save a Life: Estimating the Health Benefits of Urban Forests

Environmental and Resource Economics - Do trees in urban areas benefit human health? More than 100 million Americans live in large cities, yet little is known about the health benefits of the trees...     

Estimating the Markov-switching almost ideal demand systems: a Bayesian approach

Allias and Nichèle (Eur Rev Agric Econ, 34(4):517–538, 2007) proposed a Markov-switching almost ideal demand system (MS-AIDS) model by extending the idea of Hamilton (Econometrica, 57(2):357–384, 1989). In this paper, we propose a Bayesian estimation for MS-AIDS model and illustrate applicability of our proposed method. We then run two sets of simulation studies to confirm the validity of the proposed method. In the empirical study on the Japanese meat market, our Bayesian estimation improves the MSEs for all meat products over the ML estimation, while successfully capturing the regime shifts of meat demand coinciding with the timing of bovine spongiform encephalopathy cases in Japan and US.     

Estimating the portion of technical analysts in a market

This article presents structural estimates of the portion of technical analysts in six markets. I find that the portion of technical analysts in the U.S. equity market has been decreasing since the 1970s. A simple asset pricing model predicts that both risk and return are increasing in the portion of technical analysts. This prediction is confirmed across stock market indexes for six countries.     

Estimating persistence in Canadian unemployment: evidence from a Bayesian ARFIMA

The degree of persistence in aggregate Canadian unemployment is estimated within a Bayesian ARFIMA class of models. The results conclude that unemployment exhibits persistence in the short and intermediate run. The evidence of persistence is stronger than previously reported by Koustas and Veloce (1996 Koustas, Z and Veloce, W. 1996. Unemployment hysteresis in Canada: an approach based on long-memory time series models. Applied Economics, 28: 823–31. [Taylor &; Francis Online], [Web of Science ®] , [Google Scholar]). This persistence cast a vital implication regarding disinflation policies, Based on the unemployment rate, these policies will prove very costly in terms of lost output and – if implemented – they considerably lengthen recessions.     

Estimating a health production function for the US: some new evidence

This study reports some new evidence on the impact of medical care, socioeconomic, lifestyle and environmental factors on the health status of the population of the USA. The results show that additional medical care utilization is relatively ineffective in lowering mortality and increasing life expectancy. The most important factors that influence death rates are related to socioeconomic status and lifestyle. The results suggest that health care policy which focuses primarily on the provision of medical care services and ignores larger economic and social considerations may do little to benefit the nation's health.