Feasibility of using administrative claims data for cost-effectiveness analysis of a clinical trial

Objective: This study was performed retrospectively to determine if Medicare claims data could be used to evaluate the cost effectiveness, from a payer perspective, of different radiation treatment schedules evaluated in a national clinical trial.

Methods: Medicare costs from all providers and all places of service were obtained from the Centers for Medicare & Medicaid Services for patients treated in the period 1992–1996 on Radiation Therapy Oncology Group 90-03, and combined with data on outcomes from the trial.

Results: Of the 1,113 patients entered, Medicare cost data and clinical outcomes were available for 187 patients. Significant differences in tolerance of treatment and outcome were noted between patients with Medicare data included in the study and patients without Medicare data, and non-Medicare patients excluded from it. Ninety-five percent confidence ellipses on the incremental cost-effectiveness scatterplots crossed both axes, indicating non-significant differences in cost effectiveness between radiation treatment schedules.

Conclusions: Claims data permit estimation of cost effectiveness, but Medicare data provide inadequate representation of results applicable to patients from the general population.

Keywords:     

Temporary layoff unemployment in Austria: empirical evidence from administrative data

Temporary layoffs (rehires, recalls) have been widely recognized as an important feature of North America's labour markets. For Europe, however, several observers have suggested that tighter regulatory impediments to the recruitment and dismissal of employees are responsible for temporary layoff unemployment being virtually non-existent. Against this background this paper uses administrative data to evaluate the quantitative importance of temporary separations among the unemployed in Austria and to track its composition by industries. The main finding of our empirical analysis is that about one-third of all unemployment spells in Austria in 1985 ended with the individual returning to the former employer. Since temporary layoff unemployment was found to be on average of shoter duration, it comprised a somewhat lower fraction of total weeks of unemployment. However, temporary layoff unemployment thus accounts for the same proportion of unemployment in Austria as in the US or Canada.     

Internal migration data in India: state of the art

The availability and content of official data on internal migration in India are reviewed. The primary data sources described are the census and the National Sample Survey. Problems concerning these data are discussed.     

Religious service attendance and labour force status: evidence from survey data using count data methods

I undertake count data estimation with data from the National Longitudinal Survey of Youth 1979 cohort and the Health and Retirement Study to evaluate the relationship between time spent out of the labour force and the frequency of religious service attendance for individuals of working age. I also examine whether being out of the labour force is correlated with the frequency of religious service attendance.

?Results using Poisson fixed-effect and negative binomial estimation suggest that men under age 50 appear to attend religious services less frequently when out of the labour force. I ascribe this finding to younger men’s religious service attendance being related to having work or the pursuit of work. Men between ages 50 and 65 attend religious services less frequently when out of the labour force, which I attribute to serious health problems in later age forcing labour market exiting and reduced frequency of religious service attendance. Women between ages 50 and 65 attend religious services more frequently when out of the labour force, which I ascribe to having more time to pursue religious activity in addition to women’s established proclivity to religious commitment.     

Identifying patient subgroups who benefit most from a treatment: using administrative claims data to uncover treatment heterogeneity

Abstract

Objectives:

To illustrate how claims data can be used to (1) develop outcome scores that predict response to a traditional treatment and (2) estimate the economic impact of individualized assignment to a newer treatment based on the outcome score. An example application is based on two treatments for attention deficit hyperactivity disorder (ADHD): osmotic-release oral system methylphenidate (OROS-MPH) and lisdexamfetamine dimesylate (LDX).

Methods:

Adolescents with ADHD initiating OROS-MPH (n?=?6320) or LDX (n?=?6394) were selected from the MarketScan claims database. A model was developed for predicting risk of switching/augmentation with OROS-MPH using multiple baseline characteristics. The model was applied to an independent sample to stratify patients by their predicted risk and, within each stratum, risk of switching/augmentation and ADHD-related total costs were compared between OROS-MPH and LDX patients using inverse probability of treatment weighting.

Results:

The prediction model resulted in substantial stratification, showing risk of switching/augmentation with OROS-MPH ranging from 11.3–42.1%. In the two strata where OROS-MPH had highest risk of switching/augmentation, LDX had significantly lower risk of switching/augmentation than OROS-MPH (by 7.0–8.2%) and lower ADHD-related annual total costs (by $264–$625 per patient).

Limitations:

The current study has used the risk of switching/augmentation as a proxy measure for treatment efficacy to establish the prediction model. Future research using a clinical measure for ADHD symptoms is warranted to verify the findings.

Conclusions:

Combining multiple patient characteristics into a predicted score for treatment outcomes with a traditional treatment can help identify subgroups of patients who benefit most from a new treatment. In this analysis, ADHD patients with a high predicted score for switching/augmentation with OROS-MPH had a lower rate of switching/augmentation with LDX. Assigning OROS-MPH and LDX treatments based on the predicted scores that are heterogeneous in a patient population may help improve clinical outcomes and the cost-effectiveness of care.     

Commodity Prices and the Dynamics of Inflation in Commodity‐Exporting Nations: Evidence from Australia and Canada*

A commodity‐price boom is under way. What does this boom mean for inflation in countries with substantial net commodity exports? The answer depends on movements in commodity prices, changes in foreign exchange rates and the determinants of domestic price inflation. We estimate equations to provide indications of the strength of each of these forces for both Australia and Canada. The results show that world commodity prices move pro‐cyclically with world industrial production and that rates of change in commodity prices are directly related to domestic inflation in both countries. However, there is an offsetting impact of exchange‐rate changes, which is strong enough in the case of Australia, but not Canada, to substantially eliminate the inflationary impact of a commodity‐price boom.     

Earnings losses of displaced workers and the business cycle: An analysis with administrative data

This paper examines the earnings losses of displaced workers over the business cycle. Long-term earnings losses for these workers during a recessionary period are 1.7 to 3.9 times larger than for those observed during a period of economic growth.     

Impact of first birth career interruption on earnings: evidence from administrative data

This article makes use of unique administrative data to expand the understanding of the role women’s intermittency decisions play in the determination of her wages. We demonstrate that treating intermittency as exogenous significantly overstates its impact. The intermittency penalty also increases in the education level of the woman. The penalty for women with a high school degree with an average amount of intermittency during 6 years after giving birth to her first child is roughly half the penalty for college graduates. We also demonstrate the value of making use of an index to capture multiple dimension of the intermittency experience, and illustrate the importance of firm dynamics in the determination of a woman’s wage.     

Economic determinants of the consumption of alcoholic beverages in Canada: a panel data analysis

In this article, the economic determinants of the demand for three alcoholic beverages (wine, spirits, and beer) are investigated with a focus on the price, income and unemployment effects. The investigation is conducted within the fixed effects panel regression framework using a balanced panel for ten Canadian provinces spanning the years 1981–2004. The estimated own price elasticities indicate that increased government taxation is an effective tool for curtailing the consumption of spirits (at the expense of lower government tax revenue), but it is less effective for curtailing the consumption of wine or beer. The cross-price elasticity estimates reveal that taxing beer or spirits may not be an effective tool for encouraging consumption switch from these alcoholic beverages to wine in light of wine’s greater health benefits. Income emerges as an important determinant of the consumption of both wine and spirits but not of beer, whereas unemployment emerges as an important determinant of the consumption of beer but not of wine or spirits. With respect to unemployment, we find no support for the addiction hypothesis in the case of wine and spirits and strong support for the severe budget constraint hypothesis in the case of beer.     

Occupational skill attainment in Canada: the role of gender,nativity status and ethnic origin

This paper examines how ethnic origin and gender interact to shape the occupational skills attainment of native and foreign born workers in Canada. Of special interest is how the occupational profile of the foreign-born evolves over time relative to that of the native-born, by gender and ethnic origin. We estimate multinomial logit models from 1991 and 2006 census data, and then simulate occupational profiles of the native and foreign-born of different ethnic origin, controlling for human capital characteristics. We find that native and foreign-born women display the ‘glass-ceiling’ and ‘sticky-floor’ syndrome in that they are significantly underrepresented in management positions and overrepresented in clerical positions relative to men, more significantly if their education was not acquired in Canada. There is variation by ethnic origin, and all groups display significant occupational mobility over time. But even after 15?years, foreign-born occupational distributions differ substantially from those of the native-born.     

Is the Government Failure Theory Still Relevant? A panel analysis using US state level data

Abstract The purpose of this paper is to empirically examine the robustness of the government failure theory. A core feature of the government failure theory is demand heterogeneity. Previous studies have brought into question the robustness of the government failure theory, due to inconsistent results concerning the explanatory power of demand heterogeneity. Therefore, in this paper we revisit this important research agenda using US state level panel data. We find the two‐way fixed effects model a suitable model for testing the government failure theory's robustness and present findings which indicate that observable demand heterogeneity has a positive effect on the size of the nonprofit sector. This paper also empirically examines the relevance of the complementary financing hypothesis in terms of the cooperative nature of the governmental and nonprofit sector relationship; that is where governments delegate the production of quasi‐public goods to the nonprofit sector.     

The League of Nations covenant and the United Nations charter: An analysis of two international constitutions

This paper uses the principles of constitutional economics to analyze the evolution of two international constitutions, the League of Nations Covenant and the United Nations Charter. A graphical model is used to illustrate the formation and success of the international organizations created by these documents. This paper concludes that there were two factors that resulted in the failure of the League. They were the redistribution of power in favor of the smaller nations and the free-rider problem caused by the non-binding nature of the League's decisions. Amendments were proposed to the League's Covenant which may have fixed these problems, but they were never ratified. The reasons for the failure of the League had a strong influence on the wording of the U.N. Charter. The analysis in this paper is an extension of the tools provided by constitutional economics, which have mostly been applied to national constitutions. The author would like to thank Bruce L. Benson, Charles J. Barrilleaux, Stefan C. Norrbin, three anonymous referees of this journal, and especially Randall G. Holcombe for helpful comments and suggestions. Any shortcomings remain the responsibility of the author.     

Downward nominal wage rigidity in Canada: Evidence from micro‐level data

We assess the importance of downward nominal wage rigidity (DNWR) in Canada using employer‐level administrative data from the major wage settlements (MWS) and household‐based survey data from the Survey of Labour Income Dynamics (SLID). MWS data cover large unionized firms in Canada, while SLID is a rich rotating panel representative of the employed population in Canada. Combining both sources of information allows for an extensive analysis of DNWR in the Canadian labour market. We find large shares of wage freezes and smaller shares of wage cuts in both MWS and SLID. Shares of freezes are higher at lower CPI inflation rates, based on provincial data. These observations are consistent with the presence of DNWR. DNWR in Canada appears to be larger than in other countries such as the United States, the United Kingdom and European countries. The incidence of DNWR is heterogeneous across firms’ and workers’ characteristics. Wages report less DNWR over longer horizons.     

The impact of the corporate income tax: evidence from state organizational form data

By taxing the income of corporate firms at a different rate than non-corporate firms, taxes can play an important role in a firm's choice of organizational form. The sensitivity of the organizational form decision to tax rates provides a key indicator of the distortion created by the corporate income tax. This paper uses new cross-sectional data on organizational form choices across states compiled in the Census of Retail Trade to estimate this sensitivity. The results document a significant impact of the relative taxation of corporate to personal income on the share of real economic activity that is done by corporations and that the impact is many times larger than has been found in the previous empirical literature based on time-series data. The results show little impact, however, on the actual operations of firms such as their labor intensity, wages and the like. They do indicate that firms are able to exploit the progressivity of the corporate income tax system by dividing into numerous firms.     

Misreporting in register data on disability status: evidence from the Swedish Public Employment Service

The issue considered in this study is whether there is misreporting in official data on disability status. While there is a rather large literature on misreporting of self-assessed disability, evidence regarding register data is scant. It seems to be a widely held view among researchers that, since individuals out of work are inclined to respond towards poor health, it would be best to have official data provided by the relevant administrative bodies. But we argue that such administrative data should be regarded with some suspicion, since the administrators also may have incentives to misreport. The empirical evidence, based on a large sample of Swedish jobseekers, suggests systematic misreporting by the Public Employment Service of official disability measures due to incentives to misreport disability.     

Threshold effects in panel data stochastic frontier models of dairy production in Canada

One of the most enduring problems in econometrics is how to properly account for heterogeneity among firms. Threshold regression models are intuitively appealing methods to deal with this issue. We consider a fixed-effect panel data stochastic frontier model (Schmidt and Sickles, 1984; Martin-Marcos and Suarez-Galvez, 2000) and, relying on Hansen (1999, 2000a), we propose an estimator that accommodates multiple thresholds. Our model assumes absence of any unmeasured time invariant heterogeneity across firms as in Greene (2005, p. 277). Slope and threshold parameters can be estimated using a within estimator combined with a grid search over the threshold parameters. Testing for threshold effects is problematic because threshold parameters are not identified under the null hypothesis, a case of the so-called Davies' problem. We apply the bootstrap procedure proposed by Hansen (1999, 2000a) to test for the presence of thresholds. An asymptotic confidence set for the threshold parameter can be obtained by inverting an LR test, using the distribution result presented in Hansen (1999, 2000a). Our empirical application features a panel of Quebec dairy farms. We use farm size as the threshold variable. The presence of a trend in the specification matters for the determination of the number of thresholds. Technical efficiency scores and rankings of farms estimated from competing model specifications are highly correlated and do not vary significantly across groups of farm sizes defined by the threshold parameter values.     

Cost-effectiveness analyses using real-world data: an overview of the literature

Abstract

Objectives: Real-world evidence (RWE) may provide good estimates of absolute event probabilities and costs in patients in actual clinical practice, but their use in decision-analytic models poses many challenges. A literature review based on a systematic search was conducted to summarize the limitations of using RWE in decision-analytic modeling reported in the literature, but also to identify existing recommendations about real-world modeling.

Methods: A literature search was performed on Medline and Embase databases, as well as relevant websites. No restrictions in language or geographical scope were imposed.

Results: A total of 14 references were included. RWE is recognized as a valuable source of data for market access and reimbursement, and as a complement to clinical trial evidence for treatment pathways, resource use, long-term natural history, and effectiveness. The main limitations identified in the literature were: confounding bias, missing data, lack of accurate data related to drug exposure and outcomes, errors during the record-keeping process, protection of private data, and insufficient numbers of patients. Although most submission guidelines recognized the potential biases associated with RWE, guidance on the appropriate methods to deal with these biases, and approaches to review different relevant evidence to inform model development, were scarce. Several initiatives have attempted to provide guidance on the use of RWE in decision-modeling.

Conclusions: RWE is likely to be particularly valuable for informing healthcare policy-makers when formulating appropriate treatment pathways, encouraging the optimal allocation of scarce resources, and improving aggregate patient outcomes. However, little guidance is available on the relative merits of using efficacy and/or effectiveness evidence in Health Technology Appraisal submissions. Further research is needed to better understand these methods and their potential applications in a broader range of scenarios and simulation studies, and their impact on economic modeling.     

Trillions gained and lost: Estimating the magnitude of growth episodes

An increasingly large literature in the empirics of growth has viewed economic growth as an ‘episodic phenomena’. We propose a new technique for measuring the total magnitude of a growth episode: the change in output per capita resulting from one structural break in the trend growth of output (acceleration or deceleration) to the next. Our method allows us to quantify the amount of income gain and loss during growth accelerations and growth decelerations. We show that the income gains and losses are staggering in magnitude, often multiples of the level of income at the start of the growth episode. The top 20 growth accelerations have a net present value (NPV) magnitude of 30 trillion dollars—twice the US GDP. The top 20 growth decelerations account for 35 trillion dollars less in NPV of output. What explains such ‘staggering’ gains and losses in income over relatively short periods is the key question that future research on economic growth should try and address.