Economic modeling for the US of the cost-efficiency and associated expanded treatment access of conversion to biosimilar pegfilgrastim-bmez from reference pegfilgrastim

Abstract

Aims: For this economic analysis, we aimed to model: (1) the cost-efficiency of prophylaxis with biosimilar pegfilgrastim-bmez for chemotherapy-induced (febrile) neutropenia (CIN/FN) compared to reference pegfilgrastim, and (2) the expanded access to CIN/FN prophylaxis and anti-neoplastic treatment that could be achieved with biosimilar cost-savings on a budget-neutral basis.

Methods: In a hypothetical panel of 20,000 cancer patients receiving CIN/FN prophylaxis and using the average sales price (ASP) for the second quarter of 2019 for reference pegfilgrastim, we: conducted an ex ante simulation from the payer perspective of the cost-savings of 10–100% conversion from reference to biosimilar pegfilgrastim-bmez using drug price discounting ranging from 10–35%; estimated the budget-neutral expanded access to biosimilar pegfilgrastim-bmez enabled by these cost-savings; and estimated the budget-neutral expanded access to anti-neoplastic treatment with pembrolizumab. The simulations were replicated using fourth quarter 2019 wholesale acquisition cost (WAC) for reference pegfilgrastim and biosimilar pegfilgrastim-bmez in a post facto analysis.

Results: In ASP simulations, cost-savings of using pegfilgrastim-bmez over reference pegfilgrastim in a 20,000 patient panel range from $1.3?M (at 15% price discount) to $3?M (35%) at 10% conversion rate and from $6.4?M to $14.9?M, respectively, at 50% conversion. These savings could provide prophylaxis with pegfilgrastim-bmez to an additional 352 (15% discount) to 1,076 patients (35%) at 10% conversion or 1,764–5,384, respectively, at 50% conversion. Alternatively, savings could be reallocated for anti-neoplastic treatment with pembrolizumab to 3 (15% discount) to 9 (35%) patients at 10% conversion or 19–45, respectively, at 50% conversion. When utilizing WAC, cost-savings range from $4.6?M (10% conversion) to $23.1?M (50%) which could provide pegfilgrastim-bmez to an additional 1,174 (10% conversion) to 5,873 patients (50%).

Conclusions: Prophylaxis with biosimilar pegfilgrastim-bmez increases the value of cancer care by generating significant cost-savings that could be reallocated to provide expanded access to CIN/FN prevention and anti-neoplastic therapy on a budget-neutral basis.     

Visitor centre staffing: Involving volunteers

Volunteer involvement in visitor centres has received little attention by tourism researchers despite the critical role staff play in welcoming tourists to a destination and promoting tourism activities. The community function of visitor centres - of which volunteering is part - has also been underplayed in previous research. Using data from a survey and interviews with visitor centre managers in Australia, this paper investigates the rationales for staffing visitor centres with volunteers and/or paid employees and, related to motivations for volunteering, the factors influencing the attractiveness of visitor centre volunteer programmes. The dominant rationales for involving volunteers are need, community involvement, visitor experience, and the personal qualities and motivations of volunteers. Visitor centre volunteering is attractive because of location and local pride, interactions with tourists and social relationships with other volunteers, and the reputation of the visitor centre and its volunteer programme.     

E-Shopping Patterns of Chinese and US Millennials

A conceptually based taxonomy of 22 distinct forms of e-shopping vehicles is proposed. A modification of the UTAUT and UTAUT2 models is introduced to explain how vehicles are interrelated in regard to consumer reliance upon them for their e-purchasing. A survey of over 1,000 millennial university students, 697 Chinese and 306 US, revealed strong support in both samples for the hypothesized six dimensional pattern underlying consumer vehicular reliance. Further, differences between Chinese and US samples lay not in the nature of the dimensions, but rather in the strength of reliance upon each dimension. Thus, the study demonstrates the utility of the concept/measure of shopper vehicular reliance, VPR (Vehicle Purchasing Reliance) for both practitioners and scientists. In cross-national comparisons, observed differences between samples in strength of reliance supported four of five hypotheses predicated on previously established national distinctions a) in trust and b) in the cultural value of individualism-collectivism.     

The Importance of taste in experimental auctions: consumers’ valuation of calorie and sweetener labeling of soft drinks

A majority of purchases that consumers make are classified as repeat purchases. One of the main reasons why consumers make repeat food purchases is the food's taste. Therefore, we examined the importance of including taste testing in nonhypothetical experimental auctions. Specifically, we used two experiments to determine consumers’ willingness to pay for soft drinks labeled with different calorie and sweetener information. In Experiment 1, participants tasted the soft drinks prior to the bidding rounds. In Experiment 2, participants did not taste the soft drinks prior to the bidding rounds. Bidding behavior for the soft drinks was significantly different between Experiment 1 and Experiment 2. Results suggest that including taste testing in the design of experimental auctions is important to accurately capture consumers’ willingness to pay for foods that are purchased repeatedly. Results also imply that policies aimed at combating obesity by making the calorie content of foods more visible may not produce desired outcomes.     

Network Marketing Businesses and Chinese Ethnicity Immigrants in Australia

This study adopts two theoretical perspectives, Social Cognitive Theory and Theory of Planned Behavior, to examine a model of network marketing business participation by Chinese immigrants in Australia. A structural equations modeling analysis showed that the social environment within a network marketing organization positively influences the self‐efficacy of Chinese network marketers and their desire to seek opportunities. These factors positively influence the actions undertaken by network marketers, and subsequently, impact positively on their performance outcome.     

The interaction of retail density and music tempo: Effects on shopper responses

Research examining the effects of store environment on shoppers has found that a number of atmospheric cues have significant effects on shoppers' cognitive, affective, and behavioral responses. To date, retail atmospheric cues have been studied in isolation, instead of simultaneously, like they occur in the retail setting. This study examines the interactive effects of two atmospheric cues—retail density and music tempo—and their impact on shopper responses within a real shopping environment. Based on the schema incongruity model, it is found that shopper hedonic and utilitarian evaluations of the shopping experience are highest under conditions of slow music/high density and fast music/low density. Significant main effects of music tempo are found for behavioral responses such as approach/avoidance tendency and extent of browsing behavior. The results underscore the need to examine interactive effects of atmospheric cues to better understand the impact of the store environment on shoppers. © 2005 Wiley Periodicals, Inc.     

The effect of increases in the level of unemployement on older workers

This study explores the influence of the level of unemployment on labour force participation and full- versus part-time status, for men and women aged 56 to 60. Comparisons are also made with 16–19- and 31–35-year-old men and women. It is found that when the unemployment increases, discourgement is greater for older men than for younger ones. For Women, Prime-aged workers exhibit less discouragement than either the older or younger women. The study also infers the original labour force status of older discouraged workers. For men, displaced workers come largely from the ranks of full-time workers. For women, both full- and part-time workers are displaced.     

Consumers as researchers – innovative experiences in UK National Health Service Research

Consumer involvement is an established priority in UK health‐ and social‐care service development and research. To date, little has been published describing the process of consumer involvement and assessing ‘consumers’ contributions to research. This paper provides a practical account of the effective incorporation of consumers into a research team, and outlines the extent to which they can enhance the research cycle; from project development and conduct, through data analysis and interpretation, to dissemination. Salient points are illustrated using the example of their collaboration in a research project. Of particular note were consumers' contributions to the development of an ethically enhanced, more robust project design, and enriched data interpretation, which may not have resulted had consumers not been an integral part of the research team.     

Mind the gap��German motherhood risks in figures and game theory issues

After childbirth, while parents are delighted at public cash transfers like the German ‘Elterngeld’ (parental leave benefit), the decline in mothers’ earnings capacity is an awkward issue that tends to hover in the background. This paper aims firstly to make a contribution to quantifying West German mothers’ foregone gross earnings that stem from intermittent labor market participation, due to the birth of their first child. Secondly, it discusses behavioral outcomes of the resulting implicit child costs in a dynamic bargaining model of household decisions. The regression results of a Mincer-type wage equation, with German Socio-Economic Panel Data (West) for the period 1984–2005 and correcting for sample selection (Two-step Heckman), indicate considerable wage penalties due to birth-related employment withdrawal. On the closure of the fecund window, mothers suffer gross hourly wage cuts of up to 25%, compared to their equally educated, non-stop full-time employed counterparts, and the total of annualized losses amounts to as much as 201,000 Euros. Although foregone earnings do not matter as much in stable partnerships, they turn out to be a veritable asymmetric specialization risk that can prevent women from having children, if divorce seems sufficiently probable.