Costs of administration,travelling, and productivity losses associated with hospital administration of multiple myeloma drugs in Finland

Aim: To estimate the drug administration, travelling, and productivity costs associated with infusion or subcutaneous proteasome inhibitor (PI) treatments (specifically carfilzomib and bortezomib) for multiple myeloma (MM) patients in Finland.

Materials and methods: Price tariffs of Finnish hospital districts are used as the basis of invoicing sent to healthcare service payers. A review of these price tariff lists was conducted and obtained data analysed to estimate the mean unit cost of PI administration visit. Travelling costs stratified by areas with different population densities were assessed, based on the national travelling reimbursement register data maintained by the Social Insurance Institution of Finland. Productivity costs due to time spent on administration visits and travelling were estimated based on an expert interview and a spatial healthcare accessibility analysis.

Results: Nineteen (95%) of the Finnish hospital districts were included in the review. Relevant unit cost information was found for 15 (75%) of the districts. The mean PI administration cost alone was 270€ (95% CI?=?189€–351€) per administration and increased to 371€ when travelling costs were included. Productivity costs added, the mean PI administration costs totalled 405€ for bortezomib and 437€ for carfilzomib.

Limitations: The costing rationale of price tariffs may vary between hospital districts. Productivity costs were estimated conservatively, due to lack of data.

Conclusions: The administration of intravenous or subcutaneous PIs to treat MM in healthcare facilities causes significant and potentially avoidable healthcare, travelling, and indirect costs, and they should be included in all health economic evaluations (HEEs). As the cost estimates utilized in this study represent most of central hospitals in the country, they provide useful information for future HEEs. A broader conclusion is that novel oral medications, such as the first oral PI, have a significant potential for reducing administration-related costs of subcutaneous or intravenous PIs.     

Disaggregative policy Delphi: Using cluster analysis as a tool for systematic scenario formation

A critical phase of scenario making is the choosing of scenarios. In the worst case, a futures researcher creates scenarios according to his/her subjective views and cannot see the real quality of the study material. Oversimplification is a typical example of this kind of bias. In this study, an attempt towards a more data sensitive method was made using Finnish transport policy as an example. A disaggregative Delphi method as opposed to traditional consensual Delphi was applied. The article summarises eight Delphi pitfalls and gives an example how to avoid them. A two-rounded disaggregative Delphi was conducted, the panelists being representatives of interest groups in the traffic sector. Panelists were shown the past development of three correlating key variables in Finland in 1970-1996: GDP, road traffic volume and the carbon dioxide emissions from road traffic. The panelists were invited to give estimates of their organisation to the probable and the preferable futures of the key variables for 1997-2025. They were also asked to give qualitative and quantitative arguments of why and the policy instruments of how their image of the future would occur. The first round data were collected by a fairly open questionnaire and the second round data by a fairly structured interview. The responses of the quantitative three key variables were grouped in a disaggregative way by cluster analysis. The clusters were complemented with respective qualitative arguments in order to form wider scenarios. This offers a relevance to decision-making not afforded by a nonsystematic approach. Of course, there are some problems of cluster analysis used in this way: The interviews revealed that quantitatively similar future images produced by the panelists occasionally had different kind of qualitative background theory. Also, cluster analysis cannot ultimately decide the number of scenarios, being a choice of the researcher. Cluster analysis makes the choice well argued, however.     

Weak Disposability in Nonparametric Production Analysis with Undesirable Outputs

Weak disposability of outputs means that firms can abate harmful emissions by decreasing the activity level. Modeling weak disposability in nonparametric production analysis has caused some confusion. This article identifies a dilemma in these approaches: conventional formulations implicitly and unintentionally assume all firms apply uniform abatement factors. However, it is usually cost-effective to abate emissions in those firms where the marginal abatement costs are lowest. This article presents a simple formulation of weak disposability that allows for non-uniform abatement factors and preserves the linear structure of the model.     

Adopting key lessons from agile manufacturing to agile software product development—A comparative study

Many industrial new product development (NPD) software projects apply nowadays agile methodologies. These methodologies, such as Scrum, eXtreme Programming (XP), and Feature-Driven Development (FDD) date back to 1990s, and the Agile Manifesto was declared in 2001. However, already before that the concept of agile manufacturing (AM) was discovered to describe a corporate ability for quick adaptation to changing requirements. There is surprising amount in common between these two fields. This raises a question of whether NPD software development companies could take even more overall advantage of those different agile approaches. This interdisciplinary paper explores the commonalities between the key concepts of AM and some of the most popular agile software methods, and consequently suggests potential new areas for software process improvement (SPI) in large-scale NPD organizations. An industrial case example illustrates how agility in embedded software product development can be enhanced by following typical NPD principles. We conclude that there is potential for further improvements in software product development industry in general by seeing agility as a wider, organization-oriented business concept following the AM/NPD learning. Current agile software process models cover only a subset of this space.     

The labour market consequences of self-employment spells: European evidence

We examine how those re-entering paid-employment after a brief self-employment spell fare upon return using data from the European Community Household Panel. Unconditionally, those re-entering paid-employment appear to have considerably lower wages than those staying in the wage sector. This difference appears to be larger in Europe than in the US. Conditional analysis suggests, however, that the difference is more apparent than real: It seems that Europeans select negatively into (and possibly out-of) self-employment, i.e., the likelihood of entering (and exiting) entrepreneurship correlates negatively with unobserved ability and/or in-paid-employment productivity. Our analysis of non-wage outcomes indicates that the selection is mostly involuntary, and that for highly educated men, the brief self-employment spells are unemployment in disguise.     

Pharmaceutical marketing through the customer portfolio: Institutional influence and adaptation

This paper discusses the dilemma of managing marketing in institutionalized business contexts. On the basis of a study of pharmaceutical marketing practices it is argued that business aspirations are dependent on understanding institutional influence and adaptation mechanisms on the customer-portfolio level. As relationships are perceived as such mechanisms, understanding network dynamics, institutional co-evolution and actor cognitions are key managerial issues. Furthermore, it is suggested that institutional discontinuities leverage institutional entrepreneurship to a critical extent.     

(In)Efficient Environmental Policy with Interacting Pollutants

Many environmental problems involve the transformation of multiple harmful substances into one or more damage agents much in the same way as a firm transforms inputs into outputs. Yet environmental management differs from a firm’s production in one important respect: while a firm seeks efficient input allocation to maximize profit, an environmental planner allocates abatement efforts to render the production of damage agents as inefficient as possible. We characterize a solution to the multiple pollutants problem and show that the optimal policy is often a corner solution, in which abatement is focused on a single pollutant. Corner solutions may arise even in well-behaved problems with concave production functions and convex damage and cost functions. Furthermore, even concentrating on a wrong pollutant may yield greater net benefits than setting uniform abatement targets for all harmful substances. Our general theoretical results on the management of flow and stock pollutants are complemented by two numerical examples illustrating the abatement of eutrophying nutrients and greenhouse gases.     

A Ricardian model of market sharing

The latest generation of multi-sectoral trade models has abandoned the conventional strategy that regards the similarly named exports of different countries as homogeneous products. Armington's assumption, that the products of different countries compete as imperfect substitutes, has become the theoretical rationale for an alternative, heterogeneous modeling procedure. This paper describes some problems with the assumption and develops a more rigorous framework for the heterogeneous strategy. The processes that lead to heterogeneity in trade are modeled explicitly: comparative advantage theory is applied at a sub-sectoral level to explain the detailed structure of international specialization. Implications of the new framework for empirical estimation are also explored.     

Product profitability: Causes and effects

The aim of this study was to determine the extent and the reasons for variation in the profitability of a product. The underlying hypothesis was that all products are not profitable. Furthermore, it was assumed that activity-based costing (ABC) would indicate greater differences in the profitability of products than the previously used marginal costing system. The case study was conducted in a company in the metal industry that manufactures and assembles industrial goods. First, the activity chains were modeled and the activity-based costs were calculated. Second, the activity-based cost of the final products was compared with the selling prices to determine the profitability. The results show that the profitability varies significantly. The most profitable 20% of the products generate more than 150% of the profits and 50% of the net sales. Finally, the study identifies the characteristics of the most profitable products and discusses the reasons for the profitability.