Treatment patterns among patients with psoriasis using a large national payer database in the United States: a retrospective study

Aim: To characterize treatment patterns of psoriasis patients in a large US managed care database.

Materials and methods: Adults with newly-diagnosed psoriasis were identified from July 3, 2006–August 31, 2014. Patients had continuous enrollment with medical and pharmacy benefits for ≥6 months prior to and ≥1 year following the index date. The index date was the point at which any of the following inclusion criteria were satisfied: first psoriasis diagnosis by a dermatologist, ≥ 2 psoriasis diagnoses ≥30 days apart, or a diagnosis of psoriasis followed by a claim for psoriasis therapy. Of primary interest was to measure and describe the following psoriasis treatment patterns: utilization rates, time to treatment discontinuation, and lines of therapy for various therapeutic classes of pharmacologic therapies.

Results: From the 128,308 patients identified, 53% were female, mean?±?SD age was 50?±?16 years, with median 3 years follow-up. Topicals were received by 86% of patients, non-biologic systemics by 13%, biologics by 6%, phototherapy by 5%, and 13% received no psoriasis-related medication. Median time from index to first treatment was 0 days for topical, 6 months for non-biologic systemic, and 6 months for biologic. Of those treated, first-line therapies included topical (95%), non-biologic systemic (4%), and biologic (2%). For those with second-line treatment, non-biologic systemic (71%) and biologic (30%) therapies were more common. The most common treatment pattern was topicals only (83%), while all other patterns comprised <5% of the treatment patterns observed.

Limitations: Like other observational studies, limitations to consider when interpreting results include the 6-month pre-index period of no psoriasis or the psoriasis medication claim may not perfectly select only incident user of psoriasis medications, claims-based algorithms may not accurately represent true treatment patterns, absence of over-the-counter medications data, and having no trend analyses over time or between groups.

Conclusions: While the majority of patients with psoriasis initiated a pharmacological therapy, a significant portion did not have a claim for any psoriasis medication. Topical treatments are the most commonly used treatments for psoriasis. Non-biologic systemic and biologic therapies were rarely used first line, but became more common in later lines of treatment.     

Consumer Willingness to Pay for Cue Attribute: The Value Beyond Its Own

Using Certified U.S. Product as a product cue, we show that consumer willingness to pay for other identifiable search and experience attributes change. Certified U.S. Product serves as a substitute for Guaranteed Tender and a complement of Guaranteed Lean. Results have important implications for policymakers and food companies interested in food labeling programs in the presence of cue attributes such as Certified U.S. Product. The substitute effects of a cue attribute on other product attributes may contribute to deteriorating product quality and the complement effects of a cue attribute could improve product quality in the market.     

Cost-effectiveness of pembrolizumab in combination with chemotherapy in the 1st line treatment of non-squamous NSCLC in the US

Abstract

Aims: To describe cost-effectiveness of pembrolizumab plus platinum and pemetrexed chemotherapy in metastatic, non-squamous, NSCLC patients in the US.

Materials and methods: A model is developed utilizing partitioned survival analysis to estimate the cost-effectiveness of KEYNOTE-189 trial comparators pembrolizumab?+?chemotherapy (carboplatin/cisplatin?+?pemetrexed) vs chemotherapy alone. Clinical efficacy, treatment utilization, health utility, and safety data are derived from the trial and projected over 20 years. For extrapolating survival beyond the trial, a novel SEER population-data approach is applied (primary analysis), with separate estimation via traditional parametric extrapolation methods. Costs for drugs and non-drug disease management are also incorporated. Based on an indirect treatment comparison, cost-effectiveness of pembrolizumab?+?chemotherapy vs pembrolizumab monotherapy is evaluated for patients with programmed death-ligand 1 (PD-L1)?≥?50%.

Results: In the full non-squamous population, pembrolizumab?+?chemotherapy is projected to increase life expectancy by 2.04 years vs chemotherapy (3.96 vs 1.92), for an approximate doubling of life years. Resultant incremental cost-effectiveness ratios (ICERs) are $104,823/QALY and $87,242/life year. In patients with PD-L1?≥?50% and 1–49%, life expectancy is more than doubled (4.53 vs 1.88 years) and (4.87 vs 2.01 years), with a 32% (2.60 vs 1.97 years) increase in PD-L1?<?1% patients. Corresponding incremental costs/quality-adjusted life year (QALY) are $103,402, $66,837, and $183,529 for PD-L1?≥?50%, 1–49%, and <1% groups, respectively. Versus pembrolizumab monotherapy in PD-L1?≥?50% patients, representing current standard of care, pembrolizumab?+?chemotherapy increases life expectancy by 65% (4.53 vs 2.74 years) at an ICER of $147,365/QALY.

Limitations and conclusions: The addition of pembrolizumab to chemotherapy is projected to extend life expectancy to a point not previously seen in previously untreated metastatic non-squamous NSCLC. Although ICERs vary by sub-group and comparator, results suggest pembrolizumab?+?chemotherapy yields ICERs near, or in most cases, well below a 3-times US per capita GDP threshold of $180,000/QALY, and may be a cost-effective first-line treatment for metastatic non-squamous NSCLC patients.     

Equity yields

We study a new data set of dividend futures with maturities up to ten years across three world regions: the US, Europe, and Japan. We use these asset prices to construct equity yields, analogous to bond yields. We decompose the equity yields to obtain a term structure of expected dividend growth rates and a term structure of risk premia, which decomposes the equity risk premium by maturity. We find that the slope of the term structure of risk premia is pro-cyclical, whereas the slope of the term structure of expected dividend growth rates is counter-cyclical. The comovement of yields across regions is, on average, higher for long-maturity yields than for short-maturity yields, whereas the variation in this comovement is much higher for short-maturity yields.     

GAAP,GFS and AASB 1049: perceptions of public sector stakeholders

Efforts by Australian standard‐setters to harmonise public sector financial reporting resulted in AASB 1049, which sought to bridge the divide between generally accepted accounting principles (GAAP)‐based and government finance statistics (GFS)‐based financial statements. However, whether AASB 1049 has resulted in information that is considered appropriate for the public sector has not been examined. We explore this issue by comparing the requirements of AASB 1049 with the responses from a survey of public sector stakeholders on the appropriate accounting treatment and presentation of selected financial items. The analysis suggests consensus with AASB 1049 on presentation issues but less consensus on accounting treatments.     

Evaluating Workplace Mandates with Flows Versus Stocks: An Application to California Paid Family Leave

Employer mandates typically have small effects on wages and employment. Such effects should be most evident using data on employment transitions and wages among new hires. Quarterly Workforce Indicators (QWI) provides county by quarter by demographic group data on the number and earnings of new hires, separations, and recalls (extended leaves). The QWI is used to examine the effects of California's 2004 paid family leave (CPFL) program, comparing outcomes for young women in California to those for other workers within and outside of California. CPFL had little effect on earnings for young women, but increased separations, hiring, and worker mobility.     

The Impact of Private Label Introduction on Assortment,Prices, and Profits of Retailers*

We study how introducing private-label brands (PLs) affects retail prices and profits, accounting for assortment adjustments of national brands (NBs). We employ an event-study framework and scanner data on the US beef market. When a PL is added to the low-priced market segment, we find that retail stores further differentiate NBs from the PL and remove same-segment NBs. When a PL is added to the high-priced segment, however, NB assortment changes are limited. PL introduction and PL-driven NB assortment changes impose small price effects on NB, but strongly cannibalize NB demand and steer consumers toward PLs, likely increasing store profits.     

Why Do Buyers Pay Different Prices for Comparable Products? A Structural Approach on the Housing Market

The Journal of Real Estate Finance and Economics - We focus on the housing market and examine why nonlocal home buyers pay 12% more for houses than local home buyers. We established a database on...