Use of a validated algorithm to estimate the annual cost of effective biologic treatment for rheumatoid arthritis

Objectives:

To estimate biologic cost per effectively treated patient with rheumatoid arthritis (RA) using a claims-based algorithm for effectiveness.

Methods:

Patients with RA aged 18–63 years in the IMS PharMetrics Plus database were categorized as effectively treated if they met all six criteria: (1) a medication possession ratio ≥80% (subcutaneous) or at least as many infusions as specified in US labeling (intravenous); (2) no biologic dose increase; (3) no biologic switch; (4) no new non-biologic disease-modifying anti-rheumatic drug; (5) no new or increased oral glucocorticoid; and (6) ≤1 glucocorticoid injection. Biologic cost per effectively treated patient was defined as total cost of the index biologic (drug plus intravenous administration) divided by the number of patients categorized by the algorithm as effectively treated. Similar methods were used for the index biologic in the second year and for a second biologic after a switch.

Results:

Rates that the index biologic was categorized as effective in the first year were 31.0% etanercept (2243/7247), 28.6% adalimumab (1426/4991), 28.6% abatacept (332/1160), 27.2% golimumab (71/261), and 20.2% infliximab (474/2352). Mean biologic cost per effectively treated patient, per the algorithm, was $50,141 etanercept, $53,386 golimumab, $56,942 adalimumab, $73,516 abatacept, and $114,089 infliximab. Biologic cost per effectively treated patient, using this algorithm, was lower for patients who continued the index biologic in the second year and higher after switching.

Conclusions:

When a claims-based algorithm was applied to a large commercial claims database, etanercept was categorized as the most effective and had the lowest estimated 1-year biologic cost per effectively treated patient. This proxy for effectiveness from claims databases was validated against a clinical effectiveness scale, but analyses of the second year or the year after a biologic switch were not included in the validation. Costs of other medications were not included in cost calculations.     

Corruption and local democratization in Indonesia: The role of Islamic parties

Indonesia has a tradition of corruption among local officials who harass and collect bribes from firms. This paper examines whether corruption is affected by local democratization and by the party composition of local assemblies. Democratization occurred in 1999 and decentralization in 2001. We have firm-level data for 2001 and 2004. The 2001 data benchmark corruption at the time of decentralization. We find that corruption declines between 2001 and 2004 overall, but much less so in districts with more secular party as opposed to Islamic party representatives in district assemblies. For a larger sample of districts, correspondingly, we find that corruption in 2004 is more in districts which voted more in favor of secular party representatives in the first elections in 1999. We argue that the effects seem to be causal, over above any effects of changing religiosity and economic circumstances across districts.     

The Application of Multivariate Stochastic Dominance Criteria to Agricultural Economic Problems

This paper provides a discussion of multivariate risk analysis and multivariate stochastic dominance criteria. The assumptions and conditions required to extend the use of stochastic dominance criteria to multivariate problems are examined. The assumptions of additive utility or statistical independence are required to apply true multivariate stochastic dominance criteria. Implications for the application of several multivariate stochastic dominance criteria to empirical problems are discussed. An empirical application is presented to demonstrate the importance of recognizing the assumptions underlying alternative multivariate stochastic dominance criteria. Alternative structural adjustments for a representative upper midwestern dairy farm are examined and assessed using multivariate stochastic dominance. The results of the analysis indicate that, if utility is assumed to be additive, dairy expansion and specialization may not be optimal. If utility is assumed to be defined in terms of overall wealth, however, dairy expansion and specialization are preferred to the present firm structure. Cet article analyse le risque des variables aléatoires multiples et les critères de prédominance des variables aléatoires stochastiques multiples. Les suppositions et les conditions requises pour étendre l'usage des critères de prédominance stochastiques aux variables aléatoires multiples sont étudiées. Les suppositions d'utilité additive ou d'indépendance statistique sont exigées pour appliquer les critères de prédominance des variables aléatoires stochastiques multiples. L'étude examine également les implications de l'application de plusieurs critères de prédominance des variables aléatoires stochastiques multiples sur des problèmes empiriques. Une application empirique est utilisée pour démontrer qu'il important de reconnaître les suppositions qui sont à la base des critères alternatifs de prédominance des variables aléatoires stochastiques multiples. Les variables aléatoires multiples de prédominance stochastique sont utilisées pour examiner et évaluer des ajustements structurels alternatifs pour une ferme laitière representative du haut-midwest. Les résultats de l'analyse indiquent que, dans les conditions d'utilityé additive, l'expansion et la spécialisation des fermes laitières pourraient ne pas être optimales. Par contre si l'utilityé est défine en termes de fortune, l'expansion et la spécialisation laitiéres sont préferables à la structure actuelle des fermes.     

The Effects of the Tax Cuts and Jobs Act of 2017 on Defined Benefit Pension Contributions*

This study examines the effect of the Tax Cuts and Jobs Act of 2017 (TCJA) on corporate defined benefit pension contributions. The TCJA decreases the corporate tax rate from 35 percent in 2017 to 21 percent in 2018 and thereafter. This change incentivizes firms to increase 2017 pension contributions to take advantage of tax deductions at a higher rate. Consistent with this incentive, we find firms increase defined benefit pension contributions by an average of 25 to 31 percent in 2017 compared with earlier years. We also find that taxpaying firms are the primary contributors. Further, taxpaying firms with high levels of pension-related deferred tax assets contribute over three times as much as taxpaying firms with low levels of pension-related deferred tax assets. We also find firms that increase pension contributions in 2017 reduce 2018 contributions, consistent with intertemporal income shifting rather than a permanent change in pension funding strategy.     

Ethical tension points in whistleblowing

This paper analyzes the number of procedural and substantive tension points with which a conscientious whistleblower struggles. Included in the former are such questions as: (1) Am I properly depicting the seriousness of the problem? (2) Have I secured the information properly, analyzed it appropriately, and presented it fairly? (3) Are my motives appropriate? (4) Have I tried fully enough to have the problem corrected within the organization? (5) Should I blow the whistle while still a member of the organization or after having left it? (6) Should I keep anonymity? (7) How ethical is it to assume the role of a judge? (8) How ethical is it to set in motion an act which will likely be very costly to many people? Substantive tension points include such questions as: (1) How fully am I living up to my moral obligations to my organization and my colleagues? (2) Am I appropriately upholding the ethical standards of my profession? (3) How adversely will my action affect my family and other primary groups? (4) Am I being true to myself? (5) How will my action affect the health of such basic values as freedom of expression, independent judgment, courage, fairness, cooperativeness, and loyalty?     

Reciprocity, Trust, and Payoff Privacy in Extensive Form Bargaining

We report decision making in two-person extensive form game trees, using six treatments that vary matching protocol, payoffs, and payoff information. Our objective is to examine game theoretic hypotheses of decision making based on dominance and backward induction in comparison with the culturally or biologically derived hypothesis that reciprocity supports more cooperation than predicted by game theory. We find strong support for cooperation under complete information, even in single-play treatments and in games of trust, unreinforced by the prospect of punishment for defection from reciprocity. Only under private information do we observe strong support for noncooperative game theory.Journal of Economic LiteratureClassification Numbers: C78, C92.     

Scale Externalities in Korea

This paper estimates the nature and magnitude of scale externalities in a developing country, Korea, in the period 1983–1993. This is a period of rapid industry deconcentration from Seoul to other metro areas, providing a context where externalities are measured when local scale magnitudes are changing dramatically. The data allow us to examine the emerging degree of national industrial concentration in different industries, as related to their scale externality magnitudes. We also examine whether individual industries agglomerate in cities which have a comparative advantage for that industry.     

The agglomeration of headquarters

This paper uses a micro data set on auxiliary establishments from 1977 to 1997 in order to investigate the determinants of headquarter agglomerations and the underlying economic base of many larger metro areas. The significance of headquarters in large urban settings is their ability to facilitate the spatial separation of their white collar activities from remote production plants. The results show that separation benefits headquarters in two main ways: the availability of differentiated local service input suppliers and the scale of other headquarter activity nearby. A wide diversity of local service options allows the headquarters to better match their various needs with specific experts producing service inputs from whom they learn, which improves their productivity. Headquarters also benefit from other headquarter neighbors, although such marginal scale benefits seem to diminish as local scale rises.     

Information systems for collaborating versus transacting: Impact on manufacturing plant performance in the presence of demand volatility

Research at the nexus of operations management and information systems suggests that manufacturing plants may benefit from the utilization of information systems for collaborating and transacting with suppliers and customers. The objective of this study is to examine the extent to which value generated by information systems for collaborating versus transacting is contingent upon demand volatility. We analyze a unique dataset assembled from non-public U.S. Census Bureau data of manufacturing plants. Our findings suggest that when faced with volatile demand, plants employing information systems for collaborating with suppliers and customers experience positive and significant benefits to performance, in terms of both labor productivity and inventory turnover. In contrast, results suggest that plants employing information systems for transacting in volatile environments do not experience such benefits. Further exploratory analysis suggests that in the context of demand volatility, these two distinct dimensions of IT-based integration have differing performance implications at different stages of the production process in terms of raw-materials inventory and finished-goods inventory, but not in terms of work-in-process inventory. Taken together, our study contributes to theoretical and managerial understanding of the contingent value of information systems in volatile demand conditions in the supply chain context.