Projecting total costs and health consequences of increasing mt-sDNA utilization for colorectal cancer screening from the payer and integrated delivery network perspectives

Abstract

Aims: To evaluate total costs and health consequences of a colorectal cancer (CRC) screening program with colonoscopy, fecal immunochemical tests (FIT), and expanded use of multitarget stool DNA (mt-sDNA) from the perspectives of Integrated Delivery Networks (IDNs) and payers in the United States.

Materials and methods: We developed a budget impact and cost-consequence model that simulates CRC screening for eligible 50- to 75-year-old adults. A status quo scenario and an increased mt-sDNA scenario were modeled. The status quo includes the current screening mix of colonoscopy (83%), FIT (11%), and mt-sDNA (6%) modalities. The increased mt-sDNA scenario increases mt-sDNA utilization to 28% over 10 years. Costs for both the IDN and the payer perspectives incorporated diagnostic and surveillance colonoscopies, adverse events (AEs), and CRC treatment. The IDN perspective included screening program costs, composed of direct nonmedical (e.g. patient navigation) and indirect (e.g. administration) costs. It was assumed that IDNs do not incur the costs for stool-based screening tests or bowel preparation for colonoscopies.

Results: In a population of one million covered lives, the 10-year incremental cost savings incurred by increasing mt-sDNA utilization was $16.2 M for the IDN and $3.3 M for the payer. The incremental savings per-person-per-month were $0.14 and $0.03 for the IDN and payer, respectively. For both perspectives, increased diagnostic colonoscopy costs were offset by reductions in screening colonoscopies, surveillance colonoscopies, and AEs. Extending screening eligibility to 45- to 75-year-olds slightly decreased the overall cost savings.

Limitations: The natural history of CRC was not simulated; however, many of the utilized parameters were extracted from highly vetted natural history models or published literature. Direct nonmedical and indirect costs for CRC screening programs are applied on a per-person-per modality basis, whereas in reality some of these costs may be fixed.

Conclusions: Increased mt-sDNA utilization leads to fewer colonoscopies, less AEs, and lower overall costs for both IDNs and payers, reducing overall screening program costs and increasing the number of cancers detected while maintaining screening adherence rates over 10 years.     

Bayesian assessment of Lorenz and stochastic dominance

We introduce a Bayesian approach for assessing Lorenz and stochastic dominance. For two income distributions, say X and Y, estimated via Markov chain Monte Carlo, we describe how to compute posterior probabilities for: (i) X dominates Y, (ii) Y dominates X and (iii) neither Y nor X dominates. The proposed approach is applied to Indonesian income distributions using mixtures of gamma densities that ensure flexible modelling. Probability curves depicting the probability of dominance at each population proportion are used to explain changes in dominance probabilities over restricted ranges relevant for poverty orderings. They also explain some seemingly contradictory outcomes from the p-values of some sampling theory tests.     

Intermediate Goods and Exchange Rate Disconnect

Open Economies Review - This paper introduces intermediate goods trade into a two-country real business cycle model and examines its implications for real exchange rate behavior. Intermediate goods...     

WHAT CAN WE LEARN FROM THE IMPLEMENTATION OF MONETARY AND MACROPRUDENTIAL POLICIES: A SYSTEMATIC LITERATURE REVIEW

The emergence of macroprudential policies, implemented by central banks as a means of promoting financial stability, has raised many questions regarding the interaction between monetary and macroprudential policies. Given the limited number of studies available, this paper sheds light on this issue by providing a critical and systematic review of the literature. To this end, we divide the theoretical and empirical studies into two broad channels of borrowers – consisting of the cost of funds and the collateral constraint – and financial intermediaries – consisting of risk‐taking and payment systems. In spite of the existing ambiguity surrounding coordination issues between monetary and macroprudential policies, it is argued that monetary policy alone is not sufficient to maintain macroeconomic and financial stability. Hence, macroprudential policies are needed to supplement monetary. In addition, we find that the role of the exchange rate is critical in the implementation of monetary and macroprudential policies in emerging markets, while volatile capital flows pose another challenge. In so far as how the arrangement of monetary and macroprudential policies varies across countries, key theoretical and policy implications have been identified.     

Does partnership at work increase trust? An analysis based on the 2004 Workplace Employment Relations Survey

In the late 1990s, partnership at work was embraced with some enthusiasm by a number of stakeholders in employment relations and incorporated in the 1999 Employment Relations Act. The implementation of the Information and Consultation Regulations has also been extensively signalled. We might therefore expect to see some evidence of partnership‐related practices in Britain. The 2004 Workplace Employment Relations Survey (WERS 2004) provides an opportunity to explore the extent of partnership practice, and also, for the first time, to explore its link to trust relations. This article reports evidence from WERS 2004 suggesting that partnership practice remains relatively undeveloped and that it is only weakly related to trust between management and employee representatives and to employees’ trust in management. Direct forms of participation generally have a more positive association with trust than representative forms. There is also modest evidence that trust may be associated with certain workplace outcomes. The case for partnership and more particularly representative partnership as a basis for mutuality and trust is not supported by this evidence.     

Are Reports of Discrimination Valid? Considering the Moral Hazard Effect

A bstract .   Antidiscrimination laws are designed to prompt employers to stop excluding black workers from jobs they offer and from treating them unequally with respect to promotion and salaries once on the job. However, a moral hazard effect can arise if the existence of the laws leads black employees to bring unjustified claims of discrimination against employers. It has been argued that employers may become more reluctant to hire black workers for fear of being subjected to frivolous lawsuits.
Using the Multi-City Study of Urban Inequality (MCSUI), we find that male and female black workers are far more likely than whites to report racial discrimination at work. This is the case even when a host of human capital and labor market factors are controlled for. Further, nearly all black workers who report they have been discriminated against on the job in the MCSUI Surveys also show statistical evidence of wage discrimination. This is not the case for white males or females. We find little evidence to support a moral hazard effect.     

Productivity efficiencies in Ukrainian polyclinics: lessons for health system transitions from differential responses to market changes

Ukraine’s recent elections revealed deep divisions between eastern regions, which favored central economic planning, and western regions, which preferred more free market reforms. This study compares polyclinics in Ukraine to see if the inflexibility of Soviet-style planned economies results in lower economic efficiency in eastern regions. Using data from two geopolitical regions, Data Envelopment Analysis (DEA) scores for polyclinic efficiencies are modeled as a function of demographic and economic determinants. Surprisingly, results indicate that polyclinics in western Ukraine are less efficient. Possible explanations, including case mix intensity, responsiveness to local preferences, physician entrepreneurial behavior and a legacy of inequitable funding, are discussed.

Rater source factors represent important subcomponents of the criterion construct space, not rater bias

We contrast normative accuracy and ecological perspectives on applications of the multitrait–multimethod methodology to multisource performance ratings and review existing research that provides critical tests of these perspectives. Existing research supports the ecological perspective which proposes that the rater source effects that are typically found in analysis of multisource performance ratings do not represent mere halo biases but alternative, perhaps equally valid perspectives on ratee performance. We suggest that future research view multifaceted research designs in the broader context of a prototype multidimensional data relational system such as that proposed by Lance, Baranik, Lau, and Scharlau (Lance, C. E., Baranik, L. E., Lau, A. R., & Scharlau, E. A. (in press). If it's not trait it must be method: (Mis)application of the multitrait–multimethod design in organizational research. In C. E. Lance & R. J. Vandenberg (Eds.), Statistical and methodological myths and urban legends: Received doctrine, verity, and fable in the organizational and social sciences. Mahwah, NJ: Erlbaum).