Economic burden of sarcoidosis in a commercially-insured population in the United States

Background: Sarcoidosis is a multi-system inflammatory disorder characterized by the presence of non-caseating granulomas in involved organs. Patients with sarcoidosis have a reduced quality-of-life and are at an increased risk for several comorbidities. Little is known about the direct and indirect cost of sarcoidosis following the initial diagnosis.

Aims: To provide an estimate of the healthcare resource utilization (HCRU) and costs borne by commercial payers for sarcoidosis patients in the US.

Methods: Patients with a first diagnosis of sarcoidosis between January 1, 1998 and March 31, 2015 (“index date”) were selected from a de-identified privately-insured administrative claims database. Sarcoidosis patients were required to have continuous health plan enrollment 12 months prior to and following their index dates. Propensity-score (1:1) matching of sarcoidosis patients with non-sarcoidosis controls was carried out based on a logistic regression of baseline characteristics. Burden of HCRU and work loss (disability days and medically-related absenteeism) were compared between the matched groups over the 12-month period following the index date (“outcome period”).

Results: A total of 7,119 sarcoidosis patients who met the selection criteria were matched with a control. Overall, commercial payers incurred $19,714 in mean total annual healthcare costs per sarcoidosis patient. The principle cost drivers were outpatient visits ($9,050 2015 USD, 46%) and inpatient admissions ($6,398, 32%). Relative to controls, sarcoidosis patients had $5,190 (36%) higher total healthcare costs ($19,714 vs $14,524; p?p?p?Background: Sarcoidosis is a multi-system inflammatory disorder characterized by the presence of non-caseating granulomas in involved organs. Patients with sarcoidosis have a reduced quality-of-life and are at an increased risk for several comorbidities. Little is known about the direct and indirect cost of sarcoidosis following the initial diagnosis.

Aims: To provide an estimate of the healthcare resource utilization (HCRU) and costs borne by commercial payers for sarcoidosis patients in the US.

Methods: Patients with a first diagnosis of sarcoidosis between January 1, 1998 and March 31, 2015 (“index date”) were selected from a de-identified privately-insured administrative claims database. Sarcoidosis patients were required to have continuous health plan enrollment 12 months prior to and following their index dates. Propensity-score (1:1) matching of sarcoidosis patients with non-sarcoidosis controls was carried out based on a logistic regression of baseline characteristics. Burden of HCRU and work loss (disability days and medically-related absenteeism) were compared between the matched groups over the 12-month period following the index date (“outcome period”).

Results: A total of 7,119 sarcoidosis patients who met the selection criteria were matched with a control. Overall, commercial payers incurred $19,714 in mean total annual healthcare costs per sarcoidosis patient. The principle cost drivers were outpatient visits ($9,050 2015 USD, 46%) and inpatient admissions ($6,398, 32%). Relative to controls, sarcoidosis patients had $5,190 (36%) higher total healthcare costs ($19,714 vs $14,524; p?<?0.001). Sarcoidosis patients also had significantly more work loss days (15.9 vs 11.3; p?<?0.001) and work loss costs ($3,288 vs $2,527; p?<?0.001) than matched controls. Sarcoidosis imposes an estimated total direct medical cost of $1.3–$8.7 billion to commercial payers, and an indirect cost of $0.2–$1.5 billion to commercial payers in work loss.

Conclusions: Sarcoidosis imposes a significant economic burden to payers in the first year following diagnosis.     

Forecasting economic time series using flexible versus fixed specification and linear versus nonlinear econometric models

Nine macroeconomic variables are forecast in a real-time scenario using a variety of flexible specification, fixed specification, linear, and nonlinear econometric models. All models are allowed to evolve through time, and our analysis focuses on model selection and performance. In the context of real-time forecasts, flexible specification models (including linear autoregressive models with exogenous variables and nonlinear artificial neural networks) appear to offer a useful and viable alternative to less flexible fixed specification linear models for a subset of the economic variables which we examine, particularly at forecast horizons greater than 1-step ahead. We speculate that one reason for this result is that the economy is evolving (rather slowly) over time. This feature cannot easily be captured by fixed specification linear models, however, and manifests itself in the form of evolving coefficient estimates. We also provide additional evidence supporting the claim that models which ‘win’ based on one model selection criterion (say a squared error measure) do not necessarily win when an alternative selection criterion is used (say a confusion rate measure), thus highlighting the importance of the particular cost function which is used by forecasters and ‘end-users’ to evaluate their models. A wide variety of different model selection criteria and statistical tests are used to illustrate our findings.     

Does Cultural Distance Hinder Trade in Goods? A Comparative Study of Nine OECD Member Nations

We examine the effect of cultural distance, a proxy for the lack of a minimum reservoir of trust necessary to initiate and complete trade deals, on bilateral trade flows. Employing data for 67 countries that span the years 1996–2001, we estimate a series of modified gravity specifications and find that cultural dissimilarity between nations has an economically significant and consistently negative effect on aggregate and disaggregated trade flows; however, estimated effects vary in magnitude and economic significance across measures of trade and our cohort of OECD reference countries. The consistently negative influence of cultural distance indicates that policymakers may wish to consider mechanisms that enhance the build-up of trust and commitment when seeking to facilitate the initiation and completion of international trade deals. Our findings also imply that coefficient estimates from related studies that do not account for the trade-inhibiting effect of cultural distance may be biased.     

Restricted electricity use among poor urban households

For a variety of reasons, this article argues, electricity must be seen by policy‐makers in South Africa not as the sole provider of all future household energy needs, but rather as one component of an energy mix which includes such ‘transitional’ fuels as coal, gas and paraffin. The reasons for this are that electricity is expensive for poor households; it is subject to power failures and disconnections for non‐payment; the poor find it difficult to monitor and to control their consumption; appliances are expensive and several are required to make best use of electricity; people prefer other fuels because they are familiar and have strong personal and cultural associations, and because Eskom is not trusted owing to its past ties to illegitimate local authorities and misunderstanding of electricity and how its use is monitored and charged for. Further, it is mistaken to equate ‘development’ with total electrification: most developed countries have fuel mixes which include gas and coal, particularly for cooking and heating. Accepting an affordable fuel mix for the poor in particular would focus attention on the problems currently associated with paraffin, gas and coal, namely fires, poisoning and air pollution.     

The Valuation Effect of Accounting Standard 158 on Firms with High and Low Financial Risk

SFAS 158 mandated balance sheet disclosure of the funded status of firms’ Defined Benefit Pension Plan using the Projected Benefit Obligation (PBO) to estimate the pension liability. SFAS 158 caused a market phenomenon because the use of the PBO engendered dramatically higher estimates of pension liability and hence the perception of risk. Our work focuses on two aspects of this change in pension accounting: first, how will industry firms change their accounting strategy in light of the new rules, and second, how will firms’ stock prices be affected by the new allegedly better estimate of pension liability? Our research suggests that firms’ accounting strategies changed in that they use higher discount rates to estimate pension liability which offset the dramatic impact of using the PBO. In addition, we find that high financial risk firms’ tendencies to use higher discount rates increase with the firms’ leverage and decrease with liquidity. To test the market reaction we utilize standard event study methodology to investigate the effects of SFAS 158 on stock returns. Our findings suggest that firms with high (low) financial risk earn negative (positive) abnormal returns on and around relevant event dates preceding the implementation of SFAS 158.     

Know-how transfer: the role of social,economic/competitive,and firm boundary factors

Using policy capture methodology, this study examines the effect of different contextual cues upon the know-how transfer efforts reported by 79 biotechnology R&D scientists. Theoretically, these different cues are believed to affect the scientists' expectation of reciprocity, and thus their know-how transfer behavior. Three types of contextual cues between the know-how source and recipient were studied: competitiveness, social relationship, and within or across firm boundaries. We find these cues are associated, in the expected directions, with know-how transfer effort. The findings support a general theory of reciprocity whereby social, competitive, and firm boundary cues have a summative effect upon the expectation of reciprocity and know-how transfer. This is the first study to examine how these cues taken together influence the know-how transfer decision. Copyright © 2008 John Wiley & Sons, Ltd.     

GROWTH,AUTONOMOUS DEMAND AND A JOINT‐PRODUCT TREATMENT OF FIXED CAPITAL

The aim of this paper is to shed light on the idea of demand‐led growth by exploring the relation between growth and autonomous demands in a two‐sector model that includes fixed capital with variable efficiency. The paper considers disequilibrium only in relation to quantities, with prices set at their long‐period levels. Results of computer simulations suggest that where producers' expectations of future growth allow for dispersion in past growth rates, as well future growth in autonomous demand, this may have a significant stabilizing effect on the dynamics of output and demand.     

Using tracking technology to improve marketing: insights from a historic town in Tasmania,Australia

ABSTRACT

This study examines the movement patterns of different market segments in an historic town. It combines traditional visitor surveys with a bespoke tourist tracking application. Two analytical stages were undertaken. The first involved analyzing the movements of tourist segments and revealed that “heritage” tourists tended to visit for the shortest lengths of time. The second phase revealed that a visit of between one and two hours seemed to provide the best opportunity to explore the village fully, while shorter and longer stays did not. The insights challenge traditional notions that heritage-oriented tourists should form the target market for historic communities.