Primary vs secondary prophylaxis with pegfilgrastim for the reduction of febrile neutropenia risk in patients receiving chemotherapy for non-Hodgkin’s lymphoma: cost-effectiveness analyses

Objective:

Evaluate the cost-effectiveness of primary vs secondary prophylaxis (PP vs SP) with pegfilgrastim to reduce the risk of febrile neutropenia (FN) in Non-Hodgkin’s Lymphoma (NHL) patients receiving myelosuppressive chemotherapy from a US payer perspective.

Methods:

A Markov model was used to compare PP vs SP with pegfilgrastim in a cohort of patients receiving six cycles of cyclophosphamide, vincristine, doxorubicin, and prednisone (CHOP) or CHOP plus rituximab (CHOP-R) chemotherapy. Model inputs, including efficacy of pegfilgrastim in reducing risk of FN and costs, were estimated from publicly available sources and peer-reviewed publications. Incremental cost-effectiveness was evaluated in terms of net cost per life-year saved (LYS), per quality-adjusted life-year (QALY) gained, and per FN event avoided over a lifetime horizon. Deterministic and probabilistic analyses were performed to assess sensitivity and robustness of results.

Results:

Lifetime costs for PP were $5000 greater than for SP; however, PP was associated with fewer FN events and more LYs and QALYs gained vs SP. Incremental cost-effectiveness ratios (ICERs) for PP vs SP for CHOP were $13,400 per FN event avoided, $29,500 per QALY gained, and $25,800 per LYS. CHOP-R results were similar ($15,000 per FN event avoided, $33,000 per QALY gained, and $28,900 per LYS). Results were most sensitive to baseline FN risk, cost per FN episode, and odds ratio for reduced relative dose intensity due to prior FN event. PP was cost-effective vs SP in 85% of simulations at a $50,000 per QALY threshold.

Limitations:

In the absence of NHL-specific data, estimates for pegfilgrastim efficacy and relative risk reduction of FN were based on available data for neoadjuvant TAC in patients with breast cancer. Baseline risks of FN for CHOP and CHOP-R were assumed to be equivalent.

Conclusions:

PP with pegfilgrastim is cost-effective compared to SP with pegfilgrastim in NHL patients receiving CHOP or CHOP-R.     

The role of “other information” in analysts’ forecasts in understanding stock return volatility

This study identifies “other information” in analysts’ forecasts as a legitimate proxy for future cash flows and examines its incremental role in explaining stock return volatility. We suggest that “other information” contains information about fundamentals beyond that reflected in current financial statements and reflects firms’ fundamentals on a more timely basis than dividends or earnings. Using standardized regressions, we find volatility increases when current “other information” is more uncertain and increases more in response to unfavorable news compared to favorable news. Variance decomposition analysis shows that the variance contribution of “other information” dominates that of expected-return news. The incremental role of “other information” is at least half of the effect of earnings in explaining future volatility. The results are more pronounced for firms with poor information environments. Overall, our results highlight the importance of including “other information” as an additional cash-flow proxy in future studies of stock prices and volatility.     

Speedier delivery: coastal shipping times and speeds during the Age of Sail †

There is a debate about whether coastal shipping experienced substantial productivity growth prior to the advent of steam power. To study changes over the long eighteenth century, this article uses thousands of coastal journey times culled from Board of Trade crew lists between 1835 and 1844 and coastal port books for the mid‐to‐late 1600s, along with a newly digitized coastal network. Comparisons between matched samples show that journey speeds, defined as miles sailed per day, were significantly higher in the crew lists compared to the port books, and that voyage cycle times, defined as days between starting two identical voyages, were substantially lower. The study also shows that voyage times in the east coast coal trade were substantially lower around 1840 than around 1700, but the difference was much smaller when peace years are compared. These new data imply that total factor productivity growth in the east coast coal trade was significant, especially if one accounts for gains from peace after 1815. The findings contribute to the larger literature studying the rate and sources of productivity growth during the industrial revolution.     

From economic theory to leisure practice via empirics: the case of demand and price

Despite the relationship of price and demand being central to economic analysis, doubts have been expressed in leisure studies about the ability of economists to contribute meaningfully to price decisions in leisure, or even to an understanding of price-demand relationships in leisure. This article uses a review of relevant theoretical and empirical considerations and a recent empirical investigation to refute such assertions. It demonstrates how leisure managers might utilize appropriate management information and market research data to improve both their understanding of the price-demand relationship and consequent pricing decisions, with the help of economic analysis.     

A Knowledge-engineering approach to accounting education

In the context of the massive expansion of the knowledge base facing all fields of professional activity, instructional science (which embraces the use of a knowledge-engineering approach to curriculum design) could well help to unvael the complexity of important pedagogical issues confronting accounting educationalists. The delineation and use of an expert knowledge base within the framework of the ‘dimensions of processing model’ of human information processing provides a valuable focus for making decision about the breadth, depth and nature of specific educatinal objectives. Knowledge engineering, which is fundamental to this process, appears to provide an appropriate framework for the systematic planning, development, delivery and evaluation of high-quality education and training programmes. Such an approach base while ensuring practitioners and teachers to keep pace with their rapidly changing knowledge base while ensuring that students acquire and become competent in the use of the cognitive skills they need in order to work effectively in their chosen profession.     

Tensions in local government employment relationships

Abstract

A wide variety of initiatives characterized under the umbrella term of new public management have been introduced over the past two decades to improve efficiency and cost-effectiveness in the public sector. The implications of these initiatives for public sector employment relationships have been the subject of on-going debate. This article contributes to this debate through examining how employees within local authorities are managed in a time of personal crisis with a particular focus on long-term sickness absence in the context of increased management drives for efficiency under the NPM agenda. The findings reveal that for managers in two local authorities that form the focus of this study there is a tension in struggling to achieve a workable balance between the needs of employees and wider operational requirements, resulting in role ambiguity for line managers and detrimental effects for vulnerable public service workers.     

Robust anomalies? A close look at accrual‐based trading strategy returns

The last 40 years have seen an extensive literature documenting so‐called anomalies in major capital markets. Evidence of ‘abnormal’ returns associated with trading strategies based on readily observable phenomena such as accounting‐based data involves experimental design choices that can be expected to influence the results. We show how evidence of an accrual anomaly in Australia is sensitive to research design specifications such as the choice of proxy for total accruals; the definition of abnormal returns (i.e. the return generating model); the impact of data trimming as a response to exceptionally large returns; and the choice between value and equal weighting of returns. We show that research design choices do matter and help reconcile conflicting prior evidence of any accrual anomaly in Australia. More broadly, our results suggest the need for caution in drawing inferences from trading strategy tests which claim to identify anomalies.     

What is professional attire today? A conjoint analysis of personal presentation attributes

Personal presentation attributes have long been understood to affect perceptions of competence and capabilities. To that end, this study investigates seven attributes associated with favorable interview presentation, including overall physical attractiveness, neatness and grooming, clothing color, conservative versus trendy attire, professional versus casual attire, and body modification (including tattoos and piercings). Participants (n = 108), including students, faculty, and hospitality industry professionals, sorted an orthogonal array of 16 full-color, laminated cards that contained photos so that respondents could see levels of clothing color, clothing conservativeness, and degree of professional attire. The remaining attributes and their corresponding levels were shown on respective analog indicators. The conjoint analysis results indicate that grooming and professional attire are the most important attributes in shaping favorable perceptions. Furthermore, faculty perceived conservative clothing to be better while students and industry professionals indicated that trendy clothing creates a more favorable presentation on the part of a job candidate.     

Retail change: effects on employees' job demands and home life

Causes and effects of occupational stress have received research attention for several decades, with increasing focus during the 1990s as organizations and individual workers attempt to adapt to economic change. Stress arising from either the work or home domain can have a variety of outcomes in the workplace, and similarly can impact in many ways on relationships and activities at home. This paper reports the first phase of a research study to identify the impact on work and home life of changes in retailing, a sector of the economy which has experienced significant change over the past few years. A qualitative methodology was adopted, using group discussions to allow staff to identify the specific changes in retailing most important for themselves, and then to explore how these changes related to satisfactions and dissatisfactions at work, and their impact on general aspects of home life. The results suggest that the 'spillover' relationship between work and home stress seems to be the most useful in describing the impact of change. This suggests that additional role demands at work brought about by change have an impact on relationships and social life outside work. However, some individuals described instances of 'compensation' between work and home, and independence between the two domains. This suggests that the issue of stress in the home/work interface is complex, and that the demands in each domain may be positively or negatively related depending on characteristics of the demands themselves, or may vary according to individual characteristics of the people in the study.