Healthcare resource utilization and costs among psoriasis patients treated with biologics,overall and by disease severity

Aims: To describe healthcare resource utilization (HCRU) and costs among biologic-treated psoriasis patients in the US, overall and by disease severity.

Materials and methods: IQVIA PharMetrics Plus administrative claims data were linked with Modernizing Medicine Data Services Electronic Health Record data and used to select adult psoriasis patients between April 1, 2010 and December 31, 2014. Eligible patients were classified by disease severity (mild, moderate, severe) using a hierarchy of available clinical measures. One-year outcomes included all-cause and psoriasis-related outpatient, emergency department, inpatient, and pharmacy HCRU and costs.

Results: This study identified 2,130 biologic-treated psoriasis patients: 282 (13%) had mild, 116 (5%) moderate, and 49 (2%) severe disease; 1,683 (79%) could not be classified. The mean age was 47.6 years; 45.4% were female. Relative to mild psoriasis patients, patients with moderate or severe disease had more median all-cause outpatient encounters (28.0 [mild] vs 32.0 [moderate], 36.0 [severe]), more median psoriasis-related outpatient encounters (6.0 [mild] vs 7.5 [moderate], 8.0 [severe]), and a higher proportion of overall claims for medications that were psoriasis-related (28% [mild] vs 37% [moderate], 34% [severe]). Relative to mild psoriasis patients, patients with moderate or severe disease had higher median all-cause total costs ($37.7k [mild] vs $42.3k [moderate], $49.3k [severe]), higher median psoriasis-related total costs ($32.7k [mild] vs $34.9k [moderate], $40.5k [severe]), higher median all-cause pharmacy costs ($33.9k [mild] vs $36.5k [moderate], $36.4k [severe]), and higher median psoriasis-related pharmacy costs ($32.2k [mild] vs $33.9k [moderate], $35.6k [severe]).

Limitations: The assessment of psoriasis disease severity may not have necessarily coincided with the timing of biologic use. The definition of disease severity prevented the assessment of temporality, and may have introduced selection bias.

Conclusions: Biologic-treated patients with moderate or severe psoriasis cost the healthcare system more than patients with mild psoriasis, primarily driven by higher pharmacy costs and more outpatient encounters.     

A systematic technique for new product idea generation: the external brain

The author outlines a novel computer-based technique to generate ideas for new products. Essentially the technique uses the so-called Dialog databank, claimed to have access to 152 million units of information, to search for all publications in the database which combine a root concept and words such as idea, innovation, novelty, and so on. The computer can then be instructed to print out the titles of a restricted number defined by the searcher from each database accessed. The searcher can then study the contents of each publication at leisure. In principle other similar databanks can be used.
The technique is illustrated by two hypothetical cases: new uses for water and new uses for metal-powder technology.
The author claims that the technique will generate a large number of ideas in a short time at low-cost, can be used selectively (eg to search within a stated time-period), will link otherwise unrelated disciplines, and is well suited to brainstorming. The main drawbacks are that much of the information may be irrelevant, it cannot provide entirely new ideas though it can link existing concepts in a new way, and it cannot print out the total text from an identified source.     

Specialized Careers

An agent has different abilities in two types of tasks. These tasks are revealed over time through his performance. The agent initially decides whether to engage in only one task (specialize) or to take on any task that arises (be a generalist). This decision trades off the cost of being idle against staying available for relatively lucrative tasks. We compare specializing with acting as a generalist in an infinite‐horizon model and provide complete characterizations of efforts. We show how specializing acts as a means of committing to exert more effort. In a two‐period version of the model, this implies that positive costs for switching strategies, through license fees, for example, may be socially desirable.     

Investment with an arithmetic process and lags

This paper presents an explicit solution of a simple investment problem with entry lags and when the underlying stochastic process is arithmetic. It is shown that, without abandonment, the optimal investment plan is independent of the length of the lag. Copyright © 2000 John Wiley & Sons, Ltd.     

Something to prove: reputation in teams

Agents work for their own reputations when young but for their firms' when old. An individual with an established reputation cannot credibly commit to exerting effort when working alone. However, by hiring and working with juniors of uncertain reputation, seniors will have incentives to exert effort. Incentives for young agents arise from a concern for their own reputation (and the opportunity to take over the firm), whereas older agents work for the reputation of their firms (and the opportunity to sell out to juniors). Thus, the article explains the choice to work in teams. It also exemplifies how type uncertainty in reputation models may be endogenously and strategically introduced.     

Multi-product newsvendor problem with value-at-risk considerations

We consider the single period stochastic inventory (newsvendor) problem with downside risk constraints. The aim in the classical newsvendor problem is maximizing the expected profit. This formulation does not take into account the risk of earning less than a desired target profit or losing more than an acceptable level due to the randomness of demand. We utilize Value at Risk (VaR) as the risk measure in a newsvendor framework and investigate the multi-product newsvendor problem under a VaR constraint. To this end, we first derive the exact distribution function for the two-product newsvendor problem and develop an approximation method for the profit distribution of the N-product case (N>2). A mathematical programming approach is used to determine the solution of the newsvendor problem with a VaR constraint. This approach allows us to handle a wide range of cases including the correlated demand case that yields new results and insights. The accuracy of the approximation method and the effects of the system parameters on the solution are investigated numerically.     

‘There are Really Two Cities Here’: Fragmented Urban Citizenship In Tel Aviv

The inflow of African migrants into Tel Aviv's southern neighborhoods has aroused much resentment from long‐term residents. Contesting the uneven burden sharing, which exacerbates already poor conditions at the local level, southern residents have aimed their grievances at municipal and national policymakers as well as the city's more affluent northern residents. In analyzing the contestation, this article challenges traditional conceptions of migrants as the binary opposition to residents of the host city, intruders on the shared and socio‐culturally homogenous urban arena. We build on recent theorizations of urban citizenship as an agency‐centered process to think through the ways in which city residents articulate their identities relationally and hierarchically against new and old ‘others’ and argue that international newcomers have destabilized long‐conceived social relations. Using narratives of long‐term southern residents, we illustrate how the uneven geographies of African migrants' settlement in Tel Aviv have (re)set in motion a process of urban citizenship formation by southern residents, thereby adding new layers of contention to what was already a highly stratified realm.     

The role of mortality in the transmission of knowledge

We investigate, both theoretically and quantitatively, a previously unexplored link between gains in adult mortality and productivity growth. Our mechanism allocates a central role to individuals as carriers of useful ideas and to personal contact as an important means of transferring these ideas. It thus implies that disrupting a human life impedes the process of knowledge transmission across time. We derive a simple and intuitive form of the dependence of aggregate knowledge transfer on adult mortality and incorporate it into a model of endogenous growth. We then quantitatively examine the relevance of the proposed link in application to the long-run growth experience of England. Our calibration exercise suggests that the reduction in adult mortality, by improving knowledge transmission across time and encouraging more innovation, was a quantitatively important force behind the takeoff in output per capita.