Cost-analysis model of colonoscopy preparation using split-dose reduced-volume oral sulfate solution (OSS) and polyethylene glycol with electrolytes solution (PEG-ELS)

Objective:

The study aimed to (1) develop a cost model for colonoscopy preparation among patients referred for colonoscopy using split-dose reduced-volume oral sulfate solution (OSS) and generic polyethylene glycol with electrolytes solution (PEG-ELS), (2) examine cost savings associated with OSS vs PEG-ELS, and (3) assess the robustness of the cost model.

Methods:

Efficacy of each agent was based on the results of a 541-patient clinical trial comparing OSS to PEG-ELS. Cleansing agent and colonoscopy procedure costs were calculated from OptumHealth Reporting & Insights claims data for 2010–Q12013. In the model, patients’ colonoscopies were tracked over a 25 or 35 year time period until the patients reached age 75. The difference per patient per year (PPPY) in total cleansing agent and colonoscopy procedure costs over the time horizon between the OSS and PEG-ELS cohort was calculated. One-way sensitivity analyses were conducted to test the robustness of the cost model.

Results:

The model showed lower cost for OSS patients over the time horizon. Total PPPY costs were $280.34 for the OSS cohort and $296.36 for the PEG-ELS cohort, resulting in a cost saving of $16.01 PPPY for the OSS cohort. This was due primarily to OSS patients having fewer colonoscopies (OSS: 0.158 vs PEG-ELS: 0.170 PPPY). Over the time horizon, cost savings of $4 763 335 were observed among 10, 000 OSS patients. Cost savings switched from OSS to PEG-ELS cohort in four cases: (1) base-case cost of a completed colonoscopy decreased by 75%, (2) base-case cost of OSS increased to over $143 per usage, (3) all non-completers were lost to follow-up, and (4) OSS bowel preparation quality dropped below PEG-ELS to 70%.

Conclusions:

From a payer’s perspective, the model showed that the use of OSS as the cleansing agent resulted in potential cost savings compared with PEG-ELS. Cost savings under OSS remained under various sensitivity analyses.     

Cost-effectiveness of axicabtagene ciloleucel for adult patients with relapsed or refractory large B-cell lymphoma in the United States

Abstract

Purpose: Axicabtagene ciloleucel (axi-cel) was recently approved for treatment of relapsed or refractory (R/R) large B-cell lymphoma (LBCL) following two or more prior therapies. As the first CAR T-cell therapy available for adults in the US, there are important questions about clinical and economic value. The objective of this study was to assess the cost-effectiveness of axi-cel compared to salvage chemotherapy using a decision model and a US payer perspective.

Materials and methods: A decision model was developed to estimate life years (LYs), quality-adjusted life years (QALYs), and lifetime cost for adult patients with R/R LBCL treated with axi-cel vs salvage chemotherapy (R-DHAP). Patient-level analyses of the ZUMA-1 and SCHOLAR-1 studies were used to inform the model and to estimate the proportion achieving long-term survival. Drug and procedure costs were derived from US average sales prices and Medicare reimbursement schedules. Future healthcare costs in long-term remission was derived from per capita Medicare spending. Utility values were derived from patient-level data from ZUMA-1 and external literature. One-way and probabilistic sensitivity analyses evaluated uncertainty. Outcomes were calculated over a lifetime horizon and were discounted at 3% per year.

Results: In the base case, LYs, QALYs, and lifetime costs were 9.5, 7.7, and $552,921 for axi-cel vs 2.6, 1.1, and $172,737 for salvage chemotherapy, respectively. The axi-cel cost per QALY gained was $58,146. Cost-effectiveness was most sensitive to the fraction achieving long-term remission, discount rate, and axi-cel price. The likelihood that axi-cel is cost-effective was 95% at a willingness to pay of $100,000 per QALY.

Conclusion: Axi-cel is a potentially cost-effective alternative to salvage chemotherapy for adults with R/R LBCL. Long-term follow-up is necessary to reduce uncertainties about health outcomes.     

Discrimination by Black Males Revisited:

ABSTRACT In an earlier article on faculty salary discrimination at a Southern, historically black, public university (SHBU), the authors presented evidence of salary discrimination by black males against other race-sex groups (Riggs and Dwyer 1995). The authors now contrast SHBU's salary model with the model of Riggs and Dwyer and apply the latter to new data to determine whether SHBU eliminated race and sex discrimination in faculty salaries. After equity adjustments, the evidence suggests that SHBU has eliminated the salary discrimination found by Riggs and Dwyer in their earlier study.     

Rethinking the externality issue for dryland salinity in Western Australia

Dryland salinity has been conceived of as a problem involving massive off-site impacts and therefore requiring coordinated action to ensure that land managers reduce those off-site impacts. In economic terms, salinity is seen as a problem of market failure due to externalities, including external costs from one farmer to another and from the farm sector to the non-farm sector. In this article, we argue that, at least in Western Australia (WA), externalities are much less important as a cause of market failure than has been widely believed. If all externalities from salinity in WA were to be internalised, the impact on farm management would be small.     

Stimulus generalization in classical conditioning: An initial investigation and extension

Conditioning as a mechanism for attitude change has received much attention over the past 10 years. This research examines stimulus generalization, the extent to which a response conditioned to one stimulus transfers to similar stimuli. Stimulus generalization relates to both brand extension and private‐label imitations of national brands. Two studies collectively provide evidence that attitudes which are conditioned to a particular brand can be transferred to a product with a similar name in the same category, as well as a product with the same name in a different category. Study Two suggests that stimulus generalization effects may be relatively transitory. © 2000 John Wiley & Sons, Inc.     

An Olympic legacy for all? The non-infrastructural outcomes of the Olympic Games for socially excluded groups (Atlanta 1996-Beijing 2008)

The use of mega sporting events to achieve social goals for socially excluded groups is heavily contested. Comparative evidence regarding the effects of the Olympic Games for these groups is scarce, and there is an even greater dearth of studies focusing on non-infrastructural programmes (such as sport participation initiatives, volunteering opportunities, training and employment schemes). This study identifies planning principles that allow for the development of such non-infrastructural benefits for socially excluded groups in host cities, and reviews their application in recent Olympic Games.This study examines data from 7 Olympic cities (Atlanta, Nagano, Sydney, Salt Lake City, Athens, Turin and Beijing). It shows that the Olympic Games generally bring few benefits for socially excluded groups, although these benefits are often important justifications in the bidding stage. The study highlights the growing importance placed by the International Olympic Committee on environmental sustainability, and proposes a similar emphasis on social sustainability.     

How Do Playful People Play? Gendered and Racial Leisure Perspectives,Motives, and Preferences of College Students

Playfulness is an aspect of personality that predisposes individuals to reframe boring situations into more amusing ones for themselves. This study extends knowledge about the playfulness construct by contrasting college students who were high or low in playfulness relative to the activity preferences they make, the motives they have, and their perspectives on their leisure time. Significant differences were found in perspectives and motives but not in activity preferences, leading to the conclusion that playfulness relates more to how individuals view their leisure and what they seek than in what they do. Only minor differences due to gender or race were observed.     

Boredom in Free Time: Relationships with Personality,Affect, and Motivation for Different Gender,Racial and Ethnic Student Groups

The propensity to experience boredom in free time was investigated by exploring relationships with the individual's demographic characteristics, personality, motivational orientation, and affective style assessed through group-administered questionnaires to 999 university students. The self-as-entertainment personality attribute consistently predicted the likelihood that students would be bored, and inverse relationships with extraversion and intrinsic motivational orientation were found for all student groups. Multiple regression analyses revealed that race, ethnicity, and gender were the only significant demographic predictors of the likelihood an individual would be bored in free time. Group similarities and differences in depicting students who were prone to experience boredom in free time are described.     

Theorizing about play: Critique and direction

This paper presents a review of the extant theoretical models of play behavior. Play theories can be clustered insofar as they suggest different motivations and presuppose distinct underlying mechanisms for playful behavior. The biological view sees the motivation to play as instinctually determined and suggests a genetically inherited predisposition to emit playful responses. The play theories discussed under this heading stress the importance of homeostatic mechanisms and the transformation of energy states as determining when play will occur. The play theories subsumed under the environmental view focus on the typology of play activities and suggest that play is only a subclass of behavior to which the principles of environmental contingencies and reinforcement in learning also apply. Cognitive explanations impart the causation to play as a function of the information‐processing mechanisms of the individual. Within this framework play is defined as a state of mind rather than an activity and it is the player's perception of his environment, in interaction with cognitive processes, which determines the characterization of a playful response. Although the theoretical models of play are discussed within these three perspectives, it is suggested that it is more useful to view these three headings as lying on a continuum, since a review of the theories shows a gradual transition and later cognitive‐based models still presume an internal biological drive. The difficulties with each perspective are discussed and a synthesis is provided which extrapolates some of the tenets of each of the models, as well as presenting an alternative and interactive view of play behavior.     

The baby boomer market maven in the United Kingdom: an experienced diffuser of marketplace information

This study identifies and profiles market mavens among the baby boomer generation in the United Kingdom. Boomers are an important market segment, yet most advertising targets younger audiences, making word-of-mouth communications crucial among this older cohort. Findings suggest boomer mavens place great importance on ‘respect’ values, are particularly concerned with fashion and compared with non-mavens are more likely to try new brands, watch more television, hold positive attitudes towards advertising and seek out bargains. The study is useful to those businesses wishing to target a mature consumer who people perceive as a good source of marketplace information and who likes introducing new brands to others.