Healthcare burden and reimbursement of hospitalization during chemotherapy for adults with Ph-negative relapsed or refractory B-cell precursor acute lymphoblastic leukemia in France: a retrospective chart review

Objective: Philadelphia chromosome negative [Ph(?)] relapsed or refractory (R/R) B-precursor acute lymphoblastic leukemia (ALL) is an extremely rare condition requiring intensive treatment. This retrospective chart review aimed to quantify hospitalizations and reimbursement in this patient population in France.

Methods: Patients aged ≥18 years and with at least one hospitalization for Ph(?) R/R B-precursor ALL were included in the study. They were relapsed with first remission lasting <12 months, relapsed after first salvage therapy, relapsed any time after hematopoietic stem cell transplant (HSCT), or were refractory to initial or salvage therapy. Data were collected from the index date (first diagnosis of R/R ALL) until death or loss to follow-up. The chemotherapy period was defined as the first chemotherapy date after the index date to the earliest of death, loss to follow-up, last chemotherapy dose plus 30 days, or initiation of HSCT. The primary outcome was the percentage of time hospitalized during the chemotherapy period.

Results: Thirty-three patients were included, with a mean age of 49 years. The mean proportion of time spent in the hospital during the chemotherapy period was 46% (95% CI =34–57%). Patients had a mean of 2.2 (SD =1.5) inpatient hospitalizations and the mean length of stay per hospitalization was 16.8 (SD =14.8) days. During the chemotherapy period, the mean amount reimbursed per hospitalization was €31 067 (SD = €4850) and the total hospitalization reimbursement per patient was €68 344. From the index date to death, excluding HSCT, the total reimbursement per patient was €108 873.

Limitations: The sample size was small, although this was expected given the rarity of the patient population.

Conclusions: Adults with Ph(?) R/R B-precursor ALL had repeated and prolonged hospitalizations during salvage chemotherapy. Approximately half the follow-up period was spent in the hospital, and this time was associated with high economic burden in France.     

Estimating the Impact of WTO and Domestic Reforms on the Indian Cotton and Textile Sectors: a General-Equilibrium Approach

The agreement to abolish the quotas on textiles and clothing introduced under the Multi‐fiber Arrangement (MFA) will create a new and much more competitive world market for India's exports of textiles and clothing. India's inefficient and costly policies, such as cotton export quotas, the hank yarn obligation, and the restrictive policies on foreign investment that have held back productivity in the Indian apparel sector, will impose serious costs. The authors consider the implications of reforming these policies in an open trading environment using a multiregion, applied general‐equilibrium model. They find that the costs of these policies to India increase substantially following abolition of the MFA; the benefits to India from domestic reforms are considerably enhanced when there is global free trade in textiles and apparel.     

Changes in the status of women and the demographic development of the family

The impact of changes in the status of women on the demographic characteristics and development of the family in the USSR is examined. Three stages of family development are distinguished: formation, growth as a result of the birth of children, and dissolution with the departure of grown children. The relationship between changes in women's social status and age at marriage, family size, and divorce is analyzed. The effects of factors such as educational level, type of employment, exposure to mass media, urban residence, and declining infant mortality rates on women's attitudes toward family size are discussed.     

A theory of natural addiction

Economic theories of rational addiction aim to describe consumer behavior in the presence of habit-forming goods. We provide a biological foundation for this body of work by formally specifying conditions under which it is optimal to form a habit. We demonstrate the empirical validity of our thesis with an in-depth review and synthesis of the biomedical literature concerning the action of opiates in the mammalian brain and their effects on behavior. Our results lend credence to many of the unconventional behavioral assumptions employed by theories of rational addiction, including adjacent complementarity and the importance of cues, attention, and self-control in determining the behavior of addicts. We offer evidence for the special case of the opiates that “harmful” addiction is the manifestation of a mismatch between behavioral algorithms encoded in the human genome and the expanded menu of choices faced by consumers in the modern world.     

Structure and understanding: Some observations on current activities in the field of structural modeling

Structural modeling has been under study in recent years as a method for dealing with complex societal problems, and is growing in acceptance as a tool for understanding complex social phenomena. Structural models demonstrate the interactions of the separate elements of a system and their combined overall effect. Thus, the nature of the problem for which this method of analysis is appropriate is different from complex problems of the traditional disciplines which lend themselves to reductionist approaches. This is because complex policy problems of society cannot be “solved” with precise analysis. Kenneth Boulding suggests that there are two ways to cope with a complex policy problem, either to “slice” the problem into partial equilibrium sections or “squeeze” it by aggregating numerous variables into a single index or macho variable. Structural modeling is an approach which comes under the general strategy of squeezing the problem and is promising because of the ability to include a range of macro variables which provide insights about social change. The articles in this issue treat several interesting aspects of this approach. In this article we wish to recall for consideration a central purpose for developing such methods. We have taken a historical approach to indicate some of the roots of the concern for the effect of technological process on social change. Within this context, we discuss the nature of the contributions made by the articles in this issue and what promise the methods offer to addressing the historical concern.     

Passive Investment Strategies and Efficient Markets

This paper presents the case for and the evidence in favour of passive investment strategies and examines the major criticisms of the technique. I conclude that the evidence strongly supports passive investment management in all markets—small–capitalisation stocks as well as large–capitalisation equities, US markets as well as international markets, and bonds as well as stocks. Recent attacks on the efficient market hypothesis do not weaken the case for indexing.     

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.     

The causes of government expenditure growth: A survey of the U.S. evidence

The growth of government budgets can be broken down into a-institutional and institutional components. The former component — the familiar substitution, income, and population/public goods-tax sharing effects — is estimated to contribute about two-fifths of the growth of U.S. government spending. The latter component — rent-seeking political redistributions, bureaucracy and perceptual/informational impedimentia — is important, too, but an exact imputation cannot be asserted given the state of the art in empirical public choice theory. The cross-effects on spending of the growth of regulation and tax preferences or tax expenditures, though interesting, is not pursued.