Treatment patterns,healthcare resource utilization,and costs in patients with acute myeloid leukemia in commercially insured and Medicare populations

Objective: To describe the setting, duration, and costs of induction and consolidation chemotherapy for adults with newly-diagnosed acute myeloid leukemia (AML), who are candidates for standard induction chemotherapy, in the US.

Methods: Adults newly-diagnosed with AML who received standard induction chemotherapy in an inpatient setting were identified from the Truven Health Analytics MarketScan (2006–2015) and SEER-Medicare (2007–2011) databases. Patients were observed from induction therapy start to the first of hematopoietic stem cell transplant, 180 days after induction discharge, health plan enrollment/data availability end, or death. Induction and consolidation chemotherapy were identified using Diagnosis-Related Group codes (chemotherapy with acute leukemia) or procedure codes for AML chemotherapy administration. AML treatment episode setting (inpatient or outpatient), duration, and costs (2015 USD, payers’ perspective) were described for commercially insured patients and Medicare beneficiaries.

Results: In total, 459 commercially insured patients and 563 Medicare beneficiaries (mean age?=?54 and 66 years; 53% and 54% male; respectively) were identified. For induction therapy, mean costs were $145,189 for commercially insured patients and $85,734 for Medicare beneficiaries, and median inpatient duration was 31 days (both). Following induction, 64% of commercially insured patients and 53% of Medicare beneficiaries had ≥1 consolidation cycle; 75% and 65% of consolidation cycles were in an inpatient setting, respectively. For consolidation cycles, in the inpatient setting, mean costs were $28,137 for commercially insured patients and $28,843 for Medicare beneficiaries, median cycle duration was 6 days (both); in the outpatient setting, mean costs were $11,271 for commercially insured patients and $5,803 Medicare beneficiaries, median duration was 5 days (both).

Limitations: Granular information on chemotherapy type administered was unavailable.

Conclusions: This is the first exploratory study providing a complete picture of recent AML treatment patterns and management costs among commercially insured patients and Medicare beneficiaries. There is substantial heterogeneity in the management and costs of AML.     

Delivering Flexibility: Contrasting Patterns in the French and the UK Food Processing Industry

This article provides a comparative analysis of changes in numerical and functional labour flexibility in the French and the UK food processing industry. Based upon case study data, it explores the interaction between competitive pressures and institutional and regulatory structures and their impact on workplace practices. The findings indicate that, faced with a similar competitive environment, firms in both countries have sought to increase labour flexibility. However, the predominant forms of flexibility vary across the two countries, partly reflecting the characteristics of national labour market institutions. Numerical flexibility dominates in the UK, with high levels of paid overtime and temporary agency work. In contrast, French workplaces rely more on internal functional flexibility while also achieving numerical flexibility through seasonal variations in work schedules and a wide range of short‐term employment contracts.     

What happens after a single surgical intervention for hidradenitis suppurativa? A retrospective claims-based analysis

Objective Hidradenitis suppurativa (HS) is often treated by surgery. The risk of recurrence after surgery is common and the consequences are substantial, but neither has been quantified using a claims database. This study aimed to estimate the burden associated with non-curative surgery in HS patients.

Methods A retrospective analysis was performed of health insurance claims data from Q1 1999 to Q2 2011 in a US claims database. The analysis included 2668 adults with ≥1 diagnosis of HS and ≥1 claim for skin surgery within 6 months after diagnosis. Healthcare resource utilization and medical costs were compared using multivariate regressions.

Results Overall, 46% of HS patients had ≥1 indicator of non-curative surgery. The incidences of inpatient, emergency department, and outpatient visits were 88%, 40%, and 30% higher, respectively, for patients with non-curative surgery vs patients without indicator of non-curative surgery (all p?<?0.001). Average medical costs were $11,858 and $6427 for patients with and without indicators of non-curative surgery, respectively. The difference of $4185 (p?<?0.001) was mainly driven by inpatient costs (difference = $2685; p?<?0.001).

Limitations Indicators of non-curative HS surgery were defined based on an empirical algorithm.

Conclusions Non-curative HS surgery occurred in almost half of all cases and represents a significant burden on patients and payers in terms of resource utilization and costs.     

Nilotinib versus dasatinib as second-line therapy in patients with Philadelphia chromosome-positive chronic myeloid leukemia in chronic phase who are resistant or intolerant to imatinib: a cost-effectiveness analysis based on real-world data

Objective: To evaluate the cost-effectiveness of second-line nilotinib vs dasatinib among patients with Philadelphia chromosome-positive chronic myeloid leukemia in chronic phase (Ph+?CML-CP) who are resistant or intolerant to imatinib, from a US third-party perspective.

Methods: A lifetime partitioned survival model was developed to compare the costs and effectiveness of nilotinib vs dasatinib, which included four health states: CP on treatment, CP post-discontinuation, progressive disease (accelerated phase [AP] or blast crisis [BC]), and death. Time on treatment, progression-free survival, and overall survival of nilotinib and dasatinib were estimated using real-world comparative effectiveness data. Parametric survival models were used to extrapolate outcomes beyond the study period. Drug treatment costs, medical costs, and adverse event costs were obtained from the literature and publicly available databases. Utilities of health states were derived from the literature. Incremental cost-effectiveness ratios, including incremental cost per life-year (LY) gained and incremental cost per quality-adjusted life-year (QALY) gained, were estimated comparing nilotinib and dasatinib. Deterministic sensitivity analyses were performed by varying patient characteristics, cost, and utility inputs.

Results: Over a lifetime horizon, nilotinib-treated patients were associated with 11.7 LYs, 9.1 QALYs, and a total cost of $1,409,466, while dasatinib-treated patients were associated with 9.5 LYs, 7.3 QALYs, and a total cost of $1,422,122. In comparison with dasatinib, nilotinib was associated with better health outcomes (by 2.2 LYs and 1.9 QALYs) and lower total costs (by $12,655). Deterministic sensitivity analysis results showed consistent findings in most scenarios.

Limitations: In the absence of long-term real-world data, the lifetime projection could not be validated.

Conclusions: Compared with dasatinib, second-line nilotinib was associated with better life expectancy, better quality-of-life, and lower costs among patients with Ph+?CML-CP who were resistant or intolerant to imatinib.     

Statistical Inference,Learning and Models in Big Data

The need for new methods to deal with big data is a common theme in most scientific fields, although its definition tends to vary with the context. Statistical ideas are an essential part of this, and as a partial response, a thematic program on statistical inference, learning and models in big data was held in 2015 in Canada, under the general direction of the Canadian Statistical Sciences Institute, with major funding from, and most activities located at, the Fields Institute for Research in Mathematical Sciences. This paper gives an overview of the topics covered, describing challenges and strategies that seem common to many different areas of application and including some examples of applications to make these challenges and strategies more concrete.     

"Breed Out the Unfit and Breed In the Fit"

A bstract    Fisher's virulent positions on such themes as "race degeneration", the necessity of sterilization measures for certain categories of the American population, and his urgent call for the control of the genetic quality of new immigrants are hardly consistent with the opalescent subtlety of academic disputes over the nature of capital and interest. Although Fisher repeats it often: in his work, this question of the nature of capital and interest is directly linked to eugenic assumptions and analysis. This second body of Fisherian work illuminates the strong epistemological and theoretical references in Fisher's work as an economist. This paper addresses this question through three major themes: the constant denunciation of a «racial decay>> of the American population and its corollary: the project of setting up a «scientific humaniculture>>; the plea against the eugenic effects of World War I, and the then haunting question of the closing of the «Golden Door>>.     

Russia's second shift: Is housework hurting women's wages?

Though the USSR officially touted equal opportunity for women, women in Russia earned only 70 percent of men's wages. The combination of women's dual roles in society and inadequate investment by the Soviets in household time-saving devices are often cited as reasons for a lack of commitment and advancement in the labor market. With the recent transition towards a market economy, there is reason to think these effects may be changing. As women become increasingly freer to substitute between formal-sector and household work, the relative importance of commitment in explaining the gender-wage disparity may have diminished. Using data from the Russian Longitudinal Monitoring Survey, this study hopes to shed light on whether differences in time allocated towards household production are capable of affecting wages.     

Manual and Automated Procedures for Compiling a Very Large Sample of Centenarian Pedigrees

A large portion of the baby boomer population will live beyond the age of 90 years, and entitlement programs and various insurance products have thus become interested in longevity risk. Beyond cohort life table predictions, actuaries have little to go on in determining which individuals or portions of populations are at increased risk of living to 90 or 100 or even older. We and others have noted strong familial risk for living beyond the oldest one percentile of survival, and we developed an algorithm that uses information about relatives’ longevity to compute the chance of an individual surviving to extreme old age. An important step of this work is to compile large samples of pedigrees with and without long-lived family members. Here we describe our process of hand curation of centenarian pedigrees and software that we have developed for the automated construction of such pedigrees using internet-based resources that can support the manual process.