Cost-effectiveness of the convergent procedure and catheter ablation for non-paroxysmal atrial fibrillation

Objective:

Patients with persistent or longstanding atrial fibrillation have modest success achieving sinus rhythm with catheter ablation or rhythm control medications. Their high risk of stroke, bleed, and heart failure leads to significant morbidity and health care costs. The convergent procedure has been shown to be successful in this population, with 80% of patients in sinus rhythm after 1 year. This study evaluated the cost-effectiveness of the convergent procedure, catheter ablation, and medical management for non-paroxysmal AF patients.

Methods:

A Markov micro-simulation model was used to estimate costs and effectiveness from a payer perspective. Parameter estimates were from the literature. Three patient cohorts were simulated, representing lower, medium, and higher risks of stroke, bleed, heart failure, and hospitalization. Effects were estimated by quality-adjusted life-years (QALYs). Single-variable sensitivity analysis was performed.

Results:

After 5 years, convergent procedure patients averaged 1.10 procedures, with 75% of survivors in sinus rhythm; catheter ablation patients had 1.65 procedures, with 49% in sinus rhythm. Compared to medical management, catheter ablation and the convergent procedure were cost-effective for the lower risk (ICER <$35,000) and medium risk (ICER <$15,000) cohorts. The procedures dominated medical management for the higher risk cohort (lower cost and higher QALYs). The convergent procedure dominated catheter ablation for all risk cohorts. Results were subject to simplifying assumptions and limited by uncertain factors such as long-term maintenance of sinus rhythm after successful procedure and incremental AF-associated event rates for AF patients relative to patients in sinus rhythm. In the absence of clinical trial data, convergent procedure efficacy was estimated with observational evidence. Limitations were addressed with sensitivity analyses and a moderate 5 year time horizon.

Conclusion:

The convergent procedure results in superior maintenance of post-ablation sinus rhythm with fewer repeat ablation procedures compared to catheter ablation, leading to lower cost and higher QALYs after 5 years.     

The Financial Knowledge Scale: New Analyses,Findings, and Development of a Short Form

We use data from the Understanding America Study (UAS) internet panel to build upon the Knoll and Houts Financial Knowledge Scale (FKS). Specifically, we provide practitioners with a shorter 10-item scale, describe additional analyses on both the full- and short-form versions of the scales, and explore the relationship between FKS scores and a variety of retirement-related outcome variables. Importantly, the full- and short-form scales are developed using a statistical model that accounts for guessing, which allows us to provide more accurate estimates of financial knowledge than similar scales that do not account for guessing. The paper also provides conversion tables that can aid in the analysis and interpretation of FKS scores in practice. With the development of a 10-item short form that accounts for guessing, we hope to provide practitioners and researchers with a tool that will enable them to reliably measure financial knowledge more parsimoniously and accurately than other measures currently in use.     

Key Factors in Understanding Trends in Hollywood Product Placements from 2005 to 2015

This study updates extant product placement research by identifying the evolutions in product placements between 2005 and 2015 in top grossing Hollywood films. Using a quantitative content analysis, this research also offers insights into how production costs impact the use and implementation of product placements. The findings revealed films with lower production costs have significantly more placements overall, products are on screen longer, more brands are in films, products are mentioned and shown more often, and films contain more character involvement. Significant increases were found between 2005 and 2015 in all variables except the number of brands and length of placements.     

Collaborating Smartly: The Role of Open Strategy in Absorptive Capacity

Research on open strategy suggests that shared knowledge through collaboration can generate co‐created value. We explore this idea by assessing it as a predictor of absorptive capacity (ACAP) in cross‐sector partnerships in pursuit of social innovation. The findings of our study indicate that aspects of strategic openness, including a shared sense of interdependence toward a mutual goal, are the primary mechanisms that enhance knowledge accretion in cross‐sector partnerships. The data also suggest that formalized organizational mechanisms are more influential for producing ACAP than informal mechanisms.     

Conspicuous activism: Digital badges and the motivation crowding effect

Digital badges provide citizens with a means to publicly signal their “good” deeds to those in their social networks and thus may act as incentive to engage with social and political causes. However, research suggests that the use of such virtual tokens of recognition may have the opposite affect among those primarily motivated by altruism. Two experiments examined the effects of digital badges on support for activist organizations and their causes. Results of Study 1 demonstrated that among participants high in altruism, being offered a digital badge as a token of recognition for support decreased perceived altruistic value of support, and in turn, willingness to nominate others to spread the word about the organization's cause. Study 2 demonstrated that receiving a digital badge as a token of recognition following compliance with a foot‐in‐the door request (intended to induce self‐perceived altruism) decreased perceived value of support, and in turn, willingness to participate in future activities to promote the organization's cause. These findings strongly support a crowding out effect, suggesting that the use of digital badges may reduce support among those who care by undermining their intrinsic motivation.     

The Superstar Inventors and Entrepreneurs: How Were They Educated?

Observations, such as the many celebrated inventive entrepreneurs with minimal schooling, lead to the hypothesis that protracted and rigorous education can impede entrepreneurship. Systematic analysis of biographies of noted inventors and entrepreneurs appears not to support the hypothesis. We do find that with time, entrepreneurial and inventor education increases as technology grows more complex. However, we find at the same time that the educational attainment of inventors has grown more rapidly than that of entrepreneurs and the educational gap has tended to widen over time.     

Negative Emotional Reactions to Project Failure and the Self-Compassion to Learn from the Experience

Project failure is likely to generate a negative emotional response for those involved in the project. But do all people feel the same way? And are some better able to regulate their emotions to learn from the failure experience? In this paper we develop an emotion framework of project failure that relies on self‐determination to explain variance in the intensity of the negative emotions triggered by project failure and self‐compassion to explain variance in learning from project failure. We discuss the implications of our model for research on entrepreneurial and innovative organizations, employees' psychological ownership, and personal engagement at work.     

Healthcare costs in patients with advanced non-small cell lung cancer and disease progression during targeted therapy: a real-world observational study

Aims: To assess healthcare costs during treatment with epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) and following disease progression in patients with advanced non-small cell lung cancer (NSCLC).

Methods: A retrospective analysis of medical records of US community oncology practices was conducted. Eligible patients had advanced NSCLC (stage IIIB/IV) diagnosed between January 1, 2008 and January 1, 2015, initiated treatment with erlotinib or afatinib (first-line or second-line), and had disease progression. Monthly Medicare-paid costs were evaluated during the TKI therapy period and following progression.

Results: The study included 364 patients. The total mean monthly cost during TKI therapy was $20,106 (95% confidence interval [CI]?=?$16,836–$23,376), of which 47.0% and 42.4% represented hospitalization costs and anti-cancer therapy costs, respectively. Following progression on TKI therapy (data available for 316 patients), total mean monthly cost was $19,274 (95% CI?=?$15,329–$23,218), and was higher in the 76.3% of patients who received anti-cancer therapy following progression than in the 23.7% of those who did not ($20,490 vs $15,364; p?<?.001). Among patients who received it, anti-cancer therapy ($11,198; 95% CI?=?$7,102–$15,295) represented 54.7% of total mean monthly cost. Among patients who did not receive anti-cancer therapy, hospitalization ($13,829; 95% CI?=?$4,922–$22,736) represented 90.0% of total mean monthly cost. Impaired performance status and brain metastases were significant predictors of increased cost during TKI therapy.

Limitations: The study design may limit the generalizability of findings.

Conclusions: Healthcare costs during TKI treatment and following progression appeared to be similar and were largely attributed to hospitalization and anti-cancer therapy. Notably, almost one-quarter of patients did not receive anti-cancer therapy following progression, potentially indicating an unmet need; hospitalization was the largest cost contributor for these patients. Additional effective targeted therapies are needed that could prolong progression-free survival, leading to fewer hospitalizations for EGFR mutation-positive patients.     

The budget impact of brodalumab for the treatment of moderate-to-severe plaque psoriasis on US commercial health plans

Introduction: Brodalumab is a new biologic approved by the US Food and Drug Administration in 2017 for the treatment of moderate-severe psoriasis. This study evaluated the impact of the introduction of brodalumab on the pharmacy budget on US commercial health plans.

Methods: An Excel-based health economic decision analytic model with a US health plan perspective was developed. The model incorporated published moderate-to-severe psoriasis prevalence data; market shares of common biologic drugs, including adalimumab, ustekinumab, secukinumab, ixekizumab, and etanercept, used for the treatment of moderate–severe psoriasis; 2017-year Wholesale Acquisition Costs for the biologic drugs; drug dispensing fee; patient co-pay; and drug contracting discount. Total annual health plan costs for the biologic drugs were estimated. Scenarios with different proportions of patients treated with brodalumab were compared to a control scenario when no brodalumab was used.

Results: In a hypothetical commercial health plan covering two million members, 7,038 moderate-to-severe psoriasis patients were estimated to be eligible for treatment with brodalumab. Prior to brodalumab approval, the proportions of patients treated by other biologics were estimated at 50.8% for adalimumab, 13.5% for ustekinumab, 14.1% for secukinumab, 4.4% for ixekizumab, and 17.2% for etanercept. With a 20% drug price discount applied to all biologics, the annual health plan costs for brodalumab, adalimumab, ustekinumab, secukinumab, ixekizumab, and etanercept were estimated at $37,224, $49,166, $55,084, $56,061, $64,396, and $57,170, respectively. When no brodalumab is used, the total annual pharmacy budget for the biologics used among these patients was estimated at $414,362,647. Among scenarios where the proportions of brodalumab usage were 3%, 8%, 16%, and 30%, the total annual pharmacy cost was estimated to be reduced by $3,698,129, $9,861,677, $19,723,355, and $36,981,290, respectively.

Conclusion: Based on the economic model, brodalumab has the potential to substantially reduce pharmacy expenditures for the treatment of patients with moderate-to-severe plaque psoriasis in the US.