Primary vs secondary prophylaxis with pegfilgrastim for the reduction of febrile neutropenia risk in patients receiving chemotherapy for non-Hodgkin’s lymphoma: cost-effectiveness analyses

Objective:

Evaluate the cost-effectiveness of primary vs secondary prophylaxis (PP vs SP) with pegfilgrastim to reduce the risk of febrile neutropenia (FN) in Non-Hodgkin’s Lymphoma (NHL) patients receiving myelosuppressive chemotherapy from a US payer perspective.

Methods:

A Markov model was used to compare PP vs SP with pegfilgrastim in a cohort of patients receiving six cycles of cyclophosphamide, vincristine, doxorubicin, and prednisone (CHOP) or CHOP plus rituximab (CHOP-R) chemotherapy. Model inputs, including efficacy of pegfilgrastim in reducing risk of FN and costs, were estimated from publicly available sources and peer-reviewed publications. Incremental cost-effectiveness was evaluated in terms of net cost per life-year saved (LYS), per quality-adjusted life-year (QALY) gained, and per FN event avoided over a lifetime horizon. Deterministic and probabilistic analyses were performed to assess sensitivity and robustness of results.

Results:

Lifetime costs for PP were $5000 greater than for SP; however, PP was associated with fewer FN events and more LYs and QALYs gained vs SP. Incremental cost-effectiveness ratios (ICERs) for PP vs SP for CHOP were $13,400 per FN event avoided, $29,500 per QALY gained, and $25,800 per LYS. CHOP-R results were similar ($15,000 per FN event avoided, $33,000 per QALY gained, and $28,900 per LYS). Results were most sensitive to baseline FN risk, cost per FN episode, and odds ratio for reduced relative dose intensity due to prior FN event. PP was cost-effective vs SP in 85% of simulations at a $50,000 per QALY threshold.

Limitations:

In the absence of NHL-specific data, estimates for pegfilgrastim efficacy and relative risk reduction of FN were based on available data for neoadjuvant TAC in patients with breast cancer. Baseline risks of FN for CHOP and CHOP-R were assumed to be equivalent.

Conclusions:

PP with pegfilgrastim is cost-effective compared to SP with pegfilgrastim in NHL patients receiving CHOP or CHOP-R.     

A Structuralist Inflation Curve

This paper presents a structuralist model of inflation and applies it to the US economy. The model uses a mark‐up rule to specify inflation as a function of income distribution and capacity utilization, as usual in structuralist macroeconomics, but it also includes inflation expectations, the government's inflation target and cost pressures from non‐labor inputs as explaining variables. The model shows how inflation and income distribution, measured by the wage share of income, are connected through an inflation curve in the long run.     

Hoarding behavior among consumers: Conceptualization and marketing implications

In the western world, and in the United States in particular, there has been an abundance of food, materials and fuel over the past several decades. However, many futurists suggest this condition will soon change and a wide range of scarcities will result. Conditions in underdeveloped countries suggest one probable reaction to shortages in hoarding. In light of the predicted shortages this paper (1) develops definition and conceptualization of what constitutes hoarding, and (2) examines the influence hoarding activities have on channel decisions. An overriding purpose of the paper is to generate interest and research into the topic before conditions necessitate that concern.     

Book Reviews

The first review discusses a book on major innovative breakthroughs. The book educationally summarizes fourteen histories of important new products and services, draws general conclusions from these cases, but seems to lack predictive lessons that can assure future dramatic new products. The second and third reviews cover books devoted to cross-functional teams and teamwork. Both books provide helpful guidance in dealing with the practical aspects of making such teams function well in new product development projects. The fourth book describes a rather mechanical lock-step approach to concurrent engineering or total quality development, which is considered its synonym. Specific components are discussed in detail. These include technological development, concept phase, design phase, and production preparation. Although the book ignores the role of marketing, it should prove useful to those interested in the detailed reviews of mechanical engineering procedures such as "The House of Q uality," engineering concept selection, and Taguchi methods of process design analysis. The reviews conclude with brief notes about three other books.     

EQUILIBRIUM GROWTH IN A MONETARY ECONOMY WITH TRANSACTIONS COSTS*

The paper describes a dynamic general equilibrium monetary economy with technological primitives that are consistent with the possibility of asymptotic equilibrium growth. The paper focuses on the relationship between equilibrium financing constraints on investment goods, transaction costs and economic growth. A generalized growth condition is derived that involves both monetary growth rates and transaction costs. The condition is used to show that (i) although inflation taxes can potentially exert a negative influence on long-run economic growth, these growth effects cannot in general be arbitrarily large; and (ii) for some monetary growth rates, money is superneutral in contrast to the models of Stockman and Abel. Numerical work indicates that although the welfare and growth effects of decreasing nominal interest rates from a benchmark are large, the costs associated with raising nominal interest rates from benchmark are not.     

A diagnostic framework for planning

The traditional framework for strategy formulation in the field of business policy is deliberately broad and generalized, so as to encompass an almost limitless number of potentially influential factors. There is also a need for a more focused view, a means for showing similarities and differences among firms and how these relate to strategy formulation—a framework, in other words, that allows companies to be diagnosed by key situational elements and uses these, in turn, to define the appropriate strategy alternatives. What is proposed is a framework based on three familiar key elements—organizational levels, management styles, and stages of growth—integrated with and related to four basic strategy alternatives.