Real-world cost of treatment for multiple sclerosis patients initiating and receiving infused disease-modifying therapies per recommended label in the United States

Abstract

Aims: The study evaluated the real-world cost of treatment in multiple sclerosis (MS) patients initiating infused disease-modifying-therapies (DMT) in the United States.

Materials and Methods: This retrospective cohort study using administrative claims data included adult patients with MS initiating index infusion DMT (ocrelizumab (OCR), natalizumab (NTZ) or alemtuzumab (ATZ)) from April 2017–September 2018 with 6-months pre/12-months post-index continuous enrollment. The primary cohort included patients who had prescribed annual dosing visits indicated by the approved product label (PL): 3 OCR, 5 ATZ, and 12–13 NTZ infusion visits within the first year of initiation. Annual treatment cost was the sum of all costs on index DMT infusion visit dates. Costs were summarized for a primary and secondary cohort of patients receiving additional doses than prescribed in PL (>3 OCR, >5 ATZ, and >13 NTZ infusion visits); and an overall cohort of patients who met minimum required annual dose (≥3 OCR, ≥5 ATZ, and ≥12 NTZ), further stratified by insurance type.

Results: For patients in the primary cohort (123 OCR, 18 ATZ, and 48 NTZ), mean (standard-deviation) annual cost of treatment with OCR, ATZ, and NTZ cohorts was $72,066 ($34,480), $121,053 ($51,097) and $93,777 ($38,815), respectively. Among patients initiating OCR and NTZ, 15 and 6% respectively, had additional infusion visits leading to greater costs. Mean annual costs of index infusion DMT treatment in the overall cohort (162 patients treated with OCR, 18 with ATZ, 56 with NTZ) were $80,582, $121,053, and $93,807, respectively. The mean costs for commercial enrollees were higher than those for MAPD enrollees.

Limitations: Small sample size, limited population generalizability, and cost-reduction for ATZ beyond the second year need to be accounted for.

Conclusions: Real-world infusion DMT treatment costs for commercially insured patients were higher than perceived expenditures based on wholesale acquisition cost and administration costs via a physician-fee schedule. Consideration of real-world costs in cost-effectiveness and treatment/coverage decisions is needed.     

Stock index futures hedging in the emerging Malaysian market

The paper investigates hedging effectiveness of dynamic and constant models in the emerging market of Malaysia where trading information is not readily available and market liquidity is lower compared to the developed equity markets. Using daily data from December 1995 to April 2001 and bivariate GARCH(1,1) and TGARCH models, the paper uses differing variance–covariance structures to obtain hedging ratios. Performance of models is compared in terms of variance reduction and expected utility levels for the full sample period as well as the three sub-periods which encompass the Asian financial crisis and introduction of new capital control measures in Malaysia. Findings show that rankings of the hedging models change for the in-sample period depending on evaluation criteria used. TGARCH based models provide better hedging performance but only in the period of higher information asymmetry following the imposition of capital controls in Malaysia. Overall, despite the structural breaks caused by the Asian financial crisis and new capital control regulations, out of sample hedging performance of dynamic GARCH models in the Malaysian emerging market is as good as the one reported for the highly developed markets in the previous literature. The findings suggest that changes in the composition of market agents caused by large scale retreat of foreign investors following the imposition of capital control regulations do not seem to have any material impact on the volatility characteristics of the Malaysian emerging market.     

Convergence to symmetry in dynamic strategic models of R&D: The undiscounted case

Will R&D increase or decrease the asymmetry between firms over time? We examine this issue in the context of a dynamic, alternate-move duopoly model of non-cooperative R&D. The asymmetry we consider is with respect to the initial stocks of technological knowledge which provides one firm a greater potential for current and future profits in the product market. Utilizing a value loss process constructed from the Optimality Equation of dynamic programming, we show that for the undiscounted case the asymmetry between the firms disappears over time. We obtain this convergence-to-symmetry result by imparting a temporal character to R&D through the notion that R&D investment cannot be changed instantaneously, by allowing research externalities, complementarity or substitutability between own and appropriated R&D, and either increasing, decreasing or constant returns to scale in the production of technical knowledge from own and rival R&D.     

Potential Discrimination in Structured Employment Interviews

This experimental study examines the effects of bias toward persons with disabilities (PWDs) upon the employment interview decision process. The design and operationalization of the study permitted examination of the effects of specific disabilities, interview performance, and the resulting interaction between disability and interview performance, using 630 undergraduate students at a major university in the southwestern United States as subjects. The results indicate that (1) interview performance has a favorable, significant main effect upon subsequent HRM decisions, (2) specific disabilities, that is, child care demands, HIV-positive status, and being wheelchair-bound, have unfavorable, significant main effects upon subsequent HRM decisions, and (3) the presence of any of the disabilities decreased the favorable impact of superior interview performance. The limitations of the structured interview to mitigate bias were demonstrated. Given the pervasive, unfavorable treatment directed toward PWDs, it appears that the enactment of the Americans with Disabilities Act of 1990 (1993) is warranted. The public policy implications of these results and recommendations for future research were discussed.     

Unobserved components in an error-correction model of consumption for Southern European countries

In this paper we show how the potential misspecification of the consumption function can be ameliorated by approximating any unmodelled long run variation with an unobserved component in the form of a time-varying trend. This methodology is applied to Greek, Portuguese and Spanish consumption functions during the post-second World war period. The empirical evidence suggests that there are many determinants of long-run consumption in these countries, in addition to income and inflation, and these unobserved long-run effects are captured by a nonstationary stochastic component. The long-run elasticity of consumption with regards to the unobserved component is greater than unity in all countries. First version received: January 1999/Final version received: June 2000     

Using a distance measure to operationalise patent originality

We introduce a distance measure to operationalise Trajtenberg, Henderson, and Jaffe’s [1997. “University Versus Corporate Patents: A Window on the Basicness of Invention.” Economics of Innovation and New Technology 5: 19–50] originality construct (an ex-ante indicator of firms’ technological capabilities). Our measure captures (1) technological diversity, (2) technology distance from patent antecedents, and (3) degree of novelty per each patented innovation. The V-score measure uses the Derwent World Patent Index system to classify technologies hierarchically – making similarities and differences pronounced. Power is gained by using all of the technology-classification codes describing a focal patent’s claims when calculating whether its technology space was incrementally different or radical from those of its antecedent patents (and identifying whether its technology-class code combinations were commonplace at the time when the patent application was made). Our V-score’s prediction of firms’ performance is contrasted with Hall, Jaffe, and Trajtenberg’s [2001. Hall, B. H., A. B. Jaffe, and M. Trajtenberg. 2001. The NBER Patent Citations Data File: Lessons, Insights and Methodological Tools. NBER Working Paper No. 8498] Herfindahl measure of the same originality construct. Results indicate that the distance measure of technological content produces differently signed results when evaluating patents’ performance effects or predicting a firm’s trajectory.     

Perfect competition in asymmetric information economies: compatibility of efficiency and incentives

The idea of perfect competition for an economy with asymmetric information is formalized via an idiosyncratic signal process in which the private signals of almost every individual agent can influence only a negligible group of agents, and the individual agents’ relevant signals are essentially pairwise independent conditioned on the true states of nature. Thus, there is no incentive for an individual agent to manipulate her private information. The existence of incentive compatible, ex post Walrasian allocations is shown for such a perfectly competitive asymmetric information economy with or without “common values”. Consequently, the conflict between incentive compatibility and Pareto efficiency is resolved exactly, and its asymptotic version is derived for a sequence of large, but finite private information economies.