Economic modeling for the US of the cost-efficiency and associated expanded treatment access of conversion to biosimilar pegfilgrastim-bmez from reference pegfilgrastim

Abstract

Aims: For this economic analysis, we aimed to model: (1) the cost-efficiency of prophylaxis with biosimilar pegfilgrastim-bmez for chemotherapy-induced (febrile) neutropenia (CIN/FN) compared to reference pegfilgrastim, and (2) the expanded access to CIN/FN prophylaxis and anti-neoplastic treatment that could be achieved with biosimilar cost-savings on a budget-neutral basis.

Methods: In a hypothetical panel of 20,000 cancer patients receiving CIN/FN prophylaxis and using the average sales price (ASP) for the second quarter of 2019 for reference pegfilgrastim, we: conducted an ex ante simulation from the payer perspective of the cost-savings of 10–100% conversion from reference to biosimilar pegfilgrastim-bmez using drug price discounting ranging from 10–35%; estimated the budget-neutral expanded access to biosimilar pegfilgrastim-bmez enabled by these cost-savings; and estimated the budget-neutral expanded access to anti-neoplastic treatment with pembrolizumab. The simulations were replicated using fourth quarter 2019 wholesale acquisition cost (WAC) for reference pegfilgrastim and biosimilar pegfilgrastim-bmez in a post facto analysis.

Results: In ASP simulations, cost-savings of using pegfilgrastim-bmez over reference pegfilgrastim in a 20,000 patient panel range from $1.3?M (at 15% price discount) to $3?M (35%) at 10% conversion rate and from $6.4?M to $14.9?M, respectively, at 50% conversion. These savings could provide prophylaxis with pegfilgrastim-bmez to an additional 352 (15% discount) to 1,076 patients (35%) at 10% conversion or 1,764–5,384, respectively, at 50% conversion. Alternatively, savings could be reallocated for anti-neoplastic treatment with pembrolizumab to 3 (15% discount) to 9 (35%) patients at 10% conversion or 19–45, respectively, at 50% conversion. When utilizing WAC, cost-savings range from $4.6?M (10% conversion) to $23.1?M (50%) which could provide pegfilgrastim-bmez to an additional 1,174 (10% conversion) to 5,873 patients (50%).

Conclusions: Prophylaxis with biosimilar pegfilgrastim-bmez increases the value of cancer care by generating significant cost-savings that could be reallocated to provide expanded access to CIN/FN prevention and anti-neoplastic therapy on a budget-neutral basis.     

What Belongs in a Constitution?

The essay argues that the content of constitutions should derive from its political functions: granting stability and legitimacy to government. There are three main candidates for inclusion in constitutions: regime arrangements, human rights, and general credo. All constitutions must include institutional arrangements. The level of detail and entrenchment may vary. There are important reasons for including Bills of rights in constitutions, but attention should be given to their mode of entrenchment and enforcement. Credos should only be included in constitutions if they are widely shared. In principles, constitutions should specify their modes of amendment and enforcement. If a society cannot have a widely-agreed constitution, it may be better to defer its enactment until such broad agreement is possible.     

Heterogeneous networks and resource acquisition of SMEs in emerging economies

It is acknowledged that social capital plays an important role in the growth of entrepreneurial firms. However, few studies have examined the contribution and function of social capital networks that contain structural holes (heterogeneous networks) in emerging economies. It is not clear how trustworthiness and behavioural commitment impact on effectiveness of these networks in obtaining resources. This study explores how heterogeneous networks characterize successful entrepreneurship of small-medium enterprises in such setting. We find that behavioural commitment moderates the relationship between heterogeneous networks and resource acquisition, while trustworthiness does not significantly moderate this relationship. The impact of the findings on the literature and practice in emerging economies is discussed, as is the need for future research in this domain.     

Linking nursing workload and performance indicators in ambulatory care

More and more ambulatory care organizations are using nursing report cards to monitor and evaluate the quality and effectiveness of nursing care in the ambulatory setting. Nurse staffing levels is usually one of the items included in a nursing report card and the one most scrutinized by ambulatory care administrators. One strategy employed by the nursing leadership at the South Texas Veterans Healthcare System to justify nurse staffing levels is linking administrative staffing monitors with nurse-sensitive outcomes via workload and performance indicators. Through this approach, nurse leaders are able to justify nurse staffing level changes, needed technology changes, process improvements, and/or workflow needs to administrators with positive results and support.     

Linking thoughts to feelings: Investigating cognitive appraisals and consumption emotions in a mixed-emotions context

While emotions have been shown to have significant influence on various consumer behaviors, the cognitive appraisals linked to consumption emotions have not been fully explored. This research investigates how individuals' cognitive interpretations of situations correspond to the emotions they experience in these contexts. Using analysis of variance and multiple discriminant analysis, our results show a systematic relationship between cognitive appraisals and 10 consumption emotions. The author's findings offer theoretical insights into these consumption emotions, the appraisal/consumption emotion correspondence, basisversus subordinate-level category differences in emotions, and mixed consumption emotions. The findings provide a practical framework for academics and practitioners interested in better understanding and managing consumption emotions. Julie A. Ruth (Ph.D., University of Michigan) is an assistant professor of marketing in the School of Business—Camden at Rutgers University. Her research interests include affect and emotions, consumer relationships, and consumer response to brand strategies such as brand alliances and sponsorships. Frédéric F. Brunel (Ph.D., University of Washington) is an assistant professor of marketing in the School of Management at Boston University. His research interests include consumer perceptions of product design and aesthetics, consumer attitude and affect, and gender and sociocultural issues in consumption. Cele C. Otnes (Ph.D., University of Tennessee) is an associate professor of business administration in the College of Commerce and Business Administration at the University of Illinois, Urbana. Her research interests include consumer rituals, affect and consumer ambivalence, and gift exchange.     

The effect of customers' emotional responses to service failures on their recovery effort evaluations and satisfaction judgments

This study examines the role of customer emotions in the context of service failure and recovery encounters. It investigates how customers' emotional responses to service failures influence their satisfaction judgments after accounting for cognitive antecedents of satisfaction. The study also considers how customers' emotional responses to service failures influence how they evaluate an organization's recovery efforts. The research is conducted by surveying customers about their satisfaction judgments in two service settings, restaurants and hotels. The results suggest that customers' emotional responses to service failures will influence their recovery effort evaluations and satisfaction judgments in some circumstances and that the effects of emotion vary across industry settings. This study identifies the types of efforts that are most effective in helping customers “recover” from the negative emotions caused by service failures. Amy K. Smith (Ph.D., University of Maryland) is currently an assistant professor of marketing at George Washington University. Her research focuses on customer assessments of services, customer satisfaction and retention, customer service, serice failure and recovery, and customer-service provider relationships in both business-to-consumer and business-to-business markets. Her research has been published in the Journal of Marketing Research and the Journal of Service Research. Ruth N. Bolton is currently a Ruby K. Powell Professor of Marketing in the Michael F. Price College of Business at the University of Oklahoma. Her research focuses on how organizations can growth the value of their customer base through customer service and support. Her research has been published in the Journal of Retailing, the Journal of Marketing, Marketing Science, Marketing Letters, the Journal of Marketing Research, and the Journal of Service Research.