Projecting total costs and health consequences of increasing mt-sDNA utilization for colorectal cancer screening from the payer and integrated delivery network perspectives

Abstract

Aims: To evaluate total costs and health consequences of a colorectal cancer (CRC) screening program with colonoscopy, fecal immunochemical tests (FIT), and expanded use of multitarget stool DNA (mt-sDNA) from the perspectives of Integrated Delivery Networks (IDNs) and payers in the United States.

Materials and methods: We developed a budget impact and cost-consequence model that simulates CRC screening for eligible 50- to 75-year-old adults. A status quo scenario and an increased mt-sDNA scenario were modeled. The status quo includes the current screening mix of colonoscopy (83%), FIT (11%), and mt-sDNA (6%) modalities. The increased mt-sDNA scenario increases mt-sDNA utilization to 28% over 10 years. Costs for both the IDN and the payer perspectives incorporated diagnostic and surveillance colonoscopies, adverse events (AEs), and CRC treatment. The IDN perspective included screening program costs, composed of direct nonmedical (e.g. patient navigation) and indirect (e.g. administration) costs. It was assumed that IDNs do not incur the costs for stool-based screening tests or bowel preparation for colonoscopies.

Results: In a population of one million covered lives, the 10-year incremental cost savings incurred by increasing mt-sDNA utilization was $16.2 M for the IDN and $3.3 M for the payer. The incremental savings per-person-per-month were $0.14 and $0.03 for the IDN and payer, respectively. For both perspectives, increased diagnostic colonoscopy costs were offset by reductions in screening colonoscopies, surveillance colonoscopies, and AEs. Extending screening eligibility to 45- to 75-year-olds slightly decreased the overall cost savings.

Limitations: The natural history of CRC was not simulated; however, many of the utilized parameters were extracted from highly vetted natural history models or published literature. Direct nonmedical and indirect costs for CRC screening programs are applied on a per-person-per modality basis, whereas in reality some of these costs may be fixed.

Conclusions: Increased mt-sDNA utilization leads to fewer colonoscopies, less AEs, and lower overall costs for both IDNs and payers, reducing overall screening program costs and increasing the number of cancers detected while maintaining screening adherence rates over 10 years.     

The determinants of board size and independence: Evidence from China

China's corporate governance reform offers an interesting context for investigating the determinants of board size and independence. Analysing a large panel dataset from 1999 to 2003, we find that Chinese board size is primarily driven by firm complexity; board independence is mainly driven by regulation. Some governance factors newly introduced in this study also have a significant impact. For example, board independence is negatively associated with the size of supervisory board and state ownership. The findings have important implications and provide new insights into the subject.     

New Insights on US Aggregate and State Level Trade with the China Region

Aggregate trade data with breakdown into related and non‐related party components show that US multinational enterprises use different trading strategies in the China region relative to other countries. US trade with the China region in 2002–2007 is characterized by arm's‐length transactions. State‐level trade data show great variability in state engagement with the region through trade: exports to the region range from 1 to 28 percent of state exports. In addition, compared to exports to other countries, exports to the region are highly concentrated. At the extreme, for some states, 96–98 percent of exports to the region are computer and electronic products. Finally, gravity regressions show that state exports to Hong Kong are positively associated with the relative size of the Hong Kong‐born population in the states. There is no evidence that stricter labor regimes lead to lower state exports.     

Motives for Giving: A Reanalysis of Two Classic Public Goods Experiments

Experimental work in economics prompted the development of theories of other‐regarding behavior. In this article we reanalyze two classic public goods experiments and focus on the nature of individuals' responses to others' behavior in order to help distinguish alternative motives for giving, including altruism, warm glow, reciprocity, and inequality aversion. Analysis that allows for asymmetric feedback responses generates support for inequality aversion motives but little for reciprocity (matching), altruism, and warm glow. We conclude that individual‐level analysis of existing public goods data can provide more insightful, informative estimates of treatment effects.     

Capital-skill complementarity,productivity and wages: Evidence from plant-level data for a developing country

Different types of labor and capital inputs have varying productive contributions that are dependent on plant characteristics. We estimate such contributions and their underlying determinants, recognizing the interactions among labor and capital components that reflect their substitutability or complementarity, for Turkish manufacturing plants. We distinguish technical and non-technical labor, and structures, machinery and computer capital, as well as the shares of female workers and imported capital in our production function specification. We find capital-skill complementary for both machinery and computers; greater productive contributions and thus wages for skilled labor are associated with more machinery intensity and computer use. The reverse is true for unskilled labor, which is complementary only with capital structures. Our results suggest that synergies among skilled (technical) labor, computers, and machinery capital have productivity- and skilled wage-enhancing effects that could contribute to productivity convergence of developing toward developed countries, even with their differing industry and input composition.