Overall survival,costs, and healthcare resource use by line of therapy in Medicare patients with newly diagnosed metastatic urothelial carcinoma

Aims: Medicare patients with metastatic or surgically unresectable urothelial carcinoma (mUC) often receive platinum-based chemotherapy as first line of therapy (LOT), but invariably progress, requiring additional LOTs and healthcare resource use (HCRU). To better understand the evolving mUC treatment landscape, the economic burden of chemotherapy-based mUC treatments among US Medicare patients was estimated.

Methods: Newly diagnosed Medicare patients with mUC were identified from the Surveillance, Epidemiology, and End Results (SEER)-Medicare database. Patients were followed from diagnosis to death, disenrollment, or end of study to characterize LOTs (first [LOT1], second [LOT2], and third or greater [LOT3+]). Kaplan-Meier methods were used to estimate overall survival (OS) by LOT. HCRU and mean costs were reported over the follow-up period, LOT duration, and maximum LOT received.

Results: Among 1,873 eligible patients with mUC (median age?=?77?years; median follow-up?=?7.5?months), 1,035 (55%) received no chemotherapy. Among chemotherapy-treated patients, 61% had LOT1 only, 25% had LOT1 and LOT2 only, and 14% had LOT3+. Median OS was 8.1?months, range was 4.3 (untreated) to 29.8 (LOT3+) months. HCRU frequency increased with additional LOTs. Mean cumulative per-patient cost was $82,912 for all patients, increasing with additional LOTs (untreated?=?$57,207; LOT1?=?$99,213; LOT2?=?$125,190; LOT3+?=?$163,884). Mean per patient per month cost was $18,827 for all patients, decreasing with increasing number of LOTs received (untreated?=?$27,211; LOT1?=?$9,601; LOT2?=?$7,325; LOT3+?=?$6,017).

Limitations: Potential for treatment misclassification when using the algorithm defining LOTs and non-generalizability of results to younger patients.

Conclusions: Over 50% of Medicare patients with mUC received no chemotherapy. Among chemotherapy-treated patients, most received only one LOT. Additional LOTs led to higher mean costs and HCRU, but as patients were followed longer, monthly costs decreased. As treatments evolve to include immuno-oncology agents, these findings provide a clinically relevant economic benchmark for mUC treatment across different traditional LOTs.     

An analysis of the location decision of young primary care physicians

The major objective of this study is to determine the factors influencing the first-time location decision of young primary care physicians. Employing a county-based data set that includes a host of health industry characteristics, demographic attributes, and economic factors, this study explores the factors that come into play when a young primary care physician decides where to practice medicine. In the demand side of the market, it was found that young physicians have an affinity for locating in moderately populated areas. Supply factors also come into play as young physicians appear most willing to locate in counties free of crime, poverty, and excessive taxes and where there is a strong academic presence. A moderate cost of living was also important.     

Tasting in 2D: implications of food shape,visual cues,and oral haptic sensory inputs

Marketers often vary the shape and dimensions of food products. But could changing the shape (e.g., molding food into cubes or rectangular prisms) or altering the dimensions (e.g., cutting food into thicker or thinner pieces) have unintended consequences in terms of influencing consumers’ size perceptions, calorie estimates, or desired consumption volume of the food? Research related to visual inputs and the elongation bias would suggest that thicker and cube-shaped foods would be perceived as larger and higher in calories; however, research related to oral haptic sensory inputs (i.e., the way the food feels in the mouth) would suggest that thinner and rectangular shaped foods would be perceived as larger and higher in calories. We test these competing predictions in a series of three experimental studies and find support for the oral haptic-based hypothesis. Conceptual and managerial implications are discussed.     

The influence of hospitable design and service on patient responses

ABSTRACT

A study of 216 respondents examined a medical center environment’s influence on patient responses. A stimulus–organism–response (S-O-R) model was adapted to the theory that more hospitable healthcare servicescape elements will affect patients’ overall satisfaction with healthcare experience, loyalty intentions, and willingness to pay out-of-pocket expenses for healthcare services. Servicescape elements included atmospherics of the healthcare environment, service delivery by healthcare staff, physical design of the healthcare environment, and wayfinding. Results of structural equation modeling confirmed that the four servicescape elements – had a significant impact on patients’ overall satisfaction with the healthcare experience. Furthermore, overall satisfaction with the healthcare experience predicted patients’ loyalty intentions and willingness to pay out-of-pocket expenses for healthcare services. The study makes a significant contribution to the empirical modeling of patients’ behavioral responses to hospitable healthcare environments.     

Does It Get Better? Recent Estimates of Sexual Orientation and Earnings in the United States

Using 2013–2015 National Health Interview Survey data, we reproduce a well‐documented finding that self‐identified lesbians earn significantly more than comparable heterosexual women. These data also show — for the first time in the literature — that self‐identified gay men also earn significantly more than comparable heterosexual men, a difference on the order of 10% of annual earnings. We discuss several possible explanations for the new finding of a gay male earnings premium and suggest that reduced discrimination and changing patterns of household specialization are unlikely to be the primary mechanisms.     

Self-selection and variations in the laboratory measurement of other-regarding preferences across subject pools: evidence from one college student and two adult samples

We measure the other-regarding behavior in samples from three related populations in the upper Midwest of the United States: college students, non-student adults from the community surrounding the college, and adult trainee truckers in a residential training program. The use of typical experimental economics recruitment procedures made the first two groups substantially self-selected. Because the context reduced the opportunity cost of participating dramatically, 91 % of the adult trainees solicited participated, leaving little scope for self-selection in this sample. We find no differences in the elicited other-regarding preferences between the self-selected adults and the adult trainees, suggesting that selection is unlikely to bias inferences about the prevalence of other-regarding preferences among non-student adult subjects. Our data also reject the more specific hypothesis that approval-seeking subjects are the ones most likely to select into experiments. Finally, we observe a large difference between self-selected college students and self-selected adults: the students appear considerably less pro-social.     

Examining CEO succession and the role of heuristics in early‐stage CEO evaluation

This study develops and tests predictions regarding factors that influence early‐stage CEO evaluation. We suggest that contextual elements of the CEO succession process will influence the heuristics that directors employ to aid in their early evaluation of a CEO because traditional performance metrics, such as firm performance, are less diagnostic of CEO quality in the first years of their tenure. Broad empirical support for our theoretical arguments is shown in a sample of Fortune 1000 firms. Copyright © 2012 John Wiley & Sons, Ltd.     

The Role of Life Experiences on Perceptions of Leisure During Adulthood: A Longitudinal Analysis

This study examined the life experiences of adults and their effect on perceptions of leisure. Data for this study came from A Study of Leisure during Adulthood (ASOLDA), a 10-year study of the values, attitudes, and perceived freedom in leisure of 84 adults. Individual growth curve modeling was used to explore patterns and change within leisure domains for the sample. Life structure predicted adults’ perceived freedom in leisure while life events were predictive of adults’ leisure attitudes. Data from interviews were used to supplement the survey data to provide a better understanding of the predictors of leisure perceptions in this study.