Healthcare resource utilization among patients with relapsed multiple myeloma in the UK,France, and Italy

Aims: To assess the real-world healthcare resource utilization (HRU) and costs associated with different treatment regimens used in the management of patients with relapsed multiple myeloma in the UK, France, and Italy.

Methods: Retrospective medical chart review of characteristics, time to progression, level of response, HRU during treatment, and adverse events (AEs). Data collection started on June 1, 2015 and was completed on July 15, 2015. In the 3 months before record abstraction, eligible patients had either disease progression after receiving one of their country’s most commonly prescribed regimens or had received the best supportive care and died. Costs were calculated based on HRU and country-specific diagnosis-related group and/or unit reference costs, amongst other standard resources.

Results: Physicians provided data for 1,282 patients (387 in the UK, 502 in France, 393 in Italy) who met the inclusion criteria. Mean [median] total healthcare costs associated with a single line of treatment were €51,717 [35,951] in the UK, €37,009 [32,538] for France, and €34,496 [42,342] for Italy, driven largely by anti-myeloma medications costs (contributing 95.0%, 90.0%, and 94.2% of total cost, respectively). During active treatment, the highest costs were associated with lenalidomide- and pomalidomide-based regimens. Mean cost per month was lowest for patients achieving a very good partial response or better. Unscheduled events (i.e. not considered part of routine management, whether or not related to multiple myeloma, such as unscheduled hospitalization, AEs, fractures) accounted for 1–9% of total costs and were highest for bendamustine.

Limitations: The use of retrospective data means that clinical practice (e.g. use of medical procedures, evaluation of treatment response) is not standardized across participating countries/centers, and some data (e.g. low-grade AEs) may be incomplete or differently adjudicated/reported. The centers involved may not be fully representative of national practice.

Conclusions: Drug costs are the main contributor to total HRU costs associated with multiple myeloma. The duration of active treatment may influence the average total costs, as well as response, associated with a single line of therapy. Improved treatment outcomes, and reductions in unscheduled events and concomitant medication use may, therefore, reduce the overall HRU and related costs of care in multiple myeloma.     

On the generic strategic stability of Nash equilibria if voting is costly

Summary. We prove that for generic plurality games with positive cost of voting, the number of Nash equilibria is finite. Furthermore all the equilibria are regular, hence stable sets as singletons.JEL Classification Numbers: C72, D72.We would like to thank Luisa Bassotto, Marco Celentani, Mamoru Kaneko, and participants at the 6 International Conference on Current Trends in Economics for helpful comments. We also thank an anonymous referee of this journal for precious advices that have substantially improved this paper. This paper was partially written while Francesco was visiting Tor Vergata University, which he thanks for hospitality and financial support. The usual disclaimer applies.     

Gender Discrimination,Entrepreneurial Talent and Self-Employment

The trend of female self-employment in Italy is stable, with a low level of participation which confirms the prediction of economic theory on discrimination. We contend that gender discrimination alters the distribution of entrepreneurial talent between employees and self-employed workers. This gives rise to the prediction that the self-employed women are less likely to survive when self-employed than men because the lesser entrepreneurial talent of women will increase their risk of failure. Applying Markovian analysis to ISTAT’s labor market transition matrices we verify this prediction: Many women try to set up on their own, but they fail to remain self-employed both because their lesser entrepreneurial talent and because they try to become entrepreneurs without any previous experience of work. ‘If you think you’re so discriminated against, why don’t you set up on your own?’     

Imitation and Experimentation in Changing Contests

This paper analyzes the equilibrium play of individuals that are randomly matched to play a contest where the dominant action changes over time. Under myopic decision making, players adopt imitation strategies similar to those observed in evolutionary models with sampling from past play in the population. If the players are patient, equilibrium strategies display elements of experimentation in addition to imitation. If the changes in the environment are infrequent enough, these strategies succeed in coordinating almost all of the players on the dominant action almost all of the time. The myopic rules, on the other hand, result in miscoordination for a positive fraction of time. Journal of Economic Literature Classification Numbers: C73, D83, D84.     

Exchange rates and prices in Europe

Zusammenfassung Wechselkurse und Preise in Europa. — Dieser Aufsatz behandelt die Implikationen von Asymmetrien in der übertragung von Preisst?rungen bei zentralisierter Wechselkurspolitik in einem System gesteuerter Kurse wie dem Europ?ischen W?hrungssystem. Es wird gezeigt, da\ bei derartigen Asymmetrien unwiderruflich feste Wechselkurse suboptimal sind, selbst dann, wenn die politischen Ziele der L?nder identisch und die Wechselkurs- und Geldpolitiken zentralisiert sind. Im empirischen Teil werden die asymmetrischen übertragungen von Preisst?rungen aufgezeigt, indem Input-Output-Matrizen für vier europ?ische L?nder simuliert werden. Dabei ergibt sich, da\ diese Asymmetrien in der Tat betr?chtlich sind und da\ sie bei einer optimalen Festsetzung der Wechselkurse ausdrücklich in Rechnung gestellt werden sollten.

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Résumé Taux de change et prix en Europe. —- Dans cet article les auteurs discutent les implications des asymétries en transmission des perturbances de prix pour une politique de taux de change centralisée dans un système de taux dirigés comme le Système Monétaire Européen. Ils démontrent que, sous des asymétries, les taux de change fixés irrévocablement sont sous-optimum, même si les buts politiques des pays sont identiques et si les politiques de taux de change et monétaires sont centralisées. Puis les auteurs donnent de l’évidence empirique pour des asymétries en transmission des perturbances de prix en simulant des matrices input-output pour quatre pays Européens. Le résultat est que ces asymétries sont vraiment considérable; par conséquent, un cadre optimum de taux de change devrait tenir compte d’elles.

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Resumen Tipos de cambio y precios en Europa. — En este trabajo se discuten las consecuencias que tienen asimetrías en la transmisión de perturbaciones de los precios para políticas de cambio centralizadas dentro de un sistema de tipos de cambio manejados como el Sistema Monetario Europeo. Se demuestra porqué en presencia de estas asimetrías tipos de cambio fijos e irrevocables son suboptimales, incluso cuando los objetivos de política son idénticos en todos los países y las politicas de cambios y monetarias son centralizadas. A continuación se présenta evidencia empfrica de asimetrías en la transmisión de perturbaciones de los precios simulando matrices insumo producto de cuatro países europeos. Los resultados indican que estas asimetrias son importantes y que a raíz de ello un régimen de cambio óptimo debiera tomarlas en cuenta explícitamente.

     

A Forecasting Model for Stock Market Diversity

We apply the recently introduced generalized tree-structured (GTS) model to the analysis and forecast of stock market diversity. Diversity is a measure of capital concentration across a market that plays a central role in the search for arbitrage. The GTS model allows for different conditional mean and volatility regimes that are directly related to the behavior of macroeconomic fundamentals through a binary threshold construction. Testing on US market data, we collect empirical evidence of the model’s strong potential in estimating and forecasting diversity accurately in comparison with other standard approaches. In addition, the GTS model allows for the construction of very simple portfolio strategies that systematically beat the standard cap-weighted S&P500 index. Financial support by the Foundation for Research and Development of the University of Lugano and by the National Centre of Competence in Research “Financial Valuation and Risk Management” (NCCR FINRISK) is gratefully acknowledged. The authors thank four anonymous referees for helpful comments.