Economic burden of skeletal-related events in patients with multiple myeloma: analysis of US commercial claims database

Aims: To estimate incremental healthcare resource utilization (HRU) and costs associated with skeletal-related events (SREs) secondary to multiple myeloma (MM), and HRU and cost differences in patients with one vs multiple SREs.

Methods: Adults with MM diagnosis between January 1, 2010–December 31, 2014, with benefits coverage ≥12 months pre- and ≥6 months post-diagnosis were followed to last coverage date or December 31, 2015, excluding patients with prior anti-myeloma treatment or cancers. SREs were identified by diagnosis or procedure codes (pathological fracture, spinal cord compression, radiation, or surgery to the bone). SRE patients (index?=?first post-diagnosis SRE) were propensity score matched 1:1 to patients without SRE (assigned pseudo-index) using baseline characteristics, and ≥1 month of continuous enrollment after index/pseudo-index date was required. Per-patient-per year (PPPY) HRU and costs (2016?US$) were determined for inpatient, outpatient, emergency department (ED), and outpatient pharmacy services during follow-up. Wilcoxon signed rank for means and McNemar’s tests for proportions were used to assess differences. Negative binomial regression and generalized linear regression analyses estimated differences in HRU and costs, respectively, for the comparison of single vs multiple SREs.

Results: Each cohort included 848 patients (mean age?=?61 – 62 years, 57% male) with no significant differences in pre-index demographic or clinical characteristics between matched cohorts. Versus non-SRE patients, SRE patients had significantly higher PPPY use (p?<?.0001) of inpatient hospitalizations, ED visits, outpatient pharmacy, and higher direct medical costs ($188,723 vs $108,160, p?<?.0001). Adjusted PPPY total costs were $209,820 in patients with multiple SREs; $159,797 in patients with one SRE.

Limitations: SRE misclassification and residual confounding are possible.

Conclusions: Among patients with MM, average annual costs were substantially higher in patients with SRE compared with matched non-SRE patients. The economic burden of SRE increased further with multiple events.     

A probabilistic interpretation of the constant gain learning algorithm

This paper proposes a novel interpretation of the constant gain learning algorithm through a probabilistic setting with Bayesian updating. The underlying process for the variable being estimated is not specified a priori through a parametric model, and only its probabilistic structure is defined. Such framework allows to understand the gain coefficient in the learning algorithm in terms of the probability of changes in the estimated variable. On the basis of this framework, I assess the range of values commonly used in the macroeconomic empirical literature in terms of the implied probabilities of changes in the estimated variables.     

Bayesian estimation of duration models: An application of the multiperiod probit model

The multiperiod probit model is presented and Bayesian estimation using the Gibbs sampler with data augmentation is described. As an empirical illustration, the multiperiod probit model is then used to estimate a duration model using employment duration data for the Canadian province of New Brunswick. Bayesian estimation with unobserved heterogeneity is shown to be a simple extension of estimation of a duration model with no unobserved heterogeneity. More importantly, perhaps, some numerical problems encountered by other authors using Maximum Likelihood are avoided.I would like to thank M. Baker, G. Koop, A. Melino and D. Poirier for helpful comments and discussions. I would also like to thank M. Baker for providing his data.     

Price dynamics in an input-output model: An alternative approach

The suggested approach is developed, on the basis of firms' markup behaviour, in terms of current prices making value coefficients change as the effects of the initial price rise spread through the economy.     

A FRAMEWORK FOR DEVELOPING IMPLEMENTATION STRATEGIES FOR A RADIO FREQUENCY IDENTIFICATION (RFID) SYSTEM IN A DISTRIBUTION CENTER ENVIRONMENT

The costs and benefits of RFID adoption by supply chains have been a matter of much debate. As a result, researchers are finding a greenfield opportunity to examine how organizations might make use of the technology in a supply chain context. This paper attempts to further explore the potential contribution and limitations of RFID in a warehouse setting in two ways. First, it discusses the issues surrounding pallet‐level tagging and case‐level tagging by developing a decision making framework. Second, insights from the framework are used to define an object‐oriented modeling framework that facilitates warehouse simulation of the RFID vs. barcode interoperability. This simulation is used to explore some of the cost/performance tradeoffs associated with six implementation strategies. Important cost tradeoffs are reported for the different strategies, and the statistical significance of the differences are evaluated.     

Profit sharing and investment by regulated utilities: A welfare analysis

We analyse the effects of different regulatory schemes (price cap and profit sharing) on the endogenous size of a firm's investment. Using a real option approach in continuous time, we show that profit sharing does not delay a firm's start-up investment compared to a pure price-cap scheme. Profit sharing does not necessarily affect total investment either, if the threshold for profit sharing is high enough. Only a profit sharing intervening for low profit levels could delay further investments. We also evaluate the effects of profit sharing on social welfare, determining profit level that should optimally trigger tighter regulation: profit sharing should be less stringent in sectors where there is more opportunity for larger investment.     

The effect of parental background along the sons’ earnings distribution: does one pattern fit for all?

This article sheds light on the differences in the mechanisms generating intergenerational inequality in the four largest Euro Area economies (Spain, Italy, Germany and France) looking at the association between parental background and sons’ earnings along the sons’ distribution. We find that in all countries returns to parental background increase along the sons’ earnings distribution and the probability of ending up in high deciles is significantly correlated with parental background. However, although these findings lend support to the existence of a common mechanism, substantial differences in returns’ steepness question the one-pattern-fits-all story.     

Individual Wage Growth: The Role of Industry Experience

This paper focuses on the effect of experience within an industry on wages. I use a correlated random effects simultaneous equation model that allows individual and match heterogeneity to affect wages, job tenure, and industry experience. I estimate my model separately for men and women using a large panel of young Italian workers for the years 1986–2004. Results show that wage returns to industry experience are much higher than wage returns to job seniority. The hypotheses of exogeneity of job seniority and industry experience in the wage equation are rejected: high‐wage workers and high‐wage matches last longer.     

International Organisations in a World of Regional Trade Agreements: Lessons from Club Theory

This essay deals with the challenge that international organizations face at the turn of the millennium. The basic insight from the theory of clubs and information theory is that coordination and cooperation require dominant providers. Cooperation becomes more difficult as players become more equal in economic size. Today's environment is less conducive to cooperation than the environment after World War II. By extension, club theory suggests that Regional Trade Agreements are not flukes. They have proliferated because cooperation is feasible in smaller groups with a few larger players. There is a significant risk, however, that regional blocs may replace the multilateral cooperative process. To reduce this risk we propose the creation of an inter‐bloc international organization dedicated to reduce blocs' barriers to trade and finance.