Primary vs secondary prophylaxis with pegfilgrastim for the reduction of febrile neutropenia risk in patients receiving chemotherapy for non-Hodgkin’s lymphoma: cost-effectiveness analyses

Objective:

Evaluate the cost-effectiveness of primary vs secondary prophylaxis (PP vs SP) with pegfilgrastim to reduce the risk of febrile neutropenia (FN) in Non-Hodgkin’s Lymphoma (NHL) patients receiving myelosuppressive chemotherapy from a US payer perspective.

Methods:

A Markov model was used to compare PP vs SP with pegfilgrastim in a cohort of patients receiving six cycles of cyclophosphamide, vincristine, doxorubicin, and prednisone (CHOP) or CHOP plus rituximab (CHOP-R) chemotherapy. Model inputs, including efficacy of pegfilgrastim in reducing risk of FN and costs, were estimated from publicly available sources and peer-reviewed publications. Incremental cost-effectiveness was evaluated in terms of net cost per life-year saved (LYS), per quality-adjusted life-year (QALY) gained, and per FN event avoided over a lifetime horizon. Deterministic and probabilistic analyses were performed to assess sensitivity and robustness of results.

Results:

Lifetime costs for PP were $5000 greater than for SP; however, PP was associated with fewer FN events and more LYs and QALYs gained vs SP. Incremental cost-effectiveness ratios (ICERs) for PP vs SP for CHOP were $13,400 per FN event avoided, $29,500 per QALY gained, and $25,800 per LYS. CHOP-R results were similar ($15,000 per FN event avoided, $33,000 per QALY gained, and $28,900 per LYS). Results were most sensitive to baseline FN risk, cost per FN episode, and odds ratio for reduced relative dose intensity due to prior FN event. PP was cost-effective vs SP in 85% of simulations at a $50,000 per QALY threshold.

Limitations:

In the absence of NHL-specific data, estimates for pegfilgrastim efficacy and relative risk reduction of FN were based on available data for neoadjuvant TAC in patients with breast cancer. Baseline risks of FN for CHOP and CHOP-R were assumed to be equivalent.

Conclusions:

PP with pegfilgrastim is cost-effective compared to SP with pegfilgrastim in NHL patients receiving CHOP or CHOP-R.     

Developing Sustainable Strategies: Foundations,Method, and Pedagogy

While the United Nations Principles of Responsible Management Education (PRME) are a very positive development in the horizon of management education over the last decade, there are still many significant challenges for engaging the mind of the manager in ways that will foster the values of PRME and the UN Global Compact. Responsible management education must address three foundational challenges in business education if it is to actualize the aspirations of PRME: (1) it must confront the cognitional myth that knowing is like looking, (2) it must move beyond mere analysis to systems thinking, and (3) it must transition from a values-neutral stance to a values-driven stance. Using Developing Sustainable Strategies, an MBA practicum in the Sustainable Management Concentration at DePaul University’s Kellstadt Graduate School of Business as a case study, this article identifies the ways in which Pragmatic Inquiry can address these challenges. The method of Pragmatic Inquiry prepares students to become responsible managers, to develop sustainable strategies, and to be creators of shared value. Built from the philosophical foundations of American pragmatism and Bernard Lonergan’s critical realism, Pragmatic Inquiry is an effective method and pedagogy for responsible management education.     

Self-employment of older Americans: do recessions matter?

As high unemployment rates linger following the latest recession, job opportunities can be sparse, especially for older workers. This might prompt older Americans to seek out opportunities in self-employment. Alternatively, recession-related decreases in economic activity might make self-employment less attractive. Using the Health and Retirement Study, we find that unemployed respondents are more likely to enter self-employment and that these decisions are clearly affected by recessions, although the effects differ by recession and gender. Unlike men, women’s self-employment decisions are very sensitive to other sources of household income, and women are less likely to become self-employed the deeper the recession.     

Are we overconfident in executive overconfidence research? An examination of the convergent and content validity of extant unobtrusive measures

Building understanding of overconfident executives is central to a growing literature that spans a number of disciplines. Much of this research has utilized unobtrusive, or indirect, measures to assess executive overconfidence from secondary data sources. We analyze the convergent and content validity of seven extant unobtrusive measures of executive overconfidence. The results of our analyses indicate that these measures do not exhibit adequate convergence, suggesting that existing measures are not measuring the same construct. Further, we administer a sort task to academic colleagues to assess whether scholars believe that the seven measures are adequately assessing the intended construct. The results of our sort task indicate that scholars did not categorize any of the seven measures as sufficient for measuring overconfidence. We conclude with suggestions for future research to address the inadequate convergent and content validity found in our assessment of extant measures of executive overconfidence.     

Options pricing under the one-dimensional jump-diffusion model using the radial basis function interpolation scheme

This paper will demonstrate how European and American option prices can be computed under the jump-diffusion model using the radial basis function (RBF) interpolation scheme. The RBF interpolation scheme is demonstrated by solving an option pricing formula, a one-dimensional partial integro-differential equation (PIDE). We select the cubic spline radial basis function and adopt a simple numerical algorithm (Briani et al. in Calcolo 44:33–57, 2007) to establish a finite computational range for the improper integral of the PIDE. This algorithm reduces the truncation error of approximating the improper integral. As a result, we are able to achieve a higher approximation accuracy of the integral with the application of any quadrature. Moreover, we a numerical technique termed cubic spline factorisation (Bos and Salkauskas in J Approx Theory 51:81–88, 1987) to solve the inversion of an ill-conditioned RBF interpolant, which is a well-known research problem in the RBF field. Finally, our numerical experiments show that in the European case, our RBF-interpolation solution is second-order accurate for spatial variables, while in the American case, it is second-order accurate for spatial variables and first-order accurate for time variables.     

Corporate cash holdings and political connections

We examine the relation between corporate liquidity and political connections measured via lobbying expenditures. This is an interesting question as many of the motives for holding cash should be diminished by political connections. Results indicate a significant and inverse relation between cash levels and lobby expenses and that the marginal value of cash decreases with lobbying. Taken together, these findings suggest firms react optimally to the reduced benefits of cash linked to political connections and that the market recognizes the weakened benefits of cash. Overall, our research shows another way political connections can shape corporate policy.     

Towards a Strategy for Knowledge Management

Knowledge management is emerging as a significant organizational and management challenge. The pressures of the emergence of the global knowledge economy, and recognition of knowledge as a key and intangible asset are making the effective management of knowledge a priority. This surge of interest has paid relatively little attention to the object of management-knowledge. Epistemologists and sociologists have produced a variety of definitions and classifications, but there is no consensus. However, with the growth in IT capability, a clear operational distinction can be drawn between information and knowledge. The former can be captured, stored and transmitted in digital form. The latter can only exist in an intelligent system. This distinction is used to develop models of the interaction between knowledge and information, and of the appropriate balance between the two in different situations. On the basis of this model, the challenges of 'knowledge management' are: Establishing and optimizing the information-knowledge balance appropriate to (or providing a competitive advantage) a company or industry; Implementing IT-based productivity improvements in information management; Implementing people- and socially-based mechanisms to enhance knowledge management; Explicitly addressing the knowledge-information interface and mechanisms for improving the processes of transition from information to knowledge, and from knowledge to information; Identifying and maintaining the core knowledge of an organization.