Economic burden of sarcoidosis in a commercially-insured population in the United States

Background: Sarcoidosis is a multi-system inflammatory disorder characterized by the presence of non-caseating granulomas in involved organs. Patients with sarcoidosis have a reduced quality-of-life and are at an increased risk for several comorbidities. Little is known about the direct and indirect cost of sarcoidosis following the initial diagnosis.

Aims: To provide an estimate of the healthcare resource utilization (HCRU) and costs borne by commercial payers for sarcoidosis patients in the US.

Methods: Patients with a first diagnosis of sarcoidosis between January 1, 1998 and March 31, 2015 (“index date”) were selected from a de-identified privately-insured administrative claims database. Sarcoidosis patients were required to have continuous health plan enrollment 12 months prior to and following their index dates. Propensity-score (1:1) matching of sarcoidosis patients with non-sarcoidosis controls was carried out based on a logistic regression of baseline characteristics. Burden of HCRU and work loss (disability days and medically-related absenteeism) were compared between the matched groups over the 12-month period following the index date (“outcome period”).

Results: A total of 7,119 sarcoidosis patients who met the selection criteria were matched with a control. Overall, commercial payers incurred $19,714 in mean total annual healthcare costs per sarcoidosis patient. The principle cost drivers were outpatient visits ($9,050 2015 USD, 46%) and inpatient admissions ($6,398, 32%). Relative to controls, sarcoidosis patients had $5,190 (36%) higher total healthcare costs ($19,714 vs $14,524; p?p?p?Background: Sarcoidosis is a multi-system inflammatory disorder characterized by the presence of non-caseating granulomas in involved organs. Patients with sarcoidosis have a reduced quality-of-life and are at an increased risk for several comorbidities. Little is known about the direct and indirect cost of sarcoidosis following the initial diagnosis.

Aims: To provide an estimate of the healthcare resource utilization (HCRU) and costs borne by commercial payers for sarcoidosis patients in the US.

Methods: Patients with a first diagnosis of sarcoidosis between January 1, 1998 and March 31, 2015 (“index date”) were selected from a de-identified privately-insured administrative claims database. Sarcoidosis patients were required to have continuous health plan enrollment 12 months prior to and following their index dates. Propensity-score (1:1) matching of sarcoidosis patients with non-sarcoidosis controls was carried out based on a logistic regression of baseline characteristics. Burden of HCRU and work loss (disability days and medically-related absenteeism) were compared between the matched groups over the 12-month period following the index date (“outcome period”).

Results: A total of 7,119 sarcoidosis patients who met the selection criteria were matched with a control. Overall, commercial payers incurred $19,714 in mean total annual healthcare costs per sarcoidosis patient. The principle cost drivers were outpatient visits ($9,050 2015 USD, 46%) and inpatient admissions ($6,398, 32%). Relative to controls, sarcoidosis patients had $5,190 (36%) higher total healthcare costs ($19,714 vs $14,524; p?<?0.001). Sarcoidosis patients also had significantly more work loss days (15.9 vs 11.3; p?<?0.001) and work loss costs ($3,288 vs $2,527; p?<?0.001) than matched controls. Sarcoidosis imposes an estimated total direct medical cost of $1.3–$8.7 billion to commercial payers, and an indirect cost of $0.2–$1.5 billion to commercial payers in work loss.

Conclusions: Sarcoidosis imposes a significant economic burden to payers in the first year following diagnosis.     

Assessing information provision and respondent involvement effects on preferences

We develop a test of the effect of information and respondent involvement on preferences for passive-use values using three treatments. Individuals from a rural community participated in one of three groups, each with a different level of involvement in the valuation assessment. The first group was highly involved, attending three meetings which allowed for information acquisition and preference construction. The second group was involved in a single meeting, and the third group was minimally involved through telephone contact and the completion of a mail administered survey. The hypothesis examined was that the degree of involvement in the exercise would affect the magnitude and consistency of preferences across the groups. The hypothesis that the preferences differ was not accepted. Furthermore, the hypothesis that variances in preferences would be higher in less involved groups was also rejected. While the analysis is based on relatively small samples the findings suggest caution in claiming that increasing degrees of respondent involvement improve economic measures of trade-offs.     

Trade in High-Tech Services

This paper examines the size, scope, and potential implications of trade in high-tech services in the U.S. The results suggest that many service activities are tradable, tradable service activities tend to employ more educated workers and pay higher wages, and high-tech services account for a large share of service activities that are tradable. Service exporters are more prevalent in high-tech industries with larger establishments and higher wages. Within industries, service exporters tend to be larger, pay higher wages, and are more productive. Tradable service activities seem consistent with U.S. comparative advantage and, as a result, less likely to be vulnerable to offshoring. Consistent with this, recent employment growth in tradable service industries is not significantly different than employment growth in non-tradable service industries.     

Exporting and Productivity in the USA

Exporting is often touted as a way to increase economic growth.This paper examines the interaction between exporting and productivitygrowth in US manufacturing. While exporting plants have substantiallyhigher productivity levels, there is no evidence that exportingincreases plant productivity growth rates. The higher productivityof exporters largely predates their entry into exporting. However,within the same industry, exporters do grow faster than non-exportersin terms of both shipments and employment. Exporting is associatedwith the reallocation of resources from less efficient to moreefficient plants. In the aggregate, these reallocation effectsare quite large, making up over 40 per cent of total factorproductivity growth in the manufacturing sector. Half of thisreallocation to more productive plants occurs within industriesand the direction of the reallocation is towards exporting plants.     

A Dynamic Analysis of University Agricultural Biotechnology Patent Production

This article examines the factors that account for agricultural biotechnology patenting success among universities using a dynamic count data model. It builds a theoretical and econometric model to capture the inherently dynamic and nonlinear process of technological innovation, wherein a feedback mechanism from previous success partially determines current patent counts. The econometric estimates reveal the importance to agricultural biotechnology patent production of land grant infrastructure, quality faculty, patent-oriented technology transfer offices, as well as dynamic feedback effects.     

VENTURE CAPITAL AND IPO LOCKUP EXPIRATION: AN EMPIRICAL ANALYSIS

Most initial public offerings (IPOs) feature “lockup” agreements, which bar insiders from selling the stock for a set period following the IPO, usually 180 days. We examine stock price behavior in the period surrounding lockup expiration for a sample of 2,529 firms from 1988 to 1997. We find that lockup expirations are, on average, associated with significant and negative abnormal returns, but the losses are concentrated in firms with venture capital backing. For the venture‐capital‐backed group, the largest losses occur for high‐tech firms and firms with the greatest post‐IPO stock price increases, the largest relative trading volume in the period surrounding expiration, and the highest quality underwriters. JEL classification: G14, G24