A layered United States Universal Service Fund for an everything-over-IP world

Support through the United States Federal Universal Service Fund for high-cost areas has been principally defined in terms of telephone service. Fund growth due to increases in wireless lines and implicit support for broadband infrastructure has created an untenable situation, and fundamental reform is expected. The cause underlying this growth is convergence between the telephone network, wireless networks, the Internet, and cable networks. This convergence will pose additional serious long-term challenges to the fund. This paper proposes a restructuring of the high-cost funds based on a layered model. Both contributions and distributions are focused on network infrastructure, without distinction between voice and broadband. The proposal uses a new definition of communication services to guarantee technology neutrality, and includes service area reform and cost efficiency measures. This layered approach repositions the fund for future converged networks.     

A Cross-Validity Comparison of Conjoint Analysis and Choice Models at Different Levels of Aggregation

Several (ratings-based) conjoint analysis and experimental choice (choice-based conjoint) models are compared on their ability to predict both aggregate choice shares among the sample and individual choices in an availability validation task. While there was a weak relationship between validations at the individual and aggregate levels, several models stand out. In general, models capturing individual differences validated well at both the individual and aggregate level. The hierarchical Bayes choice and conjoint models validated particularly well.Among choice models, the hierarchical Bayes choice model had the highest aggregate and individual level-validations. It was followed by the hybrid and seven segment latent segment choice models. Overall, the highest validating ratings-based conjoint model was the hierarchical Bayes model. However, the seven segment latent segment conjoint model produced better aggregate choice share validations than any other conjoint model. These results indicate that validations can be improved either by using benefit segment models and/or merging different types of data to estimate more individualized models.In most cases, rescaling improved the ratings-based, but not the choice-based choice share validations. This suggests that one might adjust for differences between ratings and choice tasks before making choice share predictions.     

Cost-effectiveness of blinatumomab versus salvage chemotherapy in relapsed or refractory Philadelphia-chromosome-negative B-precursor acute lymphoblastic leukemia from a US payer perspective

Objective: To evaluate the cost-effectiveness of blinatumomab (Blincyto) vs standard of care (SOC) chemotherapy in adults with relapsed or refractory (R/R) Philadelphia-chromosome-negative (Ph?) B-precursor acute lymphoblastic leukemia (ALL) based on the results of the phase 3 TOWER study from a US healthcare payer perspective.

Methods: The Blincyto Global Economic Model (B-GEM), a partitioned survival model, was used to estimate the incremental cost-effectiveness ratio (ICER) of blinatumomab vs SOC. Response rates, event-free survival (EFS), overall survival (OS), numbers of cycles of blinatumomab and SOC, and transplant rates were estimated from TOWER. EFS and OS were estimated by fitting parametric survival distributions to failure-time data from TOWER. Utility values were based on EORTC-8D derived from EORTC QLQ-C30 assessments in TOWER. A 50-year lifetime horizon and US payer perspective were employed. Costs and outcomes were discounted at 3% per year.

Results: The B-GEM projected blinatumomab to yield 1.92 additional life years and 1.64 additional quality-adjusted life years (QALYs) compared with SOC at an incremental cost of $180,642. The ICER for blinatumomab vs SOC was estimated to be $110,108/QALY gained in the base case. Cost-effectiveness was sensitive to the number and cost of inpatient days for administration of blinatumomab and SOC, and was more favorable in the sub-group of patients who had received no prior salvage therapy. At an ICER threshold of $150,000/QALY gained, the probability that blinatumomab is cost-effective was estimated to be 74%.

Limitations: The study does not explicitly consider the impact of adverse events of the treatment; no adjustments for long-term transplant rates were made.

Conclusions: Compared with SOC, blinatumomab is a cost-effective treatment option for adults with R/R Ph???B-precursor ALL from the US healthcare perspective at an ICER threshold of $150,000 per QALY gained. The value of blinatumomab is derived from its incremental survival and health-related quality-of-life (HRQoL) benefit over SOC.     

Communicating nutrition information at the point of purchase: An eye‐tracking study of shoppers at two grocery stores in the United States

Providing nutrition information at the point of purchase is one approach that can be used to help consumers adopt and maintain a healthy diet. Previous research has examined consumer self‐reported notice and use of the information as well as how the design of the information affects its attention and use in a laboratory environment using eye‐tracking methodology. This study advances the literature by applying eye‐tracking methodology to explore consumer visual and choice behavior in a real shopping environment, and by recognizing that nutrition information competes with other visual stimuli in the store and consumers are vulnerable to a “limited attention span” for nutrition information in a shopping setting. Data came from a cross‐sectional survey conducted in two grocery stores in the United States in July 2014 with a convenience sample of 60 grocery shoppers while they were selecting and buying items from one of three product categories (ready‐to‐eat cereal, snacks, and soup). The study finds that point‐of‐purchase nutrition information faced strong competition for participants’ attention from other visual elements in a real shopping environment and the attention is dominated by nonnutrition elements, particularly brand/product name, product imagery, and product pricing. Nutrition‐related information, on the other hand, received much less attention, with claims and front‐of‐package nutrition symbols seen by more participants than the Nutrition Facts label. The study suggests that to more effectively enable nutrition information to “catch the eyes” of shoppers at the point of purchase, increasing consumer exposure to the information and enhancing shopper education may merit further investigation.     

APT VS. CAPM ESTIMATES OF THE RETURN-GENERATING FUNCTION PARAMETERS FOR REGULATED PUBLIC UTILITIES

In public utility rate hearings, there are extensive arguments concerning the most appropriate model of the return-generating function. Bower, Bower, and Logue (1984) suggest that the APT is superior to the CAPM, but their results have troublesome ranking differences between the two models when applied to returns from electric versus natural gas utilities. The purposes of this paper are to develop forward estimates of the parameters for both of these models applied to five different utility portfolios of electric and natural gas companies at a point in time, and to test whether these estimates are valid during a subsequent or future period. Also, forecasting errors for each model are compared to determine which model is best and to ascertain if there are any ranking conflicts. There are no ranking conflicts with the models as the market model consistently underestimates the actual return. Thus, the analysis suggests that the arbitrage model is a superior representation of the return-generating process of these utilities.     

Reserve funds key to keeping health plans fiscally fit

To avoid an economic roller coaster ride, plan sponsors should establish an appropriate financial reserve during the good times to provide a safety net during the bad. Because no law expressly requires multiemployer health funds to maintain reserves, each fund's needs should be determined by its trustees, in consultation with professional advisors. This article explores the role of reserves in helping plans to prepare for various needs and contingencies.