Treatment patterns and healthcare costs among newly-diagnosed patients with chronic myeloid leukemia receiving dasatinib or nilotinib as first-line therapy in the United States

Objective: To compare treatment patterns and economic outcomes of dasatinib and nilotinib as 1st-line therapies for chronic myeloid leukemia (CML).

Methods: Adult CML patients initiated on first-line dasatinib or nilotinib in 2010–2014 were identified from two large US administrative claims databases. Treatment patterns, tyrosine kinase inhibitor (TKI) adherence and healthcare resource utilization (HRU) and costs were measured from the 1st-line TKI initiation (index date) to the end of follow-up.

Results: A total of 604 and 418 patients were included in the dasatinib and nilotinib cohorts (mean ages = 50.9 and 52.5 years, 46.4% and 45.7% female), respectively. Among the dasatinib patients, 91% started with 100?mg/day, 3% with <100?mg/day, and 6% with >100?mg/day. Among the nilotinib patients, 76% started with 600?mg/day, 16% with >600?mg/day, and 8% <600?mg/day. The dasatinib cohort had a higher hazard of dose decrease (hazard ratio [HR]?=?1.66; p?=?.002) and of switching to another TKI (HR =1.62; p?=?.019) compared to the nilotinib cohort. The hazard of dose increase (HR =0.76; p?=?.423) and treatment discontinuation (HR =1.10; p?=?.372) were not significantly different between cohorts. There was also no significant difference in TKI adherence levels (mean proportion of days covered [PDC] difference over first 6 months = ?0.0003, p?=?.981; mean PDC difference over first 12 months = ?0.0022, p?=?.880) and HRU (inpatient day incidence rate ratio [IRR]?=?1.03, p?=?.930; emergency room IRR =1.26, p?=?.197; and days with outpatient services IRR = 1.01, p?=?.842). The dasatinib cohort incurred higher healthcare costs by $749 per patient per month (p?=?.044) compared to the nilotinib cohort.

Limitation: Information on CML phase and Sokal score was not available.

Conclusions: Dasatinib was associated with an increased hazard of dose decrease and switching to another TKI and higher healthcare costs, vs nilotinib.     

Food and beverage television advertising exposure and youth consumption,body mass index and adiposity outcomes

This study examines the relationships between exposure to food and beverage product television advertisements and consumption and obesity outcomes among youth. Individual‐level data on fast food and soft drink consumption and body mass index (BMI) for young adolescents from the Early Childhood Longitudinal Study, kindergarten cohort, (1998–1999) and adiposity measures for children from the US National Health and Nutrition Examination Survey (2003–2004) were combined with designated market area (DMA) Nielsen media advertising ratings data. To account for unobserved individual‐level and DMA‐level heterogeneity, various fixed‐ and random‐effects models were estimated. The results showed that exposure to soft drink and sugar‐sweetened beverage (SSB) advertisements is economically and statistically significantly associated with higher frequency of soft drink consumption among youth even after controlling for unobserved heterogeneity, with elasticity estimates ranging from 0.4 to 0.5. The association between fast food advertising exposure and fast food consumption disappeared once we controlled for unobservables. Exposure to cereal advertising was significantly associated with young adolescents' BMI percentile ranking, but exposures to fast food and soft drink advertisements were not. The results on adiposity outcomes revealed that children's exposure to cereal advertising was associated with both percent body fatness and percent trunk fatness; fast food advertising was significantly associated with percent trunk fatness and marginally significantly associated with percent body fatness; and exposure to SSB advertising was marginally significantly associated with percent body and trunk fatness. The study results suggest that continued monitoring of advertising is important and policy debates regarding the regulation of youth‐directed marketing are warranted.     

Policy Support for Women Entrepreneurs’ Access to Financial Capital: Evidence from Canada,Germany, Ireland,Norway, and the United States

This cross‐country study documents policies and practices designed to increase women entrepreneurs’ access to financial capital in Canada, Germany, Ireland, Norway, and the United States. Drawing on feminist theory, we examine assumptions of policy alongside the eligibility criteria, rules and regulations of practices. Our findings reveal that four of the five country policies examined were predicated on a neo‐liberal perspective that positions women entrepreneurs as economic assets. We offer insights into opportunities for modernizing policies and practices in ways that will enhance the legitimacy of a more diverse array of women entrepreneurs and increase their access to financial capital.     

The Performance Impact of Informal and Formal Institutional Differences in Cross-Border Alliances

This study addresses the simultaneous and diverse effects of differences in informal and formal institutions on cross-border alliances’ financial performance. We utilize data from 405 microfinance institutions (MFIs), based in 74 developing countries, that have alliances with partners from developed countries. We find that the impact of informal institutional differences between MFIs and their cross-border partners is sigmoid-shaped, with performance first increasing, then declining, before improving again as informal institutional differences grow large. By contrast, formal institutional differences appear to be detrimental to MFIs’ performance. Consistent with our prediction, we find that MFIs’ cross-border experience moderates both formal and informal institutional effects.     

Petty corruption: A game-theoretic approach

The paper explores a game-theoretic model of petty corruption involving a sequence of entrepreneurs and a track of bureaucrats. Each entrepreneur's project is approved if and only if it is cleared by each bureaucrat. The project value is stochastic; its value is observed only by the entrepreneur, but its distribution is common knowledge. Each bureaucrat clears the project only if a bribe is paid. The bribe for qualified projects ("extortion") and unqualified projects ("capture") may differ. We identify the nature and welfare implications of different types of equilibria under appropriate technical assumptions on the structure of the game.     

How Purchase Type Influences Consumption-Related Posting Behavior on Social Media: The Moderating Role of Materialism

It is now common to see consumers post their own purchases on social media to communicate feelings and/or thoughts about the consumption items to their social media audience. The authors conducted two surveys with a student sample and an Amazon MTurk sample to investigate factors leading to such behavior. The results show that purchase type predicts the consumption-related posting behavior—experiential purchases are more likely to get posted than material purchases, and materialism serves as a moderator in the influence of purchase type on the posting behavior. Specifically, lower-materialism consumers are more likely to post experiential purchases on social media than material purchases, while higher-materialism consumers do not show such a pattern. This article pioneers in investigating consumption-related posting behavior and provides important implications to research on user-generated content, materialism, and purchase type.     

Seven tools for creating adaptive policies

Experience demonstrates that policies crafted to operate within a certain range of conditions are often faced with unexpected challenges outside of that range. The result is that many policies have unintended impacts and do not accomplish their goals. Adaptive policies are designed to function more effectively in complex, dynamic, and uncertain conditions. Based on over a dozen case studies on public policies relating to agriculture and water resources management in Canada and India, we conclude that there are seven tools policymakers should follow to create adaptive policies. Adaptive policies anticipate and plan for the array of conditions that lie ahead: (#1) using integrated and forward-looking analysis; (#2) monitoring key performance indicators to trigger built-in policy adjustments; (#3) undertaking formal policy review and continuous learning; and (#4) using multi-stakeholder deliberation. But not all situations can be anticipated. Unknown unknowns and deep uncertainty will always be part of policymaking. Adaptive policies are able to navigate toward successful outcomes in settings that cannot be anticipated in advance. This can be done by working in concert with certain characteristics of complex adaptive systems and thereby facilitating autonomous actions among stakeholders on the ground. To a degree, adaptive policy tools #3 and #4 can be used toward this purpose, but most directly, such autonomous tools include: (#5) enabling self-organization and social networking; (#6) decentralizing decisionmaking to the lowest and most effective jurisdictional level; and (#7) promoting variation in policy responses. This paper elaborates on these seven tools as a pragmatic guide for policymakers who find themselves working in highly complex, dynamic, and uncertain settings.     

A POLICY ANALYSIS OF EXCHANGE RATE FLUCTUATIONS ON THE RURAL SECTOR: THE EXPERIENCE OF THE CANADIAN RED MEAT INDUSTRY*

Since 1976 the Canadian dollar has devalued by more than 20 percent vis-à-vis the US dollar. Many commentators have hypothesised that the devaluation has provided substantial benefits to Canadian producers of red meat. To test this hypothesis, a policy model of the North American red meat sector is formulated which captures the exchange rate effects on both product and factor prices. The model specification and validation are presented, followed by the simulation results for a 10 percent devaluation of the Canadian dollar. The major conclusion is that the exchange rate has not been a significant factor in the determination of production, consumption and trade of red meats.     

The Influence of Exchange Rates on Red Meat Trade between Canada and the United States

The effect of exchange rates on the trade of red meat between Canada and the United States is an important policy issue. While Canadian producers benefit from higher livestock prices as the Canadian dollar declines in value, higher costs of feed grains and protein as well as macroeconomic effects offset much of the perceived gain. In this paper, these effects are quantified using a quarterly econometric model of the North American livestock sector in which both livestock and feed prices in Canada are linked, through exchange rates, to their counterparts in the United States market. The results suggest that devaluation leads to significant increases in Canadian net exports of beef and to small increases in net exports of pork. Both effects are small when compared with total North American trade and production. ?effet du taux ?échange sur le commerce de viande rouge entre le Canada et les Etats-Unis a de considérables implications sur les politiques agricoles. Bien que les producteurs Canadiens bénéficient lorsque les prix de la viande sont haussés par une dévaluation du dollar Canadien, ces gains sont réduits par des prix plus élevés pour les grains et les protéines de même que par des répercussions macroéonomiques. Dans cet article, les effets de changements dans le taux ?échange sont quantifiés par ?entremise ?un modèle économétrique trimestriel des secteurs bovins et porcins en Amérique du Nord. Les prix des animaux et des grains au Canada sont reliés à leurs vis-à-vis américains par le taux ?échange. Les résultats suggèrent qu' une dévaluation entraîne une hausse significative de ?exportation nette de boeuf et une faible augmentation de ?exportation nette de pore. Toutefois, les effets sont modestes lorsque comparés aux volumes de production et de ventes pour le marché Nord Américain.