The economic burden of common adverse events associated with metastatic colorectal cancer treatment in the United States

Aims: Adverse events (AEs) associated with treatments for metastatic colorectal cancer (mCRC) may compromise the course of treatment, impact quality-of-life, and increase healthcare resource utilization. This study assessed the direct healthcare costs of common AEs among mCRC patients in the US.

Methods: Adult mCRC patients treated with chemotherapy or targeted therapies were identified from administrative claims databases (2009–2014). Up to the first three mCRC treatment episodes per patient were considered and categorized as with or without the AE system/organ category during the episode. Total healthcare costs (2014 USD) were measured by treatment episode and reported on a monthly basis. Treatment episodes with the AE category were matched by treatment type and line of treatment to those without the AE category. Adjusted total cost differences were estimated by comparing costs during treatment episodes with vs without the AE category using multivariate regression models; p-values were estimated with bootstrap.

Results: A total of 4158 patients with ≥1 mCRC treatment episode were included (mean age?=?59 years; 58% male; 60% with liver and 14% with lung metastases; 2,261 [54%] with a second and 1,115 [27%] with a third episode). On average, two treatment episodes were observed per patient with an average length of 166 days per episode. Adjusted monthly total cost difference by AE category included hematologic ($1,480), respiratory ($1,253), endocrine/metabolic ($1,213), central nervous system (CNS; $1,136), and cardiovascular ($1,036; all p?Limitations: Claims do not include information on the cause of AEs, and potentially less severe AEs may not have been reported by the physician when billing the medical service. This study aimed to assess the association between costs and AEs and not the causation of AEs by treatment.

Conclusions: The most costly AEs among mCRC patients were hematologic, followed by respiratory, endocrine/metabolic, CNS, and cardiovascular.     

Costs of providing infusion therapy for patients with inflammatory bowel disease in a hospital-based infusion center setting

Aims: Inflammatory bowel disease (IBD) (e.g. ulcerative colitis [UC] and Crohn’s disease [CD]) severely impacts patient quality-of-life. Moderate-to-severe disease is often treated with biologics requiring infusion therapy, adding incremental costs beyond drug costs. This study evaluates US hospital-based infusion services costs for treatment of UC or CD patients receiving infliximab or vedolizumab therapy.

Materials and methods: A model was developed, estimating annual costs of providing monitored infusions using an activity-based costing framework approach. Multiple sources (published literature, treatment product inserts) informed base-case model input estimates.

Results: The total modeled per patient infusion therapy costs in Year 1 with infliximab and vedolizumab was $38,782 and $41,320, respectively, and Year 2+, $49,897 and $36,197, respectively. Drug acquisition cost was the largest total costs driver (90–93%), followed by costs associated with hospital-based infusion provision: labor (53–56%, non-drug costs), allocated overhead (23%, non-drug costs), non-labor (23%, non-drug costs), and laboratory (7–10%, non-drug costs).

Limitations: Limitations included reliance on published estimates, base-case cost estimates infusion drug, and supplies, not accounting for volume pricing, assumption of a small hospital infusion center, and that, given the model adopts the hospital perspective, costs to the patient were not included in infusion administration cost base-case estimates.

Conclusions: This model is an early step towards a framework to fully analyze infusion therapies’ associated costs. Given the lack of published data, it would be beneficial for hospital administrators to assess total costs and trade-offs with alternative means of providing biologic therapies. This analysis highlights the value to hospital administrators of assessing cost associated with infusion patient mix to make more informed resource allocation decisions. As the landscape for reimbursement changes, tools for evaluating the costs of infusion therapy may help hospital administrators make informed choices and weigh trade-offs associated with providing infusion services for IBD patients.     

Parametric links for binary choice models: A Fisherian–Bayesian colloquy

The familiar logit and probit models provide convenient settings for many binary response applications, but a larger class of link functions may be occasionally desirable. Two parametric families of link functions are investigated: the Gosset link based on the Student t latent variable model with the degrees of freedom parameter controlling the tail behavior, and the Pregibon link based on the (generalized) Tukey λ family, with two shape parameters controlling skewness and tail behavior. Both Bayesian and maximum likelihood methods for estimation and inference are explored, compared and contrasted. In applications, like the propensity score matching problem discussed below, where it is critical to have accurate estimates of the conditional probabilities, we find that misspecification of the link function can create serious bias. Bayesian point estimation via MCMC performs quite competitively with MLE methods; however nominal coverage of Bayes credible regions is somewhat more problematic.     

Similar patient outcomes yet different hospital costs between flowable hemostatic agents

Abstract

Introduction:

SURGIFLO? and FLOSEAL® are absorbable gelatin-based products that form hemostatic matrices. These products are indicated as adjuncts to hemostasis when control of bleeding by conventional surgical techniques (such as suture, ligature or cautery) is ineffective or impractical. This study analyzed the effect of surgery time and the choice of product on cost to the hospital and patient outcomes.     

New development: The paradox of outcomes—the more we measure,the less we understand

The use of ‘outcomes’ as a concept to measure the effectiveness of social policy interventions is inherently flawed and creates unwelcome paradoxes. This article explains why, instead of improving the lives of those who receive support, a focus on outcome information distorts both the priorities and practice of organizations who deliver such support, resulting in poorer results for those most in need. It provides an important first stage towards the evolution of new ways of conceptualizing ways to create improvements in social policy delivery.     

An empirical examination of perceived retail crowding,emotions, and retail outcomes

Crowded retail shopping conditions can result from many shoppers being present during a given time and at a given place, as well as from limited customer space owing to inadequate floor layout design and allocation of fixtures and merchandise on the floor. This study investigated the effects of the perception of human crowding and spatial crowding on consumer shopping behavior through mediation of emotions of pleasure, arousal, dominance, and a feeling of satisfaction in an international market. A store intercept survey was conducted on 554 hypermarket consumers in Taipei, Taiwan. The proposed structural relationships among perceived retail crowding, emotions, and retail outcomes were analyzed by using confirmatory factor analysis and structural equation modeling with Lisrel 8.54.

The results of the study demonstrated the effectiveness of the proposed model in delineating the relationships of retail crowding-emotions-satisfaction-retail outcomes under actual retail environments. The study found that while human crowding perceived during shopping at a hypermarket store positively impacted shoppers' feelings rather than negatively, spatial crowding perceived due to high spatial density negatively impacted shoppers' positive emotions. The findings supported the view that retail crowding affected various shopping activities through influencing positive emotions and summary feelings of satisfaction. Managerial implications of the study were also discussed.     

我国省对县(市)一般性转移支付的绩效评价——基于DEA二次相对效益模型的研究

一般性转移支付是我国转移支付制度的重要组成部分,它是中央财政为了平衡地区间财力差异、促进基本公共服务均等化为目的的重要制度安排。然而,中央财政以均等化为目标、以标准财政收支差为依据对省(市、自治区)拨付一般性转移支付资金,以及省对县(市)级政府拨付该项资金时,并没有规定具体用途,因此,县(市)级地方政府拥有对这部分资金完全的自主支配权。在多重目标,尤其是经济增长目标的压力下,一般性转移支付资金可能被挪用和挤占,上级政府实现公共服务均等化的政策意图难以达到预期的效果。本文的目的是:从制度层面论述一般性转移支付政策目标与效率评价的内在联系;探讨DEA二次相对效益模型对一般性转移支付绩效评价的适用性;从基本公共服务资金配置和提升效率两个方面,构建了省对县(市)一般性转移支付绩效评价体系;以云南省的县(市)为样本,对一般性转移支付绩效进行实证模拟评价;提出建立绩效评价是完善省对县(市)一般性转移支付制度的重要内容。     

A simple voting scheme generates all binary relations on finite sets

A simple head-to-head voting scheme in which voters hold complete and transitive preferences over alternatives generates all binary relations on finite sets. The minimal number of voters required to generate a binary relation provides a measure of complexity for binary relations. Complexity so defined tells us, by how much a given binary relation fails to qualify as a total preorder.