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.     

中国直接税与间接税比重变化趋势研究

直接税与间接税的比重,是税制结构研究的主要问题之一。本文通过对相关资料的整理和分析,概要描述了中国若干重要历史时期特别是新中国成立60年来历次重大税制改革以后直接税与间接税比重变化的轨迹,并探讨了上述比重变化的趋势和进一步合理调整上述比重的途径。     

Non-maximizing output behavior for firms with a cost-constrained technology

In many public service industries, firms are constrained by a cost (budget) and characterized by non-maximizing output behavior, due to bureaucratic behavior, for instance. This paper proposes a model based on the assumption that firms with a cost constraint do not maximize service levels due to resource preferences. It derives the exact relationships between services delivered, (shadow) input prices, cost constraints, and optimal input quantities. From these relationships, allocative efficiencies, technical efficiencies, output ray elasticities, and marginal cost can easily be derived.      

Matching-adjusted indirect comparison of adalimumab vs etanercept and infliximab for the treatment of psoriatic arthritis

Abstract

Objectives:

No head-to-head trial has compared the efficacy of adalimumab vs etanercept and infliximab for psoriatic arthritis (PsA). This study implements a matching-adjusted indirect comparison technique to address that gap.

Methods:

Patient-level data from a placebo-controlled trial of adalimumab (ADEPT) were re-weighted to match average baseline characteristics from pivotal published trials of etanercept and infliximab. ADEPT patients were re-weighted by odds of enrollment in comparator trials, estimated using logistic regression. Matched-on characteristics included PsA duration, age, gender, severity, active psoriasis, and concomitant treatment. After matching, placebo-adjusted treatment arms were compared at weeks 12 (or 14) and 24. Outcomes included ACR20/50/70, PsARC, HAQ, and modified TSS. PASI50/75/90 were compared for patients with active psoriasis. Cost per responder (CPR) was assessed in the US and Germany using matching-adjusted end-points and drug list prices. Statistical significance was assessed using weighted t-tests.

Results:

After matching, adalimumab-treated patients had greater placebo-adjusted rates of ACR70 and PASI50/75/90 at week 24 compared with etanercept (all p?<?0.05). Adalimumab patients had a higher placebo-adjusted rate of ACR70 than infliximab at week 14 (p?=?0.034). Adalimumab treatment had lower CPR for ACR70 and PASI50/75/90 compared with etanercept at week 24, in both the US and Germany (all p?<?0.02). Adalimumab had lower CPR than infliximab for all outcomes at week 24 (all p?<?0.05).

Conclusion:

Adalimumab is associated with higher ACR70 and PASI50/75/90 response rates than etanercept at week 24 and a higher ACR70 response rate than infliximab at week 14. Adalimumab has significant advantages over etanercept and infliximab in CPR across multiple end-points.

Key limitations:

The matching-adjusted indirect comparison method cannot account for unobserved differences in patient characteristics across trials, and only a head-to-head randomized clinical trial can fully avoid the limitations of indirect comparisons. CPR findings are limited to the US and German markets, and may not be generalizable to other markets with different relative pricing.     

Term structure and the estimated monetary policy rule in the Eurozone

In this paper we estimate a standard version of the New Keynesian Monetary (NKM) model augmented with term structure in order to analyze two issues. First, we analyze the effect of introducing an explicit term structure channel in the NKM model on the estimated parameter values of the model, with special emphasis on the interest rate smoothing parameter using data for the Eurozone. Second, we study the ability of the model to reproduce some stylized facts such as highly persistent dynamics, the weak comovement between economic activity and inflation, and the positive, strong comovement between interest rates observed in actual Eurozone data. The Sect. 3 implemented is a classical structural method based on the indirect inference principle. We are grateful to Eduardo Ley, two anonymous referees and seminar participants at the XXXI Simposio de Análisis Económico (Oviedo, Spain) and Bank of Spain for their useful comments. Financial support from Ministerio de Ciencia y Tecnología and Universidad del País Vasco (Spain) and Fundación Séneca through projects SEJ2004-04811/ECON, 9/UPV00035.321-13511/2001 and I02937/PHCS/05, respectively, is gratefully acknowledged. The first author also thanks Fundación Ramón Areces for financial support.     

Financing Constraints and the Timing of Innovations in the German Services Sector

Using newly available data at the firm level, this study provides convincing evidence of the importance of financial constraints in explainingthe timing of innovations in the German services sector. Based on a dynamic model of firms' optimalR & D behavior under financial constraints, we estimate various versions of aneconometric specification of the model with dichotomous innovation data by using a univariateordered probit model. Additionally, a new estimation technique is applied to account forthe scaling of the regressor variables. Our results are consistent with the theoretical view that,because of capital market imperfections, internal finance should be an important determinant ofinnovative activities by private firms not only in the manufacturing sector but as well as inthe services sector.     

The Distributional Effects of Indirect Tax Changes in Italy

This paper evaluatesthe distributional and welfare effects of two recent changesof Value Added Tax (VAT) and excise taxes in Italy applying andcomparing two related and complementary methods of analysis:the first based on the distributional characteristics of Feldstein(1972) and recently applied by Newbery (1995); the second basedon the theory of marginal dominance developed by Mayshar andYitzhaki (1996). The paper finds no evidence that the reformshave redistributed purchasing power among households. But themost striking result is that a simpler two-rate VAT structure,set according to the European directives on VAT coordination,could have replaced the present system producing the same revenueand increasing welfare. This last result provides a clear instancein which reducing the number of VAT rates can be welcome evenin the presence of distributional concerns.     

中国间接税与直接税的比例关系研究—— IMF政府财政数据支持的解释

利用国际货币基金组织提供的政府财政数据,将世界各国(地区)的税制结构分成六种类型,并对中国间接税比重进行横向比较。结果发现：当前我国基本属于“间接税为主”的税制模式,尽管中国间接税比重在可控范围内,但是已经高于世界经验水平。如果税制结构得不到改善,将逐渐偏离世界发展一般经验规律。在分析影响间接税规模的影响因素基础之上,提出构建与本国经济发展相适应、与宏观经济目标一致的“双主体”税制结构;逐步降低间接税比重、提高直接税比重;提高税收征管水平等政策建议。     

A causal analysis framework for land-use change and the potential role of bioenergy policy

We propose a causal analysis framework to increase understanding of land-use change (LUC) and the reliability of LUC models. This health-sciences-inspired framework can be applied to determine probable causes of LUC in the context of bioenergy. Calculations of net greenhouse gas (GHG) emissions for LUC associated with biofuel production are critical in determining whether a fuel qualifies as a biofuel or advanced biofuel category under regional (EU), national (US, UK), and state (California) regulations. Biofuel policymakers and scientists continue to discuss to what extent presumed indirect land-use change (ILUC) estimates should be included in GHG accounting for biofuel pathways. Current estimates of ILUC for bioenergy rely largely on economic simulation models that focus on causal pathways involving global commodity trade and use coarse land-cover data with simple land classification systems. This paper challenges the application of such models to estimate global areas of LUC in the absence of causal analysis. The proposed causal analysis framework begins with a definition of the change that has occurred and proceeds to a strength-of-evidence approach that includes plausibility of relationship, completeness of causal pathway, spatial co-occurrence, time order, analogous agents, simulation model results, and quantitative agent–response relationships. We discuss how LUC may be allocated among probable causes for policy purposes and how the application of the framework has the potential to increase the validity of LUC models and resolve controversies about ILUC, such as deforestation, and biofuels.     

Value orientations and heritage tourism management at Petra Archaeological Park,Jordan

Involving different stakeholders, including tourists, in managing tourism and understanding their value orientations are key concepts to achieve sustainability of heritage tourism. However, tourists have been mostly ignored in managing heritage attractions. Given the importance of values in heritage tourism management, and the different tourists' preferences toward management actions, this article aims to explore the value orientations of different types of tourists at Petra Archaeological Park, and how these values influence their management actions preferences. Majority of the tourists were preservation value oriented, and they preferred direct management actions rather than indirect actions. Results indicated that whenever the level of the importance of heritage tourism increases in tourists' trip motivations, tourists tend to be more preservation value oriented and support direct management actions.