Using observational analysis of multiple sclerosis relapse to design outcomes-based contracts for disease-modifying drugs: a feasibility assessment

Abstract

Objective:

To assess predictors and costs of multiple sclerosis (MS) relapse, a potential outcome measure in payer-manufacturer risk-sharing agreements for disease-modifying drugs (DMDs).

Methods:

A retrospective cohort analysis of medical/pharmacy claims was used. Study patients had ≥1 DMD (interferon beta, glatiramer, natalizumab) claim, without DMD claims in a 6-month pre-period before DMD initiation; were aged 18–64 years and continuously enrolled from the pre-period through a 24-month post-period; and had ≥2 MS medical claims during the 30-month study period. Post-period relapse cohorts included: (1) severe (hospitalization with MS diagnosis); (2) moderate (outpatient services including intravenous methylprednisolone); and (3) none. Poisson regression modeled severe relapse frequency, logistic regression modeled ≥1 severe relapse, and generalized linear modeling predicted healthcare costs. Tested predictors included demographics, insurance type, index DMD, pre-period health status, and DMD medication possession ratio (MPR).

Results:

Severe relapse was experienced by 14.5% and moderate relapse by 13.8% of 2291 patients. In logistic regression, severe relapse was predicted by plan type; age (odds ratio [OR]?=?1.018, 95% confidence interval [CI]?=?1.005–1.031); pre-period Charlson Comorbidity Index (OR?=?1.307, 95% CI?=?1.166–1.464); pre-period proxy measure indicating impaired activities of daily living (OR?=?1.470, 95% CI?=?1.134–1.905); pre-period MS hospitalization (OR?=?2.174, 95% CI?=?1.537–3.074); and DMD non-adherence (MPR OR?=?0.101, 95% CI?=?0.068–0.151). Poisson regression results were similar. Predicted mean [standard deviation] all-cause healthcare expenditures were tripled for patients with severe compared with moderate relapse ($48,173 [$8665] and $13,334 [$1929], respectively).

Limitations:

Commercially insured patients from a single payer; use may have been inconsistent with approved indications; proxy relapse measure may have misclassified patients.

Conclusions:

Severe MS relapses requiring hospitalization, although affecting less than 15% of patients initiating DMD treatment, are associated with high medical costs. The only actionable predictor of severe relapse identified in observational analysis was MPR, raising questions about the feasibility of using observational data to guide outcomes-based contracting.     

Land rental market, off-farm employment and agricultural production in Southeast China: A plot-level case study

This paper performs a plot-level analysis of the impact of land rental market participation and off-farm employment on land investment, input use, and rice yields for 215 plots cultivated by 52 households in three villages in Northeast Jiangxi Province. Our findings show that households that rent extra land are relatively more productive, but contradict results of earlier studies which found that tenure status of plots affects the level of land investments. We further find that off-farm employment does not significantly affect rice yields. This result contradicts those of earlier studies which found that the negative lost-labor effect of off-farm employment dominates the positive income effect. Another novel finding is that people working locally off-farm tend to switch from green manure planting towards the use of organic manure on their rice plots. We conclude that policies that will further stimulate the development of land rental markets, which is still in its infancy, can contribute significantly to higher rice production in Southeast China. Another implication of our results is that worries about the negative impact that the continuously growing off-farm employment may have on China's goal to remain self-sufficient in grain production are less relevant at the moment for the region examined in our study.     

A Reduced‐Form Model for Warrant Valuation

This paper studies warrant valuation using a reduced‐form model. Analogous to the credit risk literature, structural models require complete information about the asset value process and the firm’s liabilities. In contrast, reduced‐form models require only information about the firm’s stock price process. We introduce a reduced‐form model where the warrant holder is a price taker, and we relate our model to structural models appearing in the literature.     

基于所有权分拆的企业剥离分类研究

针对各种不同的企业剥离形式的分类问题,本文提出一种基于所有权分拆的企业剥离形式的分类方法。按照我国现行民法通则和物权法,所有权由占有权、使用权、处分权和收益权这四项基本权利构成。剥离发生时,被剥离资产的这四项基本权利可以被分拆开,并把这些分拆开的基本权利在剥离的各参与方之间进行分配。在理论上,这四种基本权利分拆开后重新产生的权利组合可导出16种基本企业剥离形态,且可归纳为两大类:完全剥离和不完全剥离。研究认为,企业剥离是被剥离资产所有权的分拆和重新配置,不同的分拆和配置导致不同的剥离形式。     

炼油企业上游供应链信息共享模型与价格契约设计

利用博弈理论,建立炼油企业上游供应链信息共享模型,得出合理的价格契约设计是炼油企业改善信息共享环境的动力,这对于炼油企业和原油供应商双方都十分有利,更有利于提高供应链的竞争力。     

INDIFFERENCE PRICE WITH GENERAL SEMIMARTINGALES

Using duality methods, we prove several key properties of the indifference price π for contingent claims. The underlying market model is very general and the mathematical formulation is based on a duality naturally induced by the problem. In particular, the indifference price π turns out to be a convex risk measure on the Orlicz space induced by the utility function.     

完全权益法与不完全权益法下合并报表方法之比较

合并报表编制方法可以分为从期初进行编制,也可以从期末进行编制。合并报表准则规定,合并时要将成本法调整为权益法后再行编制,由于完全权益法与不完全权益法的差异,会导致两种编制方法有不同的适应性。在完全权益法下编制合并报表适合从期初进行编制,在不完全权益法下编制合并报表适合从期末进行编制。     

Do formal contracts and relational governance function as substitutes or complements?

Relational exchange arrangements supported by trust are commonly viewed as substitutes for complex contracts in interorganizational exchanges. Many argue that formal contracts actually undermine trust and thereby encourage the opportunistic behavior they are designed to discourage. In this paper, we develop and test an alternative perspective: that formal contracts and relational governance function as complements. Using data from a sample of information service exchanges, we find empirical support for this proposition of complementarity. Managers appear to couple their increasingly customized contracts with high levels of relational governance (and vice versa). Moreover, this interdependence underlies their ability to generate improvements in exchange performance. Our results concerning the determinants of these governance choices show their distinct origins, which further augments their complementarity in practice. Copyright © 2002 John Wiley & Sons, Ltd.     

The Relations between Minimal Martingale Measure and Minimal Entropy Martingale Measure

We consider incomplete markets, where each risky asset fluctuation is a continuous semimartingale, and study a subset of Equivalent Local Martingale Measures in which Minimal Martingale Measure minimizes relative entropy.We also discuss, as special cases, some models with the risky assetfluctuation represented as a solution of some stochastic differential equations.Finally, we mention that the predictable representation property is essentialin order that Minimal Martingale Measure coincides with Minimal Entropy Martingale Measure.     

Everybody wins? A discourse analysis of competing stakeholder expectations in Social Impact Bonds

ABSTRACT

This paper explores how diverse stakeholders frame their expectations of Social Impact Bonds (SIBs). Using discourse analysis, the authors examine competing expectations in SIB press releases, showing how they differ between stakeholders, between institutional contexts, and how they evolve over time. The paper highlights how the prioritization of social finance and collaboration discourses privileges the role of private investors, which in turn diminishes the role of service providers as innovators.