Cost estimate of platelet transfusion in the United States for patients with chronic liver disease and associated thrombocytopenia undergoing elective procedures

Aims: This study aimed to estimate the cost of platelet transfusion in patients with chronic liver disease (CLD)-associated thrombocytopenia undergoing an elective procedure in the United States.

Materials and methods: The study was conducted in two parts: development of a conceptual framework identifying direct, indirect and intangible costs of platelet transfusion, followed by the estimation of the total cost of platelet transfusion in patients with CLD-associated thrombocytopenia before an elective procedure in the United States using the conceptual framework and cost data obtained from a literature search. The cost of the entire care required to raise a patient’s platelet count before the procedure was considered.

Results: The final conceptual framework included the costs of generating the supply of platelets, the platelet transfusion itself, adverse events associated with platelet transfusion and refractoriness to platelet transfusion. When costs were accounted for in all the framework cost categories, the total direct cost of a platelet transfusion in a patient with CLD and associated thrombocytopenia was estimated to be in the range of $5258 to $13,117 (2017?US dollars) in the United States. The largest portion of costs was incurred by the transfusion event itself ($3723 to $4436) and the cost of refractoriness ($874 to $7578), which included the opportunity cost of a delayed procedure and subsequent platelet transfusions with human leukocyte antigen-matched platelets.

Limitations and conclusions: Although we were unable to include all cost components identified in the conceptual framework in our total cost estimate, thus likely underestimating the true total cost, and despite the data gaps and challenges limiting our estimate of the full cost of a platelet transfusion in patients with CLD-associated thrombocytopenia undergoing an elective procedure in the United States, this study outlines a comprehensive conceptual framework for estimating the cost elements of a platelet transfusion in these patients.     

Pacific trade and regionalization, 1965–1990

The configuration of the Pacific continues to be vague despite much discussion of regionalization of the Pacific countries. This article discusses the factors contributing to regionalization in the Pacific and examines Pacific trade over the 1965–1990 period in order to define the geographic structure of the region. Our results indicate that Pacific trade is characterized by a hierarchy with dominant vertical linkages centered on two main market cores: Japan and the United States. The presence of several subregional cores reveals the Pacific to be a multiple node trading region rather than a unified region. Implications of our findings for emerging global trade patterns are discussed.     

Determinants of Nikkei futures mispricing in international markets: Dividend clustering,currency risk,and transaction costs

This paper develops a comprehensive modified cost-of-carry model to study the mispricing of Nikkei 225 index futures contracts traded in Osaka, Singapore, and Chicago based on a new 19-year data set. Using this improved model, we find that dividend clustering, currency risk, and transaction costs all play an essential role in the estimation of Nikkei mispricing. An exponential smooth transition autoregressive-GARCH model is used to describe the international dynamics of Nikkei mispricing. The results indicate that generally mean reversion in mispricing and limits to arbitrage are driven more by transaction costs than by heterogeneous investors.     

The growing popularity of spiritual brands: What drives purchase intent?

In this study, we investigate the reason for the growing popularity of FMCG (Fast Moving Consumer Goods) household products branded, promoted and sold in India by local spiritual leaders. We find that religiosity and normative community pressure are important purchase drivers for such products. Surprisingly, pragmatism in the presence of normative pressure also contributes to demand. We argue that self-identity theory provides a contextualized explanation in association with social identity theory to explain the influence of normative pressure on increased demand. The results of the study suggest that integrating social and self-identity theories provides a fuller insight into consumer behaviour in a complex social context.     

Consumer attitude towards brand-extension incongruity: The moderating role of need for cognition and need for change

Abstract

This paper integrates two contradictory predictions from the schema incongruity theory: a linear versus an inverted-U relationship between brand-extension incongruity and evaluation. It suggests two personality variables, namely, need for cognition and need for change that moderate the relationship. The major proposition that the relationship would be linear for individuals low in both personality dimensions and inverted-U for those high on both was supported by the data obtained through a questionnaire study. The highest evaluation was obtained for the moderately incongruent extension compared to the congruent and extremely incongruent brand extensions of an established brand for individuals high on both personality dimensions. Four innovative behaviour types identified on the basis of a combination of high and low categories of participants on the two personality dimensions also provided similar results. Theoretical and practical implications of the findings, limitations of the present study, and future possibilities are discussed.     

The cost-effectiveness of levodopa/carbidopa intestinal gel compared to standard care in advanced Parkinson’s disease

Background: Parkinson’s disease (PD) is an incurable, progressive neurological condition, with symptoms impacting movement, walking, and posture that eventually become severely disabling. Advanced PD (aPD) has a significant impact on quality-of-life (QoL) for patients and their caregivers/families. Levodopa/carbidopa intestinal gel (LCIG) is indicated for the treatment of advanced levodopa-responsive PD with severe motor fluctuations and hyper-/dyskinesia when available combinations of therapy have not given satisfactory results.

Aims: To determine the cost-effectiveness of LCIG vs standard of care (SoC) for the treatment of aPD patients.

Methods: A Markov model was used to evaluate LCIG vs SoC in a hypothetical cohort of 100 aPD patients with severe motor fluctuations from an Irish healthcare perspective. Model health states were defined by Hoehn &; Yahr (H&;Y) scale—combined with amount of time in OFF-time—and death. SoC comprised of standard oral therapy?±?subcutaneous apomorphine infusion and standard follow-up visits. Clinical efficacy, utilities, and transition probabilities were derived from published studies. Resource use was estimated from individual patient-level data from Adelphi 2012 UK dataset, using Irish costs, where possible. Time horizon was 20 years. Costs and outcomes were discounted at 4%. Both one-way and probabilistic sensitivity analyses were conducted.

Results: The incremental cost-effectiveness ratio for LCIG vs SOC was €26,944/quality adjusted life year (QALY) (total costs and QALYs for LCIG vs SoC: €537,687 vs €514,037 and 4.37 vs 3.49, respectively). LCIG is cost-effective at a payer threshold of €45,000. The model was most sensitive to health state costs.

Conclusion: LCIG is a cost-effective treatment option compared with SoC in patients with aPD.     

From Coping Strategies to Tactics: London's Low‐Pay Economy and Migrant Labour

This article examines the means by which low‐paid migrant workers survive in a rapidly changing and increasingly unequal labour market. In a departure from the coping strategies literature, it is argued that the difficulties migrant workers face in the London labour market reduces their ability to ‘strategize’. Instead, workers adopt a range of ‘tactics’ that enable them to ‘get by’, if only just, on a day‐to‐day basis. The article explores these tactics with reference to the connections between different workers’ experiences of the workplace, home and community, and demonstrates the role of national, ethnic and gender relations in shaping migrant workers’ experiences of the London labour market and of the city more widely.     

The association of pain interference and opioid use with healthcare utilization and costs,and wage loss among adults with osteoarthritis in the United States

Abstract

Aim: To examine associations of opioid use and pain interference with activities (PIA), healthcare resource utilization (HRU) and costs, and wage loss in noninstitutionalized adults with osteoarthritis in the United States (US).

Methods: Adults with osteoarthritis identified from the Medical Expenditure Panel Survey for 2011/2013/2015 were stratified by no-opioid use with no/mild PIA, no-opioid use with moderate/severe PIA, opioid use with no/mild PIA, and opioid use with moderate/severe PIA. Outcomes included annualized total HRU, direct healthcare costs, and wage loss. Multivariable regression analyses were used for comparisons versus no-opioid use with no/mild PIA (referent). The counterfactual recycled prediction method estimated incremental costs. Results reflect weighted nationally representative data.

Results: Of 4,921 participants (weighted n?=?20,785,007), 46.5% had no-opioid use with no/mild PIA; 23.2% had no-opioid use with moderate/severe PIA; 9.6% had opioid use with no/mild PIA; and 20.7% had opioid use with moderate/severe PIA. Moderate/severe PIA and/or opioid use were associated with significantly higher HRU and associated costs, and wage loss. Relative to adults with no/mild PIA, opioid users with moderate/severe PIA were more likely to have hospitalizations, specialist visits, and emergency room visits (all p?<?.001). Relative to the referent, opioid use with no/mild PIA had higher per-patient incremental annual total healthcare costs ($11,672, 95% confidence interval [CI]?=?$11,435–$11,909) and wage loss ($1,395, 95% CI?=?$1,376–$1,414) as did opioid use with moderate/severe PIA ($13,595, 95% CI?=?$13,319–$13,871; and $2,331, 95% CI?=?$2,298–$2,363) (all p?<?.001). Compared with the referent, estimated excess national total healthcare costs/lost wages were $23.3 billion/$1.3 billion for opioid use with no/mild PIA, and $58.5 billion/$2.2 billion for opioid use with moderate/severe PIA.

Limitations: Unobservable/unmeasured factors that could not be accounted for.

Conclusions: Opioid use with moderate/severe PIA had significantly higher HRU, costs, and wage loss; opioid use was more relevant than PIA to the economic burden. These results suggest unmet needs for alternative pain management strategies.     

Who Learns What?—A Study Based on Entrepreneurs from Biotechnology New Ventures

Despite a proliferation of research in the field of entrepreneurship, our understanding of entrepreneurial learning remains limited. We do not have systematic answers to many key questions. To what extent does the context of the learning shape that learning? How does the prior experience of an entrepreneur influence what they learn in new ventures? Does the specific role that the entrepreneur plays in a new venture, and the characteristics of the venture team, influence learning? To address this gap, and to progress the broader program of empirical research into entrepreneurial learning, we need to more fully explicate both the context and the content of learning. That is the objective and contribution of this study. We find that prior experience, the “division of (decision‐making) labor” and the “knowledge” characteristic of the venture team shape learning. One implication is that future research will need to assess more carefully both the content of new learning from the new venture experience, and the context of learning.     

The effect of functional status impairment on nursing home admission risk among patients with advanced Parkinson’s disease

Abstract

Aims: To estimate the relationship between functional status (FS) impairment and nursing home admission (NHA) risk in Parkinson’s disease (PD) patients, and quantify the effect of advanced PD (APD) treatment on NHA risk relative to standard of care (SoC).

Materials and methods: PD patients were identified in the Medicare Current Beneficiary Survey (MCBS) (1992–2010). A working definition based on the literature and clinical expert input determined APD status. A logit model estimated the relationship between FS impairment and NHA risk. The effect of levodopa-carbidopa intestinal gel (LCIG) on NHA risk relative to SoC was simulated using clinical trial data (control: optimized oral levodopa-carbidopa IR, ClinicalTrials.gov NCT00660387 and NCT0357994).

Results: Non-advanced PD and APD significantly increased NHA risk when controlling for demographics (p?<?0.01). APD status was no longer significant after controlling for FS limitations, implying that FS limitations explain the increased NHA risk in APD patients. Reduced impairment in FS in patients with APD treated with LCIG reduced risk of NHA by 13.5% relative to SoC.

Limitations: This study applies clinical trial results to real-world data. LCIG treatment might have a different effect on NHA risk for the nationally representative population than the effect measured in the trial. Both data sources employ different instruments to measure FS, instrument wording and study follow-up differed, which might bias our estimates. Finally, there lacks consensus on a definition of APD. The prevalence of APD in this study is high, perhaps due to the specific definition used.

Conclusions: Patients with APD experience a higher risk in NHA than those with non-advanced disease. This increased risk in NHA in patients with APD is explained by greater limitations in FS. The relative reduction in risk of NHA for the APD population treated with LCIG is quantitatively similar to doubling Medicaid home care services.