RxRisk-V is a clinically relevant, open source risk adjustment system that is easily tailored to fit specific questions, populations, or needs. Although it does not perform better than diagnosis-based measures available on the market, it may provide a reasonable alternative to proprietary systems where accurate computerized pharmacy data are available.

Objective. To estimate patients' elasticity of demand, willingness to pay, and consumer surplus for five high-cost specialty medications treating metastatic disease or hematologic malignancies. Data Source/Study Setting. Claims data from 71 private health plans from 1997 to 2005. Study Design. This is a revealed preference analysis of the demand for specialty drugs among cancer patients. We exploit differences in plan generosity to examine how utilization of specialty oncology drugs varies with patient out-of-pocket costs. Data Collection/Extraction Methods. We extracted key variables from administrative health insurance claims records. Principal Findings. A 25 percent reduction in out-of-pocket costs leads to a 5 percent increase in the probability that a patient initiates specialty cancer drug therapy. Among patients who initiate, a 25 percent reduction in out-of-pocket costs reduces the number of treatments (claims) by 1-3 percent, depending on the drug. On average, the value of these drugs to patients who use them is about four times the total cost paid by the patient and his or her insurer, although this ratio may be lower for oral specialty therapies. Conclusions. The decision to initiate therapy with specialty oncology drugs is responsive to price, but not highly so. Among patients who initiate therapy, the amount of treatment is equally responsive. The drugs we examine are highly valued by patients in excess of their total costs, although oral agents warrant further scrutiny as copayments increase.

Newborns discharged within 30 hours of birth are at increased risk of death within the first year of life.

In this paper we challenge the traditional distinction between public goods and private goods. Economists use a definition of public goods that rests on the inherent properties of the good itself. Referring to criteria such as non-rivalness and non-excludability, they assert that the distinction is fixed in nature and cannot be altered by human observes. We argue that the boundary between public and private goods is socially constructed. That is, what is a public good and what is a private good is not determined by fixed criteria; rather it is decided by society. Thus, what is a public good in one community might be a private good in another. It is this moveable boundary between public and private that makes it essential to analyźe public policy with values up front, not hidden behind the seemingly technical concept of public goods.

Context The prevalence of overweight and obesity in Saudi Arabia has been rising. Although the health burden of excess weight is well established, little is known about the economic burden. Aims To assess the economic burden—both direct medical costs and the value of absenteeism and presenteeism—resulting from overweight and obesity in Saudi Arabia. Settings and design The cost of overweight and obesity in Saudi Arabia was estimated from a societal perspective using an epidemiologic approach. Methods and materials Data were obtained from previously published studies and secondary databases. Statistical analysis used Overweight/obesity-attributable costs were calculated for six major noncommunicable diseases; sensitivity analyses were conducted for key model parameters. Results The impact of overweight and obesity for these diseases is found to directly cost a total of $3.8 billion, equal to 4.3 percent of total health expenditures in Saudi Arabia in 2019. Estimated overweight and obesity–attributable absenteeism and presenteeism costs a total of $15.5 billion, equal to 0.9 percent of GDP in 2019. Conclusions Even when limited to six diseases and a subset of total indirect costs, results indicate that overweight and obesity are a significant economic burden in Saudi Arabia. Future studies should identify strategies to reduce the health and economic burden resulting from excess weight in Saudi Arabia.

Pharmaceutical companies and generic drug manufacturers have long been at odds over “data exclusivity” regulations. These rules require a waiting period of up to eight years before generic drug companies can access valuable clinical trial data necessary to bring less expensive forms of innovative drugs to market. Pharmaceutical companies want the data exclusivity period lengthened to protect their investment. Generic manufacturers want the period shortened so they can bring less expensive versions of drugs to patients sooner. We examine the long-term effect of extending the data exclusivity period for “conventional” small-molecule drugs to twelve years – the same exclusivity period already extended to large-molecule biologic drugs under the Affordable Care Act. We conclude that Americans would benefit from a longer period of data exclusivity.

Context. Preventive care has been shown as a high‐value health care service. Many employers now offer expanded coverage of preventive care to encourage utilization. Objective. To determine whether expanding coverage is an effective means to encourage utilization. Design. Comparison of screening rates before and after introduction of deductible‐free coverage. Setting. People insured through large corporations between 2002 and 2006. Patients or Other Participants. Preferred Provider Organization (PPO) enrollees from an employer introducing deductible‐free coverage, and a control group enrolled in a PPO from a second employer with no policy change. Main Outcome Measures. Adjusted probability of endoscopy, fecal occult blood test (FOBT), lipid screens, mammography, and Papanicolaou (pap) smears. Intervention. Introduction of first‐dollar coverage (FDC) of preventive services in 2003. Results. After adjusting for demographics and secular trends, there were between 23 and 78 additional uses per 1,000 eligible patients of covered preventive screens (lipid screens, pap smears, mammograms, and FOBT), with no significant changes in the control group or in a service without FDC (endoscopy). Conclusions. FDC improves utilization modestly among healthy individuals, particularly those in lower deductible plans. Compliance with guidelines can be encouraged by lowering out‐of‐pocket costs, but patients' predisposing characteristics merit attention.

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