Commercial Perspective Research Articles

Pink sincerity: post-postmodernism and double appropriation in marketing

ABSTRACT This paper argues that popular culture can teach marketing how to incorporate ideological perspectives. Through a rhetorical analysis of the movie Barbie, focusing on a post-postmodern narrative strategy of irony and sincerity, the paper demonstrates how the movie integrates critical and celebratory feminist perspectives with commercial perspectives on the Barbie doll. We argue that Barbie is an ambiguous and contextually sensitive text, which includes both critical and celebratory perspectives on Barbie and Mattel, as well as cultural commentary on feminism and marketing. We operationalise this post-postmodern narrative strategy as double appropriation and argue that, in the case of feminism, it specifically plays out as pink sincerity. We suggest the concept of double appropriation and pink sincerity has implications for brand’s sincere ideological engagement.

Academic Entrepreneurial Orientation for Sustainable Development Goals in Higher Education in Indonesia: A Confirmatory Factor Analysis

Objective: This study aims to create a model for measuring the academic entrepreneurial orientation of higher education lecturers in Indonesia. Theoretical Framework: Academic entrepreneurship theory describes the perspective of commercialization of research in higher education to benefit society. This theoretical framework highlights the importance of individual entrepreneurial orientation in commercialization and academic entrepreneurship in higher education. Method: This research uses a quantitative survey. The target population was lecturers who have conducted research with commercial potential at eleven state universities in Indonesia. The research consisted of 330 samples, according to the ideal number of samples for structural equation modeling (SEM) analysis. Data analysis was conducted using confirmatory factor analysis and SEM techniques using the AMOS 21 program. Results and Discussion: The study shows that 15 factors contribute to lecturers' academic entrepreneurial orientation, proving to measure and explain their existence in the model and significantly supporting it. Research Implications: This study's findings can be a practical guide for universities to measure the entrepreneurial orientation of lecturers and develop it in the future. For the academic world, this research can inspire further research in the field of entrepreneurship, especially academic entrepreneurship. Originality/Value: This study presents a new model for building and measuring the academic entrepreneurial orientation of higher education lecturers in Indonesia in support of sustainable development goals.

Indiferentní reakce sazenic borovice lesní a buku lesního ošetřených hydroabsorbenty

Super-absorbents are expected to amend soils as they are capable of retaining water, which turns dry loose powdery substances (also capsule) into hydrogel. These were applied to prevent an artificial regeneration failure due to drought events. Four commercially-available products were mixed with soil from planting holes (the capsule was put to the soil) in order to support bare-root Scots pine and European beech seedlings after a spring planting on eleven clear-cut sites in 2020–2021. The plantations were designed as rows with 4 × 150 plants treated with four hydrogels plus 150 plants without hydrogel as a control. The performance evaluation of new plantations was based on attributes such as mortality/survival and relative height and root-collar diameter increments. The plants, which lost their initial size, due to pine weevil damage, dry tops and damage by game, were excluded from the evaluation. Besides the plant response to the applied super-absorbents, the planting operations were evaluated from economic point of view. The 2020 plantations showed higher mortality than 2021 ones; both years showed an excessive loss. The hydrogels did not help the plants to survive better compared to control and growth data also showed ambiguous results. Therefore, from commercial perspective, the application of all tested super-absorbents just increased the renewal costs.

Implication of Financial Services Marketing: A Study with reference to Behavioral Economics

Abstract Purpose – It has been argued that the insights provided by behavioral economics have profound Implications for the study and practice of marketing. The purpose of this paper is to provide a detailed analysis of how such insights help enhance understanding of aspects of marketing and consumer behavior in financial services markets. Design/methodology/approach – This paper looks at various facets of behavioral economics Which it is felt provide particularly important and salient insights in the context of financial services. In particular, it studies loss aversion and prospect theory, status quo bias and defaults, framing and anchoring effects, hyperbolic discounting, availability effect and salience and over-confidence. In doing so, it provides a number of examples from the financial services context which provide insightful and informative insights for both commercial practitioners and policymakers. In each case, relevant phenomena are introduced and explained before providing a number of applications and examples from the financial services domain. Findings – The authors find that the insights afforded by behavioral economics are useful in helping to explain various aspects of consumer behavior in financial services markets. It is shown that an understanding of the implications of behavioral economics may help in fashioning a choice architecture that is more likely to bring the desired consumer response, from either a commercial or policymaking perspective. Practical implications – This analysis provides important insights for those responsible for the Marketing of financial services, policymakers in the financial services domain, third sector agencies seeking to foster greater engagement with financial services and other interested parties. Originality/value – The paper adds value by drawing together various aspects of behavioral Economics, providing an analysis of their relevance to financial services marketing and offering Numerous examples and applications. Keywords-: Financial services, Behavioral economics, Consumer behavior in financial services, Marketing Paper type-: Conceptual paper

Strategies for the Total Synthesis of Fucoxanthin from a Commercial Perspective

AbstractFucoxanthin, the light-harvesting pigment of various algae, has shown promising biological activity in pre-clinical and clinical models. It has also received marketing approval as a nutraceutical and cosmetic ingredient in the USA and other countries. The commercial synthesis of this natural ingredient assumes significance because of various drawbacks (low yield, patent infringement, longer duration of cultivation, etc.) associated with its extraction and isolation procedures. This review is intended to provide an appraisal of the total syntheses of fucoxanthin reported to date along with a detailed explanation of the commercially viable approach. Finally, we briefly discuss the future of research for the total synthesis of fucoxanthin.

Hydrotalcite-Enhanced Tough and Strong Hydrogel Endowed by Coordination and Electrostatic Interactions for Both Strain and Pressure Sensors.

Polymer hydrogels have a wide range of applications in the field of flexible wearable devices from the perspective of easy commercialization and environmental compatibility. However, traditional hydrogels often fail to achieve adequate mechanical strength and performance such as toughness, resilience, and ionic conductivity. Herein, a significant enhancement of tensile strength in 2 orders of magnitude (from 36 kPa to 1.5 MPa) is obtained by the introduction of hydrotalcite into polymer network via multiple, multilevel, and strong interactions of strengthened interface interactions, and the enhancement effect is superior to most of known records. Meanwhile, the enhanced conductivity may be rationally attributed to effective channels of hydrotalcite for ion transport. As a result, high toughness (9.5 MJ/m3), stretchability (1520%), excellent resilience (100% rebound of 400% strain), high conductivity (2.6 mS/cm), and low-temperature resistance are successfully achieved. The work shows an efficient approach to design desired ultratough and multifunctional hydrogels.

Historical Reasons for the Difference in Football Performance between China and Japan

The gap between China and Japan in football performance is widening, but few articles have been written on its impact on football from a historical perspective. This article hopes to bring some enlightenment and suggestions for the development direction of Chinese football in the process of studying the historical reasons of the two countries on the performance of football. This article compares the origin, folk development, representative significance, and political aspects of football in the two countries, and analyzes several factors that lead to differences in participation levels from the perspective of commercialization, official support, and historical background. It is concluded that the main impact of historical reasons on Chinese and Japanese football is the formation of a localized and mature football culture in Japan, which is not present in China. Based on this conclusion, it is concluded that the development direction of Chinese football should be aimed at developing and forming its own football culture.

Commercial perspectives: Genome editing as a breeding tool for health and well-being in dairy cattle

Genome editing is the latest breeding tool capable of accelerating the rate of genetic improvement for health and well-being traits in food animals. It enables the introduction of beneficial alleles within a single generation, including those of low frequency or absent in the population, while effectively bypassing linkage drag. For the dairy industry, genome editing can be used to make rapid genetic improvements that are precise, efficient, and transgene-free for functional traits that are not practically addressed without disrupting conventional breeding goals for overall economic merit based on genomic selection. Herein, various case studies for dairy cattle breeding are presented that demonstrate applications of genome editing for enhancing heat stress tolerance, reduced disease susceptibility, and/or other qualitative traits absent in some breeds. One case highlights the success of simultaneous editing of multiple loci through recent advancements in embryonic stem cell biology. Multiplexed editing is crucial for addressing the polygenic nature inherent to many economically important traits in livestock. However, maximizing the benefits of genome editing depends on the continued discovery of targets for editing that are commercially important. Commercialization also depends on rapidly evolving regulatory statutes for risk assessment, where some countries already permit the commercialization of cattle with non-GMO genome alterations through existing regulations. New breeding technologies like genome editing are now poised to have significant impact in equipping elite performance cattle to be more resilient to infectious disease and climate change without the loss of production gains obtained from decades of selection.

Advanced therapies in orthopaedics.

Advanced therapies are expected to play a crucial role in supporting repair after injury, halting the degeneration of musculoskeletal tissue to enable and promote physical activity. Despite advancements, the progress in developing advanced therapies in orthopaedics lags behind specialties like oncology, since innovative regenerative treatment strategies fall short of their expectations in musculoskeletal clinical trials. Researchers should focus on understanding the mechanism of action behind the investigated target before conducting clinical trials. Strategic research networks are needed that not only enhance scientific exchange among like-minded researchers but need to include early on commercial views, companies and venture perspectives, regulatory insights and reimbursement perspectives. Only in such collaborations essential roadblocks towards clinical trials and go-to-patients be overcome.

An AHP-based evaluation framework for automotive stamping suppliers

PurposeThis study aims to establish a robust evaluation framework for suppliers within the automotive supply chain, specifically in the stamping sector. The primary objectives are to elucidate the performance criteria of suppliers, identify indicators and scales for measuring these criteria and find the importance of the criteria.Design/methodology/approachThe evaluation framework comprises a criteria hierarchy and indicators developed based on the evaluation criteria of major automotive manufacturers. Specific indicators and measurement scales are recommended for assessing suppliers. Importance weights for the criteria are assigned based on the input of nine experts using the Analytic Hierarchy Process (AHP). Finally, four sheet metal stamping tooling (SMST) suppliers are evaluated by four specialists using the proposed evaluation framework.FindingsThe study introduces a novel classification of criteria, encompassing financial and commercial perspectives, delivery capability, supplier facility and cultural approaches and business process necessities. The findings underscore the significance of financial and commercial stability in the selection of SMST suppliers, emphasizing their role in mitigating risks associated with disruptions, bankruptcies and unforeseen events. Additionally, several SMST evaluation factors identified in this study contribute to the development of resilience capabilities, highlighting the crucial importance of their inclusion and assessment in the proposed evaluation framework.Originality/valueThis research presents a comprehensive model for evaluating SMST suppliers, which tackles the multidisciplinary challenges within the automotive supply chain. Given the inadequacy or nonexistence of current SMTS selection models, this study bridges the gap by exploring potential and necessary criteria, alongside 116 specific indicators and measurement scales.

Performance Optimization of Alkaline Water Electrolysis Via Catalyst Morphology Tuning and Novel Cell Design

Hydrogen is a basic energy carrier for numerous valuable industrial products. Green hydrogen produced using renewable electricity and water electrolysis is pivotal in advancing a decarbonized sustainable energy ecosystem. Two primary electrolysis technologies, alkaline water electrolysis (AWE) and polymer electrolyte membrane water electrolysis (PEMWE), have demonstrated a viable commercial perspective. AWE is particularly well-suited for large-scale deployment, especially at the gigawatt scale, due to low capital cost and long lifetime. [1]. The performance of AWE is largely determined by the effectiveness of nickel-based oxygen evolution reaction (OER) catalysts and PGM-based or PGM-free hydrogen evolution reaction (HER) catalysts. To enhance the catalyst activity and cell performance, we meticulously control morphology and chemical composition of the catalysts. Cell testing was conducted in cells of various active areas (5, 25, and 50cm2) to demonstrate the result consistency and scalability. An innovative cell design, incorporating a reference hydrogen electrode in both cathode and anode, enabled the real-time acquisition of half-cell polarization curves during tests. This configuration proved valuable information to identify performance limitations in the single cells, thus guiding effective cell design and optimization. Furthermore, a cell comprising Ni-based anode and PGM cathode demonstrated remarkable stability.1. Schalenbach, Aleksandar R. Zeradjanin, Olga Kasian, Serhiy Cherevko, and Karl J.J. Mayrhofer, Int. J. Electrochem. Sci., 1173–1226 (2018).

Bioactive Exploration in Functional Foods: Unlocking Nature's Treasures.

Functional foods offer an appealing way to improve health and prevent chronic diseases, and this subject has received much attention lately. They are effective in preventing chronic diseases like cancer, diabetes, heart disease, and obesity, according to research. This work presents an in-depth analysis of functional foods, covering key challenges from a scientific, legal, and commercial perspective. Multiple databases were searched to find studies on functional foods included in the systematic literature review. Various aspects of functional foods, from their classification, impact on human wellness, effectiveness in inhibiting chronic diseases, the regulatory environment, global market trends, and industry challenges, are all clarified in this thorough review. This study aims to enhance understanding and establish a pathway for functional foods to be acknowledged as valid choices in the field of dietary supplements. It provides a thorough investigation of bioactive compounds present in functional foods, including but not limited to polyphenols, carotenoids, omega fatty acids, prebiotics, probiotics, and dietary fiber, along with an overview of their potential to mitigate chronic illnesses. We engage in an in-depth exploration of regulatory frameworks, shed light on groundbreaking research advancements, and meticulously examine strategies for commercialization and the variety of global challenges that accompany them. Establishing scientific consensus, navigating complex regulatory processes, dealing with skeptical consumers, and rising levels of competition are all problems that need to be solved in this field. The field of functional foods can advance further, promoting better public health outcomes, by deeply comprehending and addressing these complex dimensions.

U.S. payer budget impact of using an AI-augmented cancer risk discrimination digital histopathology platform to identify high-risk of recurrence in women with early-stage invasive breast cancer

Aims Use of gene expression signatures to predict adjuvant chemotherapy benefit in women with early-stage breast cancer is increasing. However, high cost, limited access, and eligibility for these tests results in the adoption of less precise assessment approaches. This study evaluates the cost impact of PreciseDx Breast (PDxBr), an AI-augmented histopathology platform that assesses the 6-year risk of recurrence in early-stage invasive breast cancer patients to help improve informed use of adjuvant chemotherapy. Materials and methods A decision-tree Markov model was developed to compare the costs of treatment guided by standard of care (SOC) risk assessment (i.e. clinical diagnostic workup with or without Oncotype DX) versus PDxBr with SOC in a hypothetical cohort of U.S. women with early-stage invasive breast cancer. A commercial payer perspective compares costs of testing, adjuvant therapy, recurrence, adverse events, surveillance, and end-of-life care. Results PDxBr use in prognostic evaluation resulted in savings of $4 million (M) in year one compared to current SOC in 1 M females members. Over 6-years, savings increased to $12.5 M. The per-treated patient costs in year one amounted to $19.5 thousand (K) for SOC and $16.9K for PDxBr. Limitations For simplicity, recurrence was not specified. We performed scenario analyses to account for variations in rates for local, regional, and distant recurrence. Second, a recurrent patient incurs the total cost of treated recurrence in the first year and goes back to remission or death. Third, CDK4/6i treatment is only incorporated in the recurrence costs but not in the first line of treatment for early-stage breast cancer due to limited data. Conclusions Sensitivity analyses demonstrated robust overall savings to changes in all variables in the model. The use of PDxBr to assess breast cancer recurrence risk has the potential to fill gaps in care and reduce costs when gene expression signatures are not available.

Adverse event costs of systemic therapies for metastatic colorectal cancer previously treated with fluoropyrimidine-, oxaliplatin- and irinotecan-based chemotherapy and biologics in the US.

Aim: The objective of this study was to compare adverse event (AE) management costs for fruquintinib, regorafenib, trifluridine/tipiracil (T/T) and trifluridine/tipiracil+bevacizumab (T/T+bev) for patients with metastatic colorectal cancer (mCRC) previously treated with at least two prior lines of therapy from the US commercial and Medicare payer perspectives. Materials & methods: A cost-consequence model was developed to calculate the per-patient and per-patient-per-month (PPPM) AE costs using rates of grade 3/4 AEs with incidence ≥5% in clinical trials, event-specific management costs and duration treatment. Anchored comparisons of AE costs were calculated using a difference-in-differences approach with best supportive care (BSC) as a common reference. AE rates and treatment duration were obtained from clinical trials: FRESCO and FRESCO-2 (fruquintinib), RECOURSE (T/T), CORRECT (regorafenib) and SUNLIGHT (T/T, T/T+bev). AE management costs for the commercial and Medicare perspectives were obtained from publicly available sources. Results: From the commercial perspective, the AE costs (presented as per-patient, PPPM) were: $4015, $1091 for fruquintinib (FRESCO); $4253, $1390 for fruquintinib (FRESCO-2); $17,110, $11,104 for T/T (RECOURSE); $9851, $4691 for T/T (SUNLIGHT); $8199, $4823 for regorafenib; and $11,620, $2324 for T/T+bev. These results were consistent in anchored comparisons: the difference-in-difference for fruquintinib based on FRESCO was -$1929 versus regorafenib and -$11,427 versus T/T; for fruquintinib based on FRESCO-2 was -$2257 versus regorafenib and -$11,756 versus T/T. Across all analyses, results were consistent from the Medicare perspective. Conclusion: Fruquintinib was associated with lower AE management costs compared with regorafenib, T/T and T/T+bev for patients with previously treated mCRC. This evidence has direct implications for treatment, formulary and pathways decision-making in this patient population.

Budget impact analysis of biosimilar natalizumab in the US.

Biosimilars provide an opportunity for a more sustainable and cost-effective treatment for multiple sclerosis (MS). This study evaluated the potential financial impact of implementing a formulary change from reference to biosimilar natalizumab (NTZ) from the US commercial payer perspective. The budget impact of transitioning to biosimilar NTZ for the treatment of relapsing-remitting MS (RRMS) was estimated over a 3-year time horizon based on real-world dosing. Additional scenario analyses were conducted by varying the price differential of biosimilar NTZ. The target population was estimated from a 1-million-member hypothetical commercial health plan. Model inputs were drug acquisition costs and treatment-related and patient coinsurance costs. Budget impact and cost savings per member per year were calculated by assuming a biosimilar uptake of 10% in year 1 to 20% in year 3. Over 3 years, 255 patients were estimated to be treated with high-efficacy disease-modifying therapies for RRMS. The inclusion of biosimilar NTZ onto a formulary would result in cumulative cost savings to payers of $452,611 over 3 years, with mean savings per treated member per year of $1179, $1769, and $2359 in years 1, 2, and 3, respectively. One-way sensitivity analyses indicated that budget impact results were most sensitive to drug acquisition costs of both reference and biosimilar NTZ. Adoption of biosimilar NTZ can yield considerable cost savings to US health plans that could result in increased treatment access for patients with RRMS.

Cost-effectiveness of large-panel next-generation sequencing in guiding first-line treatment decisions for patients with nonsquamous advanced non-small cell lung cancer.

Clinical practice guidelines recommend broad-panel genomic profiling to identify actionable genomic alterations for patients with advanced non-small cell lung cancer (aNSCLC). To assess the cost-effectiveness of large-panel next-generation sequencing (LP-NGS) compared with current empirical single-gene test (SGT) patterns to inform first-line treatment decisions for patients with aNSCLC from a US commercial payer perspective, accounting for the effect of testing turnaround time and time to treatment initiation. We developed a discrete-event simulation model to estimate the impact of LP-NGS vs SGT for patients with nonsquamous aNSCLC. Discrete events and timing included testing patterns, receipt of the initial test result, treatment initiation (targeted vs nontargeted therapies), switching, retesting, rebiopsies, clinical trial participation, progression on therapy, and death. LP-NGS and SGT cohorts each comprised 100,000 adults with aNSCLC simulated over a 5-year postdiagnosis period, assumed to have the same distribution of genomic alterations. The model predicted the proportion of patients receiving appropriate first-line therapy according to clinical practice guidelines. Economic outcomes included expected life-years gained, quality-adjusted life-years, and the total costs of care over 5 years. Sensitivity and scenario analyses explored the robustness of the base-case model results. In the base-case model, LP-NGS was likely to identify more alterations than SGT. Total 5-year costs per patient were $539,658 for LP-NGS and $544,550 for SGT (net difference, $4,892 lower costs per patient for LP-NGS), which is likely to be cost-effective 95.1% of the time. The most influential model parameters on the 5-year total costs of care were preprogression nondrug medical costs on nontargeted therapy, NGS turnaround time, and clinical trial participation. This study suggests that LP-NGS to guide first-line treatment decisions is clinically more appropriate (more likely to identify alterations and subsequently allocate patients to clinically appropriate therapy) and provides a dominant cost-effectiveness treatment strategy over 5 years for patients with newly diagnosed aNSCLC in the United States.

A chromosome-scale Mytilus edulis genome assembly for aquaculture, marine ecology, and evolution.

The smooth-shelled blue mussel, Mytilus edulis is part of the Mytilus species complex, encompassing at least three putative species: M. edulis, Mytilus galloprovincialis, and Mytilus trossulus. These three species occur on both sides of the Atlantic and hybridize in nature, and both M. edulis and M. galloprovincialis are important aquaculture species. They are also invasive species in many parts of the world. Here, we present a chromosome-level assembly of M. edulis. We used a combination of PacBio sequencing and Dovetail's Omni-C technology to generate an assembly with 14 long scaffolds containing 94% of the predicted length of the M. edulis genome (1.6 out of 1.7 Gb). Assembly statistics were as follows: total length = 1.65 Gb, N50 = 116 Mb, L50 = 7, and L90 = 13. BUSCO analysis showed 92.55% eukaryote BUSCOs identified. AB-Initio annotation using RNA-seq from mantle, gills, muscle, and foot predicted 47,128 genes. These gene models were combined with IsoSeq validation resulting in 45,379 full CDS protein sequences and 129,708 isoforms. Using GBS and shotgun sequencing, we also sequenced several eastern Canadian populations of Mytilus to characterize single-nucleotide as well as structural variance. This high-quality genome for M. edulis provides a platform to develop tools that can be used in breeding, molecular ecology and evolution to address questions of both commercial and environmental perspectives.

Costs associated with novel first-line (1L) treatments in patients (pts) with locally advanced or metastatic urothelial carcinoma (la/mUC) from a United States (US) Medicare and commercial payer perspective.

e16552 Background: Recent drug approvals in the 1L treatment (tx) setting have expanded options for pts with la/mUC. It is important to understand the economic burden of these novel therapies within the current tx landscape. This study estimated first-year cost of care in the US from a Medicare and commercial payer perspective for pts with la/mUC treated with the following 1L tx: enfortumab vedotin (EV) + pembrolizumab (PEM) in platinum-eligible pts, nivolumab (NIV) + platinum-based chemotherapy (PBC) in cisplatin-eligible pts, and 1L PBC with or without avelumab (AVE) 1L maintenance (1LM). Methods: A cost of care model was developed to estimate direct medical care costs in the first year of tx with EV + PEM, NIV + PBC, and PBC with and without AVE 1LM in pts with la/mUC who are eligible for 1L PBC; pts treated with NIV + PBC were eligible for cisplatin. The latest available costs (2023 USD)—including drug acquisition and administration, disease management, adverse event (AE) management, and subsequent therapy (second-line or later line) costs—were calculated based on tx duration, progression-free survival, overall survival, and AE incidence with various therapies. Efficacy and safety data were sourced from key published trials (EV-302, CheckMate-901, JAVELIN Bladder 100) and product prescribing information. Results: Estimated first-year costs per treated pt are shown in the Table. Cost per treated pt was estimated to range between $56,952 to $438,660 and $90,918 to $457,390 for Medicare and commercial payers, respectively, with the highest cost for EV+PEM and the lowest for PBC only. Drug acquisition costs in the 1L represented the majority of the costs except PBC, for which subsequent tx and administration costs represented the largest cost component. Conclusions: Costs per treated pt were lower for PBC with AVE 1LM than for EV+PEM and NIV+PBC. As value-based oncology care is becoming increasingly important in the US, comprehensive understanding of costs across different tx options and sequences can facilitate informed tx choice. [Table: see text]

Budget impact model of LungFlag, a predictive risk model for lung cancer screening.

10534 Background: Lung cancer screening (LCS) programs using low-dose computed tomography (LDCT) for early detection reduce mortality and have been widely recommended. LungFlag is a machine-learning risk prediction model that uses patient-level data to identify individuals at high risk of developing non-small cell lung cancer (NSCLC), prompting their physician to recommend screening with LDCT. Methods: A budget impact model was developed to estimate the costs associated with adoption of LungFlag as an adjunct to existing US Preventive Services Task Force (USPSTF) screening guidelines for a hypothetical US commercial health plan population of 1 million beneficiaries. The model calculates the total expected annual costs of screening for NSCLC with LDCT in scenarios with and without LungFlag, including healthcare resource utilization for detecting NSCLC and treatment of patients diagnosed with NSCLC. Incremental costs were evaluated over a 5-year period. Results: Among 36,803 USPSTF-eligible persons, we assumed that 4600 (12.5%) had already initiated LCS, leaving 32,203 persons who were candidates for pre-screening with LungFlag. The model estimated that 17 additional NSCLC diagnoses per year would be detected by screening when using LungFlag, with most in stage 1. Over 5 years, LungFlag was estimated to result in 33 fewer patients with stage 3 or stage 4 NSCLC at diagnosis and 22 fewer NSCLC-related deaths. Use of LungFlag increased annual costs during the first 2 years and provided cost savings from Year 4 onwards (Table). Cost savings from LungFlag were attributable to reductions in the costs of advanced NSCLC treatment. Conclusions: In a population of 1 million commercial health plan beneficiaries, the adoption of LungFlag as an adjunct to existing screening guidelines for USPSTF-eligible patients was estimated to prevent 22 additional NSCLC-related deaths, with a cost savings of $2.87 million over 5 years from a US commercial payer perspective. [Table: see text]

Informing optimal treatment (tx) sequences for platinum-eligible patients with locally advanced or metastatic urothelial carcinoma (la/mUC) in the United States: Results of a clinical simulation modeling exercise.

e13514 Background: Platinum-based chemotherapy (PBT) followed by avelumab (AVE) as first-line (1L) maintenance for patients with nonprogressive disease (PBT ± AVE) is the standard of care in la/mUC. This study compared the overall survival (OS) and cost-effectiveness of the tx sequence of PBT ± AVE followed by enfortumab vedotin (EV) or other therapies, including immuno-oncology (IO), in second line (2L; ie, PBT + 2L EV/IO or PBT + AVE + 2L EV/IO) vs 1L EV + pembrolizumab (PEM) for PBT-eligible patients (PBTp) from a US commercial payer perspective. Methods: A partitioned survival model compared outcomes with PBT ± AVE and EV + PEM among PBTp. Inputs included progression-free survival and OS, time to tx discontinuation, adverse event (AE) incidence, and health utilities and costs. Efficacy inputs were sourced and extrapolated from patient data in JAVELIN Bladder 100 (data cut: Jun 4, 2021), AVENANCE real-world study (1), and published data (EV-302 trial). Safety data were sourced from US prescribing information. Drug, subsequent tx, disease management, and AE management costs (2023 USD) were calculated. The optimal tx sequencing scenario assumed 80% of patients starting PBT were eligible to receive AVE (2023 Flatiron data cut; (2)), 70% of patients progressing on PBT ± AVE would start 2L, and 70% of those would be eligible for EV. Outcomes included life-years (LYs), quality-adjusted LYs (QALYs), costs, and incremental cost-effectiveness ratio (ICER). Scenarios and probabilistic sensitivity analyses (PSAs) were conducted to assess uncertainty. Results: LY, QALY, costs, and ICER modeling outcomes are shown in the Table. Use of EV in 2L after PBT ± AVE is associated with 0.76 lower QALYs, but given the large cost saving, it represents a cost-effective use of resources at the $150,000/QALY willingness to pay (WTP) threshold. PSAs showed that PBT ± AVE is likely to be more cost-effective over a broad and relevant WTP threshold range ($0-500,000/QALY). Results were sensitive to drug acquisition costs and eligibility to receive AVE and 2L EV. Conclusions: Based on this simulation exercise, the use of 2L EV after PBT ± AVE achieves considerable survival benefit at substantially lower costs vs 1L EV + PEM in PBTp with la/mUC. Given the shift toward value-based care in oncology, such analyses are becoming increasingly relevant to guide clinical decision-making. There is a need to assess tx alternatives that balance healthcare costs while optimizing outcomes in patients with la/mUC. 1. Barthélémy et al, J Clin Oncol 2024;42[suppl 4]: Abstract 561. 2. Moon et al, J Clin Oncol 2023;41[suppl 16]: Abstract 4567. [Table: see text]