Trends In Spending Research Articles

Money Attitude and Socio-Demographic Factors as Determinants of University Students’ Spending Behavior in Shah Alam, Malaysia

ABSTRACTNowadays, uncontrollable spending habit towards Malaysian young generations are becoming progressively. They have a tendency to have less value of money compared to the elder generations in spending their money. Since the cost of living in Malaysia has improved remarkably, the young generations enjoyed spending their money heavenly, therefore Malaysia faced changes in lifestyle and spending trend. This study proposes to investigate the relationship between money attitude and socio-demographic as determinants of college students’ spending behaviours. As such, the correlation between money attitude factors (power-prestige, distrust, retention-time and anxiety) and spending behaviours among Malaysian college students is a topic worthy of further exploration. At the same time, this study also attempts to explore whether college students’ spending behaviours are affected by their socio-demographic factors such as gender, age. The sample of this study consists of 176 students from three different universities in the Shah Alam area i.e University Selangor (UNISEL), University Management Science (MSU) and Universiti Teknologi Malaysia (UiTM). The regression analysis showed that there were only two factors of money attitude (power-prestige, and anxiety) that had a significant effect on spending behaviour among these universities’ students. However, from the analysis, it can be revealed that none of the socio-demographic factors had a significance (more than 0.05) towards the spending behaviour of the students. Thus, age (positive result) is the most influenced factor of the students’ spending behaviour. Consequently, several suggestions have been put forward and hoped that it will assist students in managing their fund effectively

US Public Health Neglected: Flat Or Declining Spending Left States Ill Equipped To Respond To COVID-19.

The COVID-19 pandemic has prompted concern about the integrity of the US public health infrastructure. Federal, state, and local governments spend $93billion annually on public health in the US, but most of this spending is at the state level. Thus, shoring up gaps in public health preparedness and response requires an understanding of state spending. We present state spending trends in eight categories of public health activity from 2008 through 2018. We obtained data from the Census Bureau for all states except California and coded the data by public health category. Although overall national health expenditures grew by 4.3percent in this period, state governmental public health spending saw no statistically significant growth between 2008 and 2018 except in injury prevention. Moreover, state spending levels on public health were not restored after cuts experienced during the Great Recession, leaving states ill equipped to respond to COVID-19 and other emerging health needs.

Population-level changes in outcomes and Medicare cost following the introduction of new cancer therapies.

To examine the population-level impacts of the introduction of novel cancer therapies with high cost in the United States, using immunotherapies in advanced nonsmall cell lung cancer (NSCLC) as an example. Surveillance, Epidemiology, and End Results data in 2012-2015 linked to Medicare fee-for-service claims until 2016. We examined population-level trends in treatment patterns, survival, and Medicare spending in patients diagnosed with advanced NSCLC, the leading cause of cancer death in the United States, between 2012 and 2015. We estimated the percentage of patients who received any antineoplastic therapy within two years of diagnosis, including novel immunotherapies. We compared the trends in overall survival and mean two-year Medicare spending per each patient before and after the introduction of immunotherapies in 2015. Not Applicable. The percentage of patients treated with any antineoplastic therapy remained the same at 46.7% in 2012 and 2015, whereas the use of immunotherapies increased from 0% to 15.2%. The two-year survival rate and median survival increased by 3.3 percentage points (95% CI: 2.0, 4.5) and 0.4months (CI: 0.0, 0.9), respectively, during the same period. The mean two-year total Medicare spending and outpatient spending per patient increased by $5735 (CI: 3479, 8040) and $7661 (CI: 5902, 9311), respectively, which were largely attributable to the increases in immunotherapy spending by $5806 (CI: 5165, 6459). The introduction of lung cancer immunotherapies was accompanied by improvements in survival and increases in spending between 2012 and 2015 in the Medicare population. As novel immunotherapies and other target therapies continue to change the clinical management of various cancers, further efforts are needed to ensure their effective and efficient use, and to understand their population-level impacts in the United States.

Cointegration Analysis of Tourism Sector, Inflation, Interest Rate and Economic Growth in a Special Autonomy Region of Aceh Province, Indonesia

This study is aimed at examining the cointegration relationship of tourism spending, inflation, interest rate, and economic growth. In addition, the correction measure is conducted to measure the tourism spending, inflation, interest rate, and economic growth trend are sustainable in Special Autonomy Province of Aceh, Indonesia between 1990 - 2019. Data from Indonesian Statistics Agency and Central Bank of Indonesia was used in this study. Johansen integration test figures out long run equilibrium of the analysed variables. Augmented Dickey Fuller test figures out that all variables are stationary at first difference. The result provides the evidence that there is one cointegrating relationship maintained. The result shows the long-term relationship of economic growth, tourism spending, inflation, and interest rate, where the null hypothesis is rejected with a statistical trace, and one vector equation co-integrates with the Max-Eigen statistical. This study recommends that policymakers should maintain low rate of inflation and constant level of interest rate.

Trends in Low-Value Health Service Use and Spending in the US Medicare Fee-for-Service Program, 2014-2018

Low-value care, defined as care offering no net benefit in specific clinical scenarios, is associated with harmful outcomes in patients and wasteful spending. Despite a national education campaign and increasing attention on reducing health care waste, recent trends in low-value care delivery remain unknown. To assess national trends in low-value care use and spending. In this cross-sectional study, analyses of low-value care use and spending from 2014 to 2018 were conducted using 100% Medicare fee-for-service enrollment and claims data. Included individuals were aged 65 years or older and continuously enrolled in Medicare parts A, B, and D during each measurement year and the previous year. Data were analyzed from September 2019 through December 2020. Being enrolled in fee-for-service Medicare for a period of time, in years. The Milliman MedInsight Health Waste Calculator was used to assess 32 claims-based measures of low-value care associated with Choosing Wisely recommendations and other professional guidelines. The calculator designates services as wasteful, likely wasteful, or not wasteful based on an absence of indication of appropriate use in the claims history; calculator-designated wasteful services were defined as low-value care. Spending was calculated as claim-line level (ie, spending on the low-value service) and claim level (ie, spending on the low-value service plus associated services), adjusting for inflation. Among 21 045 759 individuals with fee-for-service Medicare (mean [SD] age, 77.4 [7.9] years; 12 515 915 [59.5%] women), the percentage receiving any of 32 low-value services decreased from 36.3% (95% CI, 36.3%-36.4%) to 33.6% (95% CI, 33.6%-33.6%) from 2014 to 2018. Uses of low-value services per 1000 individuals decreased from 677.8 (95% CI, 676.2-679.5) to 632.7 (95% CI, 632.6-632.8) from 2014 to 2018. Three services comprised approximately two-thirds of uses among 32 low-value services per 1000 individuals: preoperative laboratory testing decreased from 213.8 (95% CI, 213.4-214.2) to 166.2 (95% CI, 166.2-166.2), while opioids for back pain increased from 154.4 (95% CI, 153.6-155.2) to 182.1 (95% CI, 182.1-182.1) and antibiotics for upper respiratory infections increased from 75.0 (95% CI, 75.0-75.1) to 82 (95% CI, 82.0-82.0). Spending per 1000 individuals on low-value care also decreased, from $52 765.5 (95% CI, $51 952.3-$53 578.6) to $46 921.7 (95% CI, $46 593.7-$47 249.7) at the claim-line level and from $160 070.4 (95% CI, $158 999.8-$161 141.0) to $144 741.1 (95% CI, $144 287.5-$145 194.7) at the claim level. This cross-sectional study found that among individuals with fee-for-service Medicare receiving any of 32 measured services, low-value care use and spending decreased marginally from 2014 to 2018, despite a national education campaign in collaboration with clinician specialty societies and increased attention on low-value care. While most use of low-value care came from 3 services, 1 of these was opioid prescriptions, which increased over time despite the harms associated with their use. These findings may represent several opportunities to prevent patient harm and lower spending.

Tapping Home Equity: Income and Spending Trends Around Cash-Out Refinances and HELOCs

Approximately two thirds of American families own a home and for most homeowners, their house is also their most important source of wealth. Homeowners are currently sitting on historically high levels of home equity and the potential withdrawal of this home equity has important implications for consumption at the macroeconomic and household levels. In this report, we examine the extent to which liquidating home equity boosts consumption, as well as how income dynamics around equity extraction may play a role in influencing households’ decision to draw from this source of wealth. Using loan-level servicing data from Chase mortgage customers combined with corresponding Chase deposit account data from 2012 to 2018, we create a sample of more than 50,000 homeowners who either obtained a cash-out refinance or drew on a home equity line of credit (HELOC). We find that for homeowners who cash-out refinanced, most refinanced into a lower interest rate but a higher monthly payment because of a larger loan balance. Also, after controlling for secular trends, homeowners who obtained a cash-out refinance had no change in income whereas homeowners who extracted equity via a HELOC experienced declining income. For both groups, consumption spiked considerably as soon as the liquidated equity flowed into the bank account but quickly settled to steady state-levels at a higher level, 5 percent and 7 percent above baseline for HELOCs and cash-out refinances, respectively. After one year, cash-out refinance homeowners spent 33 percent of their total equity extracted while those with a HELOC spent 47 percent overall. For both sample groups, these marginal propensities to consume (MPCs) were highest for younger homeowners and those with higher loan-to-values (LTVs). Taken together, these findings have important implications for macroeconomic and housing policies.

Trends in Pediatric Private Insurance and Medicaid Spending: A Repeated Cross-Sectional Analysis of Data from 2002 to 2014.

Given increased focus on health spending, this investigation aims to compare trends in pediatric Medicaid and private insurance spending on type of service from 2002 to 2014 in order to inform policy and research. A repeated cross-sectional analysis of 2002 to 2014 National Health Expenditure Accounts data was conducted. Total spending, per capita spending, and compounded annual growth rates for type of service were determined for children ages 0 to 18 at the national level. Per capita spending growth was higher for private insurance than for Medicaid, and the areas of high per capita spending growth differed for private insurance and Medicaid. While Medicaid spent more per capita on hospital care than private insurance, private insurance demonstrated greater per capita spending growth on hospital care than Medicaid (8.49% vs 1.99%, respectively). Conversely, per capita spending on home health care grew more for Medicaid (6.79%) than for private insurance (3.18%). Trends in private insurance and Medicaid overall and per capita spending differ. Medicaid experienced higher annual growth in total spending than per capita spending, while private insurance had greater annual growth in per capita spending than total spending. Growth in private insurance per capita spending was higher than growth in Medicaid per capita spending, but growth in Medicaid total spending was higher than growth in private insurance total spending. These data suggest that Medicaid and private insurance may have different drivers of spending growth, highlighting the need for policy makers to examine spending patterns by payer. Further research to determine why such differences in spending growth exist will better inform efforts to increase health care value.

State and regional policy on industrial waste management: the EU experience for Ukraine

Purpose. To identify the main trends caused by the divergence of the policy of Ukraine and the EU in the formation and accumulation of waste and threats to the environment. Methodology. Using the methods of content analysis, quantitative and qualitative comparison, EU policy on waste management is analyzed and logical generalization is used to establish the features of waste management financing for industries and regions. Findings. Regional irregularities of industrial waste accumulation, including hazardous waste, trends of their change are revealed. The reasons for regional peculiarities of waste management in the EU and Ukraine are established. It is established that the distribution of capital investments both in environmental protection in general and in waste management in particular does not always coincide with the leading regions of accumulation. It is established that limitation of financial instruments for waste management only by budgetary resources leads to a reduction in capital investment. A comparison of trends in environmental spending and waste management indicated a significant difference. Analysis of environmental investment by polluting industries, which are unevenly represented in different regions, revealed a significant difference between them. Originality. Regions that are the main polluters have been identified. The discrepancy between trends of capital investments in environmental protection and waste management was revealed. It is established that the list of leading regions in terms of capital investments in environmental protection does not correlate with the list of leading regions of waste accumulation. It is pointed out that uneven investment creates risks of increasing the rate of waste accumulation, in particular hazardous waste. Forecasting of indicators of waste management of the following periods is carried out. Practical value. There are risks of increasing the rate of waste accumulation, especially hazardous waste, both in Ukraine in general and in some regions, inequalities in some areas in the amount of capital investment into environmental protection, which will form an effective waste management policy. Identifying common features and differences in waste management in the EU and Ukraine will allow implementing effective environmental protection tools, reducing risks in industrial waste management.

Status and problems of financing the scientific sphere as a result of monitoring

Scientific research, new knowledge, technological innovations are the main source of economic growth of the state, ensuring its national security, competitiveness and living standards. The development of science in any country is influenced by global trends in knowledge generation, key factors influencing science and technology policy, global trends in research and development spending. Budget funding for science is a key government tool that supports the activities of public sector organizations of science, universities, regulates the development of priority areas of science and innovation. The state of scientific potential, its effectiveness for the country’s economy is determined by the adequacy of funds needed to perform competitive research and development, which are in demand in both domestic and foreign markets. The article considers the global costs of research and development in the United States, leading countries in Europe and Asia, shows trends in their change. The results of comparative assessment of financial costs of the world’s leading countries for research and development are presented. A brief analysis of current trends in the field of research is presented. Based on the results of the monitoring, the current state of indicators of financing of scientific and scientific-technical activity in Ukraine, volumes of budgetary financing of scientific researches and developments on priority directions of development of science and technology are analyzed. It is determined that neither the amount of budget funding nor the structure of expenditures on research and development do not meet the requirements of innovative economic development and building a knowledge-based society.

Estimating the Teacher Gap and Funding Requirements in Eastern and Southern Africa

This paper estimates the number of teachers required to meet different pupil-teacher (P-T) ratio targets in 2030 for all education levels in Eastern and Southern Africa (ESA). It also assesses the affordability of those targets based on different scenarios and presents detailed projections for the region as well as for 20 countries. To meet goals around education and learning, the model finds that governments in ESA will need to pay for more than five million additional teachers by 2030. When compared to affordability estimates, which reflect the latest teacher compensation spending trends, government investments will need to double. While there is variation across countries, the compounding shortage of teachers is a serious risk to improving learning across the region.These findings underscore the need to invest more resources in teachers and education systems more generally. If governments were able to progressively increase their investment in education to reach six percent of GDP in 2030, which is in line with the most ambitious target in the Incheon Declaration, it would be possible to recruit an additional three million teachers, which partially closes the gap. However, most governments will need to invest much more, including up to eight percent of GDP, to maximize learning opportunities and outcomes for all children in the region.Boosting investments in education systems is a particularly daunting task in the context of COVID-19 and the multitude of competing priorities. Nevertheless, governments are strongly encouraged to steadily increase the amount of resources allocated to the education sector each year, strengthen efforts to improve value for money and transparency in education spending processes, make the case to receive greater external support for education, and negotiate for debt relief that directly benefits the education sector, including through debt-for-education swaps.Boosting investments is particularly challenging in the context of COVID-19 and the multitude of competing priorities. However, governments can: (i) steadily increase the amount of resources allocated to the education sector in the annual budget cycle; (ii) convert some of the new Special Drawing Rights (SDRs) allocated by the IMF to invest in the education sector; (iii) strengthen efforts to improve value for money and transparency in education spending processes; (iv) develop compelling investment cases to receive greater external support for education from donors and international financial institutions; and (v) negotiate for debt relief that directly benefits the education sector, including through debt-for-education swaps.

THE NEXUS BETWEEN PUBLIC SPENDING ON EDUCATION AND ECONOMIC GROWTH OF KOSOVO – ECONOMETRIC APPROACH

The main aim of this study is to analyze the trend of public spending dedicated to education in case of Kosovo over the years and to measure the impact of public spending in education on economic growth of Kosovo. In order to achieve the goal, the Pearson Correlation is used and a multifactorial regression model (OLS) has been modified and adapted, where we have determined the Gross Domestic Product (GDP) as depended variable and as independent variable in the model conclude: (i) Total public expenditure on education (ii) Public expenditure on Secondary Education and (iii) Public expenditure on Higher Education (University). The data used is secondary data from the Kosovo’s State Budget, Ministry of Finance and Transfers, and Kosovo Agency of Statistics. We come in conclusion that public spending dedicated to the Higher Education (University) has a positive impact on Kosovo's economic growth meanwhile the public spending on secondary education and total public expenditure on education in the model circumstances show no significance. The paper comes with further recommendations on public spending policies dedicated to education in order to influence Kosovo's economic growth.

Abstract 14164: Trends in U.S. Spending on Diabetes Therapies by Insurance Payer From 2007 to 2017

Importance: Diabetes mellitus is an important cardiovascular risk factor, and diabetes therapies are among the most commonly prescribed medications in the U.S. While the introduction of new, high-cost therapies has increased costs, recent trends in national spending on diabetes medications by insurance payer have not been examined. Understanding the burden of costs amongst all payers may help inform strategies to optimize drug expenditures in the US. Objective: To produce nationally representative estimates of US spending on diabetes therapies from 2007 to 2017, stratified by insurance payers (Medicare, Medicaid, Private, VA, and TRICARE—a program for civilian health benefits for US Armed Forces). Trends in out-of-pocket costs were also examined. Design/Setting: Retrospective analysis of patient-level data from the Medical Expenditure Panel Survey, a nationally representative survey that is the most complete source of data on healthcare costs in the US, from 2007 to 2017. Participants: All patients receiving one or more classes of diabetes therapies. Outcomes: Inflation-adjusted total national expenditures on all diabetes therapies. Results: There were substantial increases in total expenditures on diabetes therapies for all payers during the study period, ranging from +165.6% for VA & TRICARE ($380.6 million to $1.0 billion) to +460.4% for Medicaid ($1.1 to $6.1 billion). Private insurers increased spending by +346.6% ($5.7 to $25.5 billion), and Medicare increased spending by +389.9% ($5.4 to $25.2 billion). Out-of-pocket spending increased more modestly (+15.7%, from $4.7 to $5.7 billion). Conclusions/Relevance: Spending on diabetes therapies increased dramatically between 2007-2017, with Medicare spending increasing by 389.9%. In contrast, increases in out-of-pocket costs have been more modest. Reasons for the rapid rate of rise in Medicare and private spending compared to out-of-pocket spending should be examined in future studies.

Potential Cost Implications for All US Food and Drug Administration Oncology Drug Approvals in 2018

The growth of cancer drug spending in the US has outpaced spending in nearly all other sectors, and an increasing proportion of the drug development pipeline is devoted to oncology. In 2018, there was a record number of drugs entering the US market. To estimate the number of patients with cancer who are eligible for the newly approved drug-indication pairs, and project potential spending and use of the approvals in the US. This is a retrospective review of 2018 US Food and Drug Administration (FDA) oncology drug approvals with estimation of the eligible population. The cost of new therapy was estimated, and savings from displaced therapies were subtracted. Two-way sensitivity analysis explored uncertainty in pricing and market diffusion. Data were collected between March 1, 2019, and September 30, 2019. Data related to the cancer drug approval (ie, indications, approval pathway, basis for approval), cancer incidence, and drug price were extracted from publicly available sources, including the FDA, National Cancer Institute, and American Cancer Society websites, as well as the RED BOOK database. The primary outcome was the projected net expenditure in the US associated with the new therapies. The secondary outcome described how variable market diffusion and pricing permit expected levels of spending. A total of 46 oncology approvals were included in the analysis, with 17 novel drugs and 29 new indications. The average price per patient per treatment course was $150 384. From a national perspective and with 100% market diffusion, the projected net expenditure for newly approved drugs was $39.5 billion per year. To maintain the recent trend of cancer drug spending, the 2018 cancer drug approvals need to be used in fewer than 20% of eligible patients. New cancer drugs approved by the FDA in 2018 would drastically increase cancer drug spending in the US if used widely. Alternatively, only low-level use of the new drugs is consistent with market forecasting.

Trends In Orphan Drug Spending And Out-Of-Pocket Spending Among US Children, 2013-18.

Among privately insured children, the proportion of inflation-adjusted total health care spending accounted for by orphan drugs increased from 4.0percent to 6.6percent between 2013 and 2018. This increase was largely driven by price growth. Mean annual out-of-pocket spending for orphan drugs rose from $486 to $866 and was higher for children than adults.

Evaluation of Risk Parity Asset Allocation Strategy in Indonesia Mutual Fund During 2010–2019 Period

Indonesia as the largest country in Southeast Asia have the highest GDP among the other countries in the region. In 2011, McKinsey & Company conducted a research to understand the annual consumer spending trend in Indonesia. According to the research, financial services will be the main consumption in Indonesia in 2030. Despite those promising situations, mutual fund industry in Indonesia was facing a big challenge in 2019. During 2019, Indonesia Financial Authority (OJK) has suspended 37 mismanaged mutual fund products from several investment managers. And actively managed mutual funds will have more exposure on this mismanagement risk.
 Aside from mismanagement and underperforming risk of actively managed mutual fund, investor also facing high risk of equity asset class. Recently, IDX Composite (IHSG) experience a tremendous -28% drop in Q1 2020. Biggest peak to bottom drawdown during that period was -37,49% from 14 January 2020 until 24 March 2020. This situation creates a challenge for mutual fund sales agent (APERD).
 But a challenging situation also offers opportunities. Mutual fund sales agent (APERD) that can offer optimum asset allocation suggestion that can give maximum risk protection can take advantage of these situation. One such unique strategy that has not been applied by other mutual fund sales agent (APERD) is risk parity that became popular after 2008 financial crisis.
 This research applied risk parity framework in passively managed mutual fund because most of actively managed mutual funds in Indonesia underperform the benchmark in the 10-year period. Because of that, passively managed mutual funds provide better investment opportunity. Four equity indexes (LQ45, Jakarta Islamic Index, Bisnis 27, and Sri Kehati) and one passively managed fixed income mutual fund (ABF Indonesia Bond Index Fund) that have existed for 10-year period was chosen to apply the risk parity method. Sharpe ratio calculation is used to evaluate the portfolio performance compared to commonly used portfolio strategy in the world according to 2018 Legg Mason Global Investment Survey.
 Result of the analysis is that risk parity portfolio offer better Sharpe ratio compared to commonly used portfolio strategy in the world. Result of 2009 - April 2020 back-testing process also show that risk parity can protect investor from equity market downturn in 77.3% of the case. With above result, risk parity can offer better risk protection for Indonesia individual investor.

Medicare expenditures for conventional and biologic disease modifying agents commonly used for treatment of rheumatoid arthritis

BackgroundBiologic disease modifying agents (bDMARDs) are an integral part of rheumatoid arthritis treatment guidelines but are associated with significant cost in the US. We present the trends in total spending and unit cost of conventional DMARDs (cDMARDs) as compared to bDMARDs in Medicare program. MethodsWe used the Medicare drug spending data for the year 2012–2017 covering all part B (fee-for-service) and part D drugs. Total spending was calculated by summing spending across various drug formulations and unit drug cost by dividing total spending by number of doses dispensed. We present the 6-year trends in total spending, total beneficiary count and unit costs of each of the commonly used cDMARDs and bDMARDs. ResultsBetween 2012 and 2017, the total spending on the cDMARDs increased 5-folds from $98 million to $579 million; this was fraction of total spending on bDMARDs which increased from $4.3 to $10.0 billion. This increase was driven largely by unit costs of drug rather than number of beneficiaries. There was a 6-fold increase in the unit cost of generic hydroxychloroquine followed by methotrexate and leflunomide. Amongst bDMARDs, adalimumab and etanercept unit cost increased by 2-folds. The increase was less pronounced for office-administered products. ConclusionsDespite the availability of several generic cDMARDs over decades, there were steep increases in the unit cost of these agents to “keep pace” with the increases in bDMARDs. As the number of elderly rheumatoid arthritis patients increases, policy interventions might be required to reduce the spending on both biologics and conventional DMARDs.

Analyzing the influence of social, cultural, behavioral traits on cycling and walking in Pakistan

Active modes of transport i.e. cycling and walking leave positive and progressive impacts on health, environment, and society. Despite these positive impacts, the developing, as well as many developed economies of the world, sees limited use of active modes of transport. The limited use can be attributed to active transport, being influenced by various social, cultural, and behavioral traits. Through this research, the influence of various social, cultural, behavioral traits on cycling and walking is to be studied. The paper utilizes Decision-Making Trial and Evaluation Laboratory (DEMATEL) for exploring the link between social, behavioral, cultural traits, and active transport in Pakistan. Findings of the research suggest that from considered social parameters, cycling and walking's image as a socially responsible investment and their role in health and safety influence the use of active transport. Exploiting these two social parameters, the use of cycling and walking can be increased. In addition, from amongst the behavioral parameters considered, economic trends and pace of life have the greatest influence on the adoption of active transport as the main mode of transport. Similarly, from considered cultural parameters, the distribution of masses in rural and urban areas, laws and policies, and spending trends motivate the most in shifting towards active modes of transport.

Impact of the economic crisis on household health expenditure in Greece: an interrupted time series analysis

Objectives and settingThe 2008 financial crisis had a particularly severe impact on Greece. To contain spending, the government capped public health expenditure and introduced increased cost-sharing. The Greek case is...

US Spending Associated With Transition From Daily to 3-Times-Weekly Glatiramer Acetate

Market exclusivity for daily injections of glatiramer acetate, a disease-modifying therapy for multiple sclerosis, expired in 2015. In 2014, the manufacturer launched an alternate 3-times-weekly version that was widely adopted, sustaining market dominance of brand-name glatiramer until late 2017. To estimate excess US spending associated with the transition from daily to 3-times-weekly glatiramer. This economic evaluation estimated total US glatiramer spending from January 1, 2011, to June 30, 2019, using a national cohort from 3 data sources that collectively represent approximately 40% of the US glatiramer market: Medicare Part D, Medicaid, and a claims database of commercially insured and Medicare Advantage patients. Calendar quarter. Outcomes were quarterly US glatiramer spending, estimated as price × use. Manufacturer list prices for generic products and estimates of net (postrebate) prices for brand-name products were used. Linear regression and interrupted time series models were used to compare spending trends in 3 periods: before generic competition (2011-2015), during generic competition for daily glatiramer (2015-2017), and during generic competition for daily and 3-times-weekly glatiramer (2017-2019). From 2011 to 2015, US glatiramer spending increased to $962 million per quarter and did not decrease with generic competition of only daily glatiramer (2015-2017). After generic competition began for 3-times-weekly glatiramer in 2017, prices decreased by 47% to 64%, and spending decreased to $508 million per quarter in 2019 (P < .001 for slope). The delay in decreased spending from 2015 to 2017 was associated with excess spending of $4.3 billion to $6.5 billion. These findings suggest that 2.5 years of delayed generic competition related to introduction of a new version of branded glatiramer acetate was associated with $4.3 billion to $6.5 billion in excess spending. Extended market exclusivity from introducing a new version of an existing brand-name drug can yield manufacturer returns out of proportion to the level of investment or risk involved; more limited incentives could encourage incremental innovations to existing drugs at a lower societal cost.

Health and dental care expenditures in the United States from 1996 to 2016.

As total health and dental care expenditures in the United States continue to rise, healthcare disparities for low to middle-income Americans creates an imperative to analyze existing expenditures. This study examined health and dental care expenditures in the United States from 1996 to 2016 and explored trends in spending across various population subgroups. Using data collected by the Medical Expenditure Panel Survey, this study examined health and dental care expenditures in the United States from 1996 to 2016. Trends in spending were displayed graphically and spending across subgroups examined. All expenditures were adjusted for inflation or deflation to the 2016 dollar. Both total health and dental expenditures increased between 1996 and 2016 with total healthcare expenditures increasing from $838.33 billion in 1996 to $1.62 trillion in 2016, a 1.9-fold increase. Despite an overall increase, total expenditures slowed between 2004 and 2012 with the exception of the older adult population. Over the study period, expenditures increased across all groups with the greatest increases seen in older adult health and dental care. The per capita geriatric dental care expenditure increased 59% while the per capita geriatric healthcare expenditure increased 50% across the two decades. For the overall US population, the per capita dental care expenditure increased 27% while the per capita healthcare expenditure increased 60% over the two decades. All groups except the uninsured experienced increased dental care expenditure over the study period. Healthcare spending is not inherently bad since it brings benefits while exacting costs. Our findings indicate that while there were increases in both health and dental care expenditures from 1996 to 2016, these increases were non-uniform both across population subgroups and time. Further research to understand these trends in detail will be helpful to develop strategies to address health and dental care disparities and to maximize resource utilization.