US Public Sector Research Articles

Cost-effectiveness analysis of 7 treatments in metastatic hormone-sensitive prostate cancer: a public-payer perspective.

Recently, several new treatment regimens have been approved for treating metastatic hormone-sensitive prostate cancer, building on androgen deprivation therapy alone. These include docetaxel androgen deprivation therapy, abiraterone acetate-prednisone androgen deprivation therapy, apalutamide androgen deprivation therapy, enzalutamide androgen deprivation therapy, darolutamide-docetaxel androgen deprivation therapy, and abiraterone-prednisone androgen deprivation therapy with docetaxel. There are no validated predictive biomarkers for choosing a specific regimen. The goal of this study was to conduct a health economic outcome evaluation to determine the optimal treatment from the US public sector (Veterans Affairs). We developed a partitioned survival model in which metastatic hormone-sensitive prostate cancer patients transitioned between 3 health states (progression free, progressive disease to castrate resistance state, and death) at monthly intervals based on Weibull survival model estimated from published Kaplan-Meier curves using a Bayesian network meta-analysis of 7 clinical trials (7208 patients). The effectiveness outcome in our model was quality-adjusted life-years (QALYs). Cost input parameters included initial and subsequent treatment costs and costs for terminal care and for managing grade 3 or higher drug-related adverse events and were obtained from the Federal Supply Schedule and published literature. Average 10-year costs ranged from $34 349 (androgen deprivation therapy) to $658 928 (darolutamide-docetaxel androgen deprivation therapy) and mean QALYs ranged from 3.25 (androgen deprivation therapy) to 4.57 (enzalutamide androgen deprivation therapy). Treatment strategies docetaxel androgen deprivation therapy, enzalutamide androgen deprivation therapy docetaxel, apalutamide androgen deprivation therapy, and darolutamide-docetaxel androgen deprivation therapy were eliminated because of dominance (ie, they were more costly and less effective than other strategies). Of the remaining strategies, abiraterone acetate-prednisone androgen deprivation therapy was the most cost-effective strategy at a willingness-to-pay threshold of $100 000/QALY (incremental cost-effectiveness ratios = $21 247/QALY). Our simulation model found abiraterone acetate-prednisone androgen deprivation therapy to be an optimal first-line treatment for metastatic hormone-sensitive prostate cancer from a public (Veterans Affairs) payer perspective.

Cost-effectiveness analysis (CEA) of seven treatment regimens in metastatic hormone-sensitive prostate cancer (mHSPC): A public payer perspective using network meta-analysis.

5081 Background: Recently several new drug treatment regimens have been approved in mHSPC state, building on using androgen deprivation therapy (ADT) alone. These include docetaxel + ADT (DA), Abiraterone Acetate + Prednisone + ADT (AAP), Apalutamide + ADT (AAT), Enzalutamide + ADT (ET), Darolutamide + Docetaxel + ADT (DAD) and AAP + ADT + Docetaxel (AAD). At present, there are no predictive biomarkers for choosing a specific drug regimen over the other. The goal of this study was to conduct an economic evaluation of FDA-approved standard of care drug regimens in the current management of mHSPC state to determine a cost-effective optimal treatment from the US public sector (Veterans Affairs-VA) perspective with a 10-year time horizon. Methods: We developed a partitioned survival model in which mHSPC patients (pts) transitioned between three health states (progression free, progressive disease to castrate resistance state, and death) at monthly intervals based on Weibull survival model estimated from published Kaplan-Meier curves using a network meta-analysis. A Bayesian network meta-analysis of seven randomized clinical trials included 7,208 mHSPC pts. The effectiveness outcome in our model was quality-adjusted life-years (QALYs) with utility values obtained from published literature. Costs in our model included those associated with treatment regimens, subsequent therapies, terminal care, and for managing grade 3-4 drug related adverse events. Costs were obtained from the Federal Supply Schedule and published literature. Incremental cost-effectiveness ratios (ICERs) were calculated for nondominated treatments. Results: Average 10-year costs ranged from $32,697 (ADT) to $649,622 (DAD). Mean QALYs ranged from 3.25 (ADT) to 4.57 (ET). Treatment with DAT, EAD, and DAD were eliminated due to dominance (i.e. they were more costly and less effective than other treatments). AAT was the most cost-effective strategy at a willingness-to-pay threshold of $100,000/QALY (ICER = $70,150/QALY). Results from our analysis for all regimens are shown. Conclusions: Our CEA simulation model found AAT is an optimal cost-effective first-line treatment strategy in mHSPC state from a public (VA) payer perspective. [Table: see text]

Cost-effectiveness analysis of seven treatment regimens in metastatic hormone-sensitive prostate cancer (mHSPC): A public payer perspective using network meta-analysis.

268 Background: Recently several new treatment regimens have been approved for treating mHSPC, building on the previous standard of care using androgen deprivation therapy (ADT) alone. These include docetaxel+ADT (DA), Abiraterone Acetate+Prednisone+ADT (AAP), Apalutamide+ADT (AAT), Enzalutamide+ADT (ET), Darolutamide+Docetaxel+ADT (DAD) and Abiraterone+Prednisone+ADT+Docetaxel (AAD). There are no current predictive biomarkers for choosing any specific regimen. The goal of this study was to determine the cost-effectiveness of these new treatments from the US public sector perspective with a lifetime horizon. Methods: We developed a partitioned survival model in which mHSPC patients transitioned between three health states (progression free, progressive disease to castrate resistance state, and death) at monthly intervals based on Weibull survival model estimated from published Kaplan-Meier curves using a network meta-analysis. A Bayesian network meta-analysis of seven clinical trials included 7,208 patients. The effectiveness outcome in our model was quality-adjusted life-years (QALYs) with utility values obtained from published literature. Costs in our model included those associated with treatment regimens and subsequent therapies, terminal care, and for managing grade 3-4 drug related adverse events, and were obtained from the Federal Supply Schedule and published literature. Results: Average lifetime costs ranged from $154,139 (AAP) to $770,848 (DAD) and mean QALYs ranged from 3.33 (ADT) to 5.08 (ET). All treatment strategies other than AAP and ET were eliminated due to dominance. Compared to AAP, the incremental cost-effectiveness ratio for ET was $484,943/QALY. Results from our analysis including all regimens are shown. Conclusions: Our simulation model found that ET in mHSPC state yielded the most QALYs and would be the most cost-effective option with a WTP threshold as high as $500,000/QALY. However, for a WTP threshold of $150,000/QALY, AAP was the most cost-effective treatment strategy. [Table: see text]

Rascvet i upadok gosudarstvennogo sektora v ekonomike SShA v XIX— XX vv.

The article deals with the development and decline of the public sector in the US economy in the 19th - 20th centuries. The object of the article is the US public enterprise sector; the subject is the establishment, development and decline of the public sector of the United States. The chronological framework of the study covers the period from the implementation of the “Louisiana Purchase” to the end of the Cold War. The authors consider the role of state institutions and enterprises in the banking sector, large infrastructure sector, postal service, as well as forms of entrepreneurship that were established to serve the needs of the state in the management of vast lands and abundant water resources owned by the state.

Foreign medical graduates and American psychiatry.

Graduates from foreign medical schools (FMGs) began to staff US state psychiatric hospitals after World War II, and became increasingly associated with the poor quality of those institutions. Public and professional commentary on FMGs criticized their skills and suitability for the US healthcare system in the 1970s, at the same time that state hospitals were under increasing attack. By the 1980s and 1990s, the association between international medical graduates (as they became known) and underserved populations became an argument in favour of easing restrictions on these graduates. The role of foreign-trained psychiatrists in the US public sector became a way for American psychiatry leaders to manage the problems of the seriously mentally ill, first with blame and then with neglect.

Cyber risks to Ukrainian and other health systems

Cyber risks to Ukrainian and other health systems

Public-Sector Unions as Equalizing Institutions: Race, Gender, and Earnings

This research demonstrates that the union wage premium is higher for Black and women workers in the US public sector, what we refer to as “an intersectional union premium.” Union mechanisms reinforce and expand the more equitable practices of the public sector, resulting in this additional boost. Using Current Population Survey data, 1983–2018, this research models intersectional effects on earnings by examining interactions between union membership and race–gender. Relative to White men, union membership boosts average earnings an additional 3% for Black men and Black women, and 2% for White women on top of the direct union premium. Corollary analyses reaffirm these effects in multiple state contexts, including by union density and union coverage. Intersectional union premiums are weaker in states that prohibit collective bargaining. These premiums are present across most types of public work, with the exception of police and fire employees. To conclude, the authors discuss how changing labor policies may impact race and gender equity in the public sector.

Complete mitochondrial genome of Asian longhorned tick, Haemaphysalis longicornis, Neumann, 1901 (Acari: Ixodida: Ixodidae) identified in the United States

Haemaphysalis longicornis (Ixodida: Ixodidae), the Asian longhorned tick, which is native to temperate East Asia, has been recently detected in the northeastern region of the United States, drawing concerns about its potential impact on the US animal and public health sectors. Knowledge about the genetic features of H. longicornis found in the US is limited. Therefore, we sequenced the complete mitochondrial genome (mt-genome) from two H. longicornis ticks recently collected in the State of New York, USA, in 2020. These ticks were morphologically identified and tested for tick-borne pathogens at the Connecticut Veterinary Medical Diagnostic Laboratory (Storrs, CT). The mt-genome was 14,694 bp in length and encoded 37 genes, including 13 protein-coding genes, 22 transfer RNAs, and two ribosomal RNAs. Phylogenetic analysis showed that the mt-genome clustered with those of other H. longicornis identified in China. The mt-genome sequence was 99.7% identical to a H. longicornis mt-genome (GenBank: MK439888) collected in China. The cox1 gene haplotype in these ticks belonged to the H1 type, which is the dominant haplotype present in central NJ and Staten Island, NY. The complete mt-genome data are needed to provide insights into genetic changes and phylogenetic studies of H. longicornis ticks.

Local Public Goods and the Spatial Distribution of Economic Activity

Using French data, we provide: a) causal evidence that a drop in local public goods provision decreases private sector activity, and b) evidence consistent with monopsony power of the public sector in local labor markets. We introduce a public sector with these two key characteristics in an otherwise standard spatial equilibrium model, and show that it delivers the main stylized facts established in our data, in particular, that the share of the public sector relative to the private is independent of the productivity of the city. We emphasize the tradeoffs between allowing governments to freely choose local public employment and wages (as in most of the US public sector), versus imposing rules that constrain public sector pay with some indexation to the local cost of living (as in many European countries). We show that wage indexation limits monopsony power -- leading to a larger public sector -- and is optimal if the indexation is sufficiently strong.

The mediating role of informal learning on work engagement: older workers in the US public sector

PurposeThe purpose of this paper is to examine the mediating relationship between organizational culture, informal learning and work engagement of older workers in a public organizational setting. More specifically, this study aimed to investigate if informal learning is a pivotal component connecting an organizational-level factor (culture) to work engagement, which, in turn, directly influences business performance in the workplace.Design/methodology/approachAfter a careful review of the selected and relevant literature, four hypotheses were developed to test the structural relationships between the selected variables.FindingsThe data analysis indicated that informal learning mediated the relationship between organizational culture and work engagement for older employees working in a public organizational setting.Practical implicationsThe findings from this study provide a solid justification for promoting informal learning in organizations to ensure knowledge transfer between younger and older generations while minimizing knowledge and financial loss for organizations.Originality/valueIn previous research, little emphasis has been placed on the impact of informal learning on work engagement. This study presents a valuable finding about the role of informal learning to facilitate work engagement for older workers.

Implications Of The Rapid Growth Of The Nurse Practitioner Workforce In The US.

Concerns about physician shortages have led policy makers in the US public and private sectors to advocate for the greater use of nurse practitioners (NPs). We examined recent changes in demographic, employment, and earnings characteristics of NPs and the implications of those changes. In the period 2010-17 the number of NPs in the US more than doubled from approximately 91,000 to 190,000. This growth occurred in every US region and was driven by the rapid expansion of education programs that attracted nurses in the Millennial generation. Employment was concentrated in hospitals, physician offices, and outpatient care centers, and inflation-adjusted earnings grew by 5.5percent over this period. The pronounced growth in the number of NPs has reduced the size of the registered nurse (RN) workforce by up to 80,000 nationwide. In the future, hospitals must innovate and test creative ideas to replace RNs who have left their positions to become NPs, and educators must be alert for signs of falling earnings that may signal the excess production of NPs.

Public Employment Redux

The public sector hires disproportionately more educated workers. Using US microdata, we show that the education bias also holds within industries and in two thirds of 3-digit occupations. To rationalize this finding, we propose a model of private and public employment based on two features. First, alongside a perfectly competitive private sector, a cost-minimizing government acts with a wage schedule that does not equate supply and demand. Second, our economy features heterogeneity across individuals and jobs, and a simple sorting mechanism that generates underemployment – educated workers performing unskilled jobs. The equilibrium model is parsimonious and is calibrated to match key moments of the US public and private sectors. We find that the public-sector wage differential and excess underemployment account for 15 percent of the education bias, with the remaining accounted for by technology. In a counterintuitive fashion, we find that more wage compression in the public sector raises inequality in the private sector. A 1 percent increase in unskilled public wages raises skilled private wages by 0.07 percent and lowers unskilled private wages by 0.06 percent.

Public Pension Governance, Funding, and Performance: A Longitudinal Appraisal

Pension plans covering US public sector employees now face the twin challenges of poor asset returns and rapid increases in liabilities, producing the worst pension funding outcomes in decades. This paper explores how public pension plan investment performance and funding is related to several structural and pension design features. Using a new longitudinal dataset on state and local public pension plans, we evaluate how investment performance is tied to stock funding ratios and how stock funding ratio in turn affects flow funding efforts. We find that articular governance structures can enhance public pension plan investment performance and funding status, and we suggest ways in which public plan design might be improved.

Public Wealth in the United States

We analyze the US public sector balance sheet and project it forward under the assumption that current policies remain in place. We first document the history of the balance sheet and its components since World War II, with a detailed account of its evolution during and after the global financial crisis. While, based on assets and liabilities alone, public sector net worth is negative, additional challenges arise from commitments to future spending implied by current legislation and demographic trends. To quantify the risks to the balance sheet, we then apply the macroeconomic scenarios from the Federal Reserve’s bank stress test to the public sector balance sheet.

Risk-Based Robust Evaluation of Hospital Efficiency

Hospital performance and efficiency are key aspects of a modern national health system. This paper focuses on the evaluation risk of hospital efficiency by investigating and ranking 329 hospitals in the US public healthcare sector. Performance dimensions cover different factors that include cost and revenue, treatment environment and capacity, labors, and technical quality. Although it is possible to appraise hospitals for the given indicators using a systemic approach, data envelopment analysis (DEA), the associated score rankings appear to be inconsistent with respect to the small amount of change in parameters. We develop a robust DEA approach that takes account of the uncertainty of outputs and the solving complexity. Ranking results show that efficient nonprofit hospitals are more sensitive to the development of technical innovation, while the performances of efficient profit-driven hospitals are more easily affected by the reduction of the patient numbers. In addition, we find that the robust approach decreases the risk to mean ratios by 7% for the profit-driven hospital group, which provides a more holistic and well-rounded performance.

Public Wealth in the United States

We analyze the US public sector balance sheet and project it forward under the assumption that current policies remain in place. We first document the history of the balance sheet and its components since World War II, with a detailed account of its evolution during and after the global financial crisis. While, based on assets and liabilities alone, public sector net worth is negative, additional challenges arise from commitments to future spending implied by current legislation and demographic trends. To quantify the risks to the balance sheet, we then apply the macroeconomic scenarios from the Federal Reserve’s bank stress test to the public sector balance sheet.

Correlational Study: Internal Auditing and Management Control Environment Innovation within Public Sector in the United States

This article is about exploring the relationship between internal human resources auditing and environmental control in the US public sector. The main purpose of this study was to examine the extent to which the determinants of internal audit staff have the potential to influence the predictive value of the public sector control environment. The tools of the work are presented by a quantitative correlation analysis to determine the interdependence of variables (aspects of recruitment, accountability) and resultant indicator (public sector environment). By systematizing literary sources and approaches to solving the problem, as well as using the COSO 2013 Internal Control Framework as a theoretical framework, the authors focus on the question of how much internal audit recruitment, and accountability experience can influence in the foreseeable future and each of the two major COSO components. The empirical analysis was presented in the research, which made it possible to substantiate the following conclusions: the results of two multiple linear regression models did not show statistically significant except for recruitment, nonparametric correlation of Kendall’s Tau-b correlation is allowed to identify significant interrelationships development. The findings of the study may be useful for implementing further transformational changes in the functioning of the global economy in the context of the growing role and importance of international audit and its positive impact on the public sector in the United States. Keywords: Internal Auditing, Personnel Factors, Control Environment, Management, Innovation.

Comparing US public university and US private sector project costs

PurposeThis study aims to focus on the factors influencing project cost at US public universities and compares them to similar projects in the US private sector. It also presents an analysis of the potential reasons for the difference or similarities in the two sectors.Design/methodology/approachThis study utilized an exploratory, comparative case study methodology performed on a small sample of public university projects and two sources of private sector cost data.FindingsThe results infer that most of the US public projects have comparable costs to that of their US private sector counterparts. The cost data from the university projects were further examined to explore if there were any possible relationships between the types of delivery methods used, sustainability certifications achieved and two project performance indexes – cost and duration.Research limitations/implicationsA more thorough analysis with a larger dataset is required to make generalizable conclusions. However, the process used in this study does provide a good overview of how facility managers could organize their own cost comparison study to evaluate their project expenditures.Practical implicationsThis research provides a starting point for future research into the topic of US public sector project costs when compared to US private sector counterparts and the impact of delivery system and sustainability on cost of US public sector projects.Originality/valueResearch on this topic is scant; as such, this paper provides a starting point for future research and offers insights into the potential impacts of project delivery method and choice of following a sustainability certification option.

Data Breaches: Public Sector Perspectives

A data breach exposes confidential, protected data to unauthorized access and manipulation. This study examines the extent and occurrences of data breaches in the US public sector through an analysis of data breaches over a five-year period. This research is motivated by two questions: What are the current trends of data breaches in the public sector and how do contextual governmental factors impact these data breaches?

Assessing The Value Of 40 Years Of Local Public Expenditures On Health.

The US public and private sectors now spend more than $3trillion on health each year. While critical studies have examined the relationship between public spending on health and health outcomes, relatively little is known about the impact of broader public-sector spending on health. Using county-level public finance data for the period 1972-2012, we estimated the impact of local public hospital spending and nonhospital health spending on all-cause mortality in the county. Overall, a 10percent increase in nonhospital health spending was associated with a 0.006percent decrease in all-cause mortality one year after the initial spending. This effect was larger and significant in counties with greater proportions of racial/ethnic minorities. Our results indicate that county nonhospital health spending has health benefits that can help reduce costs and improve health outcomes in localities across the nation, though greater focus on population-oriented services may be warranted.