Cost-effectiveness of adjuvant chemotherapy for stage III colon cancer in the South African public healthcare setting.

e18849 Background: Colon cancer incidence and mortality rates are increasing in low- and middle-income countries, such as South Africa (SA). Adjuvant chemotherapy after curative resection for stage III colon cancer prolongs overall survival, but it is unclear which regimen is most cost-effective in resource-constrained settings, such as the SA public healthcare system. Methods: A decision-analytic Markov model was developed to compare lifetime costs and health outcomes for 60-year-old stage III colon cancer patients treated with six adjuvant chemotherapy regimens in a public hospital in SA: fluorouracil, leucovorin, and oxaliplatin (FOLFOX) for 3 and 6 months, capecitabine and oxaliplatin (CAPOX) for 3 and 6 months, capecitabine for 6 months, and fluorouracil/leucovorin (5-FU/LV; Mayo regimen) for 6 months. Transition probabilities were derived from clinical trials to estimate risks of toxicity, disease recurrence, and survival. Costs from a SA societal perspective and utility estimates were obtained from literature and local expert opinion. The primary outcome was the incremental cost-effectiveness ratio (ICER) in international dollars (I$) per disability-adjusted life year (DALY) averted, with a willingness-to-pay (WTP) threshold of one times the 2020 GDP per capita of SA (I$13,006.57; ZAR89,225). Results: Our model found CAPOX for 3 months to be the most cost-effective strategy, at a lifetime cost below the local WTP threshold (I$5,380.82; ZAR36,912.44) and 5.74 DALYs averted, compared to no chemotherapy. FOLFOX for 6 months was also on the efficiency frontier, with a higher total cost (I$22,747.47; ZAR156,047.64) and 0.18 additional DALYs averted (ICER = I$99,021.35/DALY averted). All other strategies were absolutely dominated. One-way sensitivity analyses found that FOLFOX for 6 months is optimal when the administration cost (i.e.: port and pump) falls to 20% of the base case price. Conclusions: In the SA public healthcare system, CAPOX for 3 months is the most cost-effective adjuvant treatment for stage III colon cancer. FOLFOX for 6 months, with a greater effectiveness, may be cost-effective if the administration cost decreases significantly. The optimal strategy in other settings may vary according to the local WTP threshold.[Table: see text]

The Determinants for Accepting and Using e-Government Revenue Application (e-filing)

The determinants for accepting and using the e-Government revenue applications (e-filing) is a phenomenon most governments, including South Africa are still grappling with, and therefore, an ongoing information systems business leadership research is a key issue. The research problem is that despite the eGovernment revenue application being implemented and maintained at a high cost, there is little uptake and optimal use. The e-Government revenue application has greater benefits such as tax calculation accuracy, tax submission done timeously during any time of the day, improving tax efficiency by reducing administration cost. Since the value and the investment is huge, the burning question is then why the accepting and usage of e-Government revenue application by taxpayers not as it should? Information from previous studies are quite on this phenomenon, in the South African context and this then left a knowledge gaps, which this paper bridges. This paper focuses on explaining and exploring the determinants for adopting and using e-Government revenue application as reasons why some of taxpayers accept and use the revenue application while others are not using it are still unknown. Argument is that despite South Africa implemented a cutting-edge system since 2006, taxpayers still queue at its branches for manual submissions. There is a need to understand the determinants for acceptance and usage of eGovernment revenue application.

A Model for Adopting and Using E-Filing

The adoption and usage of e-filing applications is a phenomenon most governments, including South Africa are still grappling with, and therefore, an ongoing information systems business leadership research is a key issue. The research problem is that despite the e-Government application being implemented and maintained at a high cost, there is little uptake and optimal use. The revenue application has greater benefits such as tax calculation accuracy, tax submission done timeously during any time of the day, improving tax efficiency by reducing administration cost. Since the value and the investment is huge, the burning question is then why the accepting and usage ofe-filing by taxpayers not as it should? Information from previous studies arequite on this phenomenon, in the South Africancontext and this then left a knowledge gaps, which this paper bridges.This paperfocuses on explaining and explore adopting and using e-filing as reasons why some of taxpayers accept and use the revenue application while others are not using it are still unknown. Argument is that despite South Africa implemented a cutting-edgesystemsince 2006, taxpayers still queueat its branches for manualsubmissions.

AB1185 BUDGET IMPACT ANALYSIS OF INTRODUCING SUBCUTANEOUS INFLIXIMAB CT-P13 SC FROM THE UK PAYER PERSPECTIVE

Background:CT-P13 subcutaneous (SC) is the first and only SC version of infliximab developed by Celltrion Healthcare and currently approved by the European Medicines Agency (EMA) for the treatment of rheumatoid arthritis (RA). Infliximab has been only available in intravenous (IV) formulation and thus this new mode of administration will allow patients to self-inject at homes. Self-injection will reduce number of outpatient visits and expected to decrease IV administration cost significantly. This research describes the economic impact of introducing infliximab SC from the UK payer perspective.Objectives:The budget impact analysis (BIA) was conducted to assess the financial impact of the adoption of infliximab SC. The BIA calculates the costs of treatment (drug acquisition cost and administration) for patients with RA as first-line treatments, and compares the cost in a scenario without infliximab SC vs a scenario with infliximab SC to estimate the budget impact over the 5 year period.Methods:A prevalence-based BIM was developed incorporating epidemiological data, administration cost data from the literature and market share data from IQVIA. The analysis compared a market scenario where a proportion of patients were treated with infliximab SC (‘World With’ infliximab SC) to an alternative market scenario where infliximab SC were not available and all patients were treated with IV (‘World Without’ infliximab SC). The model assumed that the clinical outcomes are same between infliximab SC and infliximab IV, and patients entering the model were all naïve and remained in the treatment for 5 years. In the ‘World With’ scenario, patients receiving infliximab IV switched to SC administration at 30% in Year 1, 45% in Year 2, and remained 60% from Year 3 to 5. The drug cost of infliximab SC is assumed to be the same as that of comparator treatments. Administration cost per infliximab IV infusion was estimated to be ₤382 and ₤3.32 per SC administration.Results:Compared to the “World Without” infliximab SC, the introduction of subcutaneous infliximab resulted in cost savings of ₤39.6 million in UK over a 5-year period, equating to 4,466 additional patients to be treated with infliximab SC in base case scenario.Sensitivity analysis includes dose-escalation up to 5mg/kg to reflect the real-world setting. In that scenario, the saving increases to ₤279.6 million over a 5-year period, equating to 30,839 additional patients to be treated with infliximab SC.Conclusion:Utilization of subcutaneous infliximab may lead to substantial cost savings for UK payers. Self-injection will significantly reduce the burden on healthcare delivery allowing resource to be spent elsewhere. Sensitivity analysis concluded that treatment with increased IV dose will result in higher savings from switching patients to subcutaneous infliximab.References:[1]European Medicines Agency. Remsima SC authorization details.https://www.ema.europa.eu/en/documents/product-information/remsima-epar-product-information_en.pdf[2]Carpenter, L., et al. (2014). Patients with Moderate Disease Activity in the First 5 Years of Rheumatoid Arthritis Still Progress Radiographically Despite Conventional Disease Modifying Therapy.: 2135.Arthritis & Rheumatology,66.[3]The NICE British National Formulary (BNF).https://bnf.nice.org.uk/medicinal-forms/[4]Tetteh, E. K., & Morris, S. (2014). Evaluating the administration costs of biologic drugs: development of a cost algorithm. Health economics review, 4(1), 26.[5]National Institute for Health and Care Excellence. (2016). Adalimumab, etanercept, infliximab, certolizumab pegol, golimumab, tocilizumab and abatacept for rheumatoid arthritis not previously treated with DMARDs or after conventional DMARDs only have failed.Disclosure of Interests:Martin Perry Grant/research support from: Grifols, Abbvie, Sandoz unrestricted educational grant, Consultant of: Abbvie, Gilead, Celltrion Advisory Board, Speakers bureau: Sandoz, Minyoung Jang Employee of: HEOR & Market access specialist in Celltrion Healthcare

The cost of chemotherapy administration: A systematic review and meta-analysis.

810 Background: Cancer treatment is a significant driver of healthcare costs worldwide, however, the economic impact of treating patients with anti-neoplastic agents is poorly elucidated. Hence, we conducted a systematic review and meta-analysis to estimate the direct costs associated with administering intravenous chemotherapy in an outpatient setting. Methods: We systematically searched four databases from 2010 to present and extracted hourly administration costs and the respective components of each estimate. Separate analyses were conducted of Canadian and United States (US) studies, respectively, to address a priori hypotheses regarding heterogeneity amongst administration cost estimates. The Drummond checklist was used to assess risk-of-bias. Data were summarized using medians with interquartile ranges and five outliers were identified; costs were presented in 2019 USD. Results: A total of 44 studies were analyzed, including sub-analyses of 19 US and seven Canadian studies. 26/44 studies were of moderate or high quality. When components of administration cost were evaluated, physician costs were reported most frequently (24 studies), followed by lab tests (13) and overhead costs (9). The median cost estimate when outliers were excluded was $142/hour (IQR = $103-166). Sensitivity analyses determined the median administration cost in the US was $149/hour (IQR = $118-158), and was $128/hour (IQR = $102-137) in Canada. Conclusions: There is currently a paucity of literature addressing the costs of chemotherapy administration, and existing studies utilize a patchwork of reporting methodologies which renders direct comparison challenging. Our results demonstrate that the cost of administering chemotherapy is approximately $125-150/hour, globally. This value is dependent upon the region of analysis, inclusiveness of cost subcomponents as well as the methodology used to estimate unit prices, as described here.

On the Robustness of PERT Fittings in Agricultural Yield Insurance

In agricultural insurance practice, risk and indemnity payment are often incurred from individual farmer’s yield. However, high administration cost and data scarcity are simultaneously quite often seen, which form huge burdens for insurers to adequately rate insurance products. Under this circumstance, some methods that could be used to estimate farmers’ yields, in particular, their distributions, are urgently needed. Among these methods, a so called PERT fitting technique often prevails due to its simplicity which only requires very little knowledge about the yield history, that is frequently implemented by both academics and practitioners. However, the very limited information used would sometimes cause severe bias, in other words, the reliability of this method is yet to be examined. In this paper, I used Monte Carlo experiments to test the robustness of PERT fittings under Var and CTE risk measures in different scenarios. The result proves that PERT method is indeed robust and trustworthy.

Attribute-Based Collusion Resistance in Group-Based Cloud Data Sharing using LKH Model

Utilizing cloud computing, users can avail a compelling and effective approach for information sharing between collective individuals in the cloud with the facility of less administration cost and little maintenance. Security in cloud computing refers to procedures, standards and processes created to provide assurance for security of information in the cloud environment. In this paper, we project a secure data sharing method in cloud for dynamic members by producing keys for users using Logic Key Hierarchy (LKH) model, i.e., a tree-based key generation technique. We have generated this key using reverse hashing and one way hash-based technique so that no exiled user can predict the new key and new users cannot predict the old keys of the network group. From numerous experiments, this work is proved to be the best in maintaining forward secrecy, backward secrecy and group compromise attacks and consumes less computation cost compared to any other hash-based key generation techniques.

DETERMINAN MARGIN KEUNTUNGAN PRODUK PEMBIAYAAN MURABAHAH

<em>Murabahah financing product at PT. Pegadaian Syariah branch Landungsari Malang, Murabahah Logam Mulia untuk Investasi Abadi (MULIA) is defined as a gold trade financing in a cash or credit in accordance with Sharia laws. This research aims at exploring the determination process of profit margin and the implementation of Standard Operating Procedure in the practice of murabahah financing at PT. Pegadaian Syariah branch of Landungsari Malang. This study uses qualitative method with two approaches. First, the researcher conducted an observation and in-depth interview to Strategi Bisnis Unit (SBU) assistant manager. The result of this study confirms that researcher get total of profit margin Rp. 85.414 in which there is administration cost Rp. 50.000, sales margin 2,5% Rp. 15.725, and installment margin 3,94% namely Rp. 24.783. Researcher get discount margin Rp. 5.094 that’s means net installment margin is Rp. 19.689. The determination of profit margin for murabahah financing has considered the terms of sharia laws by using consensus principle which is mentioned in Quran surah An Nisa verse 29. This verse explains that any transaction should not bother customers. With this basis, therefore, the practice of murabahah financing has been compatible with the regulations written on Standard Operating Procedure of the firm.</em>

APAKAH EARNINGS MANAGEMENT MAMPU MENGURANGI TINGKAT STICKINESS COST?

The purpose of this research is to determine the occurence of stickiness cost in SG&A (Selling, General and Administration) cost and to see whether the stickiness cost degree can be derive through earning management. Multiple linear regression using regression model from Anderson et al. and Farzaneh et al. are carried out to analyze the data. The results of this research show that SG&A cost is sticky, because it increased by 0.908% at 1% increase in sales but decreased by 0.016% at 1% decrease in sales. It happens because the manager retain the unutilized resources when facing a decline in sales. Furthemore, the results of this research find that earning management can derive the degree of stickiness cost, even cause anti-sticky in SG&A cost. It happens because the manager who has an incentive to avoid reporting loses and earning decreases, try to reduce cost when sales decline by earning management.