Health insurance and consumer welfare : The case of monopolistic drug markets

Individual moral hazard engendered by health insurance and monopolistic production are both typical phenomena of drug markets. We develop a simple model containing these two elements and show that private agents tend to overinsure themselves against health respectively drug expenses if drugs can be produced at low marginal costs. If marginal costs are negligible, health insurance should be abandoned at all

Delta-like protein 3 expression in paired chemonaive and chemorelapsed small cell lung cancer samples

Rovalpituzumab tesirine (Rova-T), an antibody-drug conjugate directed against Delta-like protein 3 (DLL3), is under development for patients with small cell lung cancer (SCLC). DLL3 is expressed on the majority of SCLC samples. Because SCLC is rarely biopsied in the course of disease, data regarding DLL3 expression in relapses is not available. The aim of this study was to investigate the expression of DLL3 in chemorelapsed (but untreated with Rova-T) SCLC samples and compare the results with chemonaive counterparts. Two evaluation methods to assess DLL3 expression were explored. Additionally, we assessed if DLL3 expression of chemorelapsed and/or chemonaive samples has prognostic impact and if it correlates with other clinicopathological data. The study included 30 paired SCLC samples, which were stained with an anti DLL3 antibody. DLL3 expression was assessed using tumor proportion score (TPS) and H-score and was categorized as DLL3 low (TPS < 50%, H-score ≤ 150) and DLL3 high (TPS ≥ 50%, H-score > 150). Expression data were correlated with clinicopathological characteristics. Kaplan-Meier curves were used to illustrate overall survival (OS) depending on DLL3 expression in chemonaive and chemorelapsed samples, respectively, and depending on dynamics of expression during course of therapy. DLL3 was expressed in 86.6% chemonaive and 80% chemorelapsed SCLC samples without significant differences between the two groups. However, the extent of expression varied in a substantial proportion of pairs (36.6% with TPS, 43.3% with H-score), defined as a shift from low to high or high to low expression. TPS and H-score provided comparable results. There were no profound correlations with clinicopathological data. Survival analysis revealed a trend toward a more favorable OS in DLL low-expressing chemonaive SCLC (p = 0.57) and, in turn, in DLL3 high-expressing chemorelapsed SCLC (p = 0.42) as well as in SCLC demonstrating a shift from low to high expression (p = 0.56) without being statistically significant. This is the first study to investigate DLL3 expression in a large cohort of rare paired chemonaive-chemorelapsed SCLC specimens. Comparative analysis revealed that DLL3 expression was not stable during the course of therapy, suggesting therapy-based alterations. Unlike in chemonaive samples, a high DLL3 expression in chemorelapsed samples indicated a trend for a more favorable prognosis. Our results highlight the importance to investigate DLL3 in latest chemorelapsed SCLC tumor tissue

Krankenversicherung, Anreize im Gesundheitswesen und Konsumentenwohlfahrt

Deutschland ; Gesetzliche Krankenversicherung ; Gesundheitswesen ; Agency-Theorie ; Moral Hazard ; Adverse Selektio

Moral Hazard, Market Power, and Second Best Health Insurance

Individual moral hazard engendered by health insurance and monopolistic production are both typical phenomena of drug markets. We develop a simple model containing these two elements and evaluate the market equilibrium on the basis of consumer and social welfare. The consumer welfare criterion suggests that in the market equilibrium individuals purchase too much insurance against the risk of drug expenses. In contrast, the social welfare criterion suggests that individuals should purchase more insurance coverage than they choose to do in the market equilibrium. -- Eine durch versicherungsbedingtes Moral Hazard verzerrte Nachfrage sowie ein durch Marktmacht verzerrtes Angebot sind typische Elemente eines Arzneimittelmarktes. Wir entwickeln ein einfaches Modell, das die beiden Elemente sowie einen kompetitiven Krankenversicherungsmarkt integriert und bewerten das Marktgleichgewicht aus der Perspektive der Konsumentenwohlfahrt und der sozialen Wohlfahrt. Das Konsumentenwohlfahrtskriterium legt nahe, daß die Individuen eine zu hohe Versicherungsdeckung gegen das Risiko erhöhter Arzneimittelausgaben im Krankheitsfall erwerben. Das Kriterium der sozialen Wohlfahrt legt dagegen den Schluß nahe, daß sich die Individuen gegen das Risiko unterversichern.Drugs,Insurance,Monopoly,Welfare

Exploring Energy Efficiency for GPU-Accelerated POWER Servers

Modern servers provide different features for managing the amount of energy that is needed to execute a given work-load. In this article we focus on a new generation of GPU-accelerated servers with POWER8 processors. For different scientific applications, which have in common that they have been written for massively-parallel computers, we measure energy-to-solution for different system configurations. By combining earlier developed performance models and a simple power model, we derive an energy model that can help to optimise for energy efficiency

New Model for Gastroenteropancreatic Large-Cell Neuroendocrine Carcinoma: Establishment of Two Clinically Relevant Cell Lines

<div><p>Recently, a novel WHO-classification has been introduced that divided gastroenteropancreatic neuroendocrine neoplasms (GEP-NEN) according to their proliferation index into G1- or G2-neuroendocrine tumors (NET) and poorly differentiated small-cell or large-cell G3-neuroendocrine carcinomas (NEC). Our knowledge on primary NECs of the GEP-system is limited due to the rarity of these tumors and chemotherapeutic concepts of highly aggressive NEC do not provide convincing results. The aim of this study was to establish a reliable cell line model for NEC that could be helpful in identifying novel druggable molecular targets. Cell lines were established from liver (NEC-DUE1) or lymph node metastases (NEC-DUE2) from large cell NECs of the gastroesophageal junction and the large intestine, respectively. Morphological characteristics and expression of neuroendocrine markers were extensively analyzed. Chromosomal aberrations were mapped by array comparative genomic hybridization and DNA profiling was analyzed by DNA fingerprinting. <i>In vitro</i> and <i>in vivo</i> tumorigenicity was evaluated and the sensitivity against chemotherapeutic agents assessed. Both cell lines exhibited typical morphological and molecular features of large cell NEC. <i>In vitro</i> and <i>in vivo</i> experiments demonstrated that both cell lines retained their malignant properties. Whereas NEC-DUE1 and -DUE2 were resistant to chemotherapeutic drugs such as cisplatin, etoposide and oxaliplatin, a high sensitivity to 5-fluorouracil was observed for the NEC-DUE1 cell line. Taken together, we established and characterized the first GEP large-cell NEC cell lines that might serve as a helpful tool not only to understand the biology of these tumors, but also to establish novel targeted therapies in a preclinical setup.</p></div

Immunohistochemical expression analyses of the cell lines NEC-DUE1 and NEC-DUE2.

<p>NSE neuron-specific enolase, VMAT vesicular monoamine transporter, CD56 cluster of differentiation 56, NCAM Neural Cell Adhesion Molecule, SSTR somatostatin receptor, CK cytokeratin, CEA carcinoembryonic antigen, Ca 19.9 carbohydrate antigen 19-9, TTF1 thyroid transcription factor 1, CDX2 caudal type homeobox 2.</p