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The Cost Savings Potential of Biosimilar Drugs in the United States

December 16, 2014 Comments off

The Cost Savings Potential of Biosimilar Drugs in the United States
Source: RAND Corporation

The U.S. Food and Drug Administration (FDA) is expected to release final regulations outlining lower-cost approval pathway requirements for so-called biosimilar drugs. The introduction of biosimilars is expected to reduce prices, albeit to a lesser degree than small-molecule generics. This Perspective combines prior research and recent data to estimate cost savings in the U.S. market. We predict that biosimilars will lead to a $44.2 billion reduction in direct spending on biologic drugs from 2014 to 2024, or about 4 percent of total biologic spending over the same period, with a range of $13 billion to $66 billion. While our estimate uses recent data and transparent assumptions, we caution that actual savings will hinge on the specifics of the final FDA regulations and on the level of competition.

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An Assessment of the Present and Future Labor Market in the Kurdistan Region — Iraq

December 15, 2014 Comments off

An Assessment of the Present and Future Labor Market in the Kurdistan Region — Iraq
Source: RAND Corporation

The study addresses the question of how the Kurdistan Regional Government can improve the private-sector labor market in the Kurdistan Region — Iraq (KRI). Doing so will involve creating mechanisms by which job-seekers can develop the right skills and find employers who will hire them, employers can find the employees they need, and the government can create an enabling environment in which the best matches between job-seekers and employers can be made. The study estimates the likely number and education levels of new job-seekers through 2020. It conducts an original, scientific survey to learn about employer perceptions of skill gaps in the KRI. Then, it investigates sectoral employment growth in comparison economies to identify promising growth sectors. Finally, it outlines policy steps for the government to take to improve the functioning of the private-sector labor market.

Designing Efficient Systematic Reviews Using Economical Allocation, Creation and Synthesis of Medical Evidence

December 4, 2014 Comments off

Designing Efficient Systematic Reviews Using Economical Allocation, Creation and Synthesis of Medical Evidence
Source: RAND Corporation

Medical literature and the actions of policymakers have emphasized the importance of evidence-based medicine in recent years, but basing clinical practice on an exploding base of evidence is challenging. Systematic reviews, which are very resource-intensive, are a crucial channel in the pathway from medical literature to clinical practice. This thesis begins by estimating the value of one systematic review, finding that synthesized evidence regarding treatments to prevent osteoporotic fractures generated a net benefit of approximately $450M. Next, the time taken to screen articles in systematic reviews is analyzed, showing that user interface changes can result in significant reductions in resource requirements. Presenting multiple articles on one screen while reviewing titles leads to a seven-fold reduction in time taken per article. Experience and mental state are also related to screening times, with abstracts reviewed at ideal session lengths requiring 33% less time than those at the beginning of a session.

To further increase the speed at which articles can be screened and decrease the cost of preparing systematic reviews, machine learning techniques allow avoidance of up to 80% of articles. When updating an existing review, savings are increased by utilizing the information present in original screening decisions to train the machine learning model. Finally, implementation issues are addressed, paying attention to technical, organizational, and institutional challenges and opportunities.

Premiums and Stability in the Individual Health Insurance Market: The Effects of Young Adult Enrollment and Subsidies

November 19, 2014 Comments off

Premiums and Stability in the Individual Health Insurance Market: The Effects of Young Adult Enrollment and Subsidies
Source: RAND Corporation

Key Findings

  • Eliminating the Affordable Care Act’s premium tax credits would substantially increase premiums and reduce overall enrollment in the individual market.
  • Reduced enrollment of young adults in the individual health insurance market would lead to modest premium increases.
  • Alternative types of subsidies — such as vouchers — could cause premiums to become more sensitive to the age mix of enrollees.
  • Eliminating the individual mandate would cause small increases in premiums but large declines in enrollment.

See also: Assessing Alternative Modifications to the Affordable Care Act: Impact on Individual Market Premiums and Insurance Coverage

Toward Meaningful Military Compensation Reform: Research in Support of DoD’s Review

November 14, 2014 Comments off

Toward Meaningful Military Compensation Reform: Research in Support of DoD’s Review
Source: RAND Corporation

Key Findings

Deficiencies in the Current System

  • Because service members do not receive retirement benefits unless they have served for 20 years, most members (about 86 percent of officers and 66 percent of enlisted personnel) receive no benefits.
  • The military compensation system emphasizes compensation in the form of deferred payments, despite the fact that the typical service member is young and has a preference for current over deferred compensation. As a result, compensation costs are higher than necessary.
  • The vesting point at 20 years of service and immediately available retirement benefits induces similar career lengths in all occupational specialties, but optimal career length may well differ by occupational specialty.

A Modernization Proposal

  • A hybrid system that combines elements of a defined-benefit plan (the military’s current system) and a defined-contribution plan (popular in the civilian sector) could address criticisms of the current system while maintaining key advantages.
  • Earlier vesting (before 20 years of service) in the proposed system can improve equity by increasing the likelihood that a service member will become vested.
  • A hybrid plan can increase efficiency and enable the services to flexibly manage the force via decisions about how the defined-benefit element is computed, how retirement eligibility criteria are defined, and when payouts are made.
  • RAND analysis indicates that a hybrid plan is able to create a steady-state force level and experience mix equivalent to the current force despite changes in the timing and amount of compensation and earlier vesting.
  • The hybrid plan could incorporate a streamlined disability retirement benefit that is both simpler and fairer than the current system’s.

Improving Strategic Competence Lessons from 13 Years of War

November 10, 2014 Comments off

Improving Strategic Competence: Lessons from 13 Years of War
Source: RAND Corporation

This report contributes to the ongoing debate about the lessons from the past 13 years of war and the requirements for addressing future conflicts. It addresses a particular disconnect in the current debate on the future of national security strategy and the role of landpower caused by an inadequate examination of the national level of strategy made by the U.S. government. The disconnect exists because there has been no systematic effort to collect and analyze insights from those who have been actively engaged in making policy and strategy from 2001 to 2014. A RAND Arroyo Center workshop provided a mechanism for eliciting insights from policymakers and academic experts involved in the formation of national-level strategy and its implementation over the past 13 years. This study analyzes and develops those insights in the context of the debate on future national security strategy. It applies those insights to the future operating environment, which will include irregular and hybrid threats, and identifies critical requirements for land forces and special operations forces to operate successfully in conjunction with other joint, interagency, and multinational partners.

The Federal Civil Service Workforce: Assessing the Effects on Retention of Pay Freezes, Unpaid Furloughs, and Other Federal-Employee Compensation Changes in the Department of Defense

October 31, 2014 Comments off

The Federal Civil Service Workforce: Assessing the Effects on Retention of Pay Freezes, Unpaid Furloughs, and Other Federal-Employee Compensation Changes in the Department of Defense
Source: RAND Corporation

Planners and policymakers must be able to assess how compensation policy, including pay freezes and unpaid furloughs, affects retention. This study begins to extend the dynamic retention model (DRM) — a structural, stochastic, dynamic, discrete-choice model of individual behavior — to federal civil service employment. Models are developed and estimated,using 24 years of data, and then used to simulate the effects of pay freezes and unpaid furloughs. A permanent three-year pay freeze decreases the size of the retained General Service (GS) workforce with at least a baccalaureate degree by 7.3 percent in the steady state. A temporary pay freeze with pay immediately restored has virtually no impact on retention. When pay is restored after ten years, the retained GS workforce falls by 2.8 percent five years after the pay freeze and 3.5 percent ten years after it. An unpaid furlough, similar to the six-day federal furlough in 2013, has no discernible effect on retention. For all subgroups of GS employees for which the model is estimated, the model fit to the actual data is excellent, and all of the model parameter estimates are statistically significant. In future work, the DRM could be extended to provide empirically based simulations of the impact of other policies on retention; to estimate effects on other occupational areas, other pay systems, or specific demographic groups; or to create a “total force” model (military and civilian) of DoD retention dynamics and the effects of compensation on those dynamics.

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