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This study estimates productivity gains and their distribution among inputs and outputs for 63 American industries over the period 1987–2012. Using the traditional surplus accounting method, the Total Factor Productivity (TFP) growth rates are divided into their price change components in order to determine the stakeholders who do or do not receive price advantages. An initial analysis showed that TFP of US industries increased at an average trend of 0.8% and established that remunerations to employees and firms’ profitability constituted 49% and 39%, respectively, of the accumulated economic surplus from the productivity gains. Suppliers of intermediate inputs retained 12.1% of the surplus. Finally, customers, equipment and structure providers were the losers in the distribution of economic surplus via, respectively, a significant growth of relative final demand prices and a substantial price decrease of these assets. A second step analysis underlined that industries with high TFP growth rates mainly benefited customers and firms via output price decreases and profitability improvements while industries with low or negative TFP changes hurt customers through significant output price increases. The sectoral level analysis also showed that employees’ remunerations depend only slightly on productivity gains produced within their industrial sectors. [ABSTRACT FROM PUBLISHER]

Hospital productivity has been a research topic for over two decades. Whereas much has been learned regarding cost, technical, scale, and allocative efficiency as well as the impact that weakly disposable inputs/outputs have on hospital behavior, we expand on this research by examining size and service offering, or focus, efficiency at the metropolitan area level for US hospitals. By using an extension of the Free Coordination Hull (FCH), we are able to determine whether hospitals in our sample could become more efficient if they provided more services (reduce inefficiency due to too narrow a focus) or fewer services (reduce inefficiency due to too broad a focus). Our results suggest that findings vary among the hospital markets. This approach could be used by policy makers and managers in order to reduce costs by sharing services, reducing services in hospitals, or expanding services in hospitals. Findings from a study such as this should aid reform programs by providing more information on the sources of hospital inefficiency. [ABSTRACT FROM AUTHOR]

Background and Objectives The proteasome inhibitor bortezomib is approved for the treatment of multiple myeloma (MM) and, in the US, for the treatment of mantle cell lymphoma following at least one prior therapy; the recommended dose and schedule is 1.3 mg/m² on days 1, 4, 8 and 11 of 21-day cycles, and the approved routes of administration in the US prescribing information are by intravenous and, following a recent update, subcutaneous injection. Findings from a phase III study demonstrated that subcutaneous administration of bortezomib, using the same dose and schedule, resulted in similar efficacy with an improved systemic safety profile (including significantly lower rates of peripheral neuropathy) versus intravenous bortezomib in patients with relapsed MM. The objectives of this report were to present a comprehensive analysis of the pharmacokinetics and pharmacodynamics of subcutaneous versus intravenous bortezomib, and to evaluate the impact of the subcutaneous administration site, subcutaneous injection concentration and demographic characteristics on bortezomib pharmacokinetics and pharmacodynamics. Patients and Methods Data were analysed from the pharmacokinetic substudy of the randomized phase III MMY-3021 study and the phase I CAN- 1004 study of subcutaneous versus intravenous bortezomib in patients aged ≥ 18 (MMY- 3021) or ≤75 (CAN-1004) years with symptomatic relapsed or refractory MM after 1-3 (MMY-3021 ) or ≥ 1 (CAN- 1004) prior therapies. Patients received up to eight 21-day cycles of subcutaneous or intravenous bortezomib 1.3 mg/m² on days 1, 4, 8 and 11. Pharmacokinetic and pharmacodynamic (20S proteasome inhibition) parameters of bortezomib following subcutaneous or intravenous administration were evaluated on day 11, cycle 1. Results Bortezomib systemic exposure was equivalent with subcutaneous versus intravenous administration in MMY-3021 [mean area under the plasma concentration-time curve from time zero to the last quantifiable timepoint (AUClast): 155 vs. 151 ng⋅h/mL; geometric mean ratio 0,992 (90 % CI 80.18, 122.80)] and comparable in CAN-1004 (mean AUClast: 195 vs. 241 ng⋅h/mL); maximum (peak) plasma drug concentration (Cmax) was lower with subcutaneous administration in both MMY-3021 (mean 20.4 vs. 223 ng/mL) and CAN-1004 (mean 22.5 vs. 162 ng/mL), and time to Cmax (tmax) was longer with subcutaneous administration in both studies (median 30 vs. 2 min). Blood 20S proteasome inhibition pharmacodynamic parameters were also similar with subcutaneous versus intravenous bortezomib: mean maximum effect (Emax) was 63.7 versus 69.3 % in MMY-3021 and 57.0 versus 68.8 % in CAN-1004, and mean area under the effect-time curve from time zero to 72 h was 1,714 versus 1,383 %⋅h in MMY-3021 and 1,619 versus 1,283 %⋅h in CAN-1004. Time to Emax was longer with subcutaneous administration in MMY-3021 (median 120 vs. 5 min) and CAN-1004 (median 120 vs. 3 min). Concentration of the subcutaneous injected solution had no appreciable effect on pharmacokinetic or pharmacodynamic parameters. There were no apparent differences in bortezomib pharmacokinetic and pharmacodynamic parameters between subcutaneous administration in the thigh or abdomen. There were also no apparent differences in bortezomib exposure related to body mass index, body surface area or age. Conclusion Subcutaneous administration results in equivalent bortezomib plasma exposure to intravenous administration, together with comparable blood 20S proteasome inhibition pharmacodynamic effects. These findings, together with the non-inferior efficacy of subcutaneous versus intravenous bortezomib demonstrated in MMY-3021, support the use of bortezomib via the subcutaneous route across the settings of clinical use in which the safety and efficacy of intravenous bortezomib has been established. [ABSTRACT FROM AUTHOR]

In this paper we propose an empirically implementable measure of aggregate-level efficiency along the lines of Debreu’s (1951) coefficient of resource utilization but restricted to the production side. The efficiency measure is based on directional distance functions, which allows the overall measure of efficiency to be decomposed into measures of technical and “structural” efficiency. The latter measure, which captures inefficiencies associated with the organization of production within an industry, is further decomposed into measures of scale and mix efficiency. The measures developed in the paper are illustrated using U.S. hospital data. The illustration sheds light on the efficacy of certificate of need (CON) regulations. [ABSTRACT FROM AUTHOR]

Excess capacity can be viewed as wasteful (an unnecessary cost) or as prudential (a ready source of supply). The role of excess capacity is an important issue at the individual firm level as well as at the community level. In this paper we explore hospital capacity for a sample hospitals operating in the 15 largest standard metropolitan statistical areas (SMSAs) in the U.S. during 2002. Using Johanson’s (, Production Functions and the Concept of Capacity, Namur, Belgium, Recherches Récentes sur le Fonction de Production (Collection, Economie Mathematique et Econometrie no. 2). [Reprinted in Finn R. Førsund (ed) (1987) The Collected Works of Leif Johanson, vol 1. Amsterdam, North-Holland, pp 350–282]) notion of capacity as the maximum rate of output possible from fixed inputs (i.e., without restrictions on variable inputs), we measure capacity in a frontier setting using directional distance functions. Rather than attempt to determine the “optimal” level of hospital capacity, we instead quantify capacity and capacity utilization rates at both the individual hospital and, by aggregating, the SMSA levels. After determining capacity and capacity utilization rates, we then introduce a model that calculates the changes in variable inputs that would be needed to utilize excess capacity. Finally, we introduce a simulation model that is used to examine whether each SMSA has enough “excess” hospital capacity to accommodate the loss of one of its five largest hospitals. The approach developed in this study should be of value to decision makers and planners in a variety of fields. [ABSTRACT FROM AUTHOR]

French and US hospital technologies are compared using directional input distance functions. The aggregation properties of the directional distance function allow comparison of hospital industry-level performance as well as standard firm-level performance with regard to productive efficiency. In addition, the underlying constituents of efficiency in the short run, congestion and technical inefficiency, and in the long run, scale inefficiency -- are analysed by decomposing the overall measure. By virtue of using the directional distance function, it is also possible to obtain an estimate of a lower bound on allocative inefficiency. It is found that French and US hospitals use quite different technologies. Long run scale inefficiencies cause most of the French hospitals' inefficiency, while short run technical inefficiency is the main source of overall productive inefficiency in the US hospitals. [ABSTRACT FROM AUTHOR]