Evaluating drug cost per responder and number needed to treat associated with lixisenatide on top of glargine when compared to rapid-acting insulin intensification regimens on top of glargine,in patients with type 2 diabetes in the UK,Italy, and Spain

Objectives: This study investigated the cost per responder and number needed to treat (NNT) in type 2 diabetes mellitus (T2DM) patients for lixisenatide compared to insulin intensification regimens using composite endpoints in the UK, Italy, and Spain.

Methods: Efficacy and safety outcomes were obtained from GetGoal Duo-2, a 26-week phase 3 trial comparing lixisenatide vs insulin glulisine (IG) once daily (QD) and three times daily (TID). Response at week 26 was extrapolated to 52 weeks, assuming a maintained treatment effect, based on long-term evidence in other T2DM populations. Responders were defined using composite end-points, based on an HbA1c threshold and/or no weight gain and/or no hypoglycemia. The HbA1c threshold was varied in sensitivity analyses. Annual treatment costs were estimated in euros (1 GBP?=?1.26 EUR), including drug acquisition and resource use costs. Cost per responder was computed by dividing annual treatment costs per patient by the proportion of responders.

Results: Lixisenatide was associated with the lowest cost per responder for all composite end-points that included a weight-related component. For the main composite end-point of HbA1c ≤7.5% AND no weight gain AND no symptomatic hypoglycemia, cost per responder results were: UK: 6,867€, 8,746€, and 12,410€; Italy: 7,057€, 9,160€, and 12,844€; Spain: 8,370€, 11,365€, and 17,038€, for lixisenatide, IG QD, and TID, respectively. The NNT analysis showed that, for every 6.85 and 5.86 patients treated with lixisenatide, there was approximately one additional responder compared to IG QD and TID, respectively.

Limitations: A limitation of the clinical inputs is the lack of 52-week trial data from GetGoal Duo-2, which led to the assumption of a maintained treatment effect from week 26 to 52.

Conclusions: This analysis suggests lixisenatide is an efficient economic resource allocation in the UK, Italy, and Spain.     

Different strokes for different folks: A method to accommodate decision -making heterogeneity

Consumer decision making is complex and no single perspective offers a complete theory of consumer decision making. While the research community acknowledges that there is heterogeneity, homogenous choice models dominate consumer decision research. This paper provides insights from one method that was designed to accommodate decision -making heterogeneity. Computer process tracing methods can be used to observe different consumer decisions in one product category to understand what and how people choose. More than two-hundred and fifty decisions were observed in this research. Consumers were asked to select one of nine air conditioner alternatives described with six salient attributes. The research findings clearly reveal consumer differences. Specifically, the attributes and decision types used differed resulting in different product choices. This paper reveals how methods that accommodate decision -making heterogeneity can be used by retailers to inform product ranging decisions for categories.     

Accounting Window Dressing and Template Regulation: A Case Study of the Australian Credit Union Industry

This article documents the response of cooperative institutions that were required to adhere to new capital adequacy regulations traditionally geared for profit-maximising organisations. Using data from the Australian credit union industry, we demonstrate that the cooperative philosophy and internal corporate governance structure of cooperatives will lead management to increase capital adequacy ratios through the application of accounting window dressing techniques. This is opposite to the intended purpose of template regulation aimed at efficiently increasing operating margins and lowering risk. Our results raise several debatable issues regarding the ethics of accounting management and the imposition of one-shoe-fits-all external regulation.      

INSTITUTIONAL ECONOMICS: SURVEYING THE ‘OLD’ AND THE ‘NEW’

This paper surveys and compares the literature on the ‘new’ institutionalism (North, Williamson, etc.) with that of the ‘old’(Veblen, Commons, Mitchell). A criterion for distinguishing these two schools is suggested, along with criticisms of the limitations of each. The ‘new’ institutionalism is associated with methodological individualism and the idea that the individual should be taken as given. Particular attention is paid to ‘new’ institutionalist treatments of markets and firms. The paper moves on to examine some ‘old’ institutionalist criticisms of ‘economic man’ as well as some negative features of the ‘old’ institutionalism. On the positive side, the latter is seen to have an ‘evolutionary’ dimension, related to modern work in the area of technological change.     

Economic science and ethical neutrality: The problem of teleology

Two disputes have continually frustrated attempts to provide a tenable method of enquiry for economic science:

1. Should theory construction in economics include a commitment to moral principles? Or should economic theory remain value-free?
2. Does the peculiar subject matter of economics demand a ‘teleological’, or a ‘mechanistic’ pattern of explanation?

It is the aim of this paper to shed light on both the preceding controversies by seeking to clarify the relation between them. In particular, it is argued via a case study of the theory of rational choice that over-simplified mechanistic constructions have distorted the normative content and applicability of economic theory. Yet still in an explosively changing world, we have a fragmented economics · One reason for this goes deep. It is the lack of a philosophical basis for economic theory. Economic life is looked upon as deliberative action, and again it is looked upon as action determined by the combination of tastes and circumstances. Which is it? Can it be both? Nobody asks, and such problems being unrecognized, the diversity of hidden assumptions creates a babel of conflicting languages!     

Knowledge at work: Some neoliberal anachronisms

With a predilection for market solutions, neoliberalism upholds that the individual is generally the best judge of his or her interests. Yet markets are never universally applied as a mechanism of allocation and there are reasons, in principle, why capitalism will always have “missing markets.” Concentrating on the application and appropriateness of neoliberal theory to the workplace, this article argues that firms are not markets, despite some tendencies in modern theory to conflate the two. The employment contract is a key characteristic of modern firms, but neoliberal theory is often silent on the distinction between an employment contract and a contract for services, and largely ignores the asymmetrical rights of authority within contracts of employment. Furthermore, the social nature of knowledge represents a challenge to neoliberal theory and policy, because it sometimes makes it more difficult to define individual property rights. Accordingly, with the growth of the knowledge economy, neoliberalism to some extent is an anachronism.