Cost-effectiveness of delayed-release dimethyl fumarate for the treatment of relapsing forms of multiple sclerosis in the United States

Objective:

To assess the cost-effectiveness of delayed-release dimethyl fumarate (DMF, also known as gastro-resistant DMF), an effective therapy for relapsing forms of multiple sclerosis (MS), compared with glatiramer acetate and fingolimod, commonly used treatments in the US.

Methods:

A Markov model was developed comparing delayed-release DMF to glatiramer acetate and fingolimod using a US payer perspective and 20-year time horizon. A cohort of patients, mean age 38 years, with relapsing-remitting MS and Kurtzke Expanded Disability Status Scale (EDSS) scores between 0–6 entered the model. Efficacy and safety were estimated by mixed-treatment comparison of data from the DEFINE and CONFIRM trials and clinical trials of other disease-modifying therapies. Data from published studies were used to derive resource use, cost, and utility inputs. Key outcomes included costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios. Alternative scenarios tested in a sensitivity analysis included drug efficacy, EDSS-related or relapse-related costs, alternative perspectives, drug acquisition costs, and utility.

Results:

Base-case results with a 20-year time horizon indicated that delayed-release DMF increased QALYs +0.450 or +0.359 compared with glatiramer acetate or fingolimod, respectively. Reductions in 20-year costs with delayed-release DMF were ?$70,644 compared with once-daily glatiramer acetate and ?$32,958 compared with fingolimod. In an analysis comparing delayed-release DMF to three-times-weekly glatiramer acetate and assuming similar efficacy and safety to the once-daily formulation, 20-year costs with delayed-release DMF were increased by $15,806 and cost per QALY gained was $35,142. The differences in costs were most sensitive to acquisition cost and inclusion of informal care costs and productivity losses. The differences in QALYs were most sensitive to the impact of delayed-release DMF on disease progression and the EDSS utility weights.

Conclusion:

Delayed-release DMF is likely to increase QALYs for patients with relapsing forms of MS and be cost-effective compared with fingolimod and glatiramer acetate.     

The Anatomy of a Socially Responsible Corporation

Prior research treats corporate social responsibility (CSR) as a unitary construct. Using principal component analysis, we show that CSR activities can be divided into two types: responsive CSR (RCSR), which includes initiatives that address specific concerns caused by firm activity, and adaptive CSR (ACSR), which are initiatives that anticipate concerns before they arise. We find that responsive motives are roughly three times more dominant than adaptive motives. Larger firms, older firms, and more diversified firms invest more in RCSR while younger firms and more focused firms tend to invest more in ACSR.     

Owners on both sides of the deal: mergers and acquisitions and overlapping institutional ownership

Using a corporate governance lens, this study considers owners with a stake in both the acquiring and the target firms in the context of mergers and acquisitions. A possible agency problem arises with regard to monitoring implications as managers may be able to take advantage of compromised monitoring because overlapping owners may focus on the aggregate value for both the acquiring and the target firms and nonoverlapping owners may be interested only in the acquirer's side of the deal. The results suggest that when more owners overlap in their ownership of both the acquiring and target firms, the acquiring firms are more likely to experience decreased shareholder value through merger and acquisition deals. This effect, however, can be constrained by stronger board control. Copyright © 2010 John Wiley & Sons, Ltd.     

How do we measure the intangible? Overcoming the measurement challenge in services

Measuring service tangibility and intangibility aspects has been an interest to service researchers. While the Likert rating scale has been widely employed for measuring mental intangibility or its dimensions, it is not free from issues such as different anchoring, that is, the same words pointing to different attitudes and understanding for different individuals. The present study proposes the usefulness of a discrete choice experiment (DCE), where respondents are asked the same questions (i.e., items) and are presented with a scale while dichotomizing the possible responses for each scale item. We show that our proposed method is accurate and generalizable across contexts and samples through multiple studies. The DCE method gives managers a better way to measure intangibility or similar service constructs like service quality, which can help them manage their service offerings and make customers happier.