Cost-effectiveness of telaprevir in combination with pegylated interferon alpha and ribavirin in treatment-experienced chronic hepatitis C genotype 1 patients

Background:

Telaprevir (TVR,T) and boceprevir (BOC,B) are direct-acting antivirals (DAAs) used for the treatment of chronic genotype 1 hepatitis C virus (HCV) infection. This analysis evaluated the cost-effectiveness of TVR combined with pegylated interferon (Peg-IFN) alfa-2a plus ribavirin (RBV) compared with Peg-IFN alfa-2a and RBV (PR) alone or BOC plus Peg-IFN alfa-2b and RBV in treatment-experienced patients.

Methods:

A Markov cohort model of chronic genotype 1 HCV disease progression reflected the pathway of experienced patients retreated with DAA therapy. The population was stratified by previous response to treatment (i.e., previous relapsers, partial responders, and null responders). Sustained virologic response (SVR) rates were derived from a mixed-treatment comparison that included results from separate Phase III trials of TVR and BOC. Incremental cost per life year (LY) gained and quality-adjusted-life-year (QALY) gained were computed at lifetime, adopting the NHS perspective. Costs and health outcomes were discounted at 3.5%. Uncertainty was assessed using deterministic and probabilistic sensitivity analyses. Sub-group analyses were carried out by interleukin (IL)-28B genotype.

Results:

Higher costs and improved outcomes were associated with T/PR relative to PR alone for all experienced patients (ICER of £6079). T/PR was cost-effective for each sub-group population with high SVR advantage in relapsers (ICER of £2658 vs £7593 and £20,875 for partial and null responders). T/PR remained cost-effective regardless of IL-28B sub-type. Compared to B/PR, T/PR prolonged QALYs by 0.57 and reduced lifetime costs by £13,960 for relapsers. For partial responders T/PR was less costly but less efficacious than B/PR, equating to an ICER of £128,117 per QALY gained.

Limitations:

No head-to-head trial provides direct evidence of better efficacy of T/PR vs B/PR.

Conclusion:

T/PR is cost-effective compared with PR alone in experienced patients regardless of treatment history and IL-28B genotype. Compared to B/PR, T/PR is always cost-saving but only more effective in relapsers.     

China in Global Economic Governance

China has made contradictory claims about its attitude toward the existing international order. Is China a “responsible stakeholder” in the existing international regimes? Or has China been a new type of great power seeking to reform the existing world order, making it more friendly toward the global South? In this article, we look beyond Chinese rhetoric and examine China's behavior in global economic governance. A comparison with other emerging powers and traditional major powers shows that China has been actively involved in global economic governance. But, thus far, China has not exercised substantive leadership nor has it pushed hard for change to benefit the developing countries. The level of its support of the current regimes varies across issue areas and is primarily driven by its changing economic interest.     

Corruption and firm behavior: Evidence from African ports

This paper investigates how corruption affects firm behavior. Using an original and unusually rich dataset on bribe payments at ports matched to firm-level data, we observe how firms adapt to different types of corruption by adjusting their transport strategies. Our results suggest that firms respond to the price effects of corruption, organizing production in a way that increases or decreases demand for the public service.     

Procedural and Distributive Justice: Examining Equity in a University Setting

The concept of organizational justice is important to understanding and predicting organizational behavior. A significant development in the research literature has been the separation of distributive and procedural justice. While much of the research has focused on negative outcomes, this research attempted to verify the presence of both forms of justice in the context of positive outcomes. Subjects completed an instrument designed to measure their perceptions of distributive and procedural justice. The subjects also reported their satisfaction and sense of fairness with their salary increases, their belief that the procedures to award the increases had been followed, and their level of information and agreement regarding the salary program. These measures, along with size of salary increase and gender were examined to determine their impact on the subjects' perceived level of justice. The data support the existence of the two distinct forms of justice, but suggest that procedural justice may, in turn, branch out into two aspects. One category involves being informed, and a second appears to deal with acceptance of procedures. A series of relationships are then considered. Significant gender effects were non-existent.     

Knowledge,beliefs and attitudes of squash venue operators relating to use of protective eyewear

Sports venues are in a position to potentially influence the safety practices of their patrons. This study examined the knowledge, beliefs and attitudes of venue operators that could influence the use of protective eyewear by squash players. A 50% random sample of all private and public squash venues affiliated with the Victorian Squash Federation in metropolitan Melbourne was selected. Face-to-face interviews were conducted with 15 squash venue operators during August 2001. Interviews were transcribed and content and thematic analyses were performed. The content of the interviews covered five topics: (1) overall injury risk perception, (2) eye injury occurrence, (3) knowledge, behaviors, attitudes and beliefs associated with protective eyewear, (4) compulsory protective eyewear and (5) availability of protective eyewear at venues. Venue operators were mainly concerned with the severe nature of eye injuries, rather than the relatively low incidence of these injuries. Some venue operators believed that players should wear any eyewear, rather than none at all, and believed that more players should use protective eyewear. Generally, they did not believe that players with higher levels of experience and expertise needed to wear protective eyewear when playing. Only six venues had at least one type of eyewear available for players to hire or borrow or to purchase. Operators expressed a desire to be informed about correct protective eyewear. Appropriate protective eyewear is not readily available at squash venues. Better-informed venue operators may be more likely to provide suitable protective eyewear.     

Non-market valuation of forest goods and services: Good practice guidelines

The European COST Action E45 on European Forest Externalities (EUROFOREX) participants developed a set of good practice guidelines for the non-market valuation of forests, elaborating on stated and revealed preference methodologies, as well as benefit transfer and meta-analytical procedures. This article presents a summary of the guidelines.     

An evidence-based review of e-HRM and strategic human resource management

One stated purpose of electronic human resource management (e-HRM) is to make the HRM function more strategic. The goal of this paper is to examine the research on e-HRM to provide evidence-based guidance to researchers and practitioners on the relationship between e-HRM and strategic HRM. We review 40 studies published from 1999 to 2011 using integrative synthesis as our evidence-based methodology. Results reveal that theoretical and empirical research in this area is still at an early stage. We find no empirical evidence showing that e-HRM predicts strategic outcomes. There is evidence suggesting that strategic HRM predicts e-HRM outcomes and that the relationship appears context dependent, however, research designs are not sufficient to establish causal direction. Our review highlights the need for more empirical studies on e-HRM and strategic HRM outcomes at a macro level.