Tofacitinib in the treatment of moderate-to-severe rheumatoid arthritis: a cost-effectiveness analysis compared with adalimumab in Taiwan

Aims: Tofacitinib is an oral Janus kinase inhibitor for the treatment of rheumatoid arthritis (RA). This analysis investigated the cost-effectiveness of the second-line treatment with tofacitinib, compared with adalimumab, both plus methotrexate (MTX), in patients with moderate-to-severe RA and an inadequate response to the first-line MTX, from a Taiwan National Health Insurance Administration perspective.

Materials and methods: A patient-level simulation model was used to project lifetime costs and quality-adjusted life-years (QALYs). Base-case analysis compared second-line treatment with tofacitinib 5?mg twice daily plus MTX vs adalimumab 40?mg every 2?weeks plus MTX. Patients switched or discontinued treatment due to a lack or loss of effectiveness or a serious adverse event. Efficacy was measured by change in Health Assessment Questionnaire-Disability Index (HAQ-DI) score. HAQ-DI scores were used to predict mortality and resource utilization, and were mapped onto utility values to estimate QALYs. Efficacy and safety data were derived from clinical trials and other secondary sources. Uncertainty in model parameters was explored using one-way deterministic and probabilistic sensitivity analyses.

Results: Patients gained 0.09 more QALYs with second-line tofacitinib plus MTX compared with adalimumab plus MTX (5.13 vs 5.04, respectively) at an additional cost of New Taiwan Dollars (NT$) 12,881. The incremental cost-effectiveness ratio was NT$143,122/QALY. One-way sensitivity analysis confirmed the base-case result was robust.

Limitations: The lack of available clinical data, particularly for HAQ-DI scores, may introduce some bias in the analysis. No patients were in an early stage of RA, which may limit the generalizability of these results. Base-case results from our study are not necessarily generalizable to countries with healthcare systems that differ considerably from Taiwan.

Conclusions: From a payer perspective, second-line treatment with tofacitinib plus MTX is a cost-effective treatment strategy, compared with adalimumab plus MTX, in patients with moderate-to-severe RA in Taiwan.

Trial registration: ClinicalTrials.gov identifier: NCT00853385.     

How Big Was the Effect of Budget Consolidation on the Australian Economy in the 1990s?

This article evaluates the effects of budget consolidation on the Australian economy in the 1990s. As the economy recovered from the 1991–92 recession, the need to improve the fiscal balance to lift national saving became the dominant influence on fiscal policy. The article argues that spending cuts by the Australian federal government announced in 1996 had immediate effects on financial markets, with reduced long‐term interest rates of about 50 basis points in 1996–97. Using a modified version of the Treasury macroeconometric model of the Australian economy (TRYM), the article simulates the net macroeconomic effects of the expenditure cuts, fiscal consolidation and lower long‐term interest rates. The article finds that the program of budget consolidation had a sizeable short‐ and medium‐term impact on the economy, raising Gross Domestic Product by up to three‐quarters of a percentage point and reducing unemployment by 0.3 percentage points over the next two to three years.     

生产要素对粮食产量的贡献系数分析

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中国创造国家竞争优势的要素分析

波特、鲁格曼、克如兹、穆恩、鲁格曼、沃柏克和乔东逊等人分别解释美国、加拿大、韩国等国家竞争优势形成的要素.本文在参考上述等人文献的基础上,试图剖析形成中国国家竞争优势的主要元素.我们的结论是:政府、对外开放、生产力和市场需求四个因素及其关联共同创造了中国国家竞争优势.     

作业成本法在我国的应用现状及实施对策

本文首先从分析我国企业应用作业成本法的实际状况出发,通过样本分析说明我国企业目前尚无真正意义上的作业成本法,然后,对我国企业实施作业成本法的瓶颈及实施作业成本法的具体方法进行了论述。     

国有及国有控股企业的绩效评价指标体系设计

国有及国有控股企业的绩效评价指标体系是国有资产监督管理体系的重要组成部分,本文在分析现行国有和国有控股企业绩效评价指标体系局限性的基础上,对如何完善国有及国有控股企业的绩效评价指标体系进行了探讨。     

基尼系数分解分析中国城市居民收入不平等

当GINI系数按组（如职业,性别,区域）分解时,它可以分为组内、组间和层迭项（overlapped）三个组成部分,从文献检索来看,GINI系数的分解方法已有许多,但大多数分解方法不仅不易于理解而且计算非常繁重.本文应用Yao和Liu（1996）提出的四步分解法克服了其他方法存在的缺点,并以中国2003年的城镇居民收入调查数据为例,说明这个新方法可以容易地应用于研究中国各地区城市居民间收入的不平等状况.本文在许多以前的研究未能认识到的层迭带部分有实质性的突破.     

创意枭雄 智慧经营——艺术家思维，企业家行动

对于Artkey,一家在中国和美国同时开展业务的艺术授权企业，帮助企业从OEM转向ODM，增加制造业出口的利润水平。这是一家较为典型的创意产业企业，它所切入的细分市场，规模达到180亿美元。     

综合素质与语言能力:高职英语教学的育人功能研究

高职英语教育教学改革要坚持以人为本的育人理念,注重学生英语综合运用能力的培养和综合素质的提升.文章以福建金融职业技术学院的教育质量问卷调查结果统计为依据,结合目前大学英语教育教学及改革的现状,从更新教育理念,改革教学模式、优化课堂教学三方面进行阐述,来探讨高职英语教育应如何改革才能更好地实现其育人功能.     

北京:经济增长与扩大就业

一种广为流传的认识是,扩大就业要通过发展经济来实现,用新古典模型对北京经济发展与就业增长的相关实证分析,并非如此.由此可见,经济增长有投资型、技术进步型和劳动扩张型.北京市今后经济的发展必须在重视投资和技术的同时,提升发展劳动密集型中小企业和第三产业的政策层面.