Cost-effectiveness of omalizumab add-on to standard-of-care therapy in patients with uncontrolled severe allergic asthma in a Brazilian healthcare setting

Objective: Omalizumab add-on to standard-of-care therapy has proven to be efficacious in severe asthma patients for whom exacerbations cannot be controlled otherwise. Moreover, evidence from different healthcare settings suggests reduced healthcare resource utilization with omalizumab. Based on these findings, this study aimed to assess the cost-effectiveness of the addition of omalizumab to standard-of-care therapy in patients with uncontrolled severe allergic asthma in a Brazilian healthcare setting.

Methods: A previously published Markov model was adapted using Brazil-specific unit costs to compare the costs and outcomes of the addition of omalizumab to standard-of-care therapy vs standard-of-care therapy alone. Model inputs were largely based on the eXpeRience study. Costs and health outcomes were calculated for lifetime-years and were annually discounted at 5%. Both one-way and probabilistic sensitivity analyses were performed.

Results: An additional cost of R$280,400 for 5.20 additional quality-adjusted life-years was estimated with the addition of omalizumab to standard-of-care therapy, resulting in an incremental cost-effectiveness ratio of R$53,890. One-way sensitivity analysis indicated that discount rates, standard-of-care therapy exacerbation rates, and exacerbation-related mortality rates had the largest impact on incremental cost-effectiveness ratios.

Limitations: Assumptions of lifetime treatment adherence and rate of future exacerbations, independent of previous events, might affect the findings. The lack of Brazilian patients in the eXpeRience study may affect the findings, although sample size and baseline characteristics suggest that the modeled population closely resembles Brazilian severe allergic asthma patients.

Conclusion: Results indicate that omalizumab as an add-on therapy is more cost-effective than standard-of-care therapy alone for Brazilian patients with uncontrolled severe allergic asthma, based on the World Health Organization’s cost-effectiveness threshold of up to 3-times the gross domestic product.     

Semantics for intuitionistic epistemic logics of shallow depths for game theory

Epistemic logic of shallow depths has been developed by Kaneko–Suzuki using classical logic. In this paper, we adopt intuitionistic logic as the base logic to limit each player’s reasoning to constructive one. The resulting logical system is denoted by IG $_{EF}$ , and we introduce epistemic possible world semantics for IG $_{EF}$ . We show the soundness and completeness of IG $_{EF}$ with respect to this semantics for it. We also show some applications to game theoretical decision making.     

Sovereign risk and procyclical fiscal policy in emerging market economies

This study develops a dynamic stochastic general equilibrium model to account for the differences in fiscal policy stance over the business cycle between developed and emerging market countries, and, in particular, for the volatile and procyclical government consumption and transfer payment in emerging market countries. Two models with and without default option in sovereign borrowings replicate the contrasting cyclical behaviors indicating that the default option is responsible for procyclical fiscal policy. Further, augmented model with third-party bailouts, together with the stochastic trend income process, successfully predicts high volatilities of fiscal expenditures. These imply that procyclical fiscal policy, entailed by default option, may exacerbate the business cycle in emerging market countries.     

Core and competitive equilibria of a coalitional exchange economy with infinite time horizon

The core and competitive equilibria of a large exchange economy on the commodity space ?^∞${?}^{\infty }$ will be discussed. We define the economy as a measure on the space of consumers’ characteristics following Hart and Kohlberg (1974), and prove the existence of competitive equilibria and their equivalence with the core without assuming the convexity of preferences.     

Drifting Rhinos and Fluid Properties: The Turn to Wildlife Production in Western Zimbabwe

This paper presents and analyzes a number of tensions that arose in the shift from extensive livestock production to wildlife ranching and tourism in a dispersed community of white farmers in western Zimbabwe. It sketches the broader context of that shift and considers some of its effects, including those on the small (black)farmers of neighbouring Communal Areas. The tensions highlighted and manifested between the ranchers of Mlilo include the necessary movement from a characteristic view of wildlife as 'vermin', destructive of the conditions for livestock (and crop) production, to an appreciation that they are an exploitable and valuable resource ('ecological capital'); and how inherited views and practices concerning the boundaries of private landed property are subverted by the demands of wildlife ranching.     

The Last Mile: Managing Driver Helper Dispatching for Package Delivery Services

Hiring seasonal driver helpers is one widely used approach by parcel delivery companies to deal with increased home-delivery volumes during peak seasons. Nonetheless, driver helper-related issues have not received much attention in academic research. This study investigates how driver helpers can be utilized in the most effective way by parcel delivery companies. We show that by separating a parcel delivery route into two sub-routes, namely “no-helper” and “with-helper” routes, the utilization rates of driver helpers can be improved, and the carrier cost be reduced considerably. Three main contributions of this study are as follows. First, based on costtrade-off insights, we develop a new mathematical model for the last-mile distribution problem, which we call the Driver Helper Dispatching Problem. Second, using this mathematical model, we perform a series of numerical experiments to identify the conditions under which the proposed “split-route solution” works most or least effectively. Finally, we perform sensitivity analyses to investigate the impact that changes in model parameters, such as fuel cost, would have on study results.     

The right to adequate housing: evictions of the homeless and the elderly caused by the 2020 Summer Olympics in Tokyo

Abstract

The reconstruction of the National Stadium for the 2020 Summer Olympics and Paralympics in Tokyo has induced displacement of two groups of vulnerable people, raising concerns of the violation of human rights, particularly the right to adequate housing. The expansion of the stadium led to the expulsion of dozens of homeless people who lived in and around the park surrounding the stadium, and a sudden decision to demolish a nearby public housing estate built for the 1964 Summer Games forced over 200 tenants, most of whom were elderly, to be relocated. While the homeless people engaged in several rounds of negotiation with the government authorities, the majority of the housing tenants reluctantly agreed to move except for a few who kept demanding respectful treatment from the metropolitan government. Presenting the preliminary results of a mixed-method three-year qualitative study, this research note demonstrates that while the authority might have offered alternative housing considered ‘adequate’ in terms of physical living conditions, the process of evictions did not afford autonomy for the affected to choose where to live. The respective status of the affected – homeless and elderly – may demand the reconsideration of the concept of ‘adequate housing’ in relation to human dignity.     

Competition,patent protection,and innovation with heterogeneous firms in an endogenous market structure

This paper revisits the relationship between competition and innovation by incorporating the heterogeneity of R&D efficiency across firms and an endogenous market structure in a dynamic general equilibrium model. Using an analytically tractable model, we show that competition and innovation can have either an inverted‐U or a negative relationship, as reported by several empirical studies. Furthermore, we show that the effect of strengthening patent protection on innovation depends on the competition level. In particular, we find a complementary relationship between competition policy and the strengthening of patent protection.     

Does citizen participation affect municipal performance? Electoral competition and fiscal performance in Japan

Subnational fiscal performance has been receiving a lot of attention from researchers in various disciplines. However, there is very little published on the impact of citizen involvement on fiscal performance. This paper shows that a lack of citizen involvement in the electoral process was associated with fiscal performance in all 807 city-level Japanese municipalities from 2006 to 2012.