Cost-effectiveness of pembrolizumab in combination with chemotherapy in the 1st line treatment of non-squamous NSCLC in the US

Abstract

Aims: To describe cost-effectiveness of pembrolizumab plus platinum and pemetrexed chemotherapy in metastatic, non-squamous, NSCLC patients in the US.

Materials and methods: A model is developed utilizing partitioned survival analysis to estimate the cost-effectiveness of KEYNOTE-189 trial comparators pembrolizumab?+?chemotherapy (carboplatin/cisplatin?+?pemetrexed) vs chemotherapy alone. Clinical efficacy, treatment utilization, health utility, and safety data are derived from the trial and projected over 20 years. For extrapolating survival beyond the trial, a novel SEER population-data approach is applied (primary analysis), with separate estimation via traditional parametric extrapolation methods. Costs for drugs and non-drug disease management are also incorporated. Based on an indirect treatment comparison, cost-effectiveness of pembrolizumab?+?chemotherapy vs pembrolizumab monotherapy is evaluated for patients with programmed death-ligand 1 (PD-L1)?≥?50%.

Results: In the full non-squamous population, pembrolizumab?+?chemotherapy is projected to increase life expectancy by 2.04 years vs chemotherapy (3.96 vs 1.92), for an approximate doubling of life years. Resultant incremental cost-effectiveness ratios (ICERs) are $104,823/QALY and $87,242/life year. In patients with PD-L1?≥?50% and 1–49%, life expectancy is more than doubled (4.53 vs 1.88 years) and (4.87 vs 2.01 years), with a 32% (2.60 vs 1.97 years) increase in PD-L1?<?1% patients. Corresponding incremental costs/quality-adjusted life year (QALY) are $103,402, $66,837, and $183,529 for PD-L1?≥?50%, 1–49%, and <1% groups, respectively. Versus pembrolizumab monotherapy in PD-L1?≥?50% patients, representing current standard of care, pembrolizumab?+?chemotherapy increases life expectancy by 65% (4.53 vs 2.74 years) at an ICER of $147,365/QALY.

Limitations and conclusions: The addition of pembrolizumab to chemotherapy is projected to extend life expectancy to a point not previously seen in previously untreated metastatic non-squamous NSCLC. Although ICERs vary by sub-group and comparator, results suggest pembrolizumab?+?chemotherapy yields ICERs near, or in most cases, well below a 3-times US per capita GDP threshold of $180,000/QALY, and may be a cost-effective first-line treatment for metastatic non-squamous NSCLC patients.     

Equity yields

We study a new data set of dividend futures with maturities up to ten years across three world regions: the US, Europe, and Japan. We use these asset prices to construct equity yields, analogous to bond yields. We decompose the equity yields to obtain a term structure of expected dividend growth rates and a term structure of risk premia, which decomposes the equity risk premium by maturity. We find that the slope of the term structure of risk premia is pro-cyclical, whereas the slope of the term structure of expected dividend growth rates is counter-cyclical. The comovement of yields across regions is, on average, higher for long-maturity yields than for short-maturity yields, whereas the variation in this comovement is much higher for short-maturity yields.     

GAAP,GFS and AASB 1049: perceptions of public sector stakeholders

Efforts by Australian standard‐setters to harmonise public sector financial reporting resulted in AASB 1049, which sought to bridge the divide between generally accepted accounting principles (GAAP)‐based and government finance statistics (GFS)‐based financial statements. However, whether AASB 1049 has resulted in information that is considered appropriate for the public sector has not been examined. We explore this issue by comparing the requirements of AASB 1049 with the responses from a survey of public sector stakeholders on the appropriate accounting treatment and presentation of selected financial items. The analysis suggests consensus with AASB 1049 on presentation issues but less consensus on accounting treatments.     

The Impact of Private Label Introduction on Assortment,Prices, and Profits of Retailers*

We study how introducing private-label brands (PLs) affects retail prices and profits, accounting for assortment adjustments of national brands (NBs). We employ an event-study framework and scanner data on the US beef market. When a PL is added to the low-priced market segment, we find that retail stores further differentiate NBs from the PL and remove same-segment NBs. When a PL is added to the high-priced segment, however, NB assortment changes are limited. PL introduction and PL-driven NB assortment changes impose small price effects on NB, but strongly cannibalize NB demand and steer consumers toward PLs, likely increasing store profits.     

Financial Flows to Transitional Economies in an Integrated Europe

MOCT-MOST: Economic Policy in Transitional Economies -     

Improving salesforce performance: A meta‐analytic investigation of the effectiveness and utility of personnel selection procedures and training interventions

Research on the effectiveness in improving salesforce performance through personnel selection procedures and training interventions was examined by meta‐analytic techniques applied with 157 predictor‐criterion effect sizes involving selection procedures and 12 effect sizes involving training interventions. Significant effect sizes, on average, were obtained for (a) composite‐domain assessment against both subjective (ratings) and objective (sales performance) criteria, (b) single‐domain assessment against both criterion types, and (c) training interventions with respect to both criterion types combined. Significant variability was found among individual effect sizes within all categories of aggregation. Of the six specific categories of single‐domain assessment considered, five yielded significant validity for each of the two criterion types. Follow‐up utility analyses revealed improvements in sales productivity of from 14.8% to 34.1% for selection procedures and of 23.1% for training. Associated dollar‐based utility estimates indicated particularly substantial dollar gains for organizations employing composite‐domain selection with rigorous selection ratios, and lesser, but still substantial, gains from single‐domain selection with rigorous selection ratios, and from training interventions. © 2001 John Wiley & Sons, Inc.     

Tradable planning permits for land-use control in Germany

In addition to a broad range of qualitative land development objectives, the German Federal Government has committed itself to reduce the growth of settlement and traffic areas from currently 113 ha (2004–2007) to 30 ha per day by 2020. In order to attain this ambitious quantitative goal, our paper presents a market-based policy of ‘tradable planning permits’. This system would control land development by fixing the total amount of open space loss in a period with allocated planning permits, which can be traded between local jurisdictions. Since this approach is based on the cap-and-trade principle, we evaluate the transfer of traditional emission trading concepts to land-use control and explore regulatory options of potential systems: an undifferentiated permit system, a trading-ratio system and variations of zonal permit systems. We subject these alternative approaches to critical evaluation by using a variety of important criteria including efficiency gains, ecological effectiveness, hot spot formation and transaction costs. Finally, we summarize the potentials, limitations and risks of a permit trading system in general while reflecting the ongoing German debate on open space preservation.     

Economics at the FCC, 2017–2018: Internet Freedom,International Broadband Pricing Comparisons,and a New Office of Economics and Analytics

The Federal Communications Commission’s (FCC’s) current strategic plan lists four priority goals: closing the digital divide; promoting innovation; protecting consumers and public safety; and reforming the FCC’s processes. Economists at the FCC contribute toward the realization of each of these goals, through analysis of the nature and significance of the underlying problems that regulations are intended to solve, as well as assessments of alternative solutions. Three major FCC initiatives demonstrate the role that economic analysis played in Commission decisions in 2017–2018: the Restoring Internet Freedom Order; the new hedonic pricing model that was used in the International Broadband Data Report; and the order that reorganized Commission economists into the Office of Economics and Analytics.