Implications of Real-world Adherence on Cost-effectiveness Analysis in Multiple Sclerosis

Abstract

Objectives:

Adherence to medication is essential for optimal outcomes, especially for chronic diseases such as multiple sclerosis (MS). Studies in MS indicate that lower adherence is associated with an increased risk of relapse, hospitalization or emergency room (ER) visits, and higher medical costs. A previous investigation assessed the cost per relapse avoided for patients with MS receiving first-line disease modifying therapies (DMTs); however, the model assumed 100% adherence.

Methods:

Because real-world utilization patterns influence the actual effectiveness of medications, this analysis assessed the impact of real-world adherence from a US commercial payer perspective, using updated costs.

Results:

As was seen in the original study, in this revised model, fingolimod was associated with the lowest cost per relapse avoided ($90,566), followed by SC IFN β-1b (Extavia: $127,024), SC IFN β-1b (Betaseron: $137,492), SC IFN β-1a ($144,016), glatiramer acetate ($160,314), and IM IFN β-1a ($312,629). The model inputs that had the greatest impact on the results were adherence-adjusted relative relapse rate reduction (RRR) of fingolimod, the wholesale acquisition costs of fingolimod, and the average number of relapses in untreated patients with MS.

Limitations:

The estimates of DMT adherence are from a single claims database study of a large national pharmacy benefit manager that only measured adherence, not actual relapses, and the model does not incorporate manufacturer discounts and rebates, which are not publicly available.

Conclusion:

These results suggest that economic analyses of MS therapies should incorporate real-world adherence rates where available, rather than relying exclusively on trial-based efficacy estimates when considering the economic value of treatment alternatives, and that highly efficacious therapies with low adherence may yield real-world efficacy that is substantially lower than that observed in closely monitored clinical trials.     

Cost-per-remission analysis of infliximab compared to adalimumab among adults with moderate-to-severe ulcerative colitis

Abstract

Objective:

To compare cost per remission (CPR) of infliximab (IFX) versus adalimumab (ADA) for the treatment of moderately-to-severely active UC.

Methods:

This is CPR model comparing IFX and ADA in the treatment of UC using clinical trial data. Clinical outcome measures include clinical remission and sustained clinical remission (SCR). Economic endpoints were modeled as medication costs. CPR ratios and number needed to treat (NNT) costs were computed at 8, 52, and 54 weeks.

Results:

CPR for bio-naïve patients for IFX and ADA at weeks 8, 52, and 54 was $42,086 vs. $79,558: $147,379 vs. $320,097; $147,379 vs. $330,767, respectively. CPR for all patients for IFX and ADA at weeks 8, 52, and 54 was $42,086 vs. $113,812; $147,379 vs. $349,197; $147,379 vs. $360,836, respectively. Cost per SCR for bio-naïve patients and all patients for IFX and ADA was $203,205 vs. $682,873 and $203,205 vs. $698,393, respectively. NNT and NNT costs for clinical remission for bio-naïve patients at weeks 8, 52, and 54 were lower for IFX (4 vs.10, $40,235 vs. $81,945; 5 vs.10, $134,115 vs. $307,293; 5 vs. 10, $134,115 vs. $317,536, respectively) than for ADA. NNT and NNT costs for clinical remission for all patients at weeks 8, 52, and 54 were lower for IFX (4 vs.14, $40,235 vs. $114,723; 5 vs.11, $134,115 vs. $338,022; 5 vs. 11, $134,115 vs. $349,290, respectively) than for ADA. NNT and NNT costs for SCR for bio-naïve and all patients were lower for IFX (8 vs. 22, $214,584 vs. $676,045; 8 vs.23, $214,584 vs. $706,774) than for ADA. Study limitations include lack of head-to-head trial data, different primary endpoints between the two clinical trials, and indirect costs were not included.

Conclusion:

IFX had lower CPR and cost per SCR than ADA in the treatment of moderately to severely active UC.     

宏观利率政策的有效性研究

宏观利率政策对经济增长具有有效性。尽管我国几次调整利率的效果不如预期那么好 ,但否定货币政策在我国已失去作用的看法是错误的。从IS -LM分析可以看出货币政策的有效性 ,但其有效性受着一些因素的约束。为此 ,必须有适当的政策促进利率政策的有效性。     

如何在校企合作中培养高职学生的创业素质

校企合作是高职院校人才培养的重要途径之一，提高人才培养质量是校企合作的根本目的。高职院校的创业教育在于培养学生的创业精神和综合素质，提高校企合作对创业教育实效性成为当前高职院校开展创业教育面临的课题。高职院校应建立校企合作长效机制，引进企业优势资源开发创业教育，深化校企合作，推动校外创新型实训基地建设，确实提高学生的创业素质，拓宽就业渠道。     

浅谈组织如何有效开展内部质量体系审核

简要介绍组织应科学制定内审计划，认真实施内审计划，并从注重审核方法，注重纠正措施的落实，加大整改力度等方面，来提高内部质量体系审核的有效性。     

Innovative human resource practices and organizational commitment: an empirical investigation

In the contemporary business environment, human resource (HR) is an indispensable input for organizational effectiveness. Hence, an effective management of human resources has an important role to play in the performance and success of organizations. Competitive pressures have encouraged organizations to be proactive in diagnosing HR problems and to adopt more innovative HR practices since these were no longer a matter of trend, but rather of survival. The present study attempted to explore the relationship of three dimensions of innovative human resource practices (IHRPs): that is, the extent of introduction of IHRPs, their importance for organizational goal achievement and satisfaction with implementation of IHRPs, with organizational commitment (OC). Regression analyses showed that the perceived extent of introduction of innovative human resource practices by the organizations was the most significant predictor of organizational commitment.     

Aid Quality and Donor Rankings

This paper offers new measures of aid quality covering 38 bilateral and multilateral donors, as well as new insights about the robustness and usefulness of such measures. The 2005 Paris Declaration on Aid Effectiveness and the follow-up 2008 Accra Agenda for Action have focused attention on common donor practices that reduce the development impact of aid. Using 18 underlying indicators that capture these practices—derived from the OECD-DAC’s Survey for Monitoring the Paris Declaration, the new AidData database, and the DAC aid tables—the authors construct an overall aid quality index and four coherently defined sub-indexes on aid selectivity, alignment, harmonization, and specialization. Compared with earlier indicators used in donor rankings, this indicator set is more comprehensive and representative of the range of donor practices addressed in the Paris Declaration, improving the validity, reliability, and robustness of rankings. One of the innovations is to increase the validity of the aid quality indicators by adjusting for recipient characteristics, donor aid volumes, and other factors. Despite these improvements in data and methodology, the authors caution against overinterpretation of overall indexes such as these. Alternative plausible assumptions regarding weights or the inclusion of additional indicators can still produce marked shifts in the ranking of some donors, so that small differences in overall rankings are not meaningful. Moreover, because the performance of some donors varies considerably across the four sub-indexes, these sub-indexes may be more useful than the overall index in identifying donors’ relative strengths and weaknesses.     

The Hotal and Catering Industry: Employment Prospects for the Eighties

Small business enterprises (SBEs) are considered to be the economic engine leading to worldwide economic development. They have attracted substantial consideration from researchers, academics and practitioners in the last three decades. Meanwhile, E-marketing (EM) has emerged as one of the key drivers in sustaining an organisation's competitive advantage. Yet, there is a lack of systematic empirical evidence regarding marketing activities that are affected by the use of EM in the (SBEs) context, and their consequent performance outcomes. Therefore, the purpose of this paper is to examine the impact of EM use by SBEs on marketing success and to develop and test a conceptual model of the antecedents and consequences of EM use by SBEs. The conceptual framework consists of the following constructs: EM budget, EM tools, pre-sales activities, after-sales activities, marketing performance and marketing effectiveness. Moreover, 12 hypotheses were developed and tested. Exploratory and confirmatory factor analyses were used to test the validity of measures, while structural equation modelling was used in hypotheses testing. Data were collected from 114 SBEs who had used different EM tools. Findings reveal that the use of EM tools has a positive influence on SBEs pre-sales activities, after-sales activities, marketing performance and marketing effectiveness. The results of this study have major implications for the marketing domain, as they stress the central role of marketing people in the successful implementation of EM in SBEs.     

Effective Nonverbal Communication Techniques

Developing effective marketing strategies for profes- sional service firms presents many unique challen es and is an im- portant area of practice development that many &ns often wer- look. Professional service firms ossess very distinctive P characteristics which differentiate them rom other service firms and require specialized marketing strategies. The purpose of this article is to assist practitioners in their efforts to develop promotional strat- egies which will enhance their firm's professional image and in- crease the firm's ability to engage new clients. These strategies arc aimed specifically at certified public accountants, lawyers, archi- tects, and other professionals.     

浅析如何将多媒体合理应用到体育英语教学中

多媒体辅助英语教学已是大势所趋,本文从多媒体优势和体育英语教学的特点等方面初步探讨了体育英语教学中的多媒体教学模式的运用,以及应注意的问题。只要扬长避短,充分发挥多媒体的优势,就能使之充分为体育英语教学服务,改善教学效果,提高教学质量。