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.     

The emergence of multi-sided platform MNEs: Internalization theory and networks

The rise of the digital economy provides firms across the globe with unique business opportunities. Companies such as Facebook, Alibaba, and Uber are competing in a new multi-sided platform world; the primary focus of these firms, from their inception, is to provide digital infrastructure, information and technology—intangible assets that enable direct interaction or value creation across platforms by linking different user group and complementors, often at the international level. Building on data drawn from multinational multisided Platform corporations (MMPCs) operating in China, we combine insights from internalization theory and network effects in understanding the value creation of such firms. We explore the boundaries of these new “breed” of MNEs in exploiting firm-specific advantages (FSAs) and in creating new knowledge between headquarters and subsidiaries. The findings suggest that internalization theory needs to shift its focus from the ‘boundaries of the firm’ to the ‘boundaries of the local network’. By integrating their internal and external networks of knowledge in adapting their business models in host markets, this new breed of MNEs is more likely than the traditional one to gain a sustainable competitive advantage in the new information age.     

I do not own a car any more: An analysis of possessions’ disposal and changes in consumers’ identities

This research aims to understand the process of cars' disposal, its context, its influences and its impacts on the meanings for consumers and their identities, as well as the new behaviours of these consumers when living without their car(s). We conducted, analysed and interpreted 20 in‐depth interviews with consumers that had previously owned at least one car and had no financial reasons for disposing of their car(s), but had decided to do it, and started to live without them, adopting alternative methods of transportation. Our findings show that these consumers faced a complicated process regarding the disposal of their car(s) but, due to the changes in their circumstances, they re‐signified relevant concepts that were connected to the ownership of a car: Their perception of freedom, comfort, safety and status changed during and after the disposal of their car(s). We also noticed that there were implications in terms of changes in their attitudes and behaviour as both citizens and consumers. As a contribution to the literature, our findings indicate that the re‐signifying of concepts related to possession of the object as well as changes in attitudes and behaviours that consumers undergo in the postdisposal stage, must be included in the model proposed for evaluating consumer behaviour in product disposal.     

The ‘disguised’ foreign investor: Brands,trademarks and the British expatriate entrepreneur in Brazil

Abstract

This article examines the impact of the British expatriate entrepreneur, and his processes of knowledge transfer, on the industrialization and economic development of Brazil between 1875 and 1914. It focuses on the textiles industry, and combines original trademark data with conventional trade and investment statistics, and also case study analysis about firms and their entrepreneurs. It argues that British investment in Brazil was higher and had a deeper impact on economic development than considered by existing research, as expatriate entrepreneurs ‘disguised’ a substantial amount of foreign investments by acting as shareholders and top managers of newly established local businesses.     

Interpreting IS alignment: A multiple case study in professional organizations

This paper centers on the interpretation attributed by organizational members to the information systems (IS) alignment concept. Its objective is to study IS alignment in professional organizations. Specifically, it reports on an interpretive study conducted in five Chilean organizations; four professional and one entrepreneurial, of which two are private and three are public. The theoretical background of our study is derived from three IS strategic alignment conceptualizations: managerial, emergent and critical. These concepts formed our theoretical framework that guided data collection and analysis. The study centers on the meanings organizational members assigned to IS strategic alignment, as well as their views on the barriers that hinder achieving this level of organizational integration. The analysis results are summarized in seven hermeneutic themes that point out the different connotations the organizations assigned to IS alignment. The significance of the findings are summarized in four insights that formulate theoretical and practical implications. These insights refer to: (1) the difficulties of achieving alignment for professional organizations, particularly public ones, (2) the limitations these organizations have in being agile, (3) the rationale for acquiring technology and determining IT skills, and (4) the imperative meaning that CIOs attribute to IS alignment. The paper concludes with a reflection on the limitations and relevance of the research.     

The connectivity of infrastructure networks and the urban space of São Paulo in the 1990s

This article explores the strategic importance of information systems for social control of networked services on urban and regional scales, and the nature of the information required for that purpose. The standard indicators of infrastructure coverage – by and large based on the number and encompassment of connections – no longer respond to the real conditions of supply and consumption. The technological and managerial innovations in flow control and dispatch, along with the effects of combined access to multi‐mode networks, render the evaluation of services’ connectivity considerably more complex than it used to be in the past. Private domination over the supply structure of these services tends to make the political struggle for equitability more dependent on the technical reliability of information than it could have been under the model of state supply. Networked services’ management has evolved to a more demand‐oriented structure, but this structure has so far reproduced the structural inequalities of Brazilian society in favor of powerful stakeholders, e.g. large consumers. The potential for more democratic control associated with this new balance between supply and demand in networked services can only evolve if more vulnerable social groups have access to sound technological and managerial information. To support this idea the article shows the importance of connectivity indicators in determining the effective access to networked utilities in the Metropolitan Area of São Paulo, in contrast to the traditional indicators of services’ coverage. Cet article explore l’importance stratégique des systémes d’information pour le contrôle social des services de réseaux au niveau urbain et régional, et la nature de l’information nécessaire pour cela. Les indicateurs habituels du niveau d’information sur l’infrastructure – généralement basés sur le nombre et la compréhension des relations – ne répondent plus aux conditions réelles de provision et de consommation. Les nouveautés de technologie et de gestion dans le contrôle du mouvement et dans les expéditions, ainsi que les effets de l’accés joint aux réseaux à modes multiples, rendent l’évaluation des liens entre les services beaucoup plus complexe que précédemment. La domination de la structure de provision de ces services par le domaine privé a tendance à rendre la lutte politique pour la justice plus dépendante de la fiabilité des informations qu’elle aurait pu l’? tre dans le modéle de provision par l’état. La gestion des services de réseaux a évolué vers une structure orientée vers la demande, mais jusqu’à présent cette structure a reproduit les inégalités structurelles de la société brésilienne qui favorise des détenteurs de pouvoir, par exemple les gros consommateurs. Les possibilités d’un contrôle plus démocratique associéà cet équilibre nouveau entre la provision et la demande dans les services de réseaux ne peut se développer que si les groupes sociaux les plus vulnérables ont accés à une information technologique et gestionnaire fiable. Pour soutenir cette opinion, l’article démontre l’importance des indicateurs de rapports pour déterminer des conditions d’accés efficaces aux entreprises de service de réseaux dans la région métropolitaine de Sao Paulo, au contraire des indicateurs traditionnels de l’information des services.     

Uncertainty reduction mechanisms in cross-sector alliances in Latin America

The present study explores three uncertainty reduction mechanisms that arise in the context of business alliance formation to assess whether these same mechanisms also operate in the development of alliances between non-profits and businesses. Secondary data from field-based case studies of Latin American cross-sector alliances are the focus of this analysis. The findings show that the same mechanisms operate to reduce uncertainty in cross-sector alliance formation and that alliance experience appears to determine the presence of some mechanisms.