Cost-effectiveness of telaprevir in combination with pegylated interferon alpha and ribavirin in previously untreated chronic hepatitis C genotype 1 patients

Background:

Telaprevir (T, TVR) is a direct-acting antiviral (DAA) used for the treatment of genotype 1 chronic hepatitis C virus (HCV) infection. The sustained virological response (SVR) rates, i.e., undetectable HCV RNA levels 24 weeks after the end of treatment, is what differentiate treatments. This analysis evaluated the cost-effectiveness of TVR combined with pegylated interferon (Peg-IFN) alfa-2a plus ribavirin (RBV), with Peg-IFN and RBV (PR) alone or with boceprevir (B, BOC) plus Peg-IFN alfa-2b and RBV, in naïve patients.

Methods:

A Markov cohort model of chronic HCV disease progression reflected the pathway of naïve patients initiating anti-HCV therapy. SVR rates were derived from a mixed-treatment comparison including results from Phase II and III trials of TVR and BOC, and trials comparing both PR regimens. SVR has significant impact on survival, quality-of-life, and costs. Incremental cost per life year (LY) gained and quality-adjusted-life-year (QALY) gained were computed at lifetime, adopting the (National Health Service) NHS perspective. Cost and health outcomes were discounted at 3.5%. Uncertainty was assessed using deterministic and probabilistic sensitivity analyses. Sub-group analyses were also performed by interleukin (IL)-28B genotype and fibrosis stage.

Results:

Higher costs and improved outcomes were associated with T/PR relative to PR alone, resulting in an ICER of £12,733 per QALY gained. T/PR retained a significant SVR advantage over PR alone and was cost-effective regardless of IL-28B genotype and fibrosis stages. T/PR regimen ‘dominated’ B/PR, generating 0.2 additional QALYs and reducing lifetime cost by £2758. Sensitivity analyses consistently resulted in ICERs less than £30,000/QALY for the T/PR regimen over PR alone.

Limitations:

No head-to-head trial provides direct evidence of better efficacy of T/PR vs B/PR.

Conclusion:

The introduction of TVR-based therapy for genotype 1 HCV patients is cost-effective for naïve patients at the £30,000 willingness-to-pay threshold, regardless of IL-28B genotype or fibrosis stage.     

A Brief Outline of the Israel–Palestinian Conflict

Before we can explore the use of management science, game theory, cognitive science and artificial intelligence to attempt to resolve (or just manage) the Israel–Palestinian dispute, we need some sort of mutual understanding about the conflict. Given such a long and multi-faceted history rife with multiple conflicting claims, interpretations and emphases, all fraught with moral and political implications, it is unlikely that any account will be acceptable to all parties as authoritative. Nevertheless, we must search for some common ground. Our examination of history commences with the life of Abraham, the father of the three great monotheistic religions: Judaism, Christianity, and Islam and continues through to a discussion of Zionism and Arab nationalism. This leads to the creation of the State of Israel on May 14, 1948; celebrated as Yom Ha’atzmaut (Independence Day) and commemorated as ‘al-Nakhba (the catastrophe), according to one’s background. Whilst our discussion concludes with recent events, including the spring 2011 protests and demonstrations spread throughout the Middle East, there is no doubt that during the time between which this article is written and it appears in a journal, momentous events will have occurred.     

Virtual worlds

Games, role‐playing, and simulations as developmental tools have been used in education since the 1800s. An emerging form of collaborative game play is virtual worlds; however, the use of virtual worlds in leadership education has not been fully investigated. The purpose of this article is to (a) demonstrate how virtual worlds are a viable venue for leadership education, and (b) present a hierarchy of skills sets that can be developed in virtual world settings. In doing so, this article provides evidence that virtual worlds can be used as a new instructional delivery environment for leadership education as the appeal and intrinsic nature of virtual environments aligns well with the experiential framework of leadership education.     

Endogenous business cycle propagation and the persistence problem: The role of labor-market frictions

Contrasting sharply with a recent trend in DSGE modeling, we propose a business cycle model where frictions and shocks are chosen with parsimony. The model emphasizes a few labor-market frictions and shocks to monetary policy and technology. The model, estimated from U.S. quarterly postwar data, accounts well for important differences in the serial correlation of the growth rates of aggregate quantities, the size of aggregate fluctuations and key comovements, including the correlation between hours and labor productivity. Despite its simplicity, the model offers an answer to the persistence problem (Chari et al., 2000) that does not rely on multiple frictions and adjustment lags or ad hoc backward-looking components. We conclude modern DSGE models need not embed large batteries of frictions and shocks to account for the salient features of postwar business cycles.     

The determinants of corporate divestment in the UK

It has been widely suggested that since the early 1980s many diversified firms narrowed the scope of their activities by refocusing on their core businesses, primarily through divestment activity. This study examines the extent and determinants of divestment across a large sample of UK firms over the period 1985–1989. Divestment is analysed using both a proportions and count data (Poisson and negative binomial regressions) approach. The results confirm that corporate divestment is not merely a reflection of managerial idiosyncrasies or mean reversion behaviour in the activities undertaken, but is a purposeful response to exogenous change in a manner broadly consistent with both the agency theoretic and strategic views of the firm.     

How loss averse are investors in financial markets?

We investigate loss aversion in financial markets using a typical asset allocation problem. Our theoretical and empirical results show that investors in financial markets are more loss averse than assumed in the literature. Moreover, loss aversion changes depending on market conditions; investors become far more loss averse during bull markets than during bear markets, indicating their more profound disutility for losses when others enjoy gains. Contrary to most previous results, we find that investors are more sensitive to changes in losses than changes in gains.     

The effect of bank ownership and deposit insurance on monetary policy transmission

In this paper we develop a theoretical model with a representative bank whose ownership is shared between state and private sector. The bank faces a risk of failure and provides private and public explicit deposit insurance. Banks owned to a larger extent by the government are more able to counteract a restrictive monetary policy because of their capacity to raise additional volume of deposits. Therefore, the greater the state’s share in the bank ownership, the less the impact of a monetary tightening on the level of loan supply.     

Can Pre-recorded Evidence Raise Conviction Rates in Cases of Domestic Violence?

This paper explores the association between pre-recorded evidence and court outcomes in cases of domestic violence. Net of controls and time fixed effects, we find that cases with pre-recorded evidence are 3.4 percentage points more likely to result in a conviction. This increase occurs through three channels: a 5.6 percentage point increase in the probability of a conviction among (the one in four) cases that proceed to a defended hearing; a 2.4 percentage point increase in the probability of a guilty plea; and, a 2.4 percentage point decrease in the probability that the prosecution withdraws their case.     

Tax competition,public input,and market power

An increase in the number of local jurisdictions providing industrial public goods may lead to a rise in the equilibrium tax rate, in contrast to the case of residential public goods. When local jurisdictions are Leviathans, an increase in competition may expand tax revenues and thus fail to tame the Leviathan, contrary to the conventional wisdom.