Cost-effectiveness of combination daclatasvir-sofosbuvir for treatment of genotype 3 chronic hepatitis C infection in the United States

Background: A phase III trial evaluated the efficacy and safety of Daklinza (daclatasvir or DCV) in combination with sofosbuvir (SOF) for treatment of genotype (GT) 3 hepatitis C virus (HCV) patients.

Aim: This study evaluated the cost-effectiveness of DCV?+?SOF vs SOF in combination with ribavirin (RBV) over a 20-year time horizon from the perspective of a United States (US) payer.

Methods: A published Markov model was adapted to reflect US demographic characteristics, treatment patterns, costs of drug acquisition, monitoring, disease and adverse event management, and mortality risks. Clinical inputs came from the ALLY-3 and VALENCE trials. The primary outcome was the incremental cost-utility ratio. Life-years, incidence of complications, number of patients achieving sustained virological response (SVR), and the total cost per SVR were secondary outcomes. Costs (2014 USD) and quality-adjusted life years (QALYs) were discounted at 3% per year. Deterministic, probabilistic, and scenario sensitivity analyses were conducted.

Results: DCV?+?SOF was associated with lower costs and better effectiveness than SOF?+?RBV in the base case and in almost all scenarios (i.e. treatment-experienced, non-cirrhotic, time horizons of 5, 10, and 80 years). DCV?+?SOF was less costly, but also slightly less effective than SOF?+?RBV in the cirrhotic and treatment-naïve population scenarios. Results were sensitive to variations in the probability of achieving SVR for both treatment arms. DCV?+?SOF costs less than $50,000 per QALY gained in 79% of all probabilistic iterations compared with SOF?+?RBV.

Conclusion: DCV?+?SOF is a dominant option compared with SOF?+?RBV in the US for the overall GT 3 HCV patient population.     

Developing firms' growth approaches as a multidimensional decision to enhance key stakeholders' wellbeing

Firms facing a dynamic marketplace associated with the increasing adoption of new-age technology, the growth of big data and analytics, and the increased importance of stakeholders seek guidance on the investment of scarce resources across these three primary dimensions. The key questions facing firms are: How can we capitalize on the three primary dimensions (the increasing new-age technology adoption, the growth of big data and analytics, and the increased importance of key stakeholders) and overcome their associated challenges to achieve sustainable firm growth? This study aims to revive the thinking based on the growth strategy literature in the current environment, by presenting a 4E growth strategy matrix comprising of entrenching, empowering, enterprising, and enriching growth strategies. We propose that a firm can invest resources to maximize on one, two, or all three primary dimensions to produce the four growth strategies. We present an organizing framework based on insights from our triangulated research approach. Each of the growth strategies discussed will result in building certain types of firm capabilities, which will then lead to serving the needs and well-being of the key stakeholders. We also present an extensive research agenda that emerges from the four growth strategies.     

Education and human capital development in the giants of Asia

Educational development has proceeded at a different pace and under different planning regimes in India, China, and Indonesia. This paper provides an overview of the role of education in their recent development—in particular their ability to capitalise on favourable trends in dependency ratios—and presents some key issues facing education planners and policy hurdles to overcome in further improving their level and quality of human capital. Common findings and useful strategies are highlighted in the conclusion, as well as the importance of seizing the opportunity of low dependency ratios to effect policies that will help develop human capital.     

Contrasting the information demands of equity- and debt-holders: Evidence from pension liabilities

In the setting of defined-benefit pension liabilities, we hypothesize that equity and debt investors value these liabilities differently. As expected, we find that investors' valuations of equity more closely align with a going concern perspective that emphasizes the long-term funding needs of pension plans. In contrast, as expected, we find that investors' pricing of short-term and unsecured debt more closely aligns with a settlement perspective that emphasizes pension termination costs. For both equity and debt securities, the settlement (going concern) perspective dominates for short-duration (long-duration) pensions. Overall, our evidence suggests that equity and debt investors perceive complex liabilities in predictably different ways that are consistent with their differing information demands, which in turn vary with the characteristics of the obligation.     

“Lifestyle Leapfrogging” in Emerging Economies: Enabling Systemic Shifts to Sustainable Consumption

This paper combines the concept of leapfrogging with systems-thinking approaches to outline the potentials for and barriers to enabling systemic shifts to strong sustainable consumption in the emerging economies of China and India. New urban consumers in China and India have the potential to “lifestyle leapfrog” the high impact lifestyle models of the industrialized countries while simultaneously improving their quality of life. This paper argues that by implementing systemic approaches in the consumption domains of mobility and housing, the historical trajectory of high environmental footprints of mobility and housing can be avoided. The analysis based on systems-thinking principles identifies existing barriers and possible solutions. The importance of policies for strong sustainable consumption is highlighted to induce positive feedbacks in the areas of markets and society facilitating both efficient technology uptake and behavioural changes.     

Managerial risk taking incentives and corporate pension policy

We examine whether the compensation incentives of top management affect the extent of risk shifting versus risk management behavior in pension plans. We find that risk shifting through pension underfunding (and, to a lesser extent, through pension asset allocation to risky securities) is stronger with compensation structures that create high wealth-risk sensitivity (vega) and weaker with high wealth-price sensitivity (delta). These findings are stronger for chief financial officers (CFOs) than for chief executive officers (CEOs), suggesting that pension policy falls within the CFO’s domain. Risk shifting through pension underfunding is also lower when the CFO’s personal stake in the pension plan is larger. Overall, these findings show that top managers’ compensation structure is an important driver of corporate pension policy. They also highlight firms within which the moral hazard concerns fueled by Pension Benefit Guaranty Corporation insurance are most relevant.     

The Value of Work: Rethinking Labor Productivity in Times of COVID-19 and Automation

This article provides a new perspective on the value of work and recommends ways to respond to labor market failures exacerbated by the COVID-19 pandemic and by increased automation. We consider the human right to work, the dangers of pursuing short-term efficiency, and the use of the U.N. Sustainable Development Goals as a framework for inclusive economic innovation. We conclude with recommended policies to build forward and achieve inclusive development.