Cost-effectiveness of droxidopa in patients with neurogenic orthostatic hypotension: post-hoc economic analysis of Phase 3 clinical trial data

Objective:

Falls are associated with neurogenic orthostatic hypotension (nOH) and are an economic burden on the US healthcare system. Droxidopa is approved by the US FDA to treat symptomatic nOH. This study estimates the cost-effectiveness of droxidopa vs standard of care from a US payer perspective.

Methods:

A Markov model was used to predict numbers of falls and treatment responses using data from a randomized, double-blind trial of patients with Parkinson’s disease and nOH who received optimized droxidopa therapy or placebo for 8 weeks. The severity of falls, utility values, and injury-related costs were derived from published studies. Model outcomes included number of falls, number of quality-adjusted life-years (QALYs), and direct costs. Incremental cost-effectiveness ratios (ICERs) were calculated. Outcomes were extrapolated over 12 months.

Results:

Patients receiving droxidopa had fewer falls compared with those receiving standard of care and gained 0.33 QALYs/patient. Estimated droxidopa costs were $30,112, with estimated cost savings resulting from fall avoidance of $14,574 over 12 months. Droxidopa was cost-effective vs standard of care, with ICERs of $47,001/QALY gained, $24,866 per avoided fall with moderate/major injury, and $1559 per avoided fall with no/minor injury. The main drivers were fall probabilities and fear of fall-related inputs.

Limitations:

A limitation of the current study is the reliance on falls data from a randomized controlled trial where the placebo group served as the proxy for standard of care. Data from a larger patient population, reflecting ‘real-life’ patient use and/or comparison with other agents used to treat nOH, would have been a useful complement, but these data were not available.

Conclusion:

Using Markov modeling, droxidopa appears to be a cost-effective option compared with standard of care in US clinical practice for the treatment of nOH.     

Cross-dynamics of volatility term structures implied by foreign exchange options

This paper examines the cross-dynamics of volatility term structure slopes implied by foreign exchange options. The empirical findings demonstrate that a few principal components can explain a vast proportion of the variation in volatility term structure slopes across the major exchange rates. Furthermore, the results indicate that the euro is the dominant currency, as the implied volatility term structure of the euro is found to affect all the other volatility term structures, while the term structure of the euro appears to be virtually unaffected by the other currencies. Finally, our results provide evidence of significant nonlinearities in the relationship between the euro and the Swiss franc.     

Strategic planning of cross-sectoral resource megaprojects: Methodology and instruments

This paper reviews issues related to the strategic planning of new cross-sectoral regional resource megaprojects aimed at the development of new infrastructure and an industrial base in Russia and the exploitation of natural resources in the Arctic and Russia’s East, which are in demand on the global market. These issues are particularly topical in view of the current transformation of the economy’s real sector.     

Effectiveness of the strategy and regional risks of creating the East Siberian Oil and gas Complex

The paper gives a systematic presentation of major risks at the pioneering stage of creating the East-Siberian Oil and gas Complex (ESOGC). It also estimates probable consequences of these risks for socioeconomic development of the regions. To assess regional risks, we have used the traditional method of analyzing regional development scenarios under different corporate business strategies. The latter are presented as a set of investment projects and intentions as well as constraints and preferences of the state represented by constituent entities of the Russian Federation. Economic effects in the ESOGC regions are analyzed by growth indicators of the region’s GRP and revenues of the regional and local budgets.