Cost effectiveness of benralizumab for severe,uncontrolled oral corticosteroid–dependent asthma in Sweden

Abstract

Aim: We investigated cost effectiveness of benralizumab vs. standard of care (SOC) plus oral corticosteroids (OCS) for patients with severe, eosinophilic OCS-dependent asthma in Sweden.

Materials and methods: A three-state, cohort-based Markov model of data from three Phase III benralizumab clinical trials (ZONDA [NCT02075255], SIROCCO [NCT01928771], and CALIMA [NCT01914757]) was used to assess the incremental cost-effectiveness ratio of benralizumab vs. SOC plus OCS. Health outcomes were estimated in terms of quality-adjusted life-years (QALYs). The model included costs and disutilities associated with extrapolated OCS-related adverse events. Patients with severe asthma were defined as those receiving OCS ≥5?mg/day.

Results: Benralizumab demonstrated a cost-effectiveness ratio vs. SOC plus OCS of 2018 Swedish Kronor (SEK) 366,855 (€34,127) per QALY gained, based on increases of 1.33 QALYs and SEK 488,742 (€45,344) per patient. Benralizumab treatment costs contributed most to incremental costs. The probability of benralizumab’s being cost-effective with willingness-to-pay (WTP) thresholds between SEK 429,972 (€40,000) and SEK 752,452 (€70,000) ranged from 75% to 99%.

Limitations: Potential limitations of these analyses include the use of combined data from three different clinical trials, a one-way sensitivity analysis that did not include mortality and transition estimates, and Observational & Pragmatic Research Institute (OPRI) data from the UK as a proxy of the Swedish health care system.

Conclusions: The results of these analyses demonstrate that benralizumab has a high probability of being cost-effective compared with SOC plus OCS for a subgroup of patients with severe, eosinophilic asthma receiving regular OCS treatment and may support clinicians, payers and patients in making treatment decisions.     

An Analysis of Tax Incentives to Attract FDI in Bangladesh： An Empirical Study

The purpose of the study is to understand whether it is still viable to use tax incentives to attract foreign direct investment （FDI） considering their effectiveness and costs to the country, and if not, what should be the alternative, effective, and viable means of promoting the vital FDI inflow. The study investigated various incentives provided by BOI, and other relevant sources available as secondary sources. However, the multinational enterprises （MNEs） are not attracting for investment in Bangladesh always with tax incentives and there are alternative means of attracting FDI such as direct financial grants, subsidies loan guarantees, etc. This paper focuses on tax incentives and the debate against the effectiveness and efficiency in attracting FDI.     

A tale of two states: asymmetries in the UK small,value and momentum premiums

This article performs comparative analysis of the asymmetries in size, value and momentum premium and their macroeconomic determinants over the UK economic cycles, using Markov switching approach. We associate Markov switching regime 1 with economic upturn and regime 2 with economic downturn. We find clear evidence of cyclical variations in the three premiums, most notable being that in the size premium, which changes from positive in expansions to negative in recessions. Macroeconomic indicators prompting such cyclicality the most are variables that proxy credit market conditions, namely the interest rates, term structure and credit spread. Overall, macro factors tend to have more significant impact on the three premiums during economic downturns. The results are robust to the choice of information variable used in modelling transition probabilities of the two-stage Markov switching model. We show that exploiting cyclicality in premiums proves particularly profitable for portfolios featuring small cap stocks in recessions at a feasible level of transaction costs.     

The evolution of aquatic agricultural systems in Southwest Bangladesh in response to salinity and other drivers of change

Aquatic agricultural systems (AAS) in coastal Southwest Bangladesh have evolved in response to a number of stimuli and constraints including improving market access, technological change, and salinization. Farming systems in the region are highly dynamic, and are characterized by the integration of varying combinations of freshwater prawns, rice, fish, vegetables, and brackish water shrimp. This paper examines the developmental history, productivity, and profitability of three distinct AAS: a low-salinity freshwater prawn-dominated system; an intermediate-salinity-mixed prawn and shrimp system, and a high-salinity shrimp-dominated system. Productivity, cropping intensity, and profitability are found to be highest in the diversified low- and intermediate-salinity systems, and lower in the high-salinity system, where cultivation of rice and vegetables is no longer possible. The paper concludes that more diverse integrated systems reduce risk and vulnerability for farming households. Salinization is found to be a double-edged sword – proving a stimulus to diversification at low levels, but reducing agro-biodiversity at higher salt concentrations. While the adaptation strategies in all systems have been successful in maintaining or improving most, though not all, system functions due to high levels of social resilience, support for effective community-based adaptation strategies will enable continued transformation and adaptation to future drivers of change.     

Investment banking in the gulf: A case study of investcorp in bahrain

Investcorp is a low-profile investment banking company that was originally founded on the tiny island of Bahrain in the Arabian Gulf. Although little known to the general public, the company is a major player in North American and European investment markets. This case study presents a profile of the company, its founder, Nemir Kirdar, and his three “founding friends.” It relates details of the company's successes and explores how these were achieved. As most of the original Management Committee members are preparing to retire, efforts are being made to ensure the continuing prosperity of the company. This requires the risky step of appointing an almost completely new management team. Readers are invited to reflect on the likely success of this strategy and whether Investcorp's focus on North America and Europe remains appropriate in a global marketplace.     

On Liu estimators for the logit regression model

This paper introduces a shrinkage estimator for the logit model which is a generalization of the estimator proposed by Liu (1993) for the linear regression. This new estimation method is suggested since the mean squared error (MSE) of the commonly used maximum likelihood (ML) method becomes inflated when the explanatory variables of the regression model are highly correlated. Using MSE, the optimal value of the shrinkage parameter is derived and some methods of estimating it are proposed. It is shown by means of Monte Carlo simulations that the estimated MSE and mean absolute error (MAE) are lower for the proposed Liu estimator than those of the ML in the presence of multicollinearity. Finally the benefit of the Lie estimator is shown in an empirical application where different economic factors are used to explain the probability that municipalities have net increase of inhabitants.     

The internationalization of an Arab bank: The case of Ahli United Bank of Bahrain

Ahli United Bank of Bahrain (AUB) has “leapfrogged” over early stages of internationalization by means of multiple rapid acquisitions of competitors. Use of this high‐cost, high‐risk strategy is well known among companies with the resources to invest in international expansion, but its application has not yet been studied in depth among companies based in the Middle East. This theory‐driven case study examines the growth record of AUB, its place in the regional banking industry in the Gulf, and its successful internationalization as an Arab bank. The article concludes with a detailed assessment of managerial and theoretical implications arising from the case study, and proposes further research to understand better the process of internationalization by companies expanding from a base in the Middle East. © 2011 Wiley Periodicals, Inc.     

Sources of change in U.S. manufactured exports during the eighties

Bowen and Pelzman (1984) used a Constant Market Share model to analyze the performance of the U.S. in manufactured exports over the years 1962 to 1977. Their findings indicated continued erosion of U.S. competitiveness in the world market. During the eighties, the U.S. performance in exporting manufactured goods has been dismal and has raised concern about the nation's ability to compete in the world market. In this paper, we present estimates of the CMS components of the export growth of the U.S. for the years 1979 to 1987. We find that the decline in export competitiveness reported by Bowen and Pelzman (1984) has continued and worsened during the eighties. Bowen and Pelzman (1984) reported the world-trade effect to be the major positive source of growth and the competitive effect to be the major retarding factor of growth. We find that in addition to the poor competitive effect during the eighties, the United States traded in sluggish export markets and within an environment of volatile growth of exports and demand in the industrialized world.