Cost-effectiveness of second-line atezolizumab in Canada for advanced non-small cell lung cancer (NSCLC)

Aim: To assess the cost-effectiveness in Canada of atezolizumab compared with docetaxel or nivolumab for the treatment of advanced NSCLC after first-line platinum-doublet chemotherapy.

Materials and methods: A three-state partitioned-survival model was developed. Clinical inputs were obtained from the phase III OAK trial comparing atezolizumab with docetaxel in patients with advanced NSCLC who progressed after first-line platinum-doublet chemotherapy. Overall survival (OS) and progression-free survival (PFS) were extrapolated beyond the trial period using parametric models. A cure model assuming a 1% cure fraction was fitted to the OS data for atezolizumab. Outcomes for nivolumab were informed by a network meta-analysis (NMA) vs atezolizumab. Resource use and costs were informed by clinical expert opinion and published Canadian sources. Utility values were obtained from the OAK trial. The perspective of the analysis was that of the Canadian publicly-funded healthcare system. The base case time horizon was 10?years, and the discount rate was 1.5% annually for both costs and effects. Scenario analyses were performed to test the robustness of the results and all analyses were performed probabilistically.

Results: Atezolizumab demonstrated a quality-adjusted life-year (QALY) gain of 0.60 compared with docetaxel at an incremental cost of $85,073, resulting in an incremental cost-effectiveness ratio (ICER) of $142,074/QALY. Atezolizumab dominated nivolumab (regardless of dosing regimen), based on modest differences in both QALYs and costs. Docetaxel was most likely to be cost effective at willingness-to-pay (WTP) thresholds below $125,000/QALY gained, while atezolizumab was most likely to be cost effective beyond this WTP threshold. In most scenario analyses, the results remained robust to changes in parameters. A reduced time horizon and alternative approaches to the NMA had the greatest impact on cost-effectiveness results.

Conclusion: Atezolizumab represents a cost-effective therapeutic option in Canada for the treatment of patients with advanced NSCLC who progress after first-line platinum doublet chemotherapy.     

Healthcare utilization and costs among relapsed or refractory multiple myeloma patients on carfilzomib or pomalidomide as monotherapy or in combination with dexamethasone

Aim: To compare monthly healthcare resource utilization (HRU) and costs among adult patients with multiple myeloma (MM) receiving second or subsequent line of treatment (LOT) with carfilzomib or pomalidomide as monotherapy or in combination with dexamethasone.

Methods and materials: Adult MM patients who received carfilzomib or pomalidomide as second/subsequent LOT between 2006 and 2014 were selected from the MarketScan databases. LOT was determined using Medical/pharmacy claims using a published algorithm. For each patient, first LOT with carfilzomib or pomalidomide was defined as index LOT. Patients with first LOT as index LOT, who received other chemotherapy in combination with carfilzomib or pomalidomide, or who underwent stem cell transplant (STC) during index LOT were excluded. Monthly HRU and costs during index LOT were compared using inverse probability of treatment weights (IPTW) based on propensity scores for receipt of carfilzomib estimated by logistic regression with LOT, patient demographics, Charlson index, comorbidities, pre-index healthcare cost, and receipt of prior SCT as covariates.

Results: After weighting, baseline characteristics were well balanced among 114 carfilzomib and 144 pomalidomide patients. Mean (95% CI) numbers of outpatient visits per month were 7.1 (5.2–8.0) with carfilzomib and 4.7 (3.9–6.1) with pomalidomide (p?=?0.006). Otherwise, there were no statistically significant differences between the groups in mean monthly HRU and costs or median time to therapy discontinuation. Mean (95% CI) monthly total healthcare costs were $19,776 (15,322–27,748) with pomalidomide and $17,321 (12,412–21,874) with carfilzomib (p?=?0.522).

Limitations: Comparison of carfilzomib vs pomalidomide may be biased if there are unobserved factors not balanced by IPTW. The relatively small sample size limits the power of analyses to detect potential differences between treatment groups.

Conclusions: Monthly HRU and costs are similar among patients with relapse or refractory MM patients receiving carfilzomib or pomalidomide as monotherapy or in combination with dexamethasone.     

Investigating Customer Resistance to Change in Transaction Relationship with an Internet Vendor

Many academics and practitioners have reiterated the importance of online customer retention to ensure long‐term profitability. Consequently, a number of studies have identified various means of customer retention. These studies lay significant emphasis on creating customer loyalty. However, retaining customers, especially in the context of Internet shopping, is very difficult because of the low costs in comparison and switching. Most of the loyalty programs have also shown disappointing results. This study suggests that by tapping on an individual customer's inclination to resist changes in a transaction relationship, an Internet vendor can achieve customer retention. Using status quo bias theory, this study examines customer resistance to change (CRC) as a means of retaining customers in a transaction relationship with the Internet vendor. The empirical study of an Internet bookstore reveals that trust, relative attractiveness, and switching costs together influence CRC. The empirical results also show that CRC and switching costs have positive effects on willingness to pay more. Implications for theory and practice are discussed.     

建立一个符合ISO标准的资产管理方法

说明一种方案,用于开发一种符合ISO 90012000要求的工业设备资产管理方法.资产管理可以称为是一种保证资产从需求报告到报废处理全寿命周期内的可用率和可靠性的方法.它包括设计、规划、协调以及实施维修、改造、修理等所需要的培训、分析和不断改进.也讨论ISO质量管理系统的好处.说明各种技术和推荐的最佳经验,指导读者如何开始研制资产管理方法.     

亚洲投资滑坡深度有限，但复苏前景暗淡

【摩根士丹利5月7日】危机前的资本支出增长极为强劲 近年来，日本之外亚洲（AXJ）地区的固定资本总投资（GFCF）出现了大幅增长，据我们估算，2001—2008年间，AXJ经济体的GFCF由9200亿美元（占GDP的28．5％）猛增至2．9万亿美元。本轮周期之中，GFCF从谷底到峰顶的升幅远超过上世纪90年代中期那轮周期的升幅。     

四大风险威胁2009年亚洲经济增长

[摩根士丹利11月6日]由于近几周金融市场形势恶化，2009年亚洲经济增长预期值的下调风险明显增大。而由于亚洲贸易与金融已实现高度一体化，一种负反馈循环已经在本地区迅速形成。目前，本地区经济增长面临着四种至关重要的风险：（1）外需冲击；（2）资本流入的急剧减速和资本成本的上升；（3）汇率冲击；（4）金融动荡的加剧。     

Stacking the deck: the effects of top management backgrounds on investor decisions

Young firms going public are dependent upon the decisions of investors for a successful public offering. Yet convincing investors to invest is not easy, as young firms have limited track records and, thus, face challenges associated with gaining legitimacy in their respective industries. This paper examines ways in which select information about firms undertaking an initial public offering (IPO) can affect investor decisions. Building upon recent research on upper echelons and signaling theory, we propose that the composition of a firm's top management team can signal organizational legitimacy that in turn affects investor decisions. In the context of young firms undertaking an IPO, such signals are critical, especially when objective measures of firm quality are not easily available. We introduce a typology of signals of organizational legitimacy to elaborate on our hypotheses. Analyses of a comprehensive set of data on the career histories of the top management teams of young biotechnology firms show that investor decisions are affected by the extent to which a firm's top management team has employment affiliations with prominent downstream organizations (e.g., pharmaceutical companies), with a diverse range of organizations, and upon the role experience of one key member of the top management team—the Chief Scientific Officer. We assess and find that these effects are not mediated by the prestige of a firm's lead underwriter. We conclude with a discussion of the implications of our study for strategy research on upper echelons and organizational legitimacy. Copyright © 2006 John Wiley & Sons, Ltd.