Cost-effectiveness analysis of secukinumab in ankylosing spondylitis from the Canadian perspective

Aim: To assess the cost-effectiveness of interleukin (IL)-17A inhibitor secukinumab vs the currently licensed biologic therapies in ankylosing spondylitis (AS) patients from a Canadian healthcare system perspective.

Methods: A decision analytic model (semi-Markov) evaluated the cost-effectiveness of secukinumab 150?mg compared to certolizumab pegol, adalimumab, golimumab, etanercept and etanercept biosimilar, and infliximab and infliximab biosimilar in a biologic-naïve population, over 60 years of time horizon (lifetime). The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI 50) response rate was used to assess treatment response at week 12. Non-responders or patients discontinuing initial-line of biologic therapy were allowed to switch to subsequent-line biologics. Model input parameters (short-term and long-term changes in BASDAI and Bath Ankylosing Spondylitis Functional Index [BASFI], withdrawal rates, adverse events, costs, resource use, utilities, and disutilities) were obtained from clinical trials, published literature, and other Canadian sources. Benefits were expressed as quality-adjusted life years (QALYs). Cost and benefits were discounted with an annual discount rate of 1.5% for all treatments.

Results: In the biologic-naïve population, secukinumab 150?mg dominated all comparators, as patients treated with secukinumab 150?mg achieved the highest QALYs (16.46) at the lowest cost (CAD 533,010) over a lifetime horizon vs comparators. In the deterministic sensitivity analysis, results were most sensitive to changes in baseline BASFI non-responders, BASDAI 50 at 3 months and discount rates. Probabilistic sensitivity analysis showed that secukinumab 150?mg demonstrated higher probability of achieving maximum net monetary benefit vs all comparators at various cost thresholds.

Conclusions: This analysis demonstrates that secukinumab 150?mg is the most cost-effective treatment option for biologic-naïve AS patients compared to certolizumab pegol, adalimumab, golimumab, etanercept and etanercept biosimilar, and infliximab and infliximab biosimilar for a lifetime horizon in Canada. Treatment with secukinumab translates into substantial benefits for patients and the healthcare system.     

The future of technology and marketing: a multidisciplinary perspective

Journal of the Academy of Marketing Science -     

Asymmetric competition in retail store formats: Evaluating inter- and intra-format spatial effects

Our study aims to analyze the role of store format in retail competitive interactions, specifically, the relationship between growth, location strategy, and market response. To assess this relationship, we propose an extension of the classic models of spatial interaction, which incorporate the asymmetric competitive effects linked to the concept of store format. An empirical application allows us to confirm greater spatial rivalry within store formats (intra-format) than between store formats (inter-format). This implies a certain hierarchical organization when consumers select a retail store, first choosing the type of store at which they will shop and later a particular store within this format. The results are important for retailers who want to configure an optimal network of store locations as well as public administrators who must regulate commercial activity.     

The impact of external reference price on consumer price expectations

Comparative pricing practices are frequently used where actual product prices are accompanied by higher external reference prices. All types of stores, regular-price department stores as well as discount stores, use comparative price claims to frame price deals as attractive [Marketing Science 4 (1985) 199]. In this paper, a quadratic model is specified for the impact of external reference price (ERP) on consumer price expectations. Based on the research on communication discrepancy and advertising claim discrepancy, which in turn draw on assimilation-contrast, attribution, and prospect theories, we hypothesize a quadratic effect of external reference prices on consumer price expectations. An interactive, computer-controlled experiment using multiple levels of ERP is used to estimate the proposed model. As hypothesized, support for an inverted U-shape relationship is found between consumers’ updated price expectations and the difference between ERP and initial price expectations. That is, as the difference between ERP and subjects’ initial price expectations increases, subjects’ updated price expectations increase to a point and then start to decrease. We find that the fit of the quadratic model specification for the effect of external reference price on price expectations is noticeably superior to that of linear, logarithmic, square root, and S-shaped specifications. Finally, we provide implications of our results for both retail managers and for regulatory authorities alike.     

Business Ethics versus Economic Incentives:<Emphasis Type="Italic">Contemporary Issues and Dilemmas</Emphasis>

Contemporary economic thought presumes that individuals in a society always act according to their self-interest or private economic incentives, while important ethical motivations for action, such as a concern for others and public interest, are largely ignored. This paper is based on my experience of teaching an undergraduate course that highlighted the divergence between economic incentives and ethical motives for action in present-day life and business. Teaching tools such as lectures, case and group discussions were employed to address important ethical dilemmas of individuals and managers in contemporary societies. Readings underscored the evolving relationship of business ethics and economic incentives, and the relevance of ancient ethical principles (e.g., Ethics of Interdependence, and Ethics of Prudence and Self-Development) to present-day business ethics. The course emphasized the imminent need in contemporary societies to reduce the divergence between economic incentives and ethical motives for action, and called for a greater understanding of business ethics today, given the complex ethical concerns that managers confront in the current global environment.     

The Efficacy of Regulation Fair Disclosure

This paper examines the impact of Securities and Exchange Commission's Regulation Fair Disclosure (FD) on information leakage around voluntary management disclosures. We find a positive correlation between stock returns two days before and after the voluntary disclosure in the pre‐Regulation FD period, but not in the post‐Regulation FD period. After Regulation FD is implemented, pre‐announcement abnormal return as a percentage of total return decreases by 26.1% (21.4%) for large firms with good (bad) news, suggesting that the amount of information leakage reduces for these firms. These findings provide support for the premise and the intended purpose of the regulation for large firms.     

The impact of collinearity on regression analysis: the asymmetric effect of negative and positive correlations

The purpose of this paper is to ascertain how collinearity in general, and the sign of correlations in specific, affect parameter inference, variable omission bias, and their diagnostic indices in regression. It is found that collinearity can reduce parameter variance estimates and that positive and negative correlation structures have an asymmetric effect on variable omission bias. It is also shown that the effects of collinearity are moderated by the relationship between the dependent variable and the regressors, a consideration not incorporated into most commonly used collinearity diagnostics. The formulae derived enable researchers to assess the sensitivity of regression results to the underlying correlation structure in the data.     

Cost-effectiveness of omalizumab add-on to standard-of-care therapy in patients with uncontrolled severe allergic asthma in a Brazilian healthcare setting

Objective: Omalizumab add-on to standard-of-care therapy has proven to be efficacious in severe asthma patients for whom exacerbations cannot be controlled otherwise. Moreover, evidence from different healthcare settings suggests reduced healthcare resource utilization with omalizumab. Based on these findings, this study aimed to assess the cost-effectiveness of the addition of omalizumab to standard-of-care therapy in patients with uncontrolled severe allergic asthma in a Brazilian healthcare setting.

Methods: A previously published Markov model was adapted using Brazil-specific unit costs to compare the costs and outcomes of the addition of omalizumab to standard-of-care therapy vs standard-of-care therapy alone. Model inputs were largely based on the eXpeRience study. Costs and health outcomes were calculated for lifetime-years and were annually discounted at 5%. Both one-way and probabilistic sensitivity analyses were performed.

Results: An additional cost of R$280,400 for 5.20 additional quality-adjusted life-years was estimated with the addition of omalizumab to standard-of-care therapy, resulting in an incremental cost-effectiveness ratio of R$53,890. One-way sensitivity analysis indicated that discount rates, standard-of-care therapy exacerbation rates, and exacerbation-related mortality rates had the largest impact on incremental cost-effectiveness ratios.

Limitations: Assumptions of lifetime treatment adherence and rate of future exacerbations, independent of previous events, might affect the findings. The lack of Brazilian patients in the eXpeRience study may affect the findings, although sample size and baseline characteristics suggest that the modeled population closely resembles Brazilian severe allergic asthma patients.

Conclusion: Results indicate that omalizumab as an add-on therapy is more cost-effective than standard-of-care therapy alone for Brazilian patients with uncontrolled severe allergic asthma, based on the World Health Organization’s cost-effectiveness threshold of up to 3-times the gross domestic product.     

Ethical Climates and Workplace Safety Behaviors: An Empirical Investigation

In this article, the important but neglected link between workplace safety-enhancing behavior and ethics is explored. Using data from 237 employees from five manufacturing plants in the Midwest, we investigated how specific local ethical climate types are linked to incidences of injuries and two types of safety-enhancing behaviors: safety compliance and safety participation. It was hypothesized that egoist climates are positively related to injuries and negatively related to safety-enhancing behaviors. In contrast, it is proposed that both benevolent and principled climates have negative relationships with injuries and positive relationships with safety-enhancing behaviors. Results provided support only for our principled climate types while benevolence has the desired negative relationship with injuries. Egoism and benevolence are not related to safety-enhancing behaviors. Theoretical and practical implications of findings are discussed. K. Praveen Parboteeah (Ph.D. Washington State University) is an Associate Professor of International Management in the Department of Management, University of Wisconsin – Whitewater. Parboteeah's research interests include international management, ethics, religion and technology and innovation management. He has published articles in numerous acadamic journals including Academy of Management Journal, Organization Science, Decision Sciences, Small Group Research, Journal of World Business, Management International Review, R&D Management and Journal of Engineering and Technology Management. Edward Andrew Kapp is an Assistant Professor in the Department of Occupational and Environmental Safety & Health at the University of Wisconsin-Whitewater. He received his Ph.D. in Industrial Engineering from the University of Wisconsin-Madision. Prior to his position at UW-Whitewater he worked in government, consulting, and private industry. Currently he teaches graduate and undergraduate courses in occupational safety, environmental health & safety management, and environmental and safety law. Dr. Kapp's research is in the area of environmental health & safety management, focusing on the influence of climate and leadership on safety performance.