A global economic model to assess the cost-effectiveness of new treatments for advanced breast cancer in Canada

Objective Considering the increasing number of treatment options for metastatic breast cancer (MBC), it is important to develop high-quality methods to assess the cost-effectiveness of new anti-cancer drugs. This study aims to develop a global economic model that could be used as a benchmark for the economic evaluation of new therapies for MBC.

Methods The Global Pharmacoeconomics of Metastatic Breast Cancer (GPMBC) model is a Markov model that was constructed to estimate the incremental cost per quality-adjusted life years (QALY) of new treatments for MBC from a Canadian healthcare system perspective over a lifetime horizon. Specific parameters included in the model are cost of drug treatment, survival outcomes, and incidence of treatment-related adverse events (AEs). Global parameters are patient characteristics, health states utilities, disutilities, and costs associated with treatment-related AEs, as well as costs associated with drug administration, medical follow-up, and end-of-life care. The GPMBC model was tested and validated in a specific context, by assessing the cost-effectiveness of lapatinib plus letrozole compared with other widely used first-line therapies for post-menopausal women with hormone receptor-positive (HR+) and epidermal growth factor receptor 2-positive (HER2+) MBC.

Results When tested, the GPMBC model led to incremental cost-utility ratios of CA$131 811 per QALY, CA$56 211 per QALY, and CA$102 477 per QALY for the comparison of lapatinib plus letrozole vs letrozole alone, trastuzumab plus anastrozole, and anastrozole alone, respectively. Results of the model testing were quite similar to those obtained by Delea et al., who also assessed the cost-effectiveness of lapatinib in combination with letrozole in HR+/HER2?+?MBC in Canada, thus suggesting that the GPMBC model can replicate results of well-conducted economic evaluations.

Conclusions The GPMBC model can be very valuable as it allows a quick and valid assessment of the cost-effectiveness of any new treatments for MBC in a Canadian context.     

Measurement of Technical Efficiency in Public Education: A Stochastic and Nonstochastic Production Function Approach

This paper uses both the stochastic and nonstochastic production function approach to measure technical efficiency in public education in Utah. The stochastic specification estimates technical efficiency assuming half normal and exponential distributions. The nonstochastic specification uses two-stage data envelopment analysis (DEA) to separate the effects of fixed inputs on the measure of technical efficiency. The empirical analysis shows substantial variation in efficiency among school districts. Although these measures are insensitive to the specific distributional assumptions about the one-sided component of the error term in the stochastic specification, they are sensitive to the treatment of fixed socioeconomic inputs in the two-stage DEA.     

Playing at the queer edges

Through autoethnography, queer theory and edgework, I examine Wild Ginger Witchcamp, an annual five‐day event where one hundred or so people gather to celebrate shared politics, spirituality and environmental concerns. I include narratives of lived experience, woven and layered into the text to illuminate the complex realities of leisure that extends beyond resisting the normative to one of the nurturing alternatives. The social health of a community depends on the community’s ability to publicly affirm itself, and it is critical that a community find a way to transmit and transform its culture. Queer theory, the related constructs of heteronormativity and counterpublics, along with edgework, can help us understand the importance of communal and culturally relevant leisure particularly for individuals and communities that do not see themselves reflected in the dominant culture.     

The Incidence of Property Taxes on Single-Family Housing*

The incidence of local property taxes, specifically the degree of capitalizing of property tax differentials in market prices, remains an unresolved question. The studies by Oates (1969) and McMillan and Carlson (1977) , which come to contradictory conclusions typify the diversity of opinion on the question. Many of the previous studies suffer from research design problems including, the use of census data for market values and property tax levels on real property; failure to control for differences in public services quality among the cities samples; and use of assessed value as a proxy for market price. A theoretical model in developed to explain the capitalization effect of property tax differentials within an urban area. Because the model is exactly identified, a single reduced from equation relating market value to a set of physical characteristics of the property and the level of property taxes can be estimated using ordinary least-squares techniques. The function is estimated using data drawn from 107 residential property sales made during 1976. Estimated parameters for the other equations then are determined indirectly. Actual market price and property tax data for each parcel ware used. It is found that property tax differentials on otherwise comparable properties are associated with significant market value differentials. Because the assessed value ranges from 7 to 20 percent of market value, the property tax procedure in the area studied appears to have randomly generated large capital gains for some and capital losses for others. Because of the limited data base, the statistical results are only indicative; the model, howevfer, should have wide applicability in a variety of questions concerning the incidence of property taxes.     

Financial Constraints for Innovation in Brazil

This paper analyzes the presence of financial constraints for investment in innovation in Brazil. Dynamic investment models are estimated for a panel dataset of 206 Brazilian non-financial firms in the period 1995–2006. Results show that innovation of Brazilian firms is subject to financial constraints in line with previous international evidence. Innovation of Brazilian firms is adversely affected by leverage and also depends on internally generated funds. The models presented incorporate relevant firm characteristics for financial constraints. Our findings suggest the need for further advances at micro- and macroeconomic levels in Brazil to mitigate the observed financial constraints.     

Cost-effectiveness of asenapine in the treatment of schizophrenia in Canada

Objective:

Asenapine is the first tetracyclic antipsychotic approved in Canada for the treatment of schizophrenia (SCZ). Asenapine has shown a comparable efficacy profile to other atypical antipsychotics and it is associated with a favourable metabolic profile and less weight gain. This study aimed to assess the economic impact of asenapine compared to other atypical antipsychotics in the treatment of SCZ in Canada.

Methods:

A decision tree combined with a Markov model was constructed to assess the cost-utility of asenapine compared with other atypical antipsychotics. The decision tree takes into account the occurrence of extrapyramidal symptoms, the probability of switching to a different antipsychotic, and the probability of gaining weight. The Markov model takes into account long-term metabolic complications including diabetes, hypertension, coronary heart diseases, and stroke. In the base-case analysis, asenapine was compared to olanzapine. Asenapine was also compared with other atypical antipsychotics commonly used in Canada in alternative scenarios. Analyses were conducted from both Canadian Ministry of Health (MoH) and societal perspectives over a 5-year time horizon.

Results:

In the treatment of SCZ, asenapine is a dominant strategy over olanzapine from both MoH and societal perspectives. Compared to quetiapine, asenapine is also a dominant strategy. Furthermore, asenapine has a favorable economic impact compared to ziprasidone and aripiprazole, as these antipsychotics are not cost-effective compared to asenapine from both MoH and societal perspectives.

Conclusion:

Despite the short time horizon, the lack of compliance data and the assumptions made, this economic evaluation demonstrates that asenapine is a cost-effective strategy compared to olanzapine and to most of the atypical antipsychotics frequently used in Canada.     

Intergenerational Politics, Fiscal Policy and Productivity

A political–economic theory of fiscal policy is presented in which tax policy preferences are derived from a conflict of interest between individuals of different ages. Policy formation is fully rational in that an individual's beliefs regarding future policies are consistent with state-contingent policy outcomes. The overlapping generations friction that prevents the young from transacting with future members of society implies that young policymakers strategically manipulate the policy preferences of the yet unborn to lower their own expected old-age tax burden. A comparison of the original equilibrium to one induced by the “constitutional commitment” of fiscal policy isolates the strategic component of tax rates and demonstrates that aggregate labor productivity is biased as a result of the conflict.Journal of Economic LiteratureClassification Numbers: E62, H30, O40.     

The Three Critical Flaws of Critical Geopolitics: Towards a Neo-Classical Geopolitics

Critical geopolitics is the dominant school of geopolitics in contemporary geography. Critical geopolitics is a body of radical scholarship that emerged in the 1980s that attempts to move beyond classic geopolitics. In order to resuscitate geopolitics, critical geopoliticians had to distance themselves from the imperialist, racist, and environmentally determinist geopolitics of the 1940s. In doing so, however, critical geopoliticians created a body of scholarship that omits important explanatory variables necessary to understand post–Cold War geopolitics. We argue that critical geopolitics unnecessarily limits the wider application of geopolitics because it is: 1) anti-geopolitics; 2) anti-cartographic; and 3) anti-environmental.     

Controlling the incentive problems in real estate leasing

This paper develops a formal model that characterizes potential conflicts of interest between real-estate landlords and tenants. The model demonstrates a tenant's incentive to undermaintain or overuse (i.e., abuse) a leased property while highlighting the moral hazard problem as a cause of the failure of the lease irrelevance proposition. As a consequence, the lease irrelevance proposition's faiure implies that if tenant abuse incentives are left unrestricted, the market for leased real estate may cease to function.The efficacies of various lease arrangements suggested by Smith and Wakeman (1985) and other researchers in controlling the tenant abuse incentives are evaluated in this framework as a means of counteracting the inherent problems. Our analysis supports the greater use of variable lease schemes (e.g., security deposits and penalty clauses), which peg real-estate lease rates to the level of property abuse rather than more traditional fixed payment contracting arrangements.