Clinical and economic evaluation of olanzapine-fluoxetine HCl combination in the treatment of bipolar depression: a managed care approach

Summary

This study was aimed to provide a clinical and economic assessmentfor health care organisations to make formulary decisions on Symbyax? (olanzapine-fluoxetine HCl combination). The combination drug was shown to be efficacious in treating bipolar depression. However, more compelling evidence is needed for the long-term effect, the effect in a more general population, its comparative advantage over other treatments, its adverse effects, and its efficacy and safety in sub-populations. Results of the budget impact analysis indicated that adding the drug to the formulary would increase medication cost per member per month (PMPM) from $1.150 to $1.172 in the base case scenario. One-way sensitivity analysis showed a rough band of a $0.21 decrease to a $0.26 increase in PMPM cost, by varying one factor at a time while holding all others at base-case levels. Further research is needed for the formulary decision of adding olanzapine-fluoxetine HCI combination drug.     

Clinical and economic impact of rivaroxaban on the burden of atrial fibrillation: The case study of Japan

Objectives: Atrial fibrillation (AF) affects an estimated 1.5 million individuals in Japan, increasing their stroke risk and imposing considerable costs on the Japanese healthcare system. To reduce stroke incidence, guidelines recommend using anticoagulants in moderate-to-high risk non-valvular AF (NVAF) patients; however, many patients receive no treatment, aspirin only, or remain poorly-controlled on vitamin K antagonists (VKAs) due to high VKA discontinuation rates and non-adherence to guidelines. A prevalence-based Markov model was developed to estimate the clinical and budgetary impact of treating these patients with Xarelto^TM (rivaroxaban, Bayer AG) in Japan.

Methods: Population, baseline risk of events, and associated management costs were estimated using data from Japanese publications where available. Treatment efficacy and safety were derived from published data and the J-ROCKET AF trial. Drug and physician visit costs were based on data from the Ministry of Health, Labor, and Welfare, the J-ROCKET AF trial, and Japanese clinical guidelines.

Results: This model demonstrates that increased use of rivaroxaban in inadequately-managed NVAF patients could avoid 456 081 non-fatal ischemic strokes (IS) and 76 975 cardiovascular deaths over 10 years in Japan. This clinical benefit offsets the increased incidence of myocardial infarctions and anticoagulant-related bleeding. Decreased event costs could lead to a ¥188.4 billion decrease in net spending over the analysis time horizon.

Conclusions: Introducing rivaroxaban may decrease the burden of NVAF in Japanese society. From a clinical perspective, the reduction in IS and embolic events outweighs the increased risk of anticoagulant-related bleeding; from an economic perspective, reduced event costs offset drug and physician visit costs, resulting in cost savings.     

The reduction of the UK budget deficit: a human rights perspective

This paper contributes to new thinking in economics by employing a human rights perspective to examine the budget deficit reduction strategy of the UK coalition government, as set out in 2010 in the June budget and October Spending Review. Focusing on economic and social rights, the paper explains the human rights obligations of governments and key human rights principles. As examples of how they should be applied to examine the deficit reduction strategy, it examines the implications of the policy changes for child poverty and gender equality, and finds that in both cases there is evidence to suggest non-compliance with the human rights obligations of the UK government.     

Cost-effectiveness of mechanical thrombectomy for acute ischemic stroke: an Australian payer perspective

Aims: The goal of this study was to assess the cost-effectiveness of mechanical thrombectomy (MT) for acute ischemic stroke (AIS) from an Australian payer perspective.

Methods: This study used a Markov model that employed a life-time time horizon, modeling patients from symptom onset of stroke until end of life. Clinical efficacy and safety data were taken from an individual patient level data (IPD) meta-analysis of clinical studies. The treatment effect of MT compared to usual care was measured by changes in modified Rankin Score (mRS). Post-treatment mRS scores were used to determine short- and long-term stroke care costs. Treatment costs were modeled, with health state utility values determined by literature review. All analyses were conducted using Microsoft Excel.

Results: In comparison to usual care, MT is associated with higher costs ($10,666 per patient) and additional quality-adjusted life years (QALYs) (0.8281 per patient), resulting in an incremental cost per QALY of $12,880. Sensitivity analyses demonstrated the reliability of the base case results across a range of assumptions. The higher cost associated with MT is, to an extent, offset by the cost savings resulting from lower stroke care costs due to improved patient outcomes. The life-time cost savings in terms of stroke care costs are estimated to be more than $8,000 per patient for patients who had received MT in combination with usual care.

Limitations: Stroke care costs based on patient disability/functional level were not available and were derived. As a consequence, long-term care costs for patients with poorer outcomes may be under-estimated. Patient outcomes at 90 days were extrapolated to a lifetime horizon, but this approach was supported by long-term evidence on stroke survival.

Conclusions: Mechanical thrombectomy is a cost-effective treatment option for AIS, with clinical benefits translating to short- and long-term cost benefits. This analysis supports rapid update of stroke care pathways to incorporate this therapy as a treatment option.     

Looking backward to look forward: water use and economic growth from a long-term perspective

Recent research has examined the relationship between natural resources and economic growth. Considered vitally important, not only for humanity’s well-being but also for the integrity of the ecosystem, the relationship between water use and economic growth has nevertheless traditionally attracted little attention by analysts. This article studies water use trends from 1900 to 2000 throughout the world and their relationship to the main determinants of economic growth. To do this, we first analyse water use trajectories. Second, to proceed with the determinants of water use, we reformulate the Ehrlich and Holdren’s impact, population, affluence, technology (IPAT) equation (1971), decomposing water use trends into changes in economic demands and in water use intensity on the basis of a decomposition analysis. Finally, a simple scenario analysis is conducted, to project future water use trends under different economic, demographic and technological assumptions.

?The empirical evidence shows that economic and population growth have been crucial in explaining the increase in water use over the past 100 years, with significant regional differences. Nevertheless, the decline in water use intensity has been responsible for a significant reduction in the growth of total water use.     

拉丁美洲1990年代经济改革特点--以墨西哥经济改革为例

拉丁美洲在20世纪90年代前后开始的全面经济改革,新自由主义属性显著。在这一过程中,墨西哥的新自由经济改革颇具代表性。因此,以墨西哥的加工贸易和国有企业私有化为例,分析拉丁美洲经济改革中的特点以及出现的问题。     

Health and economic impact of PHiD-CV in Canada and the UK: a Markov modelling exercise

Abstract

Objective:

The spectrum of diseases caused by Streptococcus pneumoniae and non-typeable Haemophilus influenzae (NTHi) represents a large burden on healthcare systems around the world. Meningitis, bacteraemia, community-acquired pneumonia (CAP), and acute otitis media (AOM) are vaccine-preventable infectious diseases that can have severe consequences. The health economic model presented here is intended to estimate the clinical and economic impact of vaccinating birth cohorts in Canada and the UK with the 10-valent, pneumococcal non-typeable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV) compared with the newly licensed 13-valent pneumococcal conjugate vaccine (PCV-13).

Methods:

The model described herein is a Markov cohort model built to simulate the epidemiological burden of pneumococcal- and NTHi-related diseases within birth cohorts in the UK and Canada. Base-case assumptions include estimates of vaccine efficacy and NTHi infection rates that are based on published literature.

Results:

The model predicts that the two vaccines will provide a broadly similar impact on all-cause invasive disease and CAP under base-case assumptions. However, PHiD-CV is expected to provide a substantially greater reduction in AOM compared with PCV-13, offering additional savings of Canadian $9.0 million and £4.9 million in discounted direct medical costs in Canada and the UK, respectively.

Limitations:

The main limitations of the study are the difficulties in modelling indirect vaccine effects (herd effect and serotype replacement), the absence of PHiD-CV- and PCV-13-specific efficacy data and a lack of comprehensive NTHi surveillance data. Additional limitations relate to the fact that the transmission dynamics of pneumococcal serotypes have not been modelled, nor has antibiotic resistance been accounted for in this paper.

Conclusion:

This cost-effectiveness analysis suggests that, in Canada and the UK, PHiD-CV’s potential to protect against NTHi infections could provide a greater impact on overall disease burden than the additional serotypes contained in PCV-13.     

Goodness-of-fit techniques for count data models: an application to the demand for dental care in Spain

This paper compares the practical performance of alternative goodness-of-fit techniques for count data models in the context of a study of the determinants of demand for dental care in Spain. We apply alternative goodness-of-fit techniques to different specifications. In particular, we implement recently proposed specification tests which are consistent in the direction of general nonparametric alternatives. The analysis suggests that a negative binomial model is an appropriate specification for dental care demand. Dental health and income are identified as important predictors of individuals' behavior. First version received: April 2000/Final version received: March 2001     

Cost effectiveness of memantine in Alzheimer's disease in the UK

Objective: This analysis assesses the cost-effectiveness of memantine for the treatment of moderate-to-severe Alzheimer's disease (AD) in the UK.

Methods: This cost-utility analysis was based on a Markov model. The model simulated 5-year progress of patients with AD until they need full-time care (FTC), defined as a patient becoming either dependent or institutionalised. Transition probabilities were based on a predictive equation, derived from the London and South-East Region epidemiological study. Resource use, utilities and mortality were obtained from the same study. Memantine efficacy was based on a meta-analysis of six large trials. The model compared memantine to its alternative in the UK, i.e. no pharmacological treatment or background therapy with acetylcholinesterase inhibitors.

Results: Memantine was found to delay the need to FTC by 6 weeks compared with current practice in the UK. It was associated with increased quality-adjusted life-years and cost savings to the healthcare system (probability of this outcome was 96%). The projections were made assuming that benefits from the 6-month treatment were sustained over time, which is regarded as the main limitation. The model underwent extensive sensitivity analyses, which confirmed the base-case findings.

Conclusions: The model suggests that memantine delays the need for FTC and decreases cost. It can be regarded as a cost-effective choice in the management of moderate and severe AD.     

Assessing the economic impact of entrepreneurship on a regional economy using social accounting matrices: the case of Andalusia

This article analyses the impact that entrepreneurial activity has, from the economic point of view, on a regional economy (Andalusia), based on a Social Accounting Matrix linear model. Moreover, to measure entrepreneurship at regional level, it is defined what can be considered an entrepreneurial initiative company from a quantitative point of view. The results obtained, in terms of Production, GDP and job creation, show how entrepreneurship, in the case of Andalusia, contributes to the sustainability of the economy, its growth and, above all, the reduction of unemployment in the short term.     

Managing wetlands: an ecological economic analysis of the Hong Kong Wetland Park

This paper addresses the question of whether the Hang Kong government made a rational economic decision when it decided to set aside land to develop a Wetland Park, or whether it should have used the land for alternative commercial developments. Different analytical methods are used to estimate the economic value of the environmental benefits of the Wetland Park： the Value Transfer Method is used to estimate the economic value oJ the ecological services provided by the Park. the Direct Market Price analysis for the economic value of the goods purchased in the Wetland Park, the Hedonic Housing Price Analysis for the value of the Park to those residing in its proximity, the Travel Cost and Contingent Valuation Method for the value of the Park to the visitors, and the Contingent Valuation for the Passive （Nonuse） Values of the Park. These benefits are compared to the opportunity cost of the land and the cost of running the Wetland Park. The article concludes that if a rate of 5% or less is used to discount fiture costs and benefits, we would find that the government＇s decision to set aside land for a Wetland Park was economically sound while using a discount rate of 6% or more shows that it was not.     

The welfare effects of innovative pharmaceuticals: an international perspective from the Dutch experience

Policy discussions on new medicines are often focused on cost containment rather than on the benefits they produce, such as health gains and cost savings in other sectors. In this study, we identify systematic differences in policies towards pharmaceuticals between countries and calculate the welfare gains of 39 innovative pharmaceuticals introduced in the Dutch market after 1997. Welfare gains are defined as the difference between the value of a QALY gained by innovative pharmaceuticals and their costs. The review shows that there are systematic differences among pharmaceutical policies and regulations between countries. It is further found that the welfare gains of pharmaceuticals are substantial and amount to €77 per capita per year in the Netherlands. The welfare gains could be higher if institutional barriers for an efficient utilization of innovative pharmaceuticals are removed.     

Between European integration and regional autonomy: the case of Italy from an economic perspective

Italy has experienced a double political phenomenon over the last few decades: a transfer of powers to a supranational entity (the EU) and a move towards regional autonomy. This paper aims to evaluate how policy competences are attributed to and exercised by the European, national and regional institutions. It develops a set of quantitative indicators analysing the legislative production of the EU, the Italian parliament and the Italian regions in various policy areas. The main findings indicate a certain substitutability between European and national legislation and that different levels of government share competences in a larger number of sectors than suggested by the economic theory.

广州市教育投资对经济增长贡献率的实证分析

有关数据表明，科技进步对经济增长的贡献率已经从20世纪初的5—20％提高到20世纪90年代的70％-80％。广州市作为经济开放的前沿城市，经济增长速度长年处于全国前列，那麽广州市教育投资的经济效益如何？为广州市经济增长带来了多大贡献呢？本文运用C—D函数模型（柯布-道格拉斯函数模型）进行了实证分析。     

Financial liberalisation and economic growth in Nigeria: an ARDL-bounds testing approach

Employing the Autoregressive Distributed Lag (ARDL)-Bounds testing approach, and using GDP – excluding the contributions from oil and gas, as well as the financial services sector – as the growth indicator between 1969 and 2008, the paper establishes a long-run relationship between economic growth and financial liberalisation, which is represented by an index. This index is calculated by using Principal Component Analysis (PCA). The paper finds that financial liberalisation policies have a positive and significant effect on economic growth in Nigeria – both in the short run and in the long run. The study, therefore, recommends that appropriate financial liberalisation policies should be pursued in Nigeria, in order to foster economic growth. However, considering the fact that financial markets are prone to market failures, the study cautions against adopting a laissez-faire approach to financial reforms.     

The contest for mineral wealth: an economic analysis of conflicts in Ghanaian mining communities

The paper uses survey data from 1458 households in 60 communities from 24 districts in 5 regions of Ghana and logistic regression to examine conflicts as a contest for mineral wealth in mining communities, estimates the determinants of conflicts in these mining communities and examines how these contests could erode and/or enhance Ghana’s gains from mining. The paper finds that the likelihood of a conflict occurring in a mining area is about 56.7%. Village effect was found to be a significant positive predictor of mining conflict. Also, improvement in primary education, employment opportunities to community members of ages 25–50, the strength of institutions and the absence of small-scale miners in a mining community reduces the probability of conflicts occurring by 12.8, 35.8, 6.57 and 17.7%, respectively. While an increase in pollution levels increases the likelihood of conflicts occurring by 7.1%, primary occupation in manufacturing and services, and increase in household monthly expenditure significantly increases the likelihood of conflicts within the mining communities as the cost of living increases.     

Uncertainty and the macroeconomy: evidence from an uncertainty composite indicator

This article proposes a uncertainty composite indicator (UCI) based on three distinct sources of uncertainty (namely financial, political, and macroeconomic) for the US economy on the period 1985–2015. For that, we use a dynamic factor model, summarizing efficiently six individual uncertainty proxies, namely two macroeconomic and financial uncertainty factors based on the unpredictability, a measure of (micro)economic uncertainty, the implied volatility index, the corporate bond spreads, and an index of economic policy uncertainty. We then compare the effects of uncertainty on economic activity when the UCI is used instead of individual uncertainty proxies in structural VAR models. The interest of our UCI is to synthesize theses effects within one measure of uncertainty. Overall, the UCI was able to account for the most important dynamics of uncertainty which play an important role in business cycles.     

汇率变动、对外贸易与经济增长——以湖南省为例

选取了2005年7月汇改以来至2013年12月的季度数据,通过建立联立方程模型,利用3SLS(三阶段最小二剩法)计量方法就人民币汇率的变动对湖南省对外贸易、经济增长的影响进行实证研究。实证结果表明:人民币实际有效汇率升值1%,经济增长速度降低0.612%;湖南省进出口额的增长速度降低2.79%,人民币实际有效汇率升值对湖南省经济总量的增长有紧缩效应。     

The economic impact of insulin-related hypoglycemia in Denmark: an analysis using the Local Impact of Hypoglycemia Tool

Aims: To estimate the direct cost of hypoglycemia in insulin-treated adults with type 1 diabetes (T1DM) and type 2 diabetes (T2DM) in Denmark.

Materials and methods: The Local Impact of Hypoglycemia Tool (LIHT) was used to estimate the costs associated with insulin-related hypoglycemia. Average utilization of healthcare resources, including the costs of pre-hospitalization, hospital admission, healthcare professional contact and follow-up, glucose/glucagon, and extra SMBG tests to monitor blood glucose following an episode, was used to calculate an average cost per severe and per non-severe hypoglycemic episode. The cost per episode was then applied to the rates of severe and non-severe hypoglycemia in people with T1DM and T2DM in Denmark.

Results: The direct cost of insulin-related hypoglycemia in Denmark is DKK 96.2 million per year, which equates to EUR 12.9 million. For people with T1DM prone to severe hypoglycemia (defined as having ≥2 severe episodes in the past year), the cost per person per year increases by DKK 4,155 compared with the T1DM population average, and for people with T2DM prone to non-severe hypoglycemia (defined as having ≥1 non-severe episode in the last 4 weeks), the cost increases by DKK 647 per person per year compared with the T2DM population average.

Conclusions: The LIHT highlights the substantial economic burden of insulin-related hypoglycemia in Denmark, and provides a means to estimate the savings that could be made by lowering hypoglycemia rates. For example, the costs associated with using a new insulin or introducing a patient education program could be offset with the cost saving from reducing hypoglycemia.     

Long-term health economic benefits of sensor-augmented pump therapy vs continuous subcutaneous insulin infusion alone in type 1 diabetes: a UK perspective

Aims/hypothesis:

Continuous subcutaneous insulin infusion (CSII) is an important treatment option for type 1 diabetes patients unable to achieve adequate glycemic control with multiple daily injections (MDI). Combining CSII with continuous glucose monitoring (CGM) in sensor-augmented pump therapy (SAP) with a low glucose-suspend (LGS) feature may further improve glycemic control and reduce the frequency of hypoglycemia. A cost-effectiveness analysis of SAP?+?LGS vs CSII plus self-monitoring of blood glucose (SMBG) was performed to determine the health economic benefits of SAP?+?LGS in type 1 diabetes patients using CSII in the UK.

Methods:

Cost-effectiveness analysis was performed using the CORE diabetes model. Treatment effects were sourced from the literature, where SAP?+?LGS was associated with a projected HbA_1c reduction of ?1.49% vs ?0.62% for CSII, and a reduced frequency of severe hypoglycemia. The time horizon was that of patient lifetimes; future costs and clinical outcomes were discounted at 3.5% and 1.5% per annum, respectively.

Results:

Projected outcomes showed that SAP?+?LGS was associated with higher mean quality-adjusted life expectancy (17.9 vs 14.9 quality-adjusted life years [QALYs], SAP?+?LGS vs CSII), and higher life expectancy (23.8 vs 21.9 years), but higher mean lifetime direct costs (GBP 125,559 vs GBP 88,991), leading to an incremental cost-effectiveness ratio (ICER) of GBP 12,233 per QALY gained for SAP?+?LGS vs CSII. Findings of the base-case analysis remained robust in sensitivity analyses.

Conclusions/interpretation:

For UK-based type 1 diabetes patients with poor glycemic control, the use of SAP?+?LGS is likely to be cost-effective compared with CSII plus SMBG.