Economic impact of onabotulinumtoxinA for overactive bladder with urinary incontinence in Europe

Background: Overactive bladder (OAB) is a common condition that has a significant impact on patients’ health-related quality-of-life and is associated with a substantial economic burden to healthcare systems. OnabotulinumtoxinA has a well-established efficacy and safety profile as a treatment for OAB; however, the economic impact of using onabotulinumtoxinA has not been well described.

Methods: An economic model was developed to assess the budget impact associated with OAB treatment in France, Germany, Italy, Spain and the UK, using onabotulinumtoxinA alongside best supportive care (BSC)—comprising incontinence pads and/or anticholinergic use and/or clean intermittent catheterisation (CIC)—vs BSC alone. The model time horizon spanned 5 years, and included direct costs associated with treatment, BSC, and adverse events.

Results: Per 100,000 patients in each country, the use of onabotulinumtoxinA resulted in estimated cost savings of €97,200 (Italy), €71,580 (Spain), and €19,710 (UK), and cost increases of €23,840 in France and €284,760 in Germany, largely due to day-case and inpatient administration, respectively. Projecting these results to the population of individuals aged 18 years and above gave national budget saving estimates of €9,924,790, €27,458,290, and €48,270,760, for the UK, Spain, and Italy, respectively, compared to cost increases of €12,160,020 and €196,086,530 for France and Germany, respectively. Anticholinergic treatment and incontinence pads were the largest contributors to overall spending on OAB management when onabotulinumtoxinA use was not increased, and remained so in four of five scenarios where onabotulinumtoxinA use was increased. This decreased resource use was equivalent to cost offsets ranging from €106,110 to €176,600 per 100,000 population.

Conclusions: In three of five countries investigated, the use of onabotulinumtoxinA, in addition to BSC, was shown to result in healthcare budget cost savings over 5 years. Scenario analyses showed increased costs in Germany and France were largely attributable to the treatment setting rather than onabotulinumtoxinA acquisition costs.     

The experience of teleworking: an annotated review

The paper reviews the contemporary literature on the experience of teleworking. Particular attention is paid to the socializing aspects of work and its comparative absence when working from home; economic considerations, both for homeworkers and for the firms; work satisfaction and motivation; supervision; roles and gender issues in homeworking; the organization of time and space; and, lastly, questions of self-discipline. The evidence reviewed is based on various teleworking trials conducted mainly during the 1980s; this information is supplemented by original research conducted by the authors which investigated the pros and cons raised by British Telecom operators who were due to take part in a teleworking trial. These operators anticipated many of the issues faced by those who actually had teleworking experience.     

The Relationship Among Union Membership, Facets of Satisfaction and Intent to Leave: Further Evidence on the Voice Face of Unions

This study examined the impact of union membership on employees’ intent to leave their jobs across a number of facets of satisfaction, as a further test of unions’ voice face. Among the findings were that there were significant relationships between job, compensation, benefits, working conditions, and immediate supervisor satisfaction and intent to leave one’s job for nonunion employees. In contrast, only the relationship between job satisfaction and intent to leave was significant for union employees. Finally, over the facets of satisfaction where one would expect unions to have the most influence, the relationship between intent to leave one’s job and satisfaction was greater for nonunion employees than for union employees. These results provide a great deal of support for the effect of unions’ voice face.

Firms as knowledge repositories

One reason firms exist is to serve as knowledge repositories. Firms compete against other firms and need profits to survive. Firms must be entrepreneurial to discover and act on profit opportunities. Knowledge required to spot profit opportunities is disbursed among economic actors and often is tacit knowledge that can only be obtained by those in close proximity. This gives rise to agglomeration economies, which can be leveraged within firms. In a competitive economy people have an incentive to keep knowledge from people in other firms, but to share it with those in their firm. One role of the firm is to act as a repository of knowledge for those within the firm’s boundaries, and to lower the cost of obtaining knowledge about profit opportunities. Entrepreneurs need firms to contain and capture the profits from their innovations.     

A Note on Attitude as a Factor in Learning Economics

Although one might naturally assume that students interested in economics will learn more in an introductory course than those not interested in the subject, this assumption had to be tested. Using a specially designed “Questionnaire on Student Attitude Toward Economics” on a pretest and posttest basis, and accounting for previous course work, the student's verbal and quantitative skills, and student program requirements, Karstensson and Vedder employed linear multiple regression analysis and found a positive relationship between precourse attitude and course grade. Changes in student attitude which occurred during the course were also analyzed.