The cost-effectiveness of solifenacin vs. trospium in the treatment of patients with overactive bladder in the German National Health Service

Objective:

To carry out a cost–utility analysis comparing initial treatment of patients with overactive bladder (OAB) with solifenacin 5?mg/day versus either trospium 20?mg twice a day or trospium 60?mg/day from the perspective of the German National Health Service.

Methods:

A decision analytic model with a 3 month cycle was developed to follow a cohort of OAB patients treated with either solifenacin or trospium during a 1 year period. Costs and utilities were accumulated as patients transitioned through the four cycles in the model. Some of the solifenacin patients were titrated from 5?mg to 10?mg/day at 3 months. Utility values were obtained from the published literature and pad use was based on a US resource utilization study. Adherence rates for individual treatments were derived from a United Kingdom general practitioner database review. The change in the mean number of urgency urinary incontinence episodes/day from after 12 weeks was the main outcome measure. Baseline effectiveness values for solifenacin and trospium were calculated using the Poisson distribution. Patients who failed second-line therapy were referred to a specialist visit. Results were expressed in terms of incremental cost–utility ratios.

Results:

Total annual costs for solifenacin, trospium 20?mg and trospium 60?mg were €970.01, €860.05 and €875.05 respectively. Drug use represented 43%, 28% and 29% of total costs and pad use varied between 45% and 57%. Differences between cumulative utilities were small but favored solifenacin (0.6857 vs. 0.6802 to 0.6800). The baseline incremental cost–effectiveness ratio ranged from €16,657 to €19,893 per QALY.

Limitations:

The difference in cumulative utility favoring solifenacin was small (0.0055–0.0057 QALYs). A small absolute change in the cumulative utilities can have a marked impact on the overall incremental cost-effectiveness ratios (ICERs) and care should be taken when interpreting the results.

Conclusion:

Solifenacin would appear to be cost-effective with an ICER of no more than €20,000/QALY. However, small differences in utility between the alternatives means that the results are sensitive to adjustments in the values of the assigned utilities, effectiveness and discontinuation rates.     

LGBT Neighbourhoods and ‘New Mobilities’: Towards Understanding Transformations in Sexual and Gendered Urban Landscapes

In this article we apply insights from ‘new mobilities’ approaches to understand the shifting sexual and gendered landscapes of major cities in the global North. The empirical context is the purported ‘demise’ of traditional gay villages in Toronto, Canada and Sydney, Australia, and the emergence of ‘LGBT neighbourhoods’ elsewhere in the inner city. We reinterpret the historical geography of twentieth century LGBT lives and the associated ‘rise and fall’ of gay enclaves through the lens of the ‘politics of mobility’. In this reading, it is apparent that multifaceted movements — migration, physical and social mobility, and motility — underpin the formation of gay enclaves and recent transformations in sexual and gendered landscapes. After the second world war, LGBT communities in the global North were embedded in specific historical geographies of mobility and we trace these in the Canadian and Australian contexts. The ‘great gay migration’ from the 1960s to the 1980s has been joined by new LGBT constellations of mobility in the 2000s, and these have imprinted upon the sexual and gendered landscapes of Toronto and Sydney.     

Life‐Cycle Consumption and Children: Evidence from a Structural Estimation

I estimate by maximum likelihood a dynamic model of optimal intertemporal allocation of consumption in the presence of children using high‐quality Danish longitudinal data. The number and age of all children can affect the marginal utility of consumption while income uncertainty, credit constraints and postretirement motives also influence household behaviour. While I estimate that children have a surprisingly small effect on the marginal utility of non‐durable consumption, data simulated from the estimated model replicates similar correlations between log consumption growth and changing household composition as found in the Danish data and typically found in UK and US data. To reconcile the results with existing studies, I illustrate how ignoring precautionary motives increases the estimated importance of children. The results indicate that precautionary motives might play a larger role than children in explaining the observed consumption age profile.     

The Adjusted Big Mac Methodology: A Clarification

The Economist's adjusted Big Mac index takes GDP into account in currency valuation, but the methodology is not explained. We show that the key to understanding the methodology is to distinguish between a currency's bilateral valuation (versus a specific currency) and the currency's overall valuation (versus a “basket” of a large number of currencies). Also, the adjusted Big Mac estimates of intrinsic foreign exchange (FX) rates have been better forecasts of actual FX changes than those of the original “raw” Big Mac index.     

Key institutions in business and management education research

The authors investigate institutional productivity in business and management education (BME) research based on the analysis of 4,464 articles published by 7,210 authors across 17 BME journals over a 10-year period, involving approximately 1,900 schools worldwide. Departing from traditional disciplinary silos, they examine the BME research field as a whole by including all traditional business disciplinary areas and producing two top 100 rankings, one based on raw number of author publications and the other based on weighted scores reflecting journal quality and coauthorship.