Cost-effectiveness of sacubitril/valsartan versus enalapril in patients with heart failure and reduced ejection fraction

Background: Sacubitril/valsartan reduces cardiovascular death and hospitalizations for heart failure (HF). However, decision-makers need to determine whether its benefits are worth the additional costs, given the low-cost generic status of traditional standard of care.

Aims: To evaluate the cost-effectiveness of sacubitril/valsartan compared to enalapril in patients with HF and reduced ejection fraction, from the Singapore healthcare payer perspective.

Methods: A Markov model was developed to project clinical and economic outcomes of sacubitril/valsartan vs enalapril for 66-year-old patients with HF over 10 years. Key health states included New York Heart Association classes I–IV and deaths; patients in each state incurred a monthly risk of hospitalization for HF and cardiovascular death. Sacubitril/valsartan benefits were modeled by applying the hazard ratios (HRs) in PARADIGM-HF trial to baseline probabilities. Primary model outcomes were total and incremental costs and quality-adjusted life years (QALYs) and the incremental cost-effectiveness ratio (ICER) for sacubitril/valsartan relative to enalapril

Results: Compared to enalapril, sacubitril/valsartan was associated with an ICER of SGD 74,592 (USD 55,198) per QALY gained. A major driver of cost-effectiveness was the cardiovascular mortality benefit of sacubitril/valsartan. The uncertainty of this treatment benefit in the Asian sub-group was tested in sensitivity analyses using a HR of 1 as an upper limit, where the ICERs ranged from SGD 41,019 (USD 30,354) to SGD 1,447,103 (USD 1,070,856) per QALY gained. Probabilistic sensitivity analyses showed the probability of sacubitril/valsartan being cost-effective was below 1%, 12%, and 71% at SGD 20,000, SGD 50,000, and SGD 100,000 per QALY gained, respectively.

Conclusions: At the current daily price sacubitril/valsartan may not represent good value for limited healthcare dollars compared to enalapril in reducing cardiovascular morbidity and mortality in HF in the Singapore healthcare setting. This study highlights the cost-benefit trade-off that healthcare professionals and patients face when considering therapy.     

Market orientation practices among small and medium hotels (SMHS) in tourist destination island of Langkawi

The purpose of the study is to investigate the underlying components of market orientation practices and their effect on the Small and Medium Hotels (SMHs) performances on tourist destination island of Langkawi. Fifty SMHs were randomly selected from a sampling frame of a list of SMHs registered with Malaysian Tourism Board. For data collection purposes, structured questionnaires were personally delivered and collected. Rotated component matrix factor analysis of the data extracted four underlying factors that explain seventy nine point four six percent of the total variances and alpha reliability coefficient of ninety eight percent. Those components were named as customer orientation, interfunctional orientation, service orientation, and competitor orientation. One sample Kolmogorov‐Smirnov Test indicates that SMHs in Langkawi practices market orientation in their operations and businesses. However, the finding of the study showed that their performances in 1998 was lower than 1997. We believe that this outcome is due to the effect of national and regional economic downturn in 1998.     

Allocative and scale efficiency among maize farmers in Zambia: a zero efficiency stochastic frontier approach

The commonly used stochastic frontier model assumes that all firms are inefficient. In this specification, inefficiency is non-negative, and the probability of inefficiency being exactly zero is also zero. To the extent that efficiency varies widely across farms in under-developed economies, it is important to employ techniques that account for both inefficiency and full efficiency to ensure unbiased efficiency estimates. In this study, we employ a zero-inefficiency stochastic frontier model to examine allocative efficiency and scale economies, as well as key determinants of efficiency among Zambian maize farmers. The results show that, unlike the stochastic frontier model, the zero-inefficiency stochastic frontier model successfully allows for both fully efficient and inefficient firms to be accounted for in the estimation procedure. The estimates also reveal the presence of scale economies, with the zero-inefficiency stochastic frontier model better predicting scale efficiency compared to the stochastic frontier model. The findings also show that inefficiency is explained by the level of education, access to extension services, distance to markets and access to credit.     

货币政策对物价稳定和经济增长的效应——中国与巴基斯坦的比较研究

本文采用自回归分布滞后模型对中国和巴基斯坦两国货币政策、通货膨胀与经济增长之间的长期关系进行了比较研究,由此得出如下几点结论:第一,两国的经验数据都印证了经济学家们普遍接受的通货膨胀是一种货币现象的推论;第二,货币非中性假说在两国的经验数据中均无法被拒绝;第三,在中国存在货币数量论所描述的货币供给与通货膨胀同步增长的预测关系,而这种关系在巴基斯坦却不存在;第四,两国若想实现较高的经济增长都必须在长期内降低通货膨胀率。     

Explaining Bank Productivity in Ghana

The objective of this paper is to examine productivity changes among Ghanaian banks. The Malmquist productivity index is employed to estimate total factor productivity changes and its components on a panel of 18 banks from 2003 to 2011. The results indicate that productivity growth was attributable to the catch‐up effect of efficiency changes. We also find productivity growth across three categories of bank size to be driven by efficiency changes. From a panel regression analysis, we identify size, concentration, income diversification and risk as the factors that explain productivity differences among Ghanaian banks. Recommendations for improving bank productivity are derived from the results. Copyright © 2015 John Wiley & Sons, Ltd.     

Citation footprints on the sands of time: An analysis of idea migrations in strategic management

We elucidate the intellectual progression of the strategic management field by examining knowledge flows to and from the Strategic Management Journal (SMJ) during the period 1980–2009. We provide a detailed mapping of the evolution of the intellectual structure of the field and identify its input‐output dependency relationships with other fields. Analysis of citation data using three analytic techniques: log‐multiplicative model, pathfinder analysis, and entropy analysis allow us to discern strategic management's influence on and engagement with other disciplines. The results show that, within the intellectual universe of strategic management, SMJ has played a central role, both as a source and storer of knowledge. We notice that, over time, there has been a decline in practitioner orientation, greater communication with finance and sociology, and increasing linkages with international business and entrepreneurship. Copyright © 2015 John Wiley & Sons, Ltd.     

Foreign direct investment and its impact on real wages: evidence from Turkish micro-level data

This paper analyzes the role of foreign direct investment (FDI) on wages, using Turkish firm-level data from 2003 to 2010, a period which coincides with significant FDI inflows both in manufacturing and service sector firms in the region. We explore the possibility of increased foreign presence translating into shifts in either labor demand or supply curves thereby resulting in changing the total wage bill or wage per worker in the host country. To empirically test this relationship we employ a dynamic specification of the wage equation. After addressing endogeneity concerns, the results reveal that foreign presence measured in terms of intra- and inter-sectoral linkages is related to higher wage bills in the host economy, hence strengthening the argument for attracting greater foreign investment to enhance labor welfare.     

Perceived Environmental Dynamism and Managerial Risk Aversion as Antecedents of Manufacturing Outsourcing: The Moderating Effects of Firm Maturity

This study investigates how perceived environmental dynamism and managerial risk aversion influence a firm's manufacturing outsourcing activities. Based on a survey of 86 small manufacturing firms, the study found that higher levels of perceived environmental dynamism and managerial risk aversion are associated with increased outsourcing activity. These relationships are moderated by firm maturity such that newer firms engage in more manufacturing outsourcing than their mature counterparts when the environment is perceived to be more dynamic. Mature firms were found to outsource more than newer firms when their top-management teams were relatively more risk averse.