Cost effectiveness of benralizumab for severe,uncontrolled oral corticosteroid–dependent asthma in Sweden

Abstract

Aim: We investigated cost effectiveness of benralizumab vs. standard of care (SOC) plus oral corticosteroids (OCS) for patients with severe, eosinophilic OCS-dependent asthma in Sweden.

Materials and methods: A three-state, cohort-based Markov model of data from three Phase III benralizumab clinical trials (ZONDA [NCT02075255], SIROCCO [NCT01928771], and CALIMA [NCT01914757]) was used to assess the incremental cost-effectiveness ratio of benralizumab vs. SOC plus OCS. Health outcomes were estimated in terms of quality-adjusted life-years (QALYs). The model included costs and disutilities associated with extrapolated OCS-related adverse events. Patients with severe asthma were defined as those receiving OCS ≥5?mg/day.

Results: Benralizumab demonstrated a cost-effectiveness ratio vs. SOC plus OCS of 2018 Swedish Kronor (SEK) 366,855 (€34,127) per QALY gained, based on increases of 1.33 QALYs and SEK 488,742 (€45,344) per patient. Benralizumab treatment costs contributed most to incremental costs. The probability of benralizumab’s being cost-effective with willingness-to-pay (WTP) thresholds between SEK 429,972 (€40,000) and SEK 752,452 (€70,000) ranged from 75% to 99%.

Limitations: Potential limitations of these analyses include the use of combined data from three different clinical trials, a one-way sensitivity analysis that did not include mortality and transition estimates, and Observational & Pragmatic Research Institute (OPRI) data from the UK as a proxy of the Swedish health care system.

Conclusions: The results of these analyses demonstrate that benralizumab has a high probability of being cost-effective compared with SOC plus OCS for a subgroup of patients with severe, eosinophilic asthma receiving regular OCS treatment and may support clinicians, payers and patients in making treatment decisions.     

Have Employment Relationships in the United States Become Less Stable?

There has been considerable debate as to whether job stability has declined in the United States. This paper uses data from the Survey of Income and Program Participation (SIPP) to examine the incidence of labor market turnover between 1986 and 1993. Specifically, we calculate one- and two-year separation rates and then analyze turnover by the source of separation. We find that the incidence of job separations did not increase over the period under investigation, but appears to have declined somewhat. When analyzing separations by reason, conditional on separating from an employer, we find little evidence of temporal changes in the composition of turnover that would indicate greater employment instability. Therefore, we do not find conclusive evidence that employment relationships have become more unstable in the recent past.      

The nature of Austrian macroeconomic time series unit root tests

It is still an open question in economic and econometric modelling whether the non-stationarity in a time series is captured by detrending or by differencing. We test thirrteen Austrian macroenconomic time series for difference versus trend stationarity using informal methods and formal procedures developed by Dickey-Fuller and Phillips-Perron. To eliminate the effects of seasonal adjustment on the tests we apply a third procedure to the unadjusted data, recently developed by Hylleberg-Engle-Granger-Yoo. Independent of the seasonal adjustment the empirical results indicate that these series are integrated of order 1.     

Unemployment insurance and union bargaining — an insider-outsider approach

A trade union is required to tax its own members to fund unemployment benefit paid to its unemployed members in an insider-outsider model of union bargaining over wages and employment. An increase in unemployment benefit imposed by the government increases employment overall but not necessarily the employment of insiders if the tax rate is exogenously fixed by the government.This paper has benefited from comments of Mick Common, Dipak Ghosh, Bob Hart, and Robin Ruffell. The comments of two anonymous referees and the advice of the Editor have greatly improved the presentation of the paper. Any remaining errors or omissions are the responsibility of the authors.     

Erratic monetary policy and price variability

This paper examines the effect of erratic monetary policy on individual behavior, as well as the aggregate economy. It is demonstrated that an increase in erratic monetary policy causes an increase in demand for inventories by individuals. This behavior by individuals in turn leads to a higher variability of the price level, as well as a higher price level in the steady state of the aggregate economy.     

Linking scenarios across geographical scales in international environmental assessments

The development and analysis of scenarios or plausible futures has evolved to be a useful approach for dealing with uncertainty about future developments in a structured and integrated manner. Commonly, scenario exercises have focussed on processes at one specific geographic scale. Recently scenario-based approaches have also been used to address multi-scale processes or to link scenarios developed at various geographical scales with each other in order to better understand the interaction of processes across scales.The level of interconnectedness across scales will vary, and depends largely on the approaches used to develop multi-scale scenarios. We distinguish five levels of interconnectedness scenarios may display across scales: (a) Equivalent, (b) Consistent, (c) Coherent, (d) Comparable, and (e) Complementary. Furthermore, we describe five different types of coupled scenario development processes: (a) Joint, (b) Parallel, (c) Iterative, (d) Consecutive, and (e) Independent.Based on this nomenclature, the relationship between the level of interconnectedness of scenarios and the degree of coupling of scenario development processes across geographical scales is discussed. Which process is best suited and how much interconnectedness is needed, will depend both on the focal issue and the primary purpose of the scenario exercise, i.e. whether the aim is education, scientific exploration, or decision-support.     

Ethical issues confronting travel agents

This article provides an overview of current and prospective ethical issues facing commercial (as opposed to leisure) travel agents. Industry wide ethical issues include conflicting pressures from suppliers and clients, competency requirements for agents and misleading advertising and sales claims (vaporware in industry jargon). Issues with travel suppliers include calculation and payment of commissions, fare loopholes, frequent flyer plans and the use and abuse of benefits directed to individual employees. Issues with corporate clients of travel agents include hidden preferred carriers or suppliers, client pressure to use fare loopholes and hidden relationships with corporate travel consultants. Future issues include protecting client privacy, free riding, and divergent international business practices. Thomas W. Dunfee is the Kolodny Professor of Social Responsibility at The Wharton School of the University of Pennsylvania. His current research interests focus on social contract theory and business ethics and on developing ethical standards for business transactions. He has published articles in the Business Ethics Quarterly,the Journal of Business Ethics,the Business and Professional Ethics Journal,and the Journal of Social Philosophyin addition to a variety of business and legal journals. He has consulted to a number of corporate clients and to several trade associations.Bruce M. Black is founder and president of McCord Travel Management. Since founding the company in 1980, he has led its growth to one of the 30 largest travel management firms in the United States, with annual sales of more than $100 million. Black is one of the inaugural members of the University of Illinois at Chicago Entrepreneurship Hall of Fame and is on the board of the International Theatre Festival of Chicago. He is also active in the exploration of a variety of industry related issues on behalf of the Super Regional Group of agencies.