Budget impact analysis of secukinumab versus adalimumab in the treatment of ankylosing spondylitis

Background: Biologic treatments have enhanced the treatment outcomes of patients with active ankylosing spondylitis (AS). Until recently, TNF-alpha-inhibitors have been the only biologics approved for the treatment of active AS. The objective of this study was to assess the potential financial impact of the first non-TNF-alpha biologic secukinumab (fully human IL-17A-inhibitor) vs adalimumab (TNF-alpha-inhibitor) in the treatment of AS in Finland.

Materials and methods: In this model-based budget impact analysis, patients were treated either with secukinumab (150?mg) or adalimumab (40?mg). The number of patients and market share of different biologics were based on national reimbursement registry data. Adalimumab was the most commonly used biologic treatment for AS, and in the base case analysis all adalimumab patients are assumed to switch to secukinumab. Response rates were based on a matching-adjusted indirect comparison between secukinumab and adalimumab. Patients not achieving response were switched to another biologic treatment.

Results: Treating AS patients with secukinumab instead of adalimumab leads to potential savings of 18.2 million euros within a 5-year time period. The total costs within the follow-up time were 59.5 million euros and 77.7 million euros with and without secukinumab, respectively. According to sensitivity analyses, a higher adoption rate of secukinumab corresponds to higher potential savings.

Conclusions: Secukinumab is a cost-saving treatment option compared with adalimumab in the treatment of AS in Finland. More patients could be treated with a biologic by allocating resources more efficiently.     

Self-employment of immigrants and natives in Sweden – a multilevel analysis

Recent research suggests that self-employment among immigrants is due to a combination of multiple situational, cultural and institutional factors, all acting together. Using multilevel regression and unique data on the entire population of Sweden for the year 2007, this study attempts to quantify the relative importance for the self-employed of embeddedness in ethnic contexts (country of birth) and regional business and public regulatory frameworks (labour market areas). This information indicates whether the layers under consideration are valid constructs of the surroundings that influence individual self-employment. The results show that 10% (women) and 8% (men) of the total variation in individual differences in self-employment can be attributed to the country of birth. When labour market areas are included in the analyses, the share of the total variation increases to 14% for women and 12% for men. The results show that the ethnic context and the economic environment play a minor role in understanding individual differences in self-employment levels. The results can have important implications when planning interventions or other actions focusing on self-employment as public measures to promote self-employment often are based on geographic areas and ethnic contexts.     

The impact of employment equity regulations on psychological contracts in South Africa

This article will show the impact of employment equity legislation on the psychological employment contracts of the three main employee groupings in South African society. This study is important in that it fills the gap in the literature that identifies labour market regulations as an important shaping influence on the psychological contract. More than 500 managers from across South African industry and from all ethnic groups were surveyed to identify differences in psychological contracts and attitudes towards the social transformation regulations. We found that the legislation has impacted differentially on the three groupings mainly in terms of their loyalty to stay with their organizations, the focus on their career development in terms of the external labour market and the degree to which they felt they had been affected by the legislation. Additionally we find that the perceived linkage between job satisfaction and labour turnover is significantly weakened by labour market legislation in the case of the beneficiaries of the legislation, but that this may not be the case for those negatively affected by the legislation. The findings have significant implications for the HRM practices of multinationals operating in societies with significant labour market regulatory interventions.     

The Methodology of Risk Perception Research

Risk perception is not strictly a matter ofsensory perception, but of attitudesand expectations. As such, it can be studied byreasonably well developed methods of attitudemeasurement and psychological scaling. Suchmeasurement needs to be applied in a pragmaticfashion, however, since the discussions of fundamentalmeasurement and requirements of scale levelsappropriate for various types of statistical analysis hasfailed in establishing a useful basis for empiricalresearch. The paper also discuses samplingprocedures and the response rateproblem. In risk perception work, there is usually abias involving too many respondents withan above average level ofeducation, but that variable tends to be weaklyrelated to risk perception variables. Finally,post-modern claims and their rejection ofquantitative methods are critically discussed.     

Perceived Determinants of Well-Being and Enjoyment Level of Leisure Activities

Two facets of leisure, perceived determinants of well-being and enjoyment of common leisure activities, were investigated in 388 participants. For well-being, a principal components (PCA) analysis yielded five components: competence, relatedness and health, wealth, personal values, and freedom of choice. For the enjoyment of leisure activities, another PCA generated seven components: wellness, sedentary leisure, intellectual leisure, social leisure, routine activities, self-realization, and inner peace. Different leisure enjoyment of young adults (18–30 years old) in contrast to adults and seniors was attributed to social transformations as also predicted by several theories of social change. The relationship between the determinants of well-being and enjoyment of leisure activities was statistically significant but meaningfully debatable.     

Combining Matching and Nonparametric Instrumental Variable Estimation: Theory and An Application to the Evaluation of Active Labour Market Policies

We show how instrumental variable and matching estimators can be combined in order to identify a broader array of treatment effects. Instrumental variable (IV) estimators are known to estimate effects only for the compliers, representing a subset of the entire population. By combining IV with matching, we can estimate the treatment effects for the always‐ and never‐takers as well. Since in many cases these groups are the (endogenous) outcome of some assignment process, such estimates also help in judging the implications of such a selection process. In our application to the effects of participation in active labour market programmes in Switzerland, we find large and lasting positive employment effects for the compliers, whereas the effects for the always‐ and never‐participants are small. In addition, the compliers have worse employment outcomes without treatment than those who participate in the programme with or without the intervention under investigation. This suggests that the earlier assignment policy of the caseworkers was inefficient in that the always‐participants were neither those unemployed who would experience the highest expected treatment effects nor those unemployed who had the largest need for assistance. Copyright © 2014 John Wiley & Sons, Ltd.