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.     

Tax planning,corporate governance and equity value

Tax planning by firms is a highly significant activity. After audit fees, tax related services are the largest source of fee income for UK accounting firms. When viewed in terms of its impact, tax planning is the major source of the corporation tax gap amongst large firms (HMRC, 2010). Although traditionally tax planning has been viewed as benefiting shareholders via increased after tax earnings, more recently the underlying motivation has been questioned. Desai and Dharmapala (2006) argue that when an information asymmetry exists between managers and shareholders with respect to tax planning, it can facilitate managers acting in their own interests resulting in a negative association between tax planning and firm value. Using a sample of UK quoted firms from 2005 to 2007 and data drawn from International Accounting Standard 12 Income Taxes (IASB, 2010) Effective Tax Rate (ETR) reconciliations, this paper reports such a negative relationship. Further, the relationship is robust to the inclusion of corporate governance measures which could be expected to moderate the potential implications of a tax related shareholder–manager information asymmetry. An innovation of this paper is in using the ETR reconciliations to examine sub-categories of tax planning activities. The paper contributes to the debate of who determines, and benefits from tax planning conducted by firms. Its findings have direct policy relevance for shareholders and tax administrations in monitoring and controlling firms’ tax planning activities.     

Food Labels’ Impact Assessment on Consumer Purchasing Behavior in Malaysia

The purpose of this study is to validate the impact of food labels among Malaysian consumers using an extended theory of planned behavior model (TPB). In doing so, the study assessed the direct and indirect effect of food labeling on consumer intention to purchase or otherwise the food products of interest. A stratified random sampling technique was adopted in selecting 2,014 consumers in Klang Valley, Malaysia. The results of structural equation modeling supported the adequacy of the proposed model. This study contributes to and extends the understanding of food labeling and purchasing behavior, identifying the rationales for purchasing of food products with labels that contains information such as halal logo, ingredients, and nutritive value.     

Conflicting Bifuzzy Multi-attribute Group Decision Making Model with Application to Flood Control Project

We propose a group decision making model based on conflicting bifuzzy sets (CBFS) where evaluation are bi-valued in accordance to the subjective assessment obtained from the experts for the positive and negative views. This paper discusses the weighting methods for particular attribute and subattribute with emphasis given to the unification of subjective and objective weights. The integration of CBFS in the model is naturally done by extending the fuzzy evaluation in parallel with the intuitionistic fuzzy. We introduce a new technique to compute the similarity measure, being the degree of agreement between the experts. We end up the paper by demonstrating the applicability of the proposed model to the empirical case of flood control project, one of the project selection problems.     

Colonialism and environmental perception in Northern Nigeria

Concern about the environment in colonial northern Nigeria developed out of a series of controversies and practices, particularly those relating to agriculture. Increasingly, local practices that have sustained the population and the environment for centuries are subjected to “scientific” scrutiny. Though many of these practices were either misunderstood or not understood at all, this did not stop the subjugation of local practices to “science”. However, this “scientific” enterprise was often conflict-ridden, with important questions being resolved only after the intervention of political authorities. The resulting colonial practices in the fields of irrigation, forest management and the application of chemical fertilizer continue to dominate the thinking of state officials in post-colonial Nigeria, leading to unsustainable policies. An earlier colonial tradition of investigating the practices of local farmers and the constraints therein would have been a more appropriate basis for post-colonial policy.     

基于信息通讯技术的开放远程教育——联合国教科文组织的视角

1.构建知识型社会的背景 1.1联合国教科文组织的工作 紧随信息社会世界首脑会议,联合国教科文组织通过了一个为期六年的中期战略计划,总体目标之一是构建具有包容性的知识社会。这一计划无疑是基于联合国教科文组织在信息社会世界首脑会上的倡导提出的。世界信息社会世界首脑会议分为两阶段,第一阶段于2003年在瑞士日内瓦召开,第二阶段于2005年在突尼斯召开。     

Paradigm shift from a liquidation culture to a corporate rescue culture in Malaysia: A legal review

The company law landscape in Malaysia has witnessed a significant change in its insolvency law with the adoption of two new corporate rescue mechanisms, the corporate voluntary arrangement and judicial management under the Companies Act 2016 (CA 2016), which has repealed the Companies Act 1965 (CA 1965). Previously, the insolvency laws under the CA 1965 were based on the traditional pro‐creditor laws of winding up and receivership, which embodied the liquidation culture. This article examines the transition of the insolvency laws in Malaysia from a liquidation culture under the CA 1965 to a corporate rescue culture under the CA 2016. It also reviews the necessary changes to the pro‐creditor laws, which are preserved under the CA 2016 in order to accommodate the pro‐debtor laws with the introduction of the corporate rescue mechanisms, which came into force on March 1, 2018. Through comparative and critical analysis of similar laws in the United Kingdom and Singapore, this article argues that while the corporate rescue mechanisms are regarded as pro‐debtor however the review reveals that the position of secured creditors are impeding its application and reforms ought to be considered.     

Impact of institutions on social network formation: communist party membership and social network investment in China

Using the 2003 wave of China General Social Survey (2003CGSS), we study the influence of the communist party on individual’s social networks in urban China and, thereby, present a case of socio-political institutions being an important ingredient in social network formation. We adopt a counterfactual framework and estimate the effect of communist party membership on social network investment as an average treatment effect. We find the treatment to be significant.     

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。     

Financial reforms,product differentiation,and trade

We hypothesize that exports of differentiated products, which entail greater upfront costs, increase more as financial reforms take place. We find strong and robust empirical support of this hypothesis with a comprehensive set of measures of reforms encompassing the banking sector, interest rates, equity and international capital markets.