Cost-effectiveness of lenalidomide plus dexamethasone vs bortezomib plus melphalan and prednisone in transplant-ineligible US patients with newly-diagnosed multiple myeloma

Objective:

To conduct a cost-effectiveness assessment of lenalidomide plus dexamethasone (Rd) vs bortezomib plus melphalan and prednisone (VMP) as initial treatment for transplant-ineligible patients with newly-diagnosed multiple myeloma (MM), from a US payer perspective.

Methods:

A partitioned survival model was developed to estimate expected life-years (LYs), quality-adjusted LYs (QALYs), direct costs and incremental costs per QALY and LY gained associated with use of Rd vs VMP over a patient’s lifetime. Information on the efficacy and safety of Rd and VMP was based on data from multinational phase III clinical trials and a network meta-analysis. Pre-progression direct costs included the costs of Rd and VMP, treatment of adverse events (including prophylaxis) and routine care and monitoring associated with MM. Post-progression direct costs included costs of subsequent treatment(s) and routine care and monitoring for progressive disease, all obtained from published literature and estimated from a US payer perspective. Utilities were obtained from the aforementioned trials. Costs and outcomes were discounted at 3% annually.

Results:

Relative to VMP, use of Rd was expected to result in an additional 2.22 LYs and 1.47 QALYs (discounted). Patients initiated with Rd were expected to incur an additional $78,977 in mean lifetime direct costs (discounted) vs those initiated with VMP. The incremental costs per QALY and per LY gained with Rd vs VMP were $53,826 and $35,552, respectively. In sensitivity analyses, results were found to be most sensitive to differences in survival associated with Rd vs VMP, the cost of lenalidomide and the discount rate applied to effectiveness outcomes.

Conclusions:

Rd was expected to result in greater LYs and QALYs compared with VMP, with similar overall costs per LY for each regimen. Results of this analysis indicated that Rd may be a cost-effective alternative to VMP as initial treatment for transplant-ineligible patients with MM, with an incremental cost-effectiveness ratio well within the levels for recent advancements in oncology.     

Nash equilibria of games when players’ preferences are quasi‐transitive

Much of game theory is founded on the assumption that individual players are endowed with preferences that can be represented by a real‐valued utility function. However, in reality human preferences are often not transitive. This is especially true for the indifference relation, which can lead an individual to make a series of choices which in their totality would be viewed by the same individual as erroneous. There is a substantial literature that raises intricate questions about individual liberty and the role of government intervention in such contexts. The aim of this paper is not to go into these ethical matters but to provide a formal structure for such analysis by characterizing games where individual preferences are quasi‐transitive. The paper identifies a set of axioms which are sufficient for the existence of Nash equilibria in such “games.”     

Walking the walk? Bank ESG disclosures and home mortgage lending

Review of Accounting Studies - We show that banks with high environmental, social, and governance (ESG) ratings issue fewer mortgages in poor localities—in number and dollar amount—than...     

Online consumer shopping behaviour: A review and research agenda

Over the last two decades, motivated by the continuous evolution of the technology-driven retail environment, researchers have studied various aspects of online consumer behaviour. This article attempts to take stock of this environment to critically assess the research gaps in the domain and provide future research directions. Applying a well-grounded systematic methodology following the TCCM (theory, context, characteristics and methodology) framework, 197 online consumer shopping behaviour articles were reviewed. The findings reveal that the application of theories remains limited in the current pool of literature that focuses more on developed nations. While studies have primarily considered categories such as apparel and grocery, in terms of methodology experimental and survey-based studies were most common. Additionally, the article suggests some future research directions. The use of combined theories to better understand technology acceptance by consumers of online-shopping is recommended. Similarly, studies across other categories like online experiential luxury, luxury services, or second-hand products that then link to novel constructs reflecting issues with payment methods, online service quality, and online store atmosphere are portrayed as meaningful avenues that will advance research in the domain.     

Twenty-five years of consumer vulnerability research: Critical insights and future directions

Consumer vulnerability is gaining increasing attention from researchers and practitioners as a social phenomenon in modern consumption-driven societies. In an attempt to conduct a comprehensive review using credible published research materials on the topic, this study applies a big data analytics approach to analyze scholarly research with a pool of 859 articles covering the last 25 years of post-modern marketing practices that have been a precursor to market-driven vulnerability. This paper identifies the most influential articles, as well as the top contributing journals and authors, along with their affiliations. In addition, this study reveals four major themes of research in consumer vulnerability, namely marketing, fraud and consumers, consumer vulnerability and well-being, ethics and vulnerable consumers, and consumption, disability and gender. These integrative perspectives will serve as a critical starting point to encourage focused theme-based exploration in the field.