Cost-effectiveness of add-on treatments to metformin in a Swedish setting: liraglutide vs sulphonylurea or sitagplitin

Objective:

To evaluate long-run cost-effectiveness in a Swedish setting for liraglutide compared with sulphonylureas (glimepiride) or sitagliptin, all as add-on to metformin for patients with type 2 diabetes insufficiently controlled with metformin in monotherapy.

Methods:

The IHE Cohort Model of Type 2 Diabetes was used to evaluate clinical and economic outcomes from a societal perspective. Model input data were obtained from two clinical trials, the Swedish National Diabetes Register and the literature. Cost data reflected year 2013 price level. The robustness of results was checked with one-way-sensitivity analysis and probability sensitivity analysis.

Results:

The cost per QALY gained for liraglutide (1.2?mg) compared to SU (glimepiride 4?mg), both as add-on to metformin, ranged from SEK 226,000 to SEK 255,000 in analyzed patient cohorts. The cost per QALY for liraglutide (1.2?mg) vs sitagliptin (100?mg) as second-line treatment was lower, ranging from SEK 149,000 to SEK 161,000. Costs of preventive treatment were driving costs, but there was also a cost offset from reduced costs of complications of ～20%. Notable cost differences were found for nephropathy, stroke, and heart failure. The predicted life expectancy with liraglutide increased the cost of net consumption for liraglutide.

Limitations:

The analysis was an ex-ante analysis using model input data from clinical trials which may not reflect effectiveness in real-world clinical practice in broader patient populations. This limitation was explored in the sensitivity analysis. The lack of specific data on loss of production due to diabetes complications implied that these costs may be under-estimated.

Conclusions:

Treatment strategies with liraglutide 1.2?mg improved the expected quality-of-life and increased costs when compared to SU and to sitagliptin for second-line add-on treatments. The cost per QALY for liraglutide was in the range considered medium by Swedish authorities.     

Investment and Uncertainty: A Theory‐based Empirical Approach*

This paper provides empirical evidence on the dynamic effects of uncertainty on firm‐level capital accumulation. A novelty in this paper is that the firm‐level uncertainty indicator is motivated and derived from a theoretical model, the neoclassical investment model with time to build. This model also serves as the base for the empirical work, where an error‐correction approach is employed. I find a negative effect of uncertainty on capital accumulation, both in the short run and the long run. This outcome cannot be explained by the model alone. Instead, the results suggest that the predominant mechanism at work stems from irreversibility constraints.     

Incentive-based regulation of CO2 emissions from international aviation

We explore the possibilities of using incentive-based environmental regulations of CO₂ emissions from international civil aviation. In theory incentive-based instruments such as an emission charge or a tradable emission permit system are better regulations than so-called command-and-control regulations such as emission limits or technology standards. However, the implementation of these instruments is a complex issue. We therefore describe and discuss how an emission charge and a tradable emission permit system for international aviation should be designed in order to improve efficiency. We also compare these two types of regulations. In brief, we find that an emission charge and a tradable emission permit system in which the permits are auctioned have more or less the same characteristics. The main advantage of a tradable emission permit system is that the effect, in terms of emission reductions, is known. On the other hand, we show that under uncertainty an emission charge is preferred. The choice of regulation is a political decision and it does not seem likely that an environmental charge or a tradable emission permit system would be implemented without consideration of the costs of the regulation. Revenue-neutral charges or gratis distribution of permits would, for this reason, be realistic choices of regulations. However, such actions are likely to result in less stringent regulations and other negative welfare effects.     

Prices and Departures in European Domestic Aviation Markets

Using data on 172 domestic city-pair markets in eight European countries, weinvestigate the effect of the market structure on airlines choices of departuresand prices. We find that flag carriers have a higher number of departures thanother airlines and that it is more likely that flag carriers are monopolists. At thesame time flag carriers do not have a higher ticket price than other airlines. Theinfluence of market power, measured with the Herfindahl index, does not havea significant effect on ticket prices, but a significant effect on the number ofdepartures: decreased market concentration and an increased number of airlinesresults in increased aggregate frequencies. Comparing the predicted ticket prices,at sample mean, between monopoly and non-monopoly routes we can reject thehypothesis of differences in equilibrium price. However, the predicted aggregatenumber of departures, calculated at sample mean, is significantly higher at non-monopoly routes compared with monopoly routes.     

The evolution of manufacturing technology and its impact on industrial structure: An international study

This paper shows that plant and firm size in manufacturing, and especially in engineering industry, in several Western industrial countries has declined since the early 1970s. Two hypotheses explaining the decline are advanced. One is de-glomeration or specialization: the divestiture of non-core businesses in order to free up scarce resources (particularly management time) to defend and nurture core business activities. The second hypothesis is that the emergence of new computer-based technology has improved the quality and productivity of small and medium scale production relative to standardized mass-production techniques which dominated previously.     

Work with and implementation of new concepts for management of product development—experiences for the Swedish Manufacturing Industry

Extensive organizational changes in the management of product development work of industrial companies are currently taking place. Speediness (time-based competition) and/or 'high' quality (total quality) are emphasized and for this purpose concepts such as simultaneous, concurrent or integrated product development have been introduced. This paper describes a study of the importance of these concepts in 29 large Swedish manufacturing companies and how these companies deal with the implementation of the new product development concepts. In addition, three in-depth studies have been carried out to enable a more detailed study to be made of the effects of the product development work on time and quality variables.     

Flexible technology and firm size

This paper provides the first empirical examination of the relationship between the application of flexible technologies and the firm-size distribution. In particular, we test the hypothesis that implementation of flexible technologies has tended to promote small firms more than large firms. Based on a sample of 36 engineering industries and using two distinct time periods between 1976 and 1986 and two different measures of what constitutes a small firm, we find that the application of certain flexible technologies, such as numerically controlled machines, has led to an increased presence of small firms, while the use of other flexible technologies, such as programmable robots, is associated with a decreased presence of small firms over time.     

The influence of spouses on household decision making under risk: an experiment in rural China

We study household decision making in a high-stakes experiment with a random sample of households in rural China. Spouses have to choose between risky lotteries, first separately and then jointly. We find that spouses’ individual risk preferences are more similar the richer the household and the higher the wife’s relative income contribution. A couple’s joint decision is typically very similar to the husband’s preferences, but women who contribute relatively more to the household income, women in high-income households, and women with communist party membership have a stronger influence on the joint decision.