Cost analysis of plasma-derived factor VIII/von Willebrand factor versus recombinant factor VIII for treatment of previously untreated patients with severe hemophilia A in the United States

Background: Inhibitor development to factor VIII (FVIII) hemophilia therapy results in increased complications and substantial economic costs. The SIPPET study, the first randomized controlled trial to compare the immunogenicity of plasma-derived FVIII (pdFVIII)/von Willebrand factor (VWF) and recombinant-DNA-derived FVIII (rFVIII), demonstrated higher inhibitor rates in previously untreated patients (PUPs) treated with rFVIII than in PUPs treated with pdFVIII/VWF.

Objective: To quantify the economic impact of treating PUPs with pdFVIII/VWF vs rFVIII.

Methods: An Excel-based clinical and economic model was developed from a US healthcare payer perspective and run over a 5-year period. The analysis utilized a cohort approach to model patient treatment and outcomes over a monthly cycle to quantify differences in costs of FVIII, bypassing agents, and hospitalizations for serious bleeds. Rates of high-titer inhibitor development were obtained from the SIPPET study. Patients developing high-titer inhibitors were treated with immune tolerance induction (ITI). Patients who developed low-titer inhibitors and those who did not develop inhibitors continued their usual FVIII treatment. Patients who were successfully treated with ITI returned to FVIII treatment, while unsuccessfully treated patients received bypassing agents. Total costs per treated patient were estimated and a one-way sensitivity analysis was conducted to quantify the impact of parameter uncertainty on the model outcomes.

Results: Total cumulative costs per patient over 5 years were $834,621 for pdFVIII/VWF patients and $1,237,163 for rFVIII patients, representing a total saving of $402,542 per patient over the 5-year period, for an average annual saving of $80,508 per patient.

Conclusions: Based on data from the SIPPET study, this analysis found that initiating FVIII treatment in severe hemophilia A PUPs with pdFVIII/VWF has the potential to offer substantial cost savings to healthcare payers, amounting to a one-third reduction in costs.     

The emergence of green talent

Several factors are driving an increase in the supply of and demand for "green talent", employees with the mindsets and skills to drive sustainability. But many business leaders do not fully understand the implications of this change in the workforce. John Glen, Chris Hilson and Eric Lowitt believe corporate chiefs need to learn – quickly.     

VOLUNTARY DISCLOSURE OF SEGMENT INFORMATION: FURTHER AUSTRALIAN EVIDENCE

This study provides further empirical evidence on incentives for Australian firms to voluntarily report segment information. Various economic reasons why firms may elect to present segment information have been hypothesised in previous research. Bradbury [1992] and McKinnon and Dalimunthe [1993] found firm size, minority interest and industry membership as significant identifiable characteristics motivating voluntary segmental disclosure. Variables found to be insignificant in Bradbury [1992] which were not examined by McKinnon and Dalimunthe [1993] are tested in this paper. Hypotheses relating to size, financial leverage, assets-in-place, earnings volatility, ownership diffusion, outside equity (minority) interest, overseas association as well as diverse and mining and oil classification hypotheses are empirically examined. Univariate tests and multivariate logit analysis suggest that for a extensive sample of diversified firms, voluntary segment disclosure is significantly related to size, leverage and involvement in mining or oil activities.     

Bottom Marx

Much of the economic analysis published in recent years has been Marxist in flavour. The publication of a dictionary of Marxist thought offers a guide to its various schools. Chris Tame dissects the contrasting interpretations of its numerous contributors.     

Power, Development, and Institutional Change: Participatory Governance in the Lower Mekong Basin

One of the central challenges for the multitude of actors concerned with the governance of transboundary river basins is how to produce meaningful mechanisms for promoting the participation of a broad cross-section of actors in resource planning and management decisions. This paper elucidates recent efforts to enhance policies of public participation within the context of governance in the Lower Mekong basin. The paper concludes that while the obstacles to institutionalizing public participation are substantial, some modicum of genuine participation, that may in time contribute to a broader project of transformation, can emerge within intergovernmental development institutions, albeit through surprising means.     

Culture and evaluation of service quality — a study of the service quality gaps in a Taiwanese setting

This research is built upon the work of Parasuraman, Zeithaml and Berry (1985) by exploring the service quality gap within a Taiwanese hospitality setting and reports the findings from 164 interviews among hotel managers, service staff, and hotel guests. One motive for the research was whether concepts derived from an American‐Euro‐centric conceptualisation of service relationships was transferable to another cultural setting. It was found that the influence of national, ethnic culture on perception of service is limited, but the factor of kuan‐hsi (personal relationship) and mien‐tsu (face) had some role to play in guest‐staff relationships. However, it is concluded that the globalisation of hotel corporate modes of operation have more influence in shaping expectations and thus the ServQual model has validity in such settings.