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.     

Social media or shopping websites? The influence of eWOM on consumers’ online purchase intentions

This study empirically tests and compares the influence of friends’ recommendations on social media and anonymous reviews on shopping websites in the context of online purchase intention. For this purpose, we analyse the impacts of these two platforms based on the components of information adoption model (IAM) which are borrowed as information quality, information credibility, information usefulness and information adoption. We conduct a survey and find anonymous reviews as more influential on consumer’ online purchase intentions than friends’ recommendations on social media. However, as this result was contrary to that expected, we conduct another study through in-depth interviews in order to enlighten our results found in the first study. In Study 2, we find the reasons why consumers prefer anonymous reviews rather than friends’ recommendations. Information quantity, information readiness, detailed information and dedicated information are factors which make shopping websites superior than social media in terms of the impact of electronic word of mouth (eWOM). Academic and managerial implications are discussed.     

A Tacit Monetary Policy of the Gulf Countries: Is There a Remittances Channel?

The strong economic ties between the Gulf Cooperation Council (GCC) economies and the USA are manifested in three ways: currency peg, coupling of monetary policy, and the adoption of the US dollar as the trading currency for oil. This paper examines how these dynamics result in a misalignment of the US monetary policy with the business cycles of the GCC economies. The study shows how the staggering amount of remittances outflow of the GCC economies plays a stabilizing role as a tacit monetary policy tool. Incorporating remittances in the money‐demand equation results in a more robust model than otherwise. We further find that the effect of the Federal Funds rate on money demand in these countries diminishes in significance during the period of oil boom between 2002 and 2009. However, the transmission effect of the recession periods in the USA into the demand for money in the GCC countries is not statistically significant.     

Does exchange-rate uncertainty matter in the Malaysia–E.U. bilateral trade? An industry level investigation

Due to ambiguity in the past literature, researchers have examined exchange rate volatility effect on trade using disaggregated data in recent years. Previous research has focused more on aggregated data having aggregation bias which has led to unnecessarily over-generalized findings. This study investigates the impact of exchange rate volatility on the Malaysian bilateral trade flows with European Union using industry level data. Our empirical findings, based on auto-regressive distributed lag framework, suggest that many import and export industries experience exchange rate volatility influence in the short run, while a very small number of industries show this effect in the long run. Moreover, the adverse impact of financial crisis (2007–2008) is more prevalent on import industries compared to export industries.     

Bringing Work Back in Islamic Ethics

Religion and work are seldom discussed. The two have caused scholars to question the religion’s role with work. This paper reviews research on the integrate between religion and work by examining issues of concept, definition, measurement, and reviewing research that examines the relationship of work and religion with respect to: different times, types of people, organize human interactions and sources of knowledge. We then discuss the methodological requirement for reintegrating work studies into social institutional theory and indicate what the conceptual payoffs of such integration might be. These payoffs include breaking new conceptual ground, resolving theoretical puzzles and envisioning the nature of new social institutions     

Environmentally friendly practices among restaurants: drivers and barriers to change

This study of environmental management in the food service industry in general and the restaurant sector in particular highlights food services’ impacts on the environment, and drivers and barriers to change. The study is based on research in Penang, Malaysia, which included a personally assisted survey of 26 restaurant managers operating casual upscale businesses. The survey findings show that implementation of environmentally friendly practices is weak in the restaurant sector. While top managers claim to be informed and concerned about environmental issues, they are reluctant to invest in environmental management systems, to change practices, to advertise environmentally friendly products or invest in the implementation of environmentally friendly practices. They note barriers to change, including weakly enforced environmental laws and regulations, scarce and intermittent green supply chain, non-existent trade pressure and poor customer and community demand for restaurant business to implement green practices. A model of barriers and drivers leading to the implementation of environmentally friendly practices is presented in this study. Government intervention, including public education, capacity building and support in the trade and agricultural change to grow more organic crops, is suggested. The study depicts the responsiveness of restaurateurs towards the implementation of environmentally friendly practices in the context of a developing country.     

A Study of the Awareness Level of Takaful Products Among Micro Enterprises in Malaysia

The small- and medium-sized enterprises （SMEs） play a vital role in the development of the Malaysian economy through its contribution of 32% of the country＇s growth domestic product （GDP）. However, the recent global financial crisis has exposed these enterprises to plausible risks that have resulted in some businesses being shuttered. Such predicament shows how crucial it is for SMEs to be prepared with some form of protection or Takaful to mitigate impending risks. The purpose of this study is to examine the extent to which micro enterprises are aware of Takaful and the benefits of its products. The study was conducted on respondents who fall into micro enterprise category located in Johor, Malaysia, and the research process involves a case study method which is in-depth interviews. The results of the current study provide an insight into how Takaful is regarded among SMEs and the need for these enterprises to be protected.     

SMEs and Halal certification

This paper reports on a survey of SMEs and their perception towards Halal certification. Based on 136 SMEs which participated in the study, only 64.9 percent of these SMEs have obtained Halal certification and 44.3 percent of these entrepreneurs are Muslims. A test of association between religion and certification was found to be significant. Although more than 60 percent have ventured internationally, there is no significant association between Halal certification and venturing internationally. Among those that have obtained Halal certification, only 50.7 percent agree that Malaysia has a proper monitoring mechanism on Halal certification compliance and only 38.2 percent of them agree that information on Halal hub in Malaysia is sufficient. This is an implementation gap which needs to be addressed.     

Managerial ties, strategic initiatives, and firm performance in Central Asia and the Caucasus

Managerial ties are an area commanding managers’ attention in emerging economies. However, no previous study has drawn on cross-country data to address a crucial question: Are more developed market-supporting institutions associated with less use of managerial ties in emerging economies? Further, to strive for better performance, firms also need to develop market-based strategic initiatives. How do these initiatives impact performance? What role do managerial ties play in the relationship? Addressing these questions, this article extends research on managerial ties in emerging economies to an underexplored region—Central Asia and the Caucasus.