Cost effectiveness of benralizumab for severe,uncontrolled oral corticosteroid–dependent asthma in Sweden

Abstract

Aim: We investigated cost effectiveness of benralizumab vs. standard of care (SOC) plus oral corticosteroids (OCS) for patients with severe, eosinophilic OCS-dependent asthma in Sweden.

Materials and methods: A three-state, cohort-based Markov model of data from three Phase III benralizumab clinical trials (ZONDA [NCT02075255], SIROCCO [NCT01928771], and CALIMA [NCT01914757]) was used to assess the incremental cost-effectiveness ratio of benralizumab vs. SOC plus OCS. Health outcomes were estimated in terms of quality-adjusted life-years (QALYs). The model included costs and disutilities associated with extrapolated OCS-related adverse events. Patients with severe asthma were defined as those receiving OCS ≥5?mg/day.

Results: Benralizumab demonstrated a cost-effectiveness ratio vs. SOC plus OCS of 2018 Swedish Kronor (SEK) 366,855 (€34,127) per QALY gained, based on increases of 1.33 QALYs and SEK 488,742 (€45,344) per patient. Benralizumab treatment costs contributed most to incremental costs. The probability of benralizumab’s being cost-effective with willingness-to-pay (WTP) thresholds between SEK 429,972 (€40,000) and SEK 752,452 (€70,000) ranged from 75% to 99%.

Limitations: Potential limitations of these analyses include the use of combined data from three different clinical trials, a one-way sensitivity analysis that did not include mortality and transition estimates, and Observational & Pragmatic Research Institute (OPRI) data from the UK as a proxy of the Swedish health care system.

Conclusions: The results of these analyses demonstrate that benralizumab has a high probability of being cost-effective compared with SOC plus OCS for a subgroup of patients with severe, eosinophilic asthma receiving regular OCS treatment and may support clinicians, payers and patients in making treatment decisions.     

Financial Flows to Eastern Europe: Determinants,Volatility and Sustainability Issues

MOCT-MOST: Economic Policy in Transitional Economies -     

Default Risk in Equity Returns

This is the first study that uses Merton's (1974) option pricing model to compute default measures for individual firms and assess the effect of default risk on equity returns. The size effect is a default effect, and this is also largely true for the book‐to‐market (BM) effect. Both exist only in segments of the market with high default risk. Default risk is systematic risk. The Fama–French (FF) factors SMB and HML contain some default‐related information, but this is not the main reason that the FF model can explain the cross section of equity returns.     

How past becomes prologue: a sensemaking interpretation of the hindsight-foresight relationship given the circumstances of crisis

Foresight is rooted in deep understanding [A.N. Whitehead. Lecture notes from address to the Harvard Business School, 1931]. Such understanding requires that we shall have first looked back to the past before venturing forward into the future. This paper uses Weick’s and colleagues’ sense making perspective in order to explore this critical relationship between the past and the future [[2], [3], [4], [5], [6] and [7]]. In particular, key sense making properties will be applied to a crisis, an occurrence of school-place violence that occurred in the United States in 1999. We shall then ask how this organization and its diverse external stakeholders used their understanding of this event to learn how to prevent such crises from occurring in the future. In other words, how capably was hindsight constructed and then how was it used to strengthen foresight into the future? This paper will conduct a theory-based empirical examination of a crisis event and its aftermath to understand how hindsight can be sharpened and then used to improve organizational foresight.     

Minimum consumption and transitional dynamics in wealth distribution

This paper investigates quantitatively how initial wealth holding differences across households are propagated through time in a one sector growth model economy. A key feature of the model is that household consumption cannot fall below a positive level each period. The existence of a minimum consumption requirement implies that the Intertemporal Elasticity of Substitution not only differs across households but also changes differently over time. This model is calibrated to match some key aggregate statistics of the U.S. economy. We find that, as in the data, the wealth distribution in our benchmark model economy exhibits a (brief) period of increasing inequality, a short period in which inequality diminishes and a steady level of inequality along the balanced growth path. However, our model illustrates that the evolution of inequality is very sensitive to the length of the transition path. Additionally, our model predicts an upsurge in wealth inequality following the productivity slowdown in the 1970s.     

An integrated algorithm for three-way compositional data

Quality & Quantity - Compositional data with a tridimensional structure are not uncommon in social sciences. The CANDECOMP/PARAFAC model is one of the most adequate techniques for modeling...