Tofacitinib in the treatment of moderate-to-severe rheumatoid arthritis: a cost-effectiveness analysis compared with adalimumab in Taiwan

Aims: Tofacitinib is an oral Janus kinase inhibitor for the treatment of rheumatoid arthritis (RA). This analysis investigated the cost-effectiveness of the second-line treatment with tofacitinib, compared with adalimumab, both plus methotrexate (MTX), in patients with moderate-to-severe RA and an inadequate response to the first-line MTX, from a Taiwan National Health Insurance Administration perspective.

Materials and methods: A patient-level simulation model was used to project lifetime costs and quality-adjusted life-years (QALYs). Base-case analysis compared second-line treatment with tofacitinib 5?mg twice daily plus MTX vs adalimumab 40?mg every 2?weeks plus MTX. Patients switched or discontinued treatment due to a lack or loss of effectiveness or a serious adverse event. Efficacy was measured by change in Health Assessment Questionnaire-Disability Index (HAQ-DI) score. HAQ-DI scores were used to predict mortality and resource utilization, and were mapped onto utility values to estimate QALYs. Efficacy and safety data were derived from clinical trials and other secondary sources. Uncertainty in model parameters was explored using one-way deterministic and probabilistic sensitivity analyses.

Results: Patients gained 0.09 more QALYs with second-line tofacitinib plus MTX compared with adalimumab plus MTX (5.13 vs 5.04, respectively) at an additional cost of New Taiwan Dollars (NT$) 12,881. The incremental cost-effectiveness ratio was NT$143,122/QALY. One-way sensitivity analysis confirmed the base-case result was robust.

Limitations: The lack of available clinical data, particularly for HAQ-DI scores, may introduce some bias in the analysis. No patients were in an early stage of RA, which may limit the generalizability of these results. Base-case results from our study are not necessarily generalizable to countries with healthcare systems that differ considerably from Taiwan.

Conclusions: From a payer perspective, second-line treatment with tofacitinib plus MTX is a cost-effective treatment strategy, compared with adalimumab plus MTX, in patients with moderate-to-severe RA in Taiwan.

Trial registration: ClinicalTrials.gov identifier: NCT00853385.     

Representation and Educational Background of European Economists in Top Journals of Economics

We assess the contribution of European authors to 10 topjournals of economics from 1980 to 1998. Despite efforts on the European Union and national levels topromote academic excellence, European authors still play a minor role in top journals. Examining the development overtime we find little evidence for an increasing share of European contributions. Particular attention has been paidto the educational background of European authors. There is still a segmentation of academic education alonglanguage barriers in continental Europe. However, a considerable proportion of European authors has received a PhD from the US.     

Analysis of Visitor Decision Making System When Visiting Natural Recreation Sites by Multinomial Logit Model

Multinomial Logit Model has analyzed the relationship between the frequency of visits to recreation areas and the motivational factors affecting the visits. Kastro Environment Preserving Site that is located in the Black Sea coast of Marmara region in Turkey, has been chosen as the site for this study. Kastro bay is a natural park that is visited only for recreational visits. The study has been conducted on a photogenic study group due to the proximity factor of Kastro bay close to Istanbul. Kastro bay is a popular recreational park due to its characteristic advantages such as a 200 m wide and approximately 2.5 km long beach and with its high quality vegetation. The vegetation type includes ash tree, oak tree, black pine, sand lily etc. Kastro bay is also the site for the Mediterranean seals (Monachus-monachus) which are at the level of extinction. Approximately 50,000 visitors visit the region during the months of July and August. It has been concluded that there is high direct correlation between the frequency of visits and the motivational factors. It has been determined that the visits are mostly based on the sea and the ecological tourism.Jel: O13, Q20, Q26, Q51, Q56, Q57     

The Case of the Missing Pollution Haven Hypothesis

One particularly vexing puzzle for economists and policymakers over the past several decades concerns the empirical significance of the theoretically predicted pollution haven hypothesis. While neoclassical theory and conventional wisdom both surmise that local economies will suffer deleterious effects from stricter environmental regulations, empirical studies have largely failed to validate such claims. This study utilizes the method of matching to show that the impact of stricter regulation is heterogeneous spatially, varying systematically based on location-specific attributes. Previous studies that assume a homogenous response may therefore inadvertently mask the overall impact of more stringent regulations by pooling unaffected and affected regions.JEL Classification: Q25, Q28, H00, L51, R1The authors wish to thank to Michael Crew, Anthony Heyes, an anonymous referee, Werner Antweiler, Randy Becker, Wayne Gray, Shelby Gerking, Michael Greenstone, Vern Henderson, and Arik Levinson. Participants at various university seminars and conferences also lent useful insights to this line of research.     

The Economics and Bioeconomics of Folk and Scientific Classification

Synopsis This paper is the product of a collaboration between a biologist (Ghiselin 1997) who works on the philosophy of classification and an economist (Landa 1981, 1994) who works on the ‘Economics of Identity’: how and why people classify people based on identity in the context of a theory of ethnic trading networks. In developing the ‘bioeconomics’ (the synthesis of economics with biology) of classification, we crossed a number of disciplinary boundaries—anthropology, economics, sociology, biology, and cognitive psychology including evolutionary psychology’s ‘fast and frugal’ heuristics. Using a bioeconomics approach, we argue that folk classifications—the classifications used by ordinary persons—have much in common with scientific classifications: underlying both is the need for economy of information processing in the brain, for the efficient organization of knowledge, and for efficiency of information acquisition and transmission of information to others. Both evolve as a result of trial and error, but in science there is relatively more foresight, understanding, and planning.     

Law without justice: The dilemmas of formalization and fairness in the legalistic organization

There is growing evidence of a litigation mentality rampant in organizations, which has created a legalistic mindset in many managers. Increasingly, managerial decisions are becoming dominated by a concern for what is legally defensible at the expense of broader social considerations such as justice and fairness. The papers in this special issue explore how this legalistic mindset has created new organizational and social dilemmas, and situations of law whithout justice.     

The effect of rule 12b-1 on bond fund expense ratios

This paper presents empirical evidence that bond mutual funds which have adopted the use of 12b-1 fees have not achieved the goal of lowering expense ratios. Using a model specific to bond funds, as opposed to generic models used in previous studies on equity funds, the analysis confirms that the 12b-1 fee is an additional cost borne by shareholders of the fund without any additional benefit. However, this cost as a percent of the net asset value of the fund has decreased from 1991 through 1994. This reduction coincides with the submission of a proposed rule change by the National Association of Security Dealers concerning maximum sales charges imposed by mutual funds on December 28, 1990 and the implementation of limits on 12b-1 fees which became effective in July of 1993.     

Revisiting managerial perspectives on dividend policy

We survey managers of Nasdaq firms that consistently pay cash dividends to determine their views about dividend policy, the relationship between dividend policy and value, and four common explanations for paying dividends. The evidence shows that managers stress the importance of maintaining dividend continuity and widely agree that changes in dividends affect firm value. Managers give the strongest support to a signaling explanation for paying dividends, weak to little support for the tax-preference and agency cost explanations, and no support to the bird-in-the-hand explanation. The study provides new evidence about how managers view dividend life cycles and residual dividend policy. The authors would like to thank two anonymous referees for helpful comments and suggestions, and Maheshan Fernando and Sumeet Chawla for providing research assistance.     

Characterizations of distributions via linearity of regression of generalized order statistics

Let X (r, n, m, k), 1 r n, denote generalized order statistics based on an absolutely continuous distribution function F. We characterize all distribution functions F for which the following linearity of regression holds E(X(r+l,n,m,k) | X(r,n,m,k))=aX(r,n,m,k)+b.We show that only exponential, Pareto and power distributions satisfy this equation. Using this result one can obtain characterizations of exponential, Pareto and power distributions in terms of sequential order statistics, Pfeifers records and progressive type II censored order statistics. Received July 2001/Revised August 2002     

Don’t kill the messenger! Whistle-blowing in America — A review with recommendations

Whistle-blowing in America business and industry has increased as interest in ethical business behavior and the cost of unethical behavior have grown. Whistle-blowing plays the important role of helping to fill the gaps in the regulatory system that is designed to check the abuse of organizational power. However, the practice of whistle-blowing is controversial and whistle-blowers often pay a high price for their actions. Firms can engage in a number of actions to encourage whistle-blowing. Creating a climate that encourages employees to report organizational wrong doing and that protects the whistle-blower is critical. To create such a climate the organization must build trust and cooperation by educating employees in the benefits of ethical and legal behavior.