Cost-effectiveness of asenapine in the treatment of bipolar I disorder patients with mixed episodes

Objective:

Around one-third of patients with bipolar I disorder (BD-I) experience mixed episodes, characterized by both mania and depression, which tend to be more difficult and costly to treat. Atypical antipsychotics are recommended for the treatment of mixed episodes, although evidence of their efficacy, tolerability, and cost in these patients is limited. This study evaluates, from a UK National Health Service perspective, the cost-effectiveness of asenapine vs olanzapine in BD-I patients with mixed episodes.

Methods:

Cost-effectiveness was assessed using a Markov model. Efficacy was informed by a post-hoc analysis of two short-term clinical trials, with response measured as a composite Young Mania Rating Score and Montgomery-Åsberg Depression Rating Scale end-point. Probabilities of discontinuation and relapse to manic, mixed, and depressive episodes were sourced from published meta-analyses. Direct costs (2012–2013 values) included drug acquisition, monitoring, and resource use related to bipolar disorder as well as selected adverse events. Benefits were measured as quality-adjusted life years (QALYs).

Results:

For treating mixed episodes, asenapine generated 0.0187 more QALYs for an additional cost of £24 compared to olanzapine over a 5-year period, corresponding to a £1302 incremental cost-effectiveness ratio. The higher acquisition cost of asenapine was roughly offset by the healthcare savings conferred through its greater efficacy in treating these patients. The model shows that benefits were driven by earlier response to asenapine during acute treatment and were maintained during longer-term follow-up. Results were sensitive to changes in key parameters including short and longer-term efficacy, unit cost, and utilities, but conclusions remained relatively robust.

Conclusions:

Results suggest that asenapine is a cost-effective alternative to olanzapine in mixed episode BD-I patients, and may have specific advantages in this population, potentially leading to healthcare sector savings and improved outcomes. Limitations of the analysis stem from gaps in clinical and economic evidence for these patients and should be addressed by future clinical trials.     

COMPLEMENTS VERSUS SUBSTITUTES AND TRENDS IN FERTILITY CHOICE IN DYNASTIC MODELS*

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The impact of sovereign risk on bond duration: Evidence from Asian sovereign bond markets

This paper examines the effect of sovereign risk on bond duration. We compare the sovereign risk-adjusted duration for U.S. dollar-denominated Asian sovereign bonds with their Macaulay duration for both investment grade bonds and speculative grade bonds. We find that the sovereign risk-adjusted duration is significantly shorter than its Macaulay counterpart for all bonds, regardless of their bond rating and their maturity. Further, the “shortening” effect of sovereign risk on duration gets stronger as bond rating deteriorates and in recessionary conditions. Our findings provide strong support for the importance of adjusting for sovereign risk when bond portfolio managers apply the popular duration measure to hedge interest rate risk.     

Revisiting the UNICEF malnutrition framework to foster agriculture and health sector collaboration to reduce malnutrition: A comparison of stakeholder priorities for action in Afghanistan

High rates of undernutrition persist in Afghanistan, but community-level information is scarce on its underlying causes. Developing policy in such situations is affected by varying stakeholder perspectives on the issues. This study uses the UNICEF malnutrition framework and a rapid assessment methodology to compare how stakeholders at community, provincial and national levels describe the food and nutrition situation. Consistent differences in problem definition by administrative level and between agriculture and health sectors were apparent. Stakeholders at all administrative levels widely agreed on the need to improve incomes and employment to ensure food security because of the many constraints to agricultural production. Provincial and national level stakeholders further agreed on the need for nutrition education at all levels of society. The research illustrates how local adaptation and application of the UNICEF malnutrition framework can reveal divergent perspectives, as a first step toward finding common ground and an appropriate policy response.     

Food Safety,Who s at Fault?

So many frequently reported scandals keep reminding us that Chinese have the strongest and toughest stomach in the world.Food safety problems constantly attract Chinese public attention.This time,it was about Red Bull.A high school student's mother in Harbin,northern China,worried if the drink would do any harm to her beloved son,who drank bottles of Red Bull during his exams     

The effect of experimenter bias in a cola taste test

In a simulated cola taste test, experimenters' nonverbal behaviors influenced subjects' cola choices, although subjects expressed no awareness of the experimenters' impact. Nonverbal intimacy behaviors may make subjects feel comfortable in same-sex pairs and uncomfortable in mixed-sex pairs, resulting in an association of these internal states with cola preferences.     

New Employment Contract Law: Focuses and Implications for Hoteliers

While there is a compelling need for hoteliers to understand the People’s Republic of China’s new Employment Contract Law, previous studies on human resource management in China have neither focused on the hospitality industry nor addressed the impact of labor laws. In response, this study differentiates the new and old versions of the labor law. A comparative analysis covering 10 areas was also performed. It is expected that this study will provide personnel managers with insights into how to develop better strategic human resource management through the promotion of collective responsibility and through the creation of an improved employment culture in the industry.