Cost-effectiveness analysis of ocrelizumab versus subcutaneous interferon beta-1a for the treatment of relapsing multiple sclerosis

Aim: To conduct a cost-effectiveness analysis to compare ocrelizumab vs subcutaneous (SC) interferon beta-1a for the treatment of relapsing multiple sclerosis (RMS).

Methods: A Markov cohort model with a 20-year horizon was developed to compare ocrelizumab with SC interferon beta-1a from a US payer perspective. A cohort of patients with relapsing-remitting MS (RRMS) and Expanded Disability Status Scale (EDSS) scores of 0–6, who initiated treatment with ocrelizumab or SC interferon beta-1a, were entered into the model. The model considered 21 health states: EDSS 0–9 in RRMS, EDSS 0–9 in secondary-progressive multiple sclerosis (SPMS), and death. Patients with RRMS could transition across EDSS scores, progress to SPMS, experience relapses, or die. Transition probabilities within RRMS while patients received ocrelizumab or SC interferon beta-1a were based on data from the two SC interferon beta-1a-controlled Phase III OPERA I and OPERA II trials of ocrelizumab in RMS. Transitions within RRMS when off-treatment, RRMS-to-SPMS transitions, transitions within SPMS, and transitions to death were based on the literature. Utilities of health states, disutilities of relapses, costs of therapies, and medical costs associated with health states, relapse, and adverse events were from the literature and publicly available data sources. The model estimated per-patient total costs, incremental cost per life year (LY) gained, and incremental cost per quality-adjusted LY (QALY) gained. Deterministic sensitivity analyses (DSA) and probabilistic sensitivity analysis (PSA) were conducted to evaluate the robustness of the model results.

Results: Ocrelizumab was associated with a cost savings of $63,822 and longer LYs (Δ?=?0.046) and QALYs (Δ?=?0.556) over a 20-year time horizon. The results of the model were robust in the DSA and PSA.

Limitations: The model did not consider subsequent treatments and their impact on disease progression.

Conclusions: The results suggest that ocrelizumab is more cost-effective than SC interferon beta-1a for the treatment of RMS.     

A Comparative Study on Perceived Ethics of Tax Evasion: Hong Kong Vs the United States

This article begins with a review of the literature on the ethics of tax evasion and identifies the three main views that have emerged over the centuries, namely always ethical, sometimes ethical, and never or almost never ethical. It then reports on the results of a survey of HK and U.S. university business students who were asked to express their opinions on the 15 statements covering the three main views. The data are then analyzed to determine which of the three viewpoints is dominant among the sample population. Although it was found that HK scores were significantly different from the U.S. scores, both HK and U.S. respondents were opposed to the view that tax evasion is always or almost always ethical. The strongest arguments justifying tax evasion were in cases where the government was corrupt, the tax system was unfair and unaffordable. The weakest arguments for justifying tax evasion were in cases where there was a selfish motive. The underlying cultural differences are further explored in hope of accounting for differing perceptions of ethics of tax evasion. Policy implications for increasing people’s awareness of ethics on tax evasion are also highlighted.     

Energy eco‐innovations for sustainable development: Exploring organizational strategic capabilities through an energy cultures framework

This article reports on research on energy eco‐innovation using case studies of firms. Positioning energy efficiency changes in an organization as “eco‐innovations,” the paper examines the firm‐level resources involved for these to be successful. To identify these resources, the energy cultures (EC) framework, an organizing tool to understand energy behaviour, is drawn on. From an analysis of 142 case studies of successful business and energy change, three models are developed. It is found that the EC framework (consisting of norms, material culture, and practices) makes explicit key resources involved in developing energy eco‐innovations. The findings show that for an eco‐innovation capability, there is a need to align the physical resources with intangible resources to lead to learning and knowledge that, in turn, needs to be aligned with the firm strategies. This research has implications for developing company strategy and practice to drive energy eco‐innovations.     

Friction in the forest: a confluence of structural and discursive political ecologies of tourism in the Ecuadorian Amazon

Abstract

Tourism in the Anthropocene is a powerful driver of global connections that has direct consequences for social and environmental well-being across the planet. This political ecological analysis of tourism in the Ecuadorian Amazonian presents ethnographic vignettes to account for the ways that interwoven global discourses related to biodiversity conservation and community development are encountered, contested, and leveraged to advance particular approaches to tourism at the local level. We invoke Tsing’s theory of friction to frame these discursive encounters in the context of tourism-related decision-making in the community of Misahuallí, including instances of discursive shifts being leveraged into improved well-being of local residents. This paper makes an important contribution to the scholarship on the political ecology of tourism by bringing the emic perspectives of local residents to the forefront and by demonstrating the value of Tsing’s friction metaphor for analyzing the global connections inherent in tourism. Frictions between inequities and imbalances of power, perpetuated by both the structures and discourses associated with the use of tourism to address conservation and development objectives, remain at the vanguard of tourism research as we move through the Anthropocene.     

Examining hotel salespeople's new membership programme sales performance

Promoting new membership programmes can be a rewarding, yet challenging task for hotels. However, high-performance sales teams can improve consumer perceptions of new membership programmes in the market and allow hotels to remain competitive. Few studies have explored how hotel sales personnel approach the task of selling new membership programmes, and studies examining the moderating influence of market orientation are also rare. The current study contributes to the hospitality sales management literature by using the goal orientation theory to examine the new membership programmes sales performance of 168 salespeople. ‘Market orientation' was included as a variable that could moderate salespeople's performance. The results show that learning goal orientation and performance-prove goal orientation positively influence salespeople's performance, but performance-avoid goal orientation negatively influences sales performance. Furthermore, hotels' levels of market orientation (high or low) can moderate the relationship between goal orientation and sales performance.     

Why the public thinks natural resources public participation processes fail: A case study of British Columbia communities

This study examines the experiences and opinions of a “public” which became involved in a government driven comprehensive land use and natural resource planning exercise in British Columbia, Canada during the 1990s. While it is generally assumed to be an inherently good thing, or at least a politically necessary thing, to involve the public in natural resources or land use planning, few studies have examined the experiences of the public or examined perceived failures from the public's perspective. This study examines British Columbia's CORE and LRMP planning processes, their successes and failures, as determined by residents of six communities that participated in these processes. Lessons on improving public processes from the viewpoint of that public are discussed.     

Distribution and drivers of costs in type 2 diabetes mellitus treated with oral hypoglycemic agents: a retrospective claims data analysis

Objective:

To describe the distribution of costs and to identify the drivers of high costs among adult patients with type 2 diabetes mellitus (T2DM) receiving oral hypoglycemic agents.

Methods:

T2DM patients using oral hypoglycemic agents and having HbA1c test data were identified from the Truven MarketScan databases of Commercial and Medicare Supplemental insurance claims (2004–2010). All-cause and diabetes-related annual direct healthcare costs were measured and reported by cost components. The 25% most costly patients in the study sample were defined as high-cost patients. Drivers of high costs were identified in multivariate logistic regressions.

Results:

Total 1-year all-cause costs for the 4104 study patients were $55,599,311 (mean cost per patient?=?$13,548). Diabetes-related costs accounted for 33.8% of all-cause costs (mean cost per patient?=?$4583). Medical service costs accounted for the majority of all-cause and diabetes-related total costs (63.7% and 59.5%, respectively), with a minority of patients incurring >80% of these costs (23.5% and 14.7%, respectively). Within the medical claims, inpatient admission for diabetes-complications was the strongest cost driver for both all-cause (OR?=?13.5, 95% CI?=?8.1–23.6) and diabetes-related costs (OR?=?9.7, 95% CI?=?6.3–15.1), with macrovascular complications accounting for most inpatient admissions. Other cost drivers included heavier hypoglycemic agent use, diabetes complications, and chronic diseases.

Limitations:

The study reports a conservative estimate for the relative share of diabetes-related costs relative to total cost. The findings of this study apply mainly to T2DM patients under 65 years of age.

Conclusions:

Among the T2DM patients receiving oral hypoglycemic agents, 23.5% of patients incurred 80% of the all-cause healthcare costs, with these costs being driven by inpatient admissions, complications of diabetes, and chronic diseases. Interventions targeting inpatient admissions and/or complications of diabetes may contribute to the decrease of the diabetes economic burden.     

Organizational culture and work–life integration: A barrier to employees’ respite?

Abstract

The management of work–life boundaries is portrayed in the literature as being a matter of individual choice. Accordingly, organizational influence has been underestimated. The first objective of this article is therefore to determine whether an organizational culture of integration (e.g. expectations about taking work home) can influence individuals’ ability to act on their personal preference for segmentation. The second objective is to determine whether a mismatch between culture and personal preferences can influence the emotional state of employees and, if so, in what way. A study of 243 employees showed that the perception of an organizational culture of integration reduced the effect of preference for segmentation on employees’ ability to detach themselves from work during rest periods. Further, a path analysis highlighted a moderated mediation, indicating that preference for segmentation was associated with reduced emotional exhaustion in employees by promoting a high level of psychological detachment, and this reduction was even stronger among those who perceived a weak culture of integration in their organization. This study proposes that jointly with individual preference for segmentation or integration, the norms and expectations of an organization have considerable influence on employees’ ability to detach and recover during non-work time.