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.     

Cost and time savings from a rapid access model of care using transient elastography to screen and triage patients with chronic Hepatitis C infection

Background:

Treatment uptake amongst patients with chronic Hepatitis C virus (HCV) in Australia is relatively low. New approaches to assessment have the potential to reduce public waiting lists, improve access to treatment, and to reduce healthcare costs.

Aim:

To describe the costs to the public hospital system and waiting time associated with a novel integrated rapid access to assessment and treatment (RAAT) model of care that utilizes Transient Elastography (TE) as a specialist outpatient-based approach for a streamlined assessment of patients with chronic HCV, compared to conventional outpatient management with liver biopsy (LB).

Methods:

Time from first medical review to treatment plan and costs associated with detection of fibrosis were recorded for patients receiving RAAT during a 3-month period, and for a similar historical cohort managed conventionally with LB. Costs related to medical and multidisciplinary team reviews and the TE/LB test itself were included.

Results:

Patients receiving RAAT had lower costs (n?=?27, median AU$2716) and shorter time to treatment (median?=?194 days) than for conventional management (n?=?13, median $5005, 420 days; p?Conclusions:

Based on real world audit data, this evaluation suggests TE, used as part of a new RAAT model of care, is cost saving to the health system in the short-term and reduces waiting times. The analysis reported here was intended to assess the costs related to detection of fibrosis, and is limited by the small sample size and potential selection bias. Future research should undertake a full economic evaluation at a whole of service level, to consider a more comprehensive and longer-term assessment of the costs and benefits associated with HCV management.     

An Evolutionary Psychology Perspective on Physical Exercise Motives: Implications for Social Marketing

This study uses the theoretical framework of evolutionary psychology to examine the motives driving physical exercise behavior, as evolutionary psychology is still under-explored in the social marketing literature. The study employs a survey that draws on a sample of 220 participants. Independent sample t-tests and analysis of variance are conducted, and findings show significant sex and marital status differences in terms of motivations to exercise. Research findings have original implications for social marketing interventions that seek to understand physical exercise motivations and to encourage increased levels of physical exercise. Further, findings contribute to the extant literature by establishing the importance of sex-based segmentation strategies and message appeals that resonate with specific segments’ innate physical exercise motives.     

The Stochastic Convergence of CO<Subscript>2</Subscript> Emissions: A Long Memory Approach

In response to equity concerns surrounding the spatial distribution of CO₂ emissions and assumptions of CO₂ convergence within some climate models, this paper examines the convergence of CO₂ emissions within the OECD over the period 1870–2004. More specifically, using the Local Whittle estimator and its variants we examine whether relative per capita CO₂ emissions are fractionally integrated, that is they are long memory processes which, although highly persistant, may revert to the mean/trend in the long run. Our results suggest that CO₂ emissions within 13 out of 18 OECD countries are indeed fractionally integrated implying that they converge over time, albeit slowly. Interestingly though, the countries whose emissions are not found to be fractionally integrated are some of the highest polluters within the OECD, at least in per capita terms. Our results have implications both for future studies of CO₂ convergence and for climate policy.     

Adapting an established measure of supervision for beach settings: is the parent supervision attributes profile questionnaire reliable?

The Parent Supervision Attributes Profile Questionnaire (PSAPQ), developed to measure aspects of caregiver supervision and protectiveness and previously applied within playgrounds and in the home, was modified for implementation in a beach setting. To assess the test-retest reliability of the PSAPQ beach modification (PSAPQ-BEACH), 20 caregivers completed the PSAPQ-BEACH twice, over a mean interval of 18 days (range 10-24). The test-retest reliability and internal consistency of the PSAPQ-BEACH scores were compared to those of the PSAPQ. All scores on the PSAPQ-BEACH were higher than the PSAPQ, providing evidence that the questionnaire remains reliable after its adaptation to beach settings.     

Modelling the impacts of policy on entry into organic farming: Evidence from Danish–UK comparisons, 1989–2007

This paper analyses organic farming entry decisions using a piece-wise linear depiction of policy. Our goal is to ascertain, from the available but limited information, whether Danish and UK policy measures toward organic agriculture have affected participation. Despite considerable interest in the growth of organic farming there has been little systematic analysis of it, although it is commonly believed that enhanced income levels have played a part. Whilst analyses of organic farming policy have provided extensive reviews of instruments applied, generally speaking, the spirit of those enquiries takes as datum that organic policies have had the desired impacts. Yet such conjectures remain mostly untested. Hence, there is a need to examine systematically if there exist relationships between the introduction of organic farming policies and the growth of organic farming, and whether particular policy measures are more effective than others. Here, we take a first step in this endeavor by undertaking an econometric analysis of the relationship between 14 organic farming policy measures and participation rates in Denmark and the UK during 1989–2007. Using two response variables – the numbers of farmers converted to organic production and the total land area under organic practice – we implement a simple, Bayesian methodology and evaluate the stepwise-linear impacts of policy. Extensions for future work are discussed. Six policy measures in the two study countries were found to be significant influences on participation, five of them direct supply-side instruments. For the UK, all of the policies are annual subsidies for organic farmers once conversion was complete. For Denmark, the policies are the introduction of organic subsidies for non-dairy farms, the extension of subsidies beyond 1997 and support for the costs of marketing services.     

Karl Marx’s Theory of Socio-Institutional Transformation in Late-Stage Capitalism

This article is in the tradition of Thorstein Veblen’s organized-intelligence-in-action definition of technology¹. It intends to identify the social technology necessary for organizing knowledge in order to get a grip on social change. Social change is seldom directed by discretionary policy; its rate is too fast for most to comprehend, and it has consequences that too often are neither desirable nor just. Since the last century scholars have “accepted the idea that the circumstances of existence were continually changing, that society was necessarily in the process of making adaptions to the changing circumstances, and that intelligent adaptation would result in human progress.“² Yet most of our social science models have yet to incorporate these dynamics. To further our understanding, scientific modeling must be developed to reflect social change as the norm, not as the exception to equilibrium.     

Purchase power: An examination of consumption as voting

Abstract

There has been a reported increase in political activity through the marketplace in the form of ‘consumer votes’. The use of marketplace votes by consumers to address their concerns about societal issues is a phenomenon that has growing relevance for firms, since they are often affected by such consumer citizenship. Therefore, this paper aims to enhance our conceptual understanding of the consumer voting phenomenon. It explores marketplace power relations and the constraints and enabling mechanisms they may pose to consumers seeking change through consumer voting. Consumer voting practices, consumer sovereignty discourses, and power tensions in marketplace encounters are examined in relation to Foucault's notions of power, technologies of the self, and governmentality. Foucault provides a critical lens to illuminate the potential for consumer resistance, an approach that so far has been somewhat neglected by the extant marketing and consumer research literature.     

Working Weeks,Rave Weekends: Identity Fragmentation and the Emergence of New Communities

Popular music is one of the most ubiquitous forms of contemporary culture. This paper looks at the phenomenon known as rave or dance culture in Britain. It examines the nature of the consumer experience at a dance club through the use of a two stage methodology. Based on observations and the collection of phenomenological data, the findings suggest that the experience is linked to a series of behaviours, which are related to fragmentation and identity. These include narcissistic identity, the emergence of new communities, the need for escape, engagement and prolonged hedonism. The paper examines these concepts in relation to postmodern consumption. In particular, an evaluation of postmodern theory and its focus on fragmentation and the project of the self is offered, by arguing for a return to "community".