Cost-effectiveness of combination daclatasvir-sofosbuvir for treatment of genotype 3 chronic hepatitis C infection in the United States

Background: A phase III trial evaluated the efficacy and safety of Daklinza (daclatasvir or DCV) in combination with sofosbuvir (SOF) for treatment of genotype (GT) 3 hepatitis C virus (HCV) patients.

Aim: This study evaluated the cost-effectiveness of DCV?+?SOF vs SOF in combination with ribavirin (RBV) over a 20-year time horizon from the perspective of a United States (US) payer.

Methods: A published Markov model was adapted to reflect US demographic characteristics, treatment patterns, costs of drug acquisition, monitoring, disease and adverse event management, and mortality risks. Clinical inputs came from the ALLY-3 and VALENCE trials. The primary outcome was the incremental cost-utility ratio. Life-years, incidence of complications, number of patients achieving sustained virological response (SVR), and the total cost per SVR were secondary outcomes. Costs (2014 USD) and quality-adjusted life years (QALYs) were discounted at 3% per year. Deterministic, probabilistic, and scenario sensitivity analyses were conducted.

Results: DCV?+?SOF was associated with lower costs and better effectiveness than SOF?+?RBV in the base case and in almost all scenarios (i.e. treatment-experienced, non-cirrhotic, time horizons of 5, 10, and 80 years). DCV?+?SOF was less costly, but also slightly less effective than SOF?+?RBV in the cirrhotic and treatment-naïve population scenarios. Results were sensitive to variations in the probability of achieving SVR for both treatment arms. DCV?+?SOF costs less than $50,000 per QALY gained in 79% of all probabilistic iterations compared with SOF?+?RBV.

Conclusion: DCV?+?SOF is a dominant option compared with SOF?+?RBV in the US for the overall GT 3 HCV patient population.     

Between mathematical formalism,normative choice rules,and the behavioural sciences: The emergence of rational choice theories in the late 1940s and early 1950s

Abstract

This paper discusses why mathematical economists of the early Cold War period favored formal-axiomatic over behavioral choice theories. One reason was that formal-axiomatic theories allowed mathematical economists to improve the conceptual and theoretical foundations of economics and thereby to increase its scientific status. Furthermore, the separation between mathematical economics and other behavioral sciences was not as clear-cut as often argued. While economists did not modify their behavioral assumptions, some acknowledged the empirical shortcomings of their models. The paper reveals the multifaceted nature of rational choice theories reflected in the changing interpretations and roles of the theories in those early years.     

Women and corporate boards of directors: The promise of increased, and substantive, participation in the post Sarbanes-Oxley era

Few aspects of corporate board diversity have generated the focused attention that the participation, position, and promise of women's service on the board has generated, especially in recent years. Of particular note is the extent to which women serve on large firm boards of directors (e.g., Fortune 500 firms). Increases in levels of participation have been described as glacial. While critics decry the level of participation of women on large-scale corporate boards, careful scrutiny suggests substantial progress. Concurrent with steady increases in the overall participation of women on corporate boards are increases in their presence on key board committees. Importantly, women's leadership of key board committees and their service as lead directors has improved in parallel with increases in their board memberships. These increases are particularly noteworthy in the post Sarbanes-Oxley (SOX) period. Such trends suggest the continued progress of women in assuming prominent positions in the corporate governance landscape, and provide evidence that the increasingly challenging environment in the post-SOX era has not attenuated the gains noted in the pre-SOX period.     

Memberships Levels in U. S. Private Clubs During the 2008–2010 Economic Downturn

This study measured membership changes in private clubs in the United States during the economic downturn from 2008 to 2010. Specifically examined were the changes clubs experienced with their number of members, waiting lists, and attrition rates. A letter was sent via e-mail to the same 1,000 private clubs that were sent a survey in a similar study conducted by Ferreira and Gustafson (2006 Ferreira, R. R. and Gustafson, C. M. 2006. Declining memberships during an economic downturn in U.S. private clubs. International Journal of Hospitality & Tourism Administration, 7(2/3): 3–18. [Taylor & Francis Online] , [Google Scholar]) The managers of these clubs were members of the Club Managers Association of America. The majority of respondents managed country clubs and member-owned clubs, representing different areas of the United States. An overall response rate of 53% was achieved. Most clubs experienced a decrease in the overall number of members and an increase in annual attrition rate. Fewer clubs reported having a waiting list of members wanting to join. The clubs without waiting lists reported a larger number of membership openings in their clubs. The results of this study suggest the levels of memberships in many private clubs are heavily influenced by economic conditions. An implication from this study is that clubs need to implement membership development strategies during economic downturns because of the decline in the number of members, candidates proposed, and waiting lists during these periods.     

Discussion of “The financial reporting of fair value based on managerial inputs versus market inputs: evidence from mortgage servicing rights”

Contrary to the guidance provided by regulators and industry associations suggesting that mortgage servicing rights (MSRs) be recorded as Level 3 assets, Altamuro and Zhang identify that 25 % of banks classify them as Level 2 assets. This variation in the asset classification of a single asset type provides a unique setting to examine the role of inputs in the fair value measurement process. Altamuro and Zhang find that the fair value of MSRs based on managerial inputs (Level 3) better reflects the economics of the underlying assets than the fair value of MSRs based on market inputs (Level 2). This discussion examines the institutional features of the MSR market, particularly the market concentration and the illiquidity of the market, that are important when considering this result. The discussion also raises a number of questions about the inputs used in the fair value process and calls for further research on this topic.     

Value of agricultural non-point source pollution measurement technology: assessment from a policy perspective

The development of accurate non-point source pollution assessment technologies allows the implementation of more efficient policies than can be undertaken in their absence. This study estimates the value of accurate measurement technology by estimating the gains from implementing a more efficient policy, one that targets agricultural non-point source emission reductions at the field scale but requires accurate field scale measurement technology, relative to a practice-based policy that can be implemented in the absence of such technology. For the environmental benefit of carbon sequestration, large cost savings are found due to improved targeting of conservation tillage subsidies for the state of Iowa. The ability of the government to cost discriminate is found to have little impact on the value of accurate measurement technology.     

Adjustment costs and factor demands in Canadian manufacturing industries

This paper examines whether there is a relationship between the commodity terms of trade (the price of primary commodities relative to the price of manufactures) and the net barter terms of trade of 42 Sub-Saharan African countries. For most countries, there is little evidence of a stable, long-run relationship between the two terms of trade series. Accordingly, the practice in the literature of proxying for movements in any given country's terms of trade by using an aggregate index of relative commodity prices is inappropriate, and is likely to engender misleading policy conclusions.     

Scale and scope economies for drug abuse treatment costs: evidence for Washington State

Drug abuse treatment has been pervasive in the US in the recent years, and the associated direct treatment costs approached $18 billion in 2001. However, there have been few published studies on scale economies, and none on scope economies, for drug abuse treatment costs. We estimate a restricted cost function for 17 hospitals in Washington State that provided inpatient and/or outpatient drug abuse treatment during the years 1997–2004. We find significant evidence of scale economies for hospitals that provide only outpatient drug abuse treatment services. The marginal costs of outpatient services are even smaller for hospitals that produce both outpatient and inpatient drug abuse treatment services. Further, these joint-production hospitals exhibit diseconomies of scope, or specialization economies. These results all imply that recent trends towards additional outpatient treatment services will enhance cost efficiency.     

Are Farmers' Market Shoppers Different From Cross-Shoppers? The Case of Hawaiian Avocado Purchasers

Small- and medium-size growers use direct marketing and farmers’ markets to access customers and avoid supply chain intermediaries that increase costs of getting products to consumers. This study examined consumers’ use of agricultural product information sources and their shopping outlet patronage preferences for one type of locally grown produce: avocados.

Two farmers’ market segments were identified: 1) shops only farmers’ markets and 2) cross-shops grocery stores. Product information came from a variety of sources: media, retailers, and organizations. “Buy Local” or “product origin” were considered in produce shopping decisions. One dimension, “Buy Local,” was significant in differentiating farmers’ market segments.