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.     

Structure,Clearinghouses and Symmetry

We introduce and justify a taxonomy for the structure of markets and minimal institutions which appear in constructing minimally complex trading structures to perform the functions of price formation, settlement and payments. Each structure is presented as a playable strategic market game and is examined for its efficiency, the number of degrees of freedom and the symmetry properties of the structure     

Probability of survival in a random exchange economy with dependent agents

Summary. In this paper I analyze the general equilibrium in a random Walrasian economy. Dependence among agents is introduced in the form of dependency neighborhoods. Under the uncertainty, an agent may fail to survive due to a meager endowment in a particular state (direct effect), as well as due to unfavorable equilibrium price system at which the value of the endowment falls short of the minimum needed for survival (indirect terms-of-trade effect). To illustrate the main result I compute the stochastic limit of equilibrium price and probability of survival of an agent in a large Cobb-Douglas economy. Received June 7, 2001; revised version: January 7, 2002 RID="*" ID="*" I would like to thank Mukul Majumdar and Thomas DiCiccio for helpful discussion and an anonymous referee for valuable comments and suggestions.     

The Real Equilibrium South African Rand/US Dollar Exchange Rate: A Comparison of Alternative Measures

This article indicates how different measures of the real exchange rate, i.e., the exchange rate adapted for cost inflation, price inflation and labour costs, influence the equilibrium view and misalignment of the South African rand/US dollar exchange rate. The approach followed is based on the behavioural equilibrium exchange rate approach by Clark and MacDonald (1998), where the exchange rate is influenced by a number of fundamental and transitory factors. The real equilibrium exchange is estimated by using a single equation regression and a number of key explanatory variables. To determine the long-run relationship a Vector Error Correction Mechanism is used.     

Money as Social Exergy

Synopsis It has been proposed that open thermodynamic systems will act to dissipate available energy gradients by self-organizing into coherent structures that, with time, evolve and develop into nested hierarchies – panarchies – that adapt to internal and external changes according to a characteristic adaptive cycle. This paper seeks to apply these ideas in the purely societal realm by investigating the role of money in economic systems. Money represents the value embodied in goods; a value that is separate from the exact nature of those goods. We suggest that money thereby liberates the ‘free value’ of economic desire and that this free value has properties analogous to energy. The result is the self-organization of structures and systems (‘econosystems’) that dissipate this ‘free value’. Econosystems act at different scales, and nested levels of econosystems form a panarchy, having effects that can be observed. In particular, it appears that money facilitates the creation of relationships between econosystem actors, increasing the connectedness of the econosystems that envelop those actors. We have identified a phenomenon whereby freed social value (i.e. money) can aggregate, or pool, at a larger econosystem scale in structures such as banks. These pools act as gradients that actors at the neighborhood scale can exploit for self-organization in the econosystem. Thus, econosystem actors appear to be freed from thermodynamic constraints by using money as a means of self-organization. However, because of these pools of aggregated social exergy, connectedness is increased at the larger scale of the econosystem. The potential consequence of this dynamic is that money may act to push larger scale econosystems toward a state of heightened vulnerability to collapse, while freeing smaller scale actors from apparent constraints. In this way, we propose that money acts to skew information feedback loops between econosystem actors and larger scale structures such as economies and ecosystems.      

Researching Preferences,Valuation and Hypothetical Bias

A number of recent papers in environmental economics have focused on the process of researching preferences – agents are uncertain about preferences but with effort may narrow their uncertainty. This issue has arisen in formulating bids in contingent valuation (CV) as well as the debate over the divergence between WTP and WTA. In the context of CV, it has been suggested that the hypothetical nature of the preference elicitation process biases responses. This paper provides both a theoretical model and experimental evidence to contribute to this debate. The model is a model of competitive bidding for a private good with two components that are particularly relevant to the debate. The first component is that bidders are unsure of their own value for the private good but may purchase information about their own value (researching preferences). The second component is that there is a probability that the auction is hypothetical – that the winning bidder will not get the private good and will not pay the winning bid. The experiment tests this theoretical model of bidding equilibrium and analyzes the effects of variations in the parameters (hypotheticalness, information costs and number of agents) on the endogenous variables (such as the proportion of bidders who become informed and the winning bid). Experimental results suggest that an increase in the hypotheticalness of an auction tends to decrease the likelihood that bidders pay for information on their valuation with an ambiguous effect on the winning bid.      

生产要素对粮食产量的贡献系数分析

文章以河南省为案例,对2001年￣2003年全省109个县的数据进行定量分析,认为在既定的技术条件下,灌溉是影响粮食生产的第一要素,同时对其他要素的贡献系数又产生直接影响。灌溉对粮食产量贡献系数与当年的降水量密切相关。为保证粮食生产的稳定发展,政府应加强农田水利设施的建设,治理水污染,推广节水设备与技术,提高用水效率,同时对各种生产要素进行合理的配置。     

Feminist Ecological Economics and Sustainability

Synopsis New developments in feminist ecological economics and ecofeminist economics are contributing to the search for theories and policy approaches to move economies toward sustainability. This paper summarizes work by ecofeminists and feminist ecological economists which is relevant to the sustainability challenge and its implications for the discipline of economics. Both democracy and lower material throughputs are generally seen as basic principles of economic sustainability. Feminist theorists and feminist ecological economists offer many important insights into the conundrum of how to make a democratic and equity-enhancing transition to an economy based on less material throughput. These flow from feminist research on unpaid work and caring labor, provisioning, development, valuation, social reproduction, non-monetized exchange relationships, local economies, redistribution, citizenship, equity-enhancing political institutions, and labor time, as well as creative modeling approaches and activism-based theorizing.      

作业成本法在我国的应用现状及实施对策

本文首先从分析我国企业应用作业成本法的实际状况出发,通过样本分析说明我国企业目前尚无真正意义上的作业成本法,然后,对我国企业实施作业成本法的瓶颈及实施作业成本法的具体方法进行了论述。