Cost-effectiveness of droxidopa in patients with neurogenic orthostatic hypotension: post-hoc economic analysis of Phase 3 clinical trial data

Objective:

Falls are associated with neurogenic orthostatic hypotension (nOH) and are an economic burden on the US healthcare system. Droxidopa is approved by the US FDA to treat symptomatic nOH. This study estimates the cost-effectiveness of droxidopa vs standard of care from a US payer perspective.

Methods:

A Markov model was used to predict numbers of falls and treatment responses using data from a randomized, double-blind trial of patients with Parkinson’s disease and nOH who received optimized droxidopa therapy or placebo for 8 weeks. The severity of falls, utility values, and injury-related costs were derived from published studies. Model outcomes included number of falls, number of quality-adjusted life-years (QALYs), and direct costs. Incremental cost-effectiveness ratios (ICERs) were calculated. Outcomes were extrapolated over 12 months.

Results:

Patients receiving droxidopa had fewer falls compared with those receiving standard of care and gained 0.33 QALYs/patient. Estimated droxidopa costs were $30,112, with estimated cost savings resulting from fall avoidance of $14,574 over 12 months. Droxidopa was cost-effective vs standard of care, with ICERs of $47,001/QALY gained, $24,866 per avoided fall with moderate/major injury, and $1559 per avoided fall with no/minor injury. The main drivers were fall probabilities and fear of fall-related inputs.

Limitations:

A limitation of the current study is the reliance on falls data from a randomized controlled trial where the placebo group served as the proxy for standard of care. Data from a larger patient population, reflecting ‘real-life’ patient use and/or comparison with other agents used to treat nOH, would have been a useful complement, but these data were not available.

Conclusion:

Using Markov modeling, droxidopa appears to be a cost-effective option compared with standard of care in US clinical practice for the treatment of nOH.     

REGULATION OF POLLUTION IN THE LABORATORY: RANDOM INSPECTIONS,AMBIENT INSPECTIONS,AND COMMITMENT PROBLEMS

We compare experimentally a traditional random inspection policy and a variant where the agency may carry out a preliminary inspection of the level of ambient pollution before implementing any individual inspection. Since the agency may have an incentive to announce high inspection probabilities and then secretly renege on its announcement to avoid implementing costly inspections, we are also interested in the agency's commitment power. We find that overall, ambient inspections increase efficiency but the effect is weaker than expected when the agency has no commitment power; and polluters' reactions to the lack of commitment power of the agency vary depending on whether the agency uses ambient inspections or not.     

Intensive tour guide training in regional Australia: an analysis of the Savannah Guides organisation and professional development schools

A number of authors believe that tour guide training may hold a key to passing on the concept of sustainable tourism to tourists. Savannah Guides Limited (SGL) is an organisation for tour guides interpreting and protecting the tropical savannahs of northern Australia. This paper examines the provision of intensive professional development schools, which the SGL organisation provides, to raise standards of professionalism for nature-based tour guides in remote regions. Its framework is based on Schein's three levels of organisational culture model, and Black and Ham's 10-element performance-based tour guide certification programme. Active participant observation of the development school process and a self-administered questionnaire to SGL members were used to understand the organisation's success. The main motivations for tour guiding are explored, as are the ways in which tour guides acquire knowledge. It is suggested that the provision of professional development schools in nature-based tourism regions benefits the guide and the tour guiding industry, and contributes to the protection of the natural environment. It is proposed that the SGL training model of professional development schools and certification be adopted by tour guiding organisations in other regional destinations as a way of nurturing and advancing quality tour guiding and professionalism.     

The motives and performance of cross-border acquirers from emerging economies: Comparison between Chinese and Indian firms

During the recent decade, the world has witnessed the rapid growth of MNEs from emerging economies. Their increasing participation in cross-border mergers and acquisitions has raised great attention in the extant literature. This study evaluates the value creation from these cross-border transactions from two representative emerging countries, namely China and India, and determines factors that result in the different performance of these international acquisition activities. Cross-border acquisitions conducted by these countries’ companies indeed lead to significant shareholder wealth creation. Furthermore, Indian shareholders are more likely to benefit from deals in small cultural distance countries, while Chinese investors gain from the cross-border expansion of manufacturing companies. Location also affects the performance of cross-border acquisitions, with acquisitions into developed countries generating higher returns to shareholders. Our sample consists of 203 Indian and 63 Chinese cross-border deals over the period 2000–2010 and our results hold after controlling for various deal-level and firm-level characteristics.     

Understanding the Influence of Cues from Other Customers in the Service Experience: A Scale Development and Validation

During most consumer exchanges, particularly in service and retailing settings, customers are “in the factory” and, as a result, the presence of other customers can have a profound impact on customer experiences. Despite studies demonstrating the importance of managing the customer experience and customer portfolios, the marketing literature lacks a comprehensive scale that can be used to assess individuals’ perceptions of other customers during commercial transactions. This study conceptualizes a three-dimension, Other Customer Perception (OCP) scale to address this gap. Using a seven-step scale development process, the multi-dimensional conceptualization is supported and validated and the research demonstrates the impact of the OCP dimensions on consumers’ approach and avoidance intentions. The findings provide a clearer understanding of how other customers can indirectly influence assessments of a customer exchange and can assist in the measurement of other customer perceptions in future research efforts.     

D-optimal two-level orthogonal arrays for estimating main effects and some specified two-factor interactions

Theoretical results are derived for finding D-optimal two-level orthogonal arrays for estimating main effects and some specified two-factor interactions. The upper bounds of the determinant of the related matrix for D-optimality are obtained. For run sizes 12 and 20, D-optimal orthogonal arrays are found for all requirement sets with three or less two-factor interactions, and all the D-optimal orthogonal arrays except one can be constructed by sequentially collecting columns. Examples are also given for run sizes 36 and 52 to discuss the guidelines to construct D-optimal orthogonal arrays.     

Some Comments on the Role of Lesbianism in Feminist Economic Transformation

This paper explores the relationship between feminism and lesbianism, arguing both that feminism has encouraged and supported lesbianism, and that the existence of lesbian feminism supports both feminist goals in general and heterosexual feminists in particular.     

Women,Children and Patience: Experimental Evidence from Indian Villages

Researchers have observed that women in developing countries often make more development friendly choices than men. We implemented experimental tasks among a large and diverse sample of married individuals in rural India and found women to make on average more patient and more risk‐averse choices than men. We find important heterogeneity in gender differences in patience: there is no difference for spouses with no children but patience levels diverge if there are small children in a family. The findings imply that conflicting spousal preferences are most likely in poor families with children.