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.     

The State in Court: the economic effects of fee-shifting rules in Spain when suing the government

Following the recent public debate concerning the situation of the Judicial system in Spain, the paper analyses the special position of the State in Court, essentially with reference to suits brought by individuals against the State before Spanish first instance Courts, although international Courts are touched as well. The analysis focuses on the incentives to litigate and to settle in a dispute with the State, focusing on the State’s special procedural rules and the fee-shifting rules applied in the Spanish Justice system. The asymmetries in favor of the State reduce the incentives to litigate against the State, but also reduce the settlement range in order to achieve out-of-Court settlements.     

The knowledge multiplier

The paper develops a formal model of external knowledge and identifies the role of knowledge multipliers. Social interactions and knowledge multipliers play a crucial role in determining the rate of technological change. The analytical identification of the knowledge multiplier expression constitutes a key step in the appreciation of the crucial role of knowledge interactions. First, social considerations endogenously change the knowledge production function of each firm. The knowledge multiplier is the specific mechanism by means of which external knowledge contributes to enhance the innovative capacity of each firm. The production function of knowledge shows that the larger the knowledge multiplier is the stronger are the cumulative positive effects of external knowledge on the generation of new knowledge. Second, social considerations explain the long-run dynamics of innovation. Social reinforcement and the knowledge multiplier determine the rise or fall in the rate of accumulation of technological knowledge.     

DOES CONTRACEPTION BENEFIT WOMEN? STRUCTURE,AGENCY, AND WELL-BEING IN RURAL MEXICO

The authors of this paper examine Amartya Sen's contributions to the concept of human well-being from a gender perspective and argue that this concept is particularly useful for explaining women's decisions on contraceptive use. The study draws on data collected in six rural communities of Chiapas, Mexico. It emphasizes the ways in which public discourse articulates the apparent benefits of having small families; the context of the household and community in which rural women make reproductive decisions; and the impact of family planning programs on women's sense of subjective well-being. In particular, it questions the assumption that reduced fertility through contraception necessarily enhances women's well-being and points to the importance that women attach to being a party to reproductive decisions. The authors also explore the links between women's assessment of these decisions and of paid work, and their actual education levels and real possibilities of employment.     

Influence of brand equity on the behavioral attitudes of customers: Spanish Tourist Paradores

Quality & Quantity - The objective of this research is to contrast an explanatory model of how brand equity influences the customer’s behaviour and behavioural intentions. It will take...     

Are voters rationally ignorant? An empirical study of Portuguese local elections

The application of the rational choice postulate to a political context invariably leads to the conclusion that most voters are ill informed when making the decision on whom to vote for. In this paper, the authors conduct an empirical evaluation of the rational ignorance theory, based on the model developed by (Rogoff and Sibert Rev Econ Stud LV:1–16, (1988) and by considering that better informed voters reward political candidates who show better performances. The levels of performance are established through the construction of an empirical frontier using the Data Envelopment Analysis (DEA) methodology. According to our results, based on the 1997 Portuguese local elections, even though swing voters do not necessarily behave as rationally ignorant voters, a large majority of voters are rationally ignorant.

The Strategic Social Map of a Nongovernmental Organization

Currently, the traditional states-nation, as far as their social commitments are concerned, are giving way to the nongovernmental organizations (NGO). These organizations have a mission, strategy, and goals different from those organizations looking simply for profits. Nevertheless, NGOs are concerned about using management and information systems at least as good as those used by private companies. Organizations try to develop a social strategy taking their social responsibility as starting point. In this paper, the authors describe how to fix the organization mission, its strategy and goals, and also how to make its action map. A strategy proposal will be described, as well as the way on how to put it into practice. The main goals of this paper is to describe the mission, strategy, and goals of the organization; design its strategic social map; fix the limits of the organization's action; apply the theoretical model to a NGO; and design an information model in order to manage the strategic development. The authors would like to express their gratitude to M. Dolors Celma Benaiges, lecturer at the Escola Universitària del Maresme, Universitat Pompeu Fabra, for her assistance reviewing and translating the paper.     

Model simplification and variable selection: A replication of the UK inflation model by Hendry (2001)

In this paper, we revisit the well-known UK inflation model by Hendry (Journal of Applied Econometrics, 2001, 16, 255–275. We replicate the results in a narrow sense using the gretl and PcGive programs. In a wide sense, we extend the study of model uncertainty using the Bayesian averaging of classical estimates (BACE) approach as an automatic model reduction strategy. We consider three different specifications to compare BACE variable selection with Hendry's reduction. We find that the BACE method can recover the path of nontrivial reduction strategy.