Cost-effectiveness of delayed-release dimethyl fumarate for the treatment of relapsing forms of multiple sclerosis in the United States

Objective:

To assess the cost-effectiveness of delayed-release dimethyl fumarate (DMF, also known as gastro-resistant DMF), an effective therapy for relapsing forms of multiple sclerosis (MS), compared with glatiramer acetate and fingolimod, commonly used treatments in the US.

Methods:

A Markov model was developed comparing delayed-release DMF to glatiramer acetate and fingolimod using a US payer perspective and 20-year time horizon. A cohort of patients, mean age 38 years, with relapsing-remitting MS and Kurtzke Expanded Disability Status Scale (EDSS) scores between 0–6 entered the model. Efficacy and safety were estimated by mixed-treatment comparison of data from the DEFINE and CONFIRM trials and clinical trials of other disease-modifying therapies. Data from published studies were used to derive resource use, cost, and utility inputs. Key outcomes included costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios. Alternative scenarios tested in a sensitivity analysis included drug efficacy, EDSS-related or relapse-related costs, alternative perspectives, drug acquisition costs, and utility.

Results:

Base-case results with a 20-year time horizon indicated that delayed-release DMF increased QALYs +0.450 or +0.359 compared with glatiramer acetate or fingolimod, respectively. Reductions in 20-year costs with delayed-release DMF were ?$70,644 compared with once-daily glatiramer acetate and ?$32,958 compared with fingolimod. In an analysis comparing delayed-release DMF to three-times-weekly glatiramer acetate and assuming similar efficacy and safety to the once-daily formulation, 20-year costs with delayed-release DMF were increased by $15,806 and cost per QALY gained was $35,142. The differences in costs were most sensitive to acquisition cost and inclusion of informal care costs and productivity losses. The differences in QALYs were most sensitive to the impact of delayed-release DMF on disease progression and the EDSS utility weights.

Conclusion:

Delayed-release DMF is likely to increase QALYs for patients with relapsing forms of MS and be cost-effective compared with fingolimod and glatiramer acetate.     

The Forms and Determinants of Social Exclusion in the European Union: The Case of Luxemburg

The paper investigates the social exclusion process in the European Union (EU), particularly in Luxemburg, addressing both conceptual and empirical issues. It examines aspects such as: the most appropriate definition of social exclusion for the case of Luxemburg, the way economic and social disadvantages cumulate within the social exclusion process, and the main determinants of social exclusion, income poverty and deprivation. To analyze the topics mentioned above, different econometric models have been applied.

Does exposure to dogs (cows) increase the preference for Puma (the colour white)? Not always

Recently, Berger, & Fitzsimons (2008) showed that conceptual fluency effects could spread to concepts sharing a second-level relation (e.g., priming “dog” can activate “cat,” which can increase the evaluation of the brand Puma). In three laboratory studies we found weak evidence for the above priming effects on related concepts. However, in a population sample, we did find evidence that repeated exposure to a prime is associated with preference for related brands and products.     

Do Perceptions of Ethical Conduct Matter During Organizational Change? Ethical Leadership and Employee Involvement

Ethical leadership matters in the context of organizational change due to the need for followers to trust the integrity of their leaders. Yet, there have been no studies investigating ethical leadership and organizational change. To fill this gap, we introduce a model of the moderating role of involvement in change. Organizational change and involvement in change are proposed as context-level moderators in the relationships of ethical leadership and work-related attitudes and performance. We employ a sample of 199 supervisor–subordinate pairs from a wide variety of organizations. Results support a three-way interaction (ethical leadership, organizational change, and involvement in change) for performance and OCBs. Our results have important implications for organizational change since ethical leadership appears to complement follower involvement when change is happening.     

Entrepreneurial orientation,entrepreneurial competencies,innovation, and performances in SMEs of Pakistan: Moderating role of social ties

The current study examines the mediating role of innovation and entrepreneurial competencies in entrepreneurial orientation’s relationship with financial, social, and environmental performance. This research also determines the role of social ties in strengthening the association between innovation and entrepreneurial competencies with social, financial, and environmental performance. Using multi-source and time-lagged studies, the data was collected from 297 small and medium-sized enterprises (SMEs) in Pakistan, and structural equation modeling was used to test direct, indirect, and moderating hypotheses. The findings show that entrepreneurial orientation, entrepreneurial competencies, and innovation positively correlate with all the types of performance under investigation and confirm the mediating role of innovation and entrepreneurial competencies. Additionally, social network ties strengthen innovation—financial performance, and entrepreneurial competencies—social performance relationship. This research proposes significant theoretical and managerial implications by determining the impact of entrepreneurial orientation on SMEs in Pakistan.