Costs and effectiveness of fingolimod versus alemtuzumab in the treatment of highly active relapsing-remitting multiple sclerosis in the UK: re-treatment,discount, and disutility

Objective: Patients with relapsing-remitting multiple sclerosis (RRMS) treated with disease modifying therapies (DMTs) who continue to experience disease activity may be considered for escalation therapies such as fingolimod, or may be considered for alemtuzumab. Previous economic modeling used Markov models; applying one alternative technique, discrete event simulation (DES) modeling, allows re-treatment and long-term adverse events (AEs) to be included in the analysis.

Methods: A DES was adapted to model relapse-triggered re-treatment with alemtuzumab and the effect of including ongoing quality-adjusted life year (QALY) decrements for AEs that extend beyond previous 1-year Markov cycles. As the price to the NHS of fingolimod in the UK is unknown, due to a confidential patient access scheme (PAS), a variety of possible discounts were tested. The interaction of re-treatment assumptions for alemtuzumab with the possible discounts for fingolimod was tested to determine which DMT resulted in lower lifetime costs. The lifetime QALY results were derived from modeled treatment effect and short- and long-term AEs.

Results: Most permutations of fingolimod PAS discount and alemtuzumab re-treatment rate resulted in fingolimod being less costly than alemtuzumab. As the percentage of patients who are re-treated with alemtuzumab due to experiencing a relapse approaches 100% of those who relapse whilst on treatment, the discount required for fingolimod to be less costly drops below 5%. Consideration of treatment effect alone found alemtuzumab generated 0.2 more QALYs/patient; the inclusion of AEs up to a duration of 1 year reduced this advantage to only 0.14 QALYs/patient. Modeling AEs with a lifetime QALY decrement found that both DMTs generated very similar QALYs with the difference only 0.04 QALYs/patient.

Conclusions: When the model captured alemtuzumab re-treatment and long-term AE decrements, it was found that fingolimod is cost-effective compared to alemtuzumab, assuming application of only a modest level of confidential PAS discount.     

Continuity properties of the private core

Let be a sequence of differential information economies, converging to a limit differential information economy (written as ). Denote by the set of all ε-private core allocations, ε ≥ 0 (for ε=0 we get the private core of Yannelis (1991), denoted by ). Under appropriate conditions, we prove the following stability results

Empirical economics acknowledges the cooperation of

Empirical economics acknowledges the cooperation of     

Convergence and approximation results for non-cooperative Bayesian games: Learning theorems

Summary LetT denote a continuous time horizon and {G ^t :tT} be a net (generalized sequence) of Bayesian games. We show that: (i) if {x ^t : tT} is a net of Bayesian Nash Equilibrium (BNE) strategies for G^t we can extract a subsequence which converges to a limit full information BNE strategy for a one shot limit full information Bayesian game, (ii) If {x ^t : tT} is a net of approximate or _t-BNE strategies for the game G^t we can still extract a subsequence which converges to the one shot limit full information equilibrium BNE strategy, (iii) Given a limit full information BNE strategy of a one shot limit full information Bayesian game, we can find a net of _t-BNE strategies {x ^t : tT} in {G ^t :tT} which converges to the limit full information BNE strategy of the one shot game.We wish to thank Larry Blume, Mark Feldman, Jim Jordan, Charlie Kahn, Stefan Krasa, Gregory Michalopoulos, Wayne Shafer, Bart Taub, and Anne Villamil for several useful discussions. The financial support of the University of Illinois at Urbana-Champaign Campus Research Board is gratefully acknowledged.     

Competition and efficiency in the MENA banking region: a non-structural DEA approach

The goal of this article is to empirically assess the relationship between competition and efficiency in the banking sector of Middle East and North African (MENA) countries spanning the period 1997–2011. To measure the level of competition, the article estimates the non-structural indicator known as the H-statistic, while the level of bank efficiency is estimated through the nonparametric methodology of the Data Envelopment Analysis (DEA) and the Bootstrap Data Envelopment Analysis (BDEA), respectively. The empirical results are robust under six econometric methodologies, providing sufficient evidence for the presence of a one-way (negative) Granger causality, running from efficiency to competition. The empirical findings lead to the rejection of the ‘Efficient Structure Hypothesis’, implying that increases in competition do not precede increases in cost efficiency.     

Does seeing more deeply into a game increase one’s chances of winning?

The substantively rational value of the games studied in this paper does not help predict subject performance in the experiment at all. An accurate model must account for the cognitive ability of the people playing the game. This paper investigates whether the variation in measured rationality bounds is correlated with the probability of winning when playing against another person in games that exceed both players’ estimated rationality bound. Does seeing deeper into a game matter when neither player can see to the end of the game? Subjects with higher measured bounds win 63 percent of the time and the larger the difference the more frequently they win.     

Ownership Dynamics with Multiple Insiders: The Case of REITs

We study ownership dynamics of multiple strategic risk-averse insiders facing a moral hazard problem. We show that, when insiders cannot commit,  ex ante , to an ownership policy, the aggregate insider stake gradually declines toward the competitive market allocation. Both the speed of adjustment and the long-term equilibrium aggregate insider ownership level are greater for companies with a larger number of insiders,  ceteris paribus . Using data from U.S. real estate investment trusts, we then test the model and find that the predictions of the model are verified empirically.     

From Socialist Subject to Capitalist Object: Industry Enclave Life Past and Present in Wuhan

There is no better place to explore the relationship of industry enclaves to urban life than China, where traditional danweis (work units) have coexisted with new foreign direct investment enclaves. Here we draw on original interviews with workers at Wuhan Iron and Steel Company (WISCO) and Foxconn in the city of Wuhan to examine industry enclaves old and new in terms of their spatial arrangement, work, institutions, and social life and identity. The article is one of the first to integrate urban and economic geographical perspectives on the subject of enclaves. It provides evidence of similarities and contrasts in the spatial arrangement of work, institutions, life and identity centred on industry enclaves old and new. These contrasts reflect wider relations between the state and the market and between social subject and commodified labour in China. In conclusion, we identify several research directions concerning the scale, diversity and reach of urban enclavism in China and beyond.