Cost-effectiveness of omalizumab add-on to standard-of-care therapy in patients with uncontrolled severe allergic asthma in a Brazilian healthcare setting

Objective: Omalizumab add-on to standard-of-care therapy has proven to be efficacious in severe asthma patients for whom exacerbations cannot be controlled otherwise. Moreover, evidence from different healthcare settings suggests reduced healthcare resource utilization with omalizumab. Based on these findings, this study aimed to assess the cost-effectiveness of the addition of omalizumab to standard-of-care therapy in patients with uncontrolled severe allergic asthma in a Brazilian healthcare setting.

Methods: A previously published Markov model was adapted using Brazil-specific unit costs to compare the costs and outcomes of the addition of omalizumab to standard-of-care therapy vs standard-of-care therapy alone. Model inputs were largely based on the eXpeRience study. Costs and health outcomes were calculated for lifetime-years and were annually discounted at 5%. Both one-way and probabilistic sensitivity analyses were performed.

Results: An additional cost of R$280,400 for 5.20 additional quality-adjusted life-years was estimated with the addition of omalizumab to standard-of-care therapy, resulting in an incremental cost-effectiveness ratio of R$53,890. One-way sensitivity analysis indicated that discount rates, standard-of-care therapy exacerbation rates, and exacerbation-related mortality rates had the largest impact on incremental cost-effectiveness ratios.

Limitations: Assumptions of lifetime treatment adherence and rate of future exacerbations, independent of previous events, might affect the findings. The lack of Brazilian patients in the eXpeRience study may affect the findings, although sample size and baseline characteristics suggest that the modeled population closely resembles Brazilian severe allergic asthma patients.

Conclusion: Results indicate that omalizumab as an add-on therapy is more cost-effective than standard-of-care therapy alone for Brazilian patients with uncontrolled severe allergic asthma, based on the World Health Organization’s cost-effectiveness threshold of up to 3-times the gross domestic product.     

Perceived benefits of loyalty programs: Scale development and implications for relational strategies

Positive outcomes of loyalty programs are clear for firms, yet little research examines customer perceptions. To address this gap, this article investigates various perceived benefits of loyalty programs using a multi-benefit framework based on utilitarian, hedonic, and relationship literature. Two quantitative studies, involving 658 French members of loyalty programs, provide a 16-item scale that measures five types of perceived benefits: monetary savings, exploration, entertainment, recognition, and social benefits. The five dimensions have different impacts on satisfaction with the program, loyalty to the program, and perceived relationship investment of the firm. This article offers a discussion of the theoretical and managerial implications of these findings for relationship marketing strategies.     

The development of new higher education courses

The main objective of this study was to present a proposal for a model explaining the construction of a new higher education course to be offered to the market. Having quite a limited theoretical basis and with few investigations dealing with innovation in educational services, a case study was made to help in construction of the model. The case study, supported by studies found and adaptation of innovation in services to the educational sector, made construction of the model possible, and this is divided in three stages: antecedents, development, and implementation of the new higher education course. The proposed model can be useful for managers of higher education institutes when they decide to put new courses on the market. As for the academic field, the study presented attempts to clarify the phenomenon, as well as showing the need for further research into the subject.     

Eco-Frontier and Place-Making: The Unexpected Transformation of a Sustainable Settlement Project in the Amazon

An important issue today is the compatibility of agricultural frontiers, which are driven by economic objectives, with conservationist views. In the Amazon, family farmers are concerned with this issue since they are at the same time actors of the agricultural frontier and considered as potential actors of the preservation of the forest. Through the study of a highly symbolic settlement project in the State of Pará, this paper focuses on the role that family farmers can play in meeting sustainability goals. The central argument which is developed in this paper is that this objective may be achieved when projects do not presuppose social and spatial relationships; rather, it advocates an approach which is attentive to place-making processes.     

The Impact of Timing on Bidding Behavior in Procurement Auctions of Contracts with Private Costs

We provide a comparison of bidding behavior between multi-round and single-round auctions considering bid lettings for asphalt construction contracts that are known to have primarily private costs. Using a reduced-form difference-in-difference approach as well as the nonparametric estimation technique that was proposed by Racine and Li (J Econom 119(1):99–130, 2004) we find that bidding is more aggressive in a sequential multi-round setting than in a simultaneous single-round format. We explore potential causes for the bidding difference across formats that are related to synergies and the level of bidder participation.     

Policy coherence between tourism and climate policies: the case of Spain and the Autonomous Community of Catalonia

Abstract

The relationship between tourism and climate change is reciprocal. The effects of climate change on tourism are undeniable. However, tourism and climate change are complex and cross-cutting phenomena that enter policy agendas at different moments and with different discourses. This paper analyses the coherence between the policy domains of climate and tourism at the formulation stage of the policy process, focusing on national and regional government levels and the key touristic offer in Spain – that of sun, sea and sand. The proposed method analyses three dimensions within policy documents: frame significance, policy scope and connotation. Results reveal the imbalance between the two policy domains; the lack of concrete actions and stable mechanisms for achieving greater coherence; and the different conceptions of the issue. The paper considers the causal relationships between tourism and climate change, the consequences of mutual impacts, and the temporal dimension of problem framing. This research brings together three fields of knowledge – tourism, climate change and public policies – and suggests enhancing coherence between tourism and climate policies in order to address the sustainability of tourism destinations.     

Taxation of shareholder capital gains and the choice of payment method in takeovers

From December 1999, shareholders who disposed of shares in Australian takeovers in exchange for scrip could elect to defer capital gains taxation until the disposal of the shares received. We investigate payment method choice by acquiring firms before and after this regulatory change to assess whether target shareholder capital gains tax liabilities became an important factor considered in choosing the form of payment. The results show that, subsequent to the regulatory change, there is a significantly higher probability that equity will be offered as consideration where target shareholder capital gains are greater. This finding confirms the importance of shareholder level taxation in explaining corporate acquisition structure and adds to previous European and US evidence on factors associated with payment method choice in takeovers.     

EBITDA margin in brazilian companies Variance decomposition and hierarchical effects

This study explores the controversy between the business and academic perspectives regarding earnings before interest, taxes, depreciation, and amortization (EBITDA). Some authors argue that EBITDA is not useful as an indicator, except for comparing companies within the same sector (Assaf Neto, 2003, McClure, 2006, Stumpp, 2000). On the other hand, the business world strongly uses this type of indicator as a tool to support its decisions (Schmalensee, 1985, Moraes, 2005). This difference in opinions has aroused interest in understanding the reasons for its use and has raised questions regarding the usefulness of EBITDA for comparing companies from both the same and different sectors. By applying Hierarchical Linear Modeling (HLM), the main goal of this research is to observe EBITDA behavior across companies selling goods in Brazil, comparing them within the same sector and across different sectors over time. This research allows for the analysis of the reasons why EBITDA patterns occasionally occur. The results show significant variation in EBITDA among companies across the same sector and across companies from different sectors. On the other hand, our results have shown, nevertheless, that the variability among companies from the same sector was the highest one, raising questions on the actual usefulness of this indicator to compare companies from the same sector.     

Evaluating the economy embedded in the Brazilian ethanol–gasoline flex-fuel car: a Real Options approach

The introduction of the flex-fuel cars in the Brazilian market in 2003 changed considerably the consumer decision-making process. Prior to this date, it was necessary to choose the automobile type only by gasoline or by ethanol fuel; today it is possible to choose a car type with both fuel options. This flexibility generates economic advantages for his owner, but what are the financial benefits of a flex-fuel car in comparison with a car using only gasoline? Geographically, where is the owner of the benefits from this flexibility located? This article presents an empirical application of the Real Options Theory in the analysis of the flex-fuel car option for five geographic Brazilian regions: Northern, Northeastern, Central-Western, Southeastern and Southern. The regional price differences as well as the consumer preferences of these regions were met. For this purpose, historical fuel prices were considered stochastic and following a Mean Reverting Stochastic process. The prediction and option values were generated by a Monte Carlo simulation. The results indicated that the option embedded on the Brazilian flex-fuel car adds considerable value to the owner in all regions and car models considered, with the Southeastern Region receiving most benefits by the flex option.