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.     

Flexibility at the Margin and Labor Market Volatility in OECD Countries*

We study the business‐cycle behavior of segmented labor markets with flexibility at the margin (e.g., just affecting fixed‐term contracts). We present a matching model with temporary and permanent jobs (i) where there is a gap in the firing costs associated with these types of jobs and (ii) where there are restrictions in the creation and duration of fixed‐term contracts. We show that a labor market with ``flexibility at the margin'' increases the unemployment volatility with respect to one that is fully regulated. This analysis yields new insights into the interpretation of the recent volatility changes witnessed in the OECD area.     

Female entrepreneurial leadership factors

This article presents the foundations, current structure and trend of academic research into leadership factors in female entrepreneurship to provide scholars in the field with an overview of the followed research directions and to explore whether the same traditional patterns are reproduced in gender studies on entrepreneurship and leadership. For this purpose, a bibliometric analysis of the Web of Science database from 2000 to 2020 was used. With a performance analysis of variables (e.g. authors, publications, journals and countries), and thanks to scientific mapping, the links among these variables were studied. The results show that the trend of publications increased from 2015, but with little influence and output. The most influential and productive countries are the USA and Spain. 35% of the journals are based in the USA and 25% in England. The most influential ones deal with entrepreneurship, business, management and leadership. Although the foundational base is influenced by the author Ahl, known for calling for new research directions related to women entrepreneurs from a social construction perspective, the most influential articles continue to investigate gender with a dominant male bias. The network analysis reveals cooperation between different countries and authors with the USA dominating. The ambiguity of entrepreneurial leadership field due to the overlap of entrepreneurship and leadership disciplines reveals through the co-citation of journals different specialisation areas: business and entrepreneurship, management and psychology, organisational behaviour. This work provides researchers with an overview that encourages them to overcome the dominant male normative lens from new epistemological perspectives.

     

Taxes and labor supply: Portugal, Europe, and the United States

I relate hours worked with taxes on consumption and labor for Portugal, France, Spain, United Kingdom and United States. From 1986 to 2001, hours per worker in Portugal decreased from 35.1 to 32.6. With the parameters for Portugal, the model predicts hours worked in 2001 with an error of only 12 min from the actual hours. Across countries, most predictions differ from the data by 1 h or less. The model is not sensible to special assumptions on the parameters. I calculate the long run effects of taxes on consumption, hours, capital and welfare for Portugal. I extend the model to discuss implications for Social Security. I discuss the steady state and the transition from a pay-as-you-go to a fully funded system.

Emergency preparedness in Romania: Dynamics,shortcomings and policy proposals

Romanians were exposed in the last century to a range of natural or man-made disasters, mainly earthquakes and floods. The transition of the country from a Communist authoritarian pattern of emergency preparedness to a democratically civilian emergency system challenges the assessment of emergency preparedness and adds more complexity in designing a better and efficient system. The aim of this paper is to briefly describe the risks and institutions dealing with disasters, to assess the emergency preparedness, the uses of Knowledge Management Systems and Foresight Methodology approaches and to discover the shortcomings of the Romanian Emergency System. The empirical study designed as a reality check focuses on the perception of the local leaders of the emergency system regarding the most probable risks, and the uses and utility of long term strategic planning and foresight methodologies, using the Delphi technique. Lessons drawn from the Romanian transition could provide an interesting case study for other emerging democracies.     

Returns to education and wage equations

The paper shows why considering a number of education-dependent covariates in a wage equation decreases the coefficient of education in that equation. This result is illustrated empirically with a meta-analysis for Portugal. The education coefficient decreases when covariates are used that can be considered post-education decisions; on the other hand, it is independent of sample size, tenure and whether hourly or monthly wages are used. These results support the use of a simple specification of the Mincer equation for the study of the total returns to education.     

Output gap in Brazil: a real-time data analysis

Recent literature for developed economies has shown that output gap estimates go through important revisions over time, impairing their reliability in real time. We organize a real-time data set for Brazil’s GDP and assess the revisions of the output gap estimated by four different methods. Similar to the findings of studies for developed economies, the output gap revisions in Brazil are substantial in all methods, with frequent changes in the output gap sign. In general, both the GDP data revision and the effect of adding new observations to the sample are relevant sources of output gap revisions. However, differently from those studies, we cannot assert that the latter source is preponderant.     

From disruptions to struggles: Theorizing power in ERP implementation projects

Enterprise resource planning (ERP) implementation projects often fail to achieve their objectives. These often problematic projects are frequently the setting for intense and growing power struggles. Existing studies (e.g., Boonstra, 2006; Shepherd, Clegg, & Stride, 2009) have provided researchers with insights about issues of power in these projects. However, existing research has yet to provide a comprehensive picture of power in these projects or insights on how this picture changes with the passage of time. Clegg's (1989) circuits of power framework provides a useful tool for developing this needed comprehensive picture. We use the circuits of power framework as a tool for categorizing existing literature on power in ERP implementations. More importantly, we draw on this framework to provide a comprehensive view of power in the particular context of these projects. Specifically, we analyze the power relations during the implementation of an ERP in an organization. We do so by identifying how disturbances to the circuits of power – power struggles – arise and intensify during the implementation of the ERP. In this way, our work makes both a theoretical and an empirical contribution to the study of power in ERP implementation projects.     

Enticing the Stork: Can we Evaluate Pro‐Natal Policies Before Having Children?

Aside from immigration, the only meaningful demographic lever available to policymakers attempting to moderate the rate of ageing is the birth rate. This article departs from previous analyses of pro‐natal policies by studying determinants of pro‐natal options ex ante, which represents an advantage for policymakers looking to craft policies with prior knowledge of whether or not a demographic policy will have a significant effect. Our multinomial regression model for a US sample involving college students shows that the preferred choice of pro‐natal incentive is dependent on gender, economic class, number of planned children and migrant status. We find that females are more likely than males to choose any pro‐natal incentive over no incentive. The highest odds for increasing planned number of children are for maternity leave and parental leave options. Respondents associating themselves with the poorest economic class are more likely to choose daycare or government grant as pro‐natal options.     

Forecasting UK consumer price inflation using inflation forecasts

The inflation rate is a key economic indicator for which forecasters are constantly seeking to improve the accuracy of predictions, so as to enable better macroeconomic decision making. Presented in this paper is a novel approach which seeks to exploit auxiliary information contained within inflation forecasts for developing a new and improved forecast for inflation by modeling with Multivariate Singular Spectrum Analysis (MSSA). Unlike other forecast combination techniques, the key feature of the proposed approach is its use of forecasts, i.e. data into the future, within the modeling process and extracting auxiliary information for generating a new and improved forecast. We consider real data on consumer price inflation in UK, obtained via the Office for National Statistics. A variety of parametric and nonparametric models are then used to generate univariate forecasts of inflation. Thereafter, the best univariate forecast is considered as auxiliary information within the MSSA model alongside historical data for UK consumer price inflation, and a new multivariate forecast is generated. We find compelling evidence which shows the benefits of the proposed approach at generating more accurate medium to long term inflation forecasts for UK in relation to the competing models. Finally, through the discussion, we also consider Google Trends forecasts for inflation within the proposed framework.