Cost-effectiveness of daclatasvir plus sofosbuvir-based regimen for treatment of hepatitis C virus genotype 3 infection in Canada

Objective:

New regimens for the treatment of chronic hepatitis C virus (HCV) genotype 3 have demonstrated substantial improvement in sustained virologic response (SVR) compared with existing therapies, but are considerably more expensive. The objective of this study was to evaluate the cost-effectiveness of two novel all-oral, interferon-free regimens for the treatment of patients with HCV genotype 3: daclatasvir plus sofosbuvir (DCV?+?SOF) and sofosbuvir plus ribavirin (SOF?+?RBV), from a Canadian health-system perspective.

Methods:

A decision analytic Markov model was developed to compare the effect of various treatment strategies on the natural history of the disease and their associated costs in treatment-naïve and treatment-experienced patients. Patients were initially distributed across fibrosis stages F0–F4, and may incur disease progression through fibrosis stages and on to end-stage liver disease complications and death; or may achieve SVR. Clinical efficacy, health-related quality-of-life, costs, and transition probabilities were based on published literature. Probabilistic sensitivity analysis was performed to assess parameter uncertainty associated with the analysis.

Results:

In treatment-naive patients, the expected quality-adjusted life years (QALYs) for interferon-free regimens were higher for DCV?+?SOF (12.37) and SOF?+?RBV (12.48) compared to that of pINF?+?RBV (11.71) over a lifetime horizon, applying their clinical trial treatment durations. The expected costs were higher for DCV?+?SOF ($170,371) and SOF?+?RBV ($194,776) vs pINF?+?RBV regimen ($90,905). Compared to pINF?+?RBV, the incremental cost-effectiveness ratios (ICER) were $120,671 and $135,398 per QALYs for DCV?+?SOF and SOF?+?RBV, respectively. In treatment-experienced patients, DCV?+?SOF regimen dominated the SOF?+?RBV regimen. Probabilistic sensitivity analysis indicated a 100% probability that a DCV?+?SOF regimen was cost saving in treatment-experienced patients.

Conclusion:

Daclatasvir plus sofosbuvir is a safe and effective option for the treatment of chronic HCV genotype 3 patients. This regimen could be considered a cost-effective option following a first-line treatment of peg-interferon/ribavirin treatment experienced patients with HCV genotype-3 infection.     

Demand-side inertia factors and their benefits for innovativeness

Inertia reflects a firm’s inability to change or innovate and may be fostered by many sources. Though researchers have focused on internal inertia factors, we examine inertia factors within a firm’s customer base: switching costs, customer preference stability, and network externalities. New products at 279 firms are examined to assess the role of these demand-side inertia factors in determining innovativeness and, ultimately, financial performance. The inertia factors are hypothesized to have differential innovativeness effects for early and late entrants. Overall, demand-side factors affect innovativeness positively, contrasting with firm-based factors (e.g., routines or assets), which typically inhibit innovativeness. Consumer preference stability is the only factor negatively related to innovativeness, though only for early entrants. Network externalities and switching costs increase innovativeness (particularly for early entrants). Demand-side inertia factors are critical determinants of innovativeness and may now be placed within the previously internally focused set of factors engendering early mover advantage.     

Reanalyzing Zero Returns to Education in Germany

Pischke and von Wachter (Review of Economics and Statistics 2008; 90 (3): 592–598) find zero earnings returns to compulsory schooling in the basic school track in Germany. We reanalyze their study using a different dataset. In an extension, we use additional instruments which allow estimation of heterogeneous effects for different groups of compliers. We can confirm the previous result and also find zero returns for other compliers in higher track schools. Moreover, we do not find a causal effect of schooling on cognitive skills. This is in line with a potential reason Pischke & von Wachter (2008) give for their result, namely that basic skills are learned earlier in Germany and additional years of schooling are no longer effective. Copyright © 2015 John Wiley & Sons, Ltd.     

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.     

Authentic leadership and intrapreneurial behavior: cross-level analysis of the mediator effect of organizational identification and empowerment

Intrapreneurial activity is positively associated with the organizational growth, and the factors that stimulate such behaviors need to be identified. The general goal of this work is to explore the relationship of authentic leadership with employees’ intrapreneurial behavior and the intervening processes. A correlational study was carried out with 212 employees of Spanish companies, in which two cross-level mediation hypotheses were tested. The results obtained indicate that employees’ organizational identification and organizational empowerment both mediate the relationship between authentic leadership and employees’ intrapreneurial behaviors. In this work, we note the importance of including authentic leadership as an antecedent of intrapreneurship.     

Effects of time horizon and asset condition on the profitability of technical trading rules

In much of the literature, the debate over technical trading strategies has centered around the question of whether an actively managed portfolio, controlled by a technical indicator, can outperform a passively managed portfolio. Typically, the time horizon is considered to be years. Additionally, the trader is assumed to use a technical trading strategy that is independent of asset conditions. These assumptions may not correspond well with reality. Traders often have much shorter time horizons and may switch between rebalancing or trading strategies on the basis of perceived shifts in market condition. This paper presents a study of the profitability of technical trading rules as a function of asset state or condition. Several common technical trading strategies were run on 296 stocks over a 15 year period. Strategies were run with 1 month rolling time horizons, significantly shorter than those used in similar studies in the literature. Stocks were segmented based on volatility and volume, which allowed for the examination of a strategy’s performance in different asset conditions. Several strategies were demonstrated to have consistently better risk-to-reward ratios under specific asset conditions and short time horizons. This finding helps to explain why some practitioners implement technical trading strategies.     

PROBLEMS IN THE COMPILATION OF INPUT-OUTPUT TABLES IN THE NETHERLANDS

This article deals with some aspects of the compilation of input-output tables (I.O. tables). A global view is given of the way in which I.O. tables are compiled in The Netherlands. It is indicated that in The Netherlands a number of developments are in progress that have led to an extension of the uses that are made of I.O. tables. The changing demands on I.O. tables that result from these developments can be met in future to an important degree. This has been made possible by extending and improving basic statistics and by increasing the uses made of automation facilities. Some problems remain, however, and one of these problems takes a central place in this article. This is the problem of accuracy and continuity: how can yearly I.O. tables be compiled that combine accuracy with consistency over time. Accuracy means here that the tables should be as complete as possible and in optimal accordance with all available information. Consistency over time means that estimates of details of I.O. tables compared with the same estimates for previous years reflect real economic developments. It is obvious that those two demands may conflict, particularly for years in which new information becomes available. It then must be decided whether accuracy or consistency in time deserves priority. What problems result from this decision and what are the consequences for the yearly I.O. tables? The problems arising from the conflicting demands of accuracy and continuity apply to the Netherlands in the last few years. This led to a revision of I.O. tables and national accounts for 1977. This revision resulted in an increase of estimated national income of more than 6 percent. For some components the adjustments have been much larger; this is particularly true for the services sector. More information on the 1977 revision is given in an annex.