International Monetary and Financial Arrangements: Present and Future

The paper deals with a broad range of topics under the rubric of the international monetary system: exchange rate agreements, International Monetary Fund structure, history and functioning of the European Monetary Union, monetary and fiscal policies adopted in recent years by different countries, with a special emphasis on central bank independence and inflation control, capital flows and cross-border assets growth and their influence on financial stability, and policy proposals to enhance financial stability. With more than four-fifths of world trade conducted under managed or full flexibility the present system can be regarded more as a flexible than a fixed exchange rate regime. EMU is a major institutional innovation; while its economic benefits have been amply discussed and perhaps exaggerated, the economic costs seem to have been underestimated. Financial liberalization has resulted in huge benefits to savers and borrowers as capital has tended to flow to its most productive uses around the world, but it has also led to fears that this has sharply reduced the effectiveness of monetary policy. This liberalization imposes a constraint on monetary policy in the sense that it forces a much higher degree of economic convergence than was true before.     

World oil prices and O.E.C.D. trade balance

This paper develops a theoretical model which postulates that while the drop in oil prices during the 1980s has benefitted O.E.C.D. countries in a way not unlike a favorable productivity shock, the concomitant shift in oil market share from Arab or cartel core petroleum exporting countries to non-Arab or non-cartel core petroleum exporting countries, has provided less benefits to the O.E.C.D. countries than has hitherto been acknowledged. The econometric analysis lends support to the model.     

Treatment patterns and healthcare costs among newly-diagnosed patients with chronic myeloid leukemia receiving dasatinib or nilotinib as first-line therapy in the United States

Objective: To compare treatment patterns and economic outcomes of dasatinib and nilotinib as 1st-line therapies for chronic myeloid leukemia (CML).

Methods: Adult CML patients initiated on first-line dasatinib or nilotinib in 2010–2014 were identified from two large US administrative claims databases. Treatment patterns, tyrosine kinase inhibitor (TKI) adherence and healthcare resource utilization (HRU) and costs were measured from the 1st-line TKI initiation (index date) to the end of follow-up.

Results: A total of 604 and 418 patients were included in the dasatinib and nilotinib cohorts (mean ages = 50.9 and 52.5 years, 46.4% and 45.7% female), respectively. Among the dasatinib patients, 91% started with 100?mg/day, 3% with <100?mg/day, and 6% with >100?mg/day. Among the nilotinib patients, 76% started with 600?mg/day, 16% with >600?mg/day, and 8% <600?mg/day. The dasatinib cohort had a higher hazard of dose decrease (hazard ratio [HR]?=?1.66; p?=?.002) and of switching to another TKI (HR =1.62; p?=?.019) compared to the nilotinib cohort. The hazard of dose increase (HR =0.76; p?=?.423) and treatment discontinuation (HR =1.10; p?=?.372) were not significantly different between cohorts. There was also no significant difference in TKI adherence levels (mean proportion of days covered [PDC] difference over first 6 months = ?0.0003, p?=?.981; mean PDC difference over first 12 months = ?0.0022, p?=?.880) and HRU (inpatient day incidence rate ratio [IRR]?=?1.03, p?=?.930; emergency room IRR =1.26, p?=?.197; and days with outpatient services IRR = 1.01, p?=?.842). The dasatinib cohort incurred higher healthcare costs by $749 per patient per month (p?=?.044) compared to the nilotinib cohort.

Limitation: Information on CML phase and Sokal score was not available.

Conclusions: Dasatinib was associated with an increased hazard of dose decrease and switching to another TKI and higher healthcare costs, vs nilotinib.