Cost-effectiveness analysis of secukinumab for the treatment of active psoriatic arthritis: a Canadian perspective

Objective: The study evaluates the cost-effectiveness of secukinumab, a fully human monoclonal antibody that selectively neutralizes interleukin (IL)-17A, vs currently licensed biologic treatments in patients with active psoriatic arthritis (PsA) from a Canadian healthcare system perspective.

Methods: A decision analytic semi-Markov model evaluated the cost-effectiveness of secukinumab 150?mg and 300?mg compared to subcutaneous biologics adalimumab, certolizumab pegol, etanercept, golimumab, and ustekinumab, and intravenous biologics infliximab and infliximab biosimilar in biologic-naive and biologic-experienced patients over a lifetime horizon. The response to treatments was evaluated after 12 weeks by PsA Response Criteria (PsARC) response rates. Non-responders or patients discontinuing initial-line of biologic treatment were allowed to switch to subsequent-line biologics. Model input parameters (Psoriasis Area Severity Index [PASI], Health Assessment Questionnaire [HAQ], withdrawal rates, costs, and resource use) were collected from clinical trials, published literature, and other Canadian sources. Benefits were expressed as quality-adjusted life years (QALYs). An annual discount rate of 5% was applied to costs and benefits. The robustness of the study findings were evaluated via sensitivity analyses.

Results: Biologic-naive patients treated with secukinumab achieved the highest number of QALYs (8.54) at the lowest cost (CAD 925,387) over a lifetime horizon vs all comparators. Secukinumab dominated all treatments, except for infliximab and its biosimilar, which achieved minimally more QALYs (8.58). However, infliximab and its biosimilar incurred more costs than secukinumab (infliximab: CAD 1,015,437; infliximab biosimilar: CAD 941,004), resulting in higher cost-effectiveness estimates relative to secukinumab. In the biologic-experienced population, secukinumab dominated all treatments as it generated more QALYs (8.89) at lower costs (CAD 954,692). Deterministic sensitivity analyses indicated the results were most sensitive to variation in PsARC response rates, change in HAQ, and utility values in both populations.

Conclusions: Secukinumab is either dominant or cost-effective vs all licensed biologics for the treatment of active PsA in biologic-naive and biologic-experienced populations in Canada.     

Integrating econometrics: A modern undergraduate economics capstone experience

Angrist and Pischke (2017) call for a pedagogical paradigm shift by pointing out that econometrics courses often do not align with modern empirical approaches employed by economists. This article's authors propose a modern capstone experience, designed to address these concerns by integrating econometrics into the traditional capstone approach. They couple a full econometrics course with a traditional capstone course by weaving a cohesive econometrics-heavy research paper through the two courses. They feel this approach addresses the lack of econometrics skills among economics majors while simultaneously making some necessary improvements to undergraduate econometrics content. They hope this article will be a valuable resource for programs changing course requirements or revamping their curriculum to better fit the increasing demand for data analysis skills in the job market.     

Cost-effectiveness of angiotensin-converting enzyme inhibitors versus angiotensin II receptor blockers as first-line treatment in autosomal dominant polycystic kidney disease

Background: Autosomal dominant polycystic kidney disease (ADPKD) is a rare kidney disorder impacting ～1:2,500 individuals among the general US population. Hypertension is a significant predictor of ADPKD progression, and a risk factor for development of cardiovascular disease (CVD), the most common cause for mortality among ADPKD patients. Angiotensin-converting enzymes inhibitors (ACE-I) are widely used as first-line treatment in ADPKD for the management of hypertension. However, their cost-effectiveness relative to other hypertensive medications, such as angiotensin II receptor blockers (ARB), has never been assessed.

Objective: To determine if ARB are more cost-effective than ACE-Is as first-line treatment in ADPKD.

Methods: A Markov-state decision model was constructed for estimation of cost and outcome benefits in hypertensive ADPKD patients. Transition probabilities were extrapolated from a retrospective cohort study comparing chronic kidney disease (CKD) stage transitions in ADPKD patients. Annual pharmaceutical costs per average daily dose per CKD stage were extracted from a US healthcare claims database. Median total healthcare costs per CKD stage or transplant were extracted from the published literature. The time horizon was set to 30 years, with 1-year duration to cycle shift. A cost-effectiveness analysis was conducted to estimate the incremental cost-effectiveness ratio (ICER) of ACE-I vs ARB per additional year of prevented transplant and/or death. A one-way probabilistic sensitivity analysis was conducted, with 10% variation in probabilities and cost.

Results: Total annual healthcare costs accrued after 30 years among ADPKD patients taking ACE-Is was estimated to be $3,505,028.41, compared to ARB at $3,644,327.65. Life expectancy was increased by 1.39 years among patients taking ACE-I. Approximate 10-year survival in patients taking ACE-Is was 47% compared to ARB at 34%.

Conclusions: ACE-I dominated ARB and displayed greater cost-effectiveness due to lower cost and increased capacity to prolong years of life without transplant or death among hypertensive ADPKD patients. This model strengthens the value of ACE-I over ARB as first-line treatment for hypertension management in ADPKD patients.     

Influence and the discretionary allocation of several prizes

When a decision process involves discretion, it may also be open to influence by various actors. If a single prize is at issue, then this influence can be modelled in the context of a rent-seeking game. However, the basic rent-seeking model needs to be extended in order to examine the amount of influence exerted when more than one prize is at stake. In this paper, we investigate the effect of several factors which may affect rent-seeking in this multi-prize framework but are not accounted for in single-prize models; examples here are the number of prizes, the division of the prize mass and the distribution mechanism which is employed.     

An investigation of marketing capabilities and upgrading performance of manufacturers in mainland China and Hong Kong

Although Chinese manufacturers are considered as latecomers or followers in global commodity chains, they have also been experiencing rapid progress in upgrading performance from own equipment manufacturing (OEM), original design manufacturing (ODM) to own brand manufacturing (OBM). Current literature on the global commodity chain has focused primarily on economic conditions that help explain manufacture upgrade while giving limited attention to what marketing capabilities support and sustain firm competitiveness through upgrading. This article examines eight different marketing capabilities to assess influence on manufacture upgrade performance. A survey of electronics manufacturers in mainland China and Hong Kong shows the significance of individual marketing capabilities and implications of their interdependency for manufacture upgrade performance. In particular, product development, marketing communication and channel management capabilities are crucial for manufacture upgrade. The results also highlight the importance of selective marketing capability development and the potential of secondary support for the relationship between substantive and dynamic capabilities.     

The role of regional airports and air services in the United Kingdom

This paper deals with the implications of the 1998 UK transport White Paper for regional airports and air services within the wider context of the promotion of an integrated and sustainable transport system. More specifically, the discussion initially addresses the political and business context of the development of air transport in the UK regions. Secondly, the recent trends defining that development are isolated, particular attention being paid to the increasing importance of supplier-led strategies in air transport and the segmented markets served by regional airports. Finally, the three, not easily reconciled, strands, which can be identified in the White Paper’s analysis of aviation are considered. These are: air transport's relationship with sustainable development; the integration of air transport with surface modes; and the contribution of air transport to regional economic growth.     

‘An edifying spectacle’: A history of ‘tourist corroborees’ in Victoria,Australia, 1835–1870

Parsons [Parsons, M. (2002). “Ah that I could convey a proper idea of this interesting wild play of the natives” corroborees and the rise of indigenous Australian cultural tourism. Australian Aboriginal Studies, 2(1), 14–27.] has persuasively argued that nineteenth century corroborees performed for non-indigenous audiences may be considered to be Australia's pre-eminent prototypical indigenous cultural tourism product. This paper extends Parsons' [Parsons, M. (1997). The tourist corroboree in South Australia. Aboriginal History, 21(1), 46–69; Parsons, M. (2002). “Ah that I could convey a proper idea of this interesting wild play of the natives” corroborees and the rise of indigenous Australian cultural tourism. Australian Aboriginal Studies, 2(1), 14–27.] analyses of ‘tourist corroborees’ in nineteenth century South Australia to corroborees staged in Victoria during the pastoral period and the gold rushes of the 1850–1870s. It argues that an Aboriginal-grown ‘business acumen’ developed rapidly in the economic climate of the Victorian goldfields. It also provides a historical context to this commodification.     

Integration, embeddedness and local economic development. The case of the clothing industry in Coventry

This paper examines the ways in which a new sector is linked to a local economy, and the implications for local economic development. The focus is on the clothing industry in Coventry which survey evidence suggests operates independently and in isolation. A major reason is that the sector is only weakly embedded in a social sense. Clothing manufacturers have a low social profile and contribute little to the institutionalised business life of the city. The consequences of low integration are examined, as are the steps necessary to anchor the sector within the local area.