A cost-effectiveness analysis of denosumab for the prevention of skeletal-related events in patients with multiple myeloma in four European countries: Austria,Belgium, Greece,and Italy

Aim: The approved indication for denosumab (120?mg) was expanded in 2018 to include skeletal-related event (SRE) prevention in patients with multiple myeloma (MM). Therefore, a cost-effectiveness analysis was conducted comparing denosumab with zoledronic acid (ZA) for SRE prevention in patients with MM from the national healthcare system perspective in a representative sample of European countries: Austria, Belgium, Greece, and Italy.

Methods: The XGEVA global economic model for patients with MM was used to calculate incremental cost-effectiveness ratios (ICERs) for denosumab vs ZA over a lifetime horizon. Clinical inputs were derived from the denosumab vs ZA randomized, phase 3 study (“20090482”) in patients newly-diagnosed with MM, and comprised real-world adjusted SRE rates, serious adverse event (SAE) rates, treatment duration, dose intensity, progression-free survival (PFS), and overall survival (OS). Economic inputs comprised country-specific denosumab and ZA acquisition and administration costs, SRE and SAE management costs, and discount rates. Health utility decrements associated with MM disease progression, SRE and SAE occurrence, and route of administration were included.

Results: Estimated ICERs (cost per quality-adjusted life-year [QALY] gained) for denosumab vs ZA in Austria, Belgium, Greece, and Italy were €26,294, €17,737, €6,982, and €27,228, respectively. Using 1–3 times gross domestic product (GDP) per capita per QALY as willingness to pay thresholds, denosumab was 69–94%, 84–96%, 79–96%, and 50–92% likely to be cost-effective vs ZA, respectively.

Limitations: Economic inputs were derived from various sources, and time to event inputs were extrapolated from 20090482 study data.

Conclusions: Denosumab is cost-effective vs ZA for SRE prevention in patients with MM in Austria, Belgium, Greece, and Italy, based on often-adopted World Health Organization thresholds. This conclusion is robust to changes in model parameters and assumptions. Cost-effectiveness estimates varied across the four countries, reflecting differences in healthcare costs and national economic evaluation guidelines.     

The decision-making dimension of the systems approach to management

Theoretically, a system is anything that is made up of various parts. Theses parts are known as subsystems. At every point in time, these parts should work in harmony so that objectives could be achieved successfully. A system could be inanimate or animate item. Examples of inanimate systems include vehicles, households, computer and institution. Examples of animate systems are human being, animal and insect. Both inanimate and animate systems are made up of various subsystems. Such subsystems are required to co-operate, collaborate and work together so that set objectives could be achieved successfully. From practical managerial point of view, business organizations are equally systems that are made up of subsystems which may take the form of departments, sections and/or units. It is supposed to be collaborations among the managers and other members in these departments, sections and/or units so that organizational objectives could be achieved. All the managers in various departments, sections and/or units are required to work together as a team to make the system coherent and closely-knit to make disintegration impossible. Closely related to the systems approach to management is managerial decision-making. Decision-making is a very important function of every manager＇s job. The success and failure stories of many organizations are the result of the quality of decisions made. Many organizations have survived turbulent conditions. Others have also collapsed in spite of favourable conditions. These varying conditions are the result of the quality of decisions made by managers at positions of authority and responsibility. Therefore the systems approach to management enjoins top managers in particular to be very circumspect and cautious in certain decision-making activities. This is because, the quality of decision a manager makes can go a long way to determine the success or failure story of an organization as exemplified in the case study in this paper.     

Buyer behaviour in a regional thoroughbred yearling market

This paper reports the results of an hedonic pricing analysis of a regional thoroughbred auction market, adding to a literature which has been built mainly on data from elite auction markets. The main contribution of the paper is the finding that the role of the dam in affecting yearling price, elusive in the existing literature, is shown to depend primarily on information about progeny performance rather than dam performance. Additional results confirm existing knowledge about the roles of the sire, yearling sex, and yearling age, and support suspicions that race horses are consumer rather than investment goods.     

Entrepreneurship and limited access: rethinking business–state relations in Russia

Predominant theories of the Russian political economy explain the vulnerability of independent business to the state, but they do not adequately explain why businesses survive and some thrive. Recent empirical studies of business conditions have not helped in this regard because most focus on ascertaining entrepreneurs’ attitudes rather than observing their behaviour. During ethnographic fieldwork within a Siberian business, the author found that informants were pessimistic about business conditions, but that they did not expect any improvement and had developed pragmatic approaches to securing their position in the local market and competencies required to generate a profit. Their relations with dominant elites were, moreover, cordial rather than antagonistic. To account for these findings, the author draws on Douglass C. North et al.’s Limited Access Order theory and Aleksei Yurchak’s concept of ‘entrepreneurial governmentality’, and seeks to reconceptualise the relationship between business and the state.     

Matching Industries between Target and Acquirer in High-Tech Mergers and Acquisitions

Mergers and acquisitions (M&As) have been regarded as a highly viable option for fostering innovation, gaining new products or services, and gaining access to new markets in high technology firms. This study analyzes several alternative variables that impact M&A choices by analyzing their relationship to the industry of both the acquirer and target. Results support two hypotheses implying that (1) M&A transactions with the same acquirer and target industry are more likely to be acquisitions that delivers a greater final share of the target organization to the acquirer, and (2) acquirers are more likely to invest greater dollar amounts in targets that have the same primary industry.     

Developing a multiple-criteria decision analysis for green economy transition: a Canadian case study

ABSTRACT

Identifying planning strategies for the transition to a green economy is a formidable challenge. We proposed a novel multiple-criteria decision analysis model which can quantitatively identify the socio-economic and environmental impacts of various government and public policies. We applied the model to four practical scenarios in Canada for determining the optimal final demand that maximizes the country's GDP and employment while minimizing GHG emissions for small, short-term changes. As a result, the model suggested potential ways to simultaneously achieve a GDP growth of 2.5 billion CAD and creation of over 25,000 new jobs, and a saving of 2514 kt CO₂. As per the final demand, the electrification of domestic heating and transport should be more promoted. The proposed analysis tool will provide decision-makers with the ability to explore the design and effects of policy reforms, regulatory changes, and targeted public expenditure strategies, thereby overcoming barriers towards a green economy.     

External Liberalization and Foreign Presence: Cross-Industry Evidence From Poland and Hungary

External liberalization—the relaxation of restrictions on cross-border trade and inbound direct investment—has played an important role in the programs of economic transition in central Europe. While liberalization is widely heralded, there has been little empirical analysis of the links between liberalization and industry structure. This analysis examines changes in foreign presence following external liberalization in Poland and Hungary. I show that the presence of proprietary and intangible assets explains much of the cross-industry variation in patterns of foreign presence and, for a given level of foreign presence, whether this will occur via trade or inbound direct investment.     

Optimal early action on greenhouse gas emissions

In this paper I argue that early action policies that focus on early actual emission reductions will tend to distort abatement investment decisions and thereby inflate the national compliance cost of a greenhouse gas emissions reduction target. Compliance cost savings stem from well-planned early action that may or may not yield early actual emission reductions. Thus, policies that target actual emission reductions, such as 'credit for early action' or an aggressive, early 'cap-and-trade' program, have the potential to be highly distorting. Simulation results from a model calibrated to the Canadian economy suggest that the associated welfare losses could be many billions of dollars.     

External Liberalization and Foreign Presence: Cross-Industry Evidence from Poland and Hungary

External liberalization—the relaxation of restrictions on cross-border trade and inbound direct investment—has played an important role in the programs of economic transition in central Europe. While liberalization is widely heralded, there has been little empirical analysis of the links between liberalization and industry structure. This analysis examines changes in foreign presence following external liberalization in Poland and Hungary. I show that the presence of proprietary and intangible assets explains much of the cross-industry variation in patterns of foreign presence and, for a given level of foreign presence, whether this will occur via trade or inbound direct investment.