Tofacitinib in the treatment of moderate-to-severe rheumatoid arthritis: a cost-effectiveness analysis compared with adalimumab in Taiwan

Aims: Tofacitinib is an oral Janus kinase inhibitor for the treatment of rheumatoid arthritis (RA). This analysis investigated the cost-effectiveness of the second-line treatment with tofacitinib, compared with adalimumab, both plus methotrexate (MTX), in patients with moderate-to-severe RA and an inadequate response to the first-line MTX, from a Taiwan National Health Insurance Administration perspective.

Materials and methods: A patient-level simulation model was used to project lifetime costs and quality-adjusted life-years (QALYs). Base-case analysis compared second-line treatment with tofacitinib 5?mg twice daily plus MTX vs adalimumab 40?mg every 2?weeks plus MTX. Patients switched or discontinued treatment due to a lack or loss of effectiveness or a serious adverse event. Efficacy was measured by change in Health Assessment Questionnaire-Disability Index (HAQ-DI) score. HAQ-DI scores were used to predict mortality and resource utilization, and were mapped onto utility values to estimate QALYs. Efficacy and safety data were derived from clinical trials and other secondary sources. Uncertainty in model parameters was explored using one-way deterministic and probabilistic sensitivity analyses.

Results: Patients gained 0.09 more QALYs with second-line tofacitinib plus MTX compared with adalimumab plus MTX (5.13 vs 5.04, respectively) at an additional cost of New Taiwan Dollars (NT$) 12,881. The incremental cost-effectiveness ratio was NT$143,122/QALY. One-way sensitivity analysis confirmed the base-case result was robust.

Limitations: The lack of available clinical data, particularly for HAQ-DI scores, may introduce some bias in the analysis. No patients were in an early stage of RA, which may limit the generalizability of these results. Base-case results from our study are not necessarily generalizable to countries with healthcare systems that differ considerably from Taiwan.

Conclusions: From a payer perspective, second-line treatment with tofacitinib plus MTX is a cost-effective treatment strategy, compared with adalimumab plus MTX, in patients with moderate-to-severe RA in Taiwan.

Trial registration: ClinicalTrials.gov identifier: NCT00853385.     

WHOM YOU CONNECT WITH MATTERS: DIRECTOR NETWORKS AND FIRM LOCATION

We examine whether board members serve as a channel for remotely located firms to access the benefits from business‐dense areas due to economies of agglomeration. We find that geographically remote firms benefit from connections to firms in top metropolitan statistical areas (MSAs) for business density. After controlling for director compensation, we find connections to top MSA firms mitigate the negative effect of increased distance from business‐dense areas. We address concerns of endogeneity by exploring a sample of firms whose directors gain board seats at top MSA firms and find a similar positive impact of connections to top MSA firms.     

The kill programme: an ethnographic study of ‘dirty work’ in a slaughterhouse

It has been argued that ‘dirty work’ is characterised by strong occupational and workgroup cultures. This literature has mainly focused on direct workers, but this article largely attends to indirect ‘dirty’ workers, specifically meat inspectors, through ethnographic research conducted in a UK slaughterhouse. Four arguments are developed; the first is that ‘dirty workers’ may not all display group cohesiveness; indeed, individualisation may be more evident depending upon the technology used, internationalisation and employment conditions. Second, there is complexity and diversity within ‘dirty work’ and even single occupations can contain considerable variety, rendering generalisations problematic. Third, we argue that much greater attention needs to be given to the wider contextual issues affecting ‘dirty work’, specifically changing labour markets, itinerant labour, economic conditions and technologies. Finally, we argue that stigmatised work may become more so if it is equated with the low wage economy and/or undercutting conditions of employment through exploiting migrant labour.     

Why Do We Care What Others Pay? The Effect of Other Consumers’ Prices on Inferences of Seller (Dis)Respect and Perceptions of Deservingness Violation

Comparisons to other consumers have been identified as particularly meaningful in shaping price fairness judgments, but why they should be so is not clear. The current work argues that fairness judgments reflect both the extent to which consumers receive what they believe they deserve and inferences about seller respect. We suggest that comparisons to consumers paying lower prices are a particularly potent source of unfairness because they highlight the violation of deservingness and readily communicate information about sellers’ opinions of consumers. Three experiments investigate these ideas. Implications for fairness theory and marketing are discussed.     

Localism and the Big Society: the asset transfer of leisure centres and libraries – fighting closures or empowering communities?

This paper critically examines the ‘asset transfer’ of leisure services from the public to the voluntary sector. Asset transfer might be theorised as ‘austerity localism’, in which volunteers are obliged to fill the gaps left by retreating public provision, or as ‘progressive localism’, which represents new opportunities through the localism and Big Society agendas to develop more locally responsive, cooperative and mutualist visions. In this way, asset transfer might overcome the limitations of the United Kingdom policies in which ‘Big Government’ is replaced by civic society. Drawing on qualitative interviews with key personnel (volunteers, managers and local authority officers) at 12 leisure facilities, a grounded assessment of the nuanced balance between ‘austerity localism’ and ‘progressive localism’ is provided, including three observations. First, the main impetus for transfer was cuts in local authority budgets which stimulated the emergence of local groups of volunteers. Secondly, the transfers themselves required interaction between local government and the volunteer groups; however, the nature of the relationship and support given varied and support was limited by austerity measures. Thirdly, volunteers do not automatically fill a gap left by the state: without support transfer viability relies on the financial and social capital among volunteer groups, and this is unevenly distributed. These findings suggest that the capacity for a ‘progressive localism’ to emerge through asset transfer is limited. However, where transfer has occurred, there are some progressive benefits of volunteer empowerment and a more flexible service.     

U.S. Auditors' Perceptions of the PCAOB Inspection Process: A Behavioral Examination

This study examines U.S. auditors' observations of the PCAOB inspection process, and its impact on their work, in order to understand the current U.S. regulatory audit climate. Using 20 interviews with experienced auditors, we consider behavioral factors (e.g., perceived power of and trust in the PCAOB) that can impact the level and form of auditor compliance according to theory from the slippery slope framework on audit regulation (Kirchler et al. 2008; Dowling et al. 2018). Our participants described an audit climate with a powerful regulator. They reported that their desire to receive “clean” inspection reports has had a substantial impact on audit procedures and quality control. However, our participants do not appear to have high trust in the PCAOB, as they questioned aspects of the inspection process and its expectations. Accordingly, we conclude that U.S. public company auditors operate in an antagonistic environment in which auditors perceive the PCAOB has high coercive power. In other words, they comply due to fear of enforcement rather than agreement with the PCAOB's views on audit quality. Some auditors also indicated that they consider both the costs and benefits of compliance. Theoretical intuition implies that any future increases to perceived costs relative to perceived benefits of compliance could ultimately decrease the PCAOB's coercive power and reduce U.S. auditor compliance. Our findings have implications for regulators and researchers interested in understanding behavioral factors that may influence regulatory compliance.     

Testing the orthodoxies of land degradation policy in Swaziland

This paper explores Swaziland's National Action Programme (NAP) to combat desertification; the country's main strategy for implementing the United Nations Convention to Combat Desertification (UNCCD). It considers whether this policy tackles real problems supported by micro-level scientific evidence and local experiences, or whether it further reinforces popular orthodoxies about land degradation. Data from one case study chiefdom in Swaziland are used to test two key orthodoxies identified within the country's NAP: (1) the presentation of degradation as a neo-Malthusian problem resulting from population pressure and (2) the assumption that the poor are responsible for degradation of their environment, in particular, the over-use of forest areas and the degradation of soils. It is found that diverse rural livelihoods inherently deliver patches of degradation at the micro-level but it is not necessarily population pressure or poor people that cause the degradation. Households with varying assets simultaneously degrade and conserve different parts of the land resource through pursuing different livelihood activities. The data indicate that while the NAP focuses on mythical problems grounded in the orthodoxies, policy attention is directed away from the more serious land degradation issues affecting rural livelihoods. The findings of this study provide a more nuanced understanding of the gaps between land degradation policy, local conservation practice and environmental and livelihood outcomes, and suggest that policymakers need to evaluate more critically the outdated and simplistic degradation orthodoxies on which much current policy is based. Stronger links need to be made between scientific and policymaking communities, while more credence should be given to land users’ own knowledges, perspectives, concepts and categories surrounding issues of soil conservation and degradation. It is suggested that steps need to be taken towards the development of broadly applicable benchmarks and indicators that bring together local and scientific knowledges across levels. Without this, popularised orthodoxies will continue to provide a basis for inappropriate land policy.     

The limits of the wage impact of discrimination

In spite of almost 40 years of active enforcement efforts by the EEOC, as well as the strong intervention by the plaintiff bar, the most popular benchmark by which we measure the influence of prejudice on wages paid to female and minority workers has changed very little. This paper maintains that to a large extent this seeming immunity of discriminatory wage gaps to the legal remedies provided by Title VII results from the mismeasurement of those effects. An alternative to the standard Oaxaca decomposition of the wage gap is offered which allows us to put plausible ranges around the true impact of antidiscrimination laws. Not only does this reduce the residual impact of the discrimination that appears to withstand Title VII remedies, it also suggests that the pre‐Title VII impact of discrimination on wages accounted for little of the gap observed at the time of its passage. Copyright © 2005 John Wiley & Sons, Ltd.     

The role of image in service promotion: focusing on the influence of film on consumer choice within tourism

This paper presents a review and discussion of the role image plays in service promotion and consumer choice in the context of film‐induced tourism. Consumers can be very sensitive to images which are important determinants of what a service customer purchases. In relation to image, the medium of film can have a very influential impact on its audience. Consumers may make purchase choices in a range of areas as a result of what they have seen in the movies. An expanding body of literature suggests that film can influence people's travel decisions and entice them to visit particular destinations they have seen on the cinema screen (reinforced through repeat viewing on video, DVD and television). Tourism is a service industry. Does the image of a destination and how it is represented help overcome some of the challenges of service marketing? Many regions throughout the British Isles have seen their consumer appeal improve because of their links with respective film and television productions. Although they have benefited tourism‐wise from this, in many cases there still has not been enough real support from tourist authorities to this growth phenomenon, and as such, the full potential of film to tap into the consumer psyche has not yet been fully realized. Academic discourse from several disciplines is examined in this communication culminating in a conceptual model of destination enhancement through film‐induced image, featuring the conscious and unconscious communication factors at work on two sets of consumers (film consumers and destination consumers). As a ‘work in progress’, the paper sets the scene for further empirical research in this interesting area of study.