Evaluation of the long-term cost-effectiveness of liraglutide therapy for patients with type 2 diabetes in France

Objectives:

The present study aimed to compare the projected long-term clinical and cost implications associated with liraglutide, sitagliptin and glimepiride in patients with type 2 diabetes mellitus failing to achieve glycemic control on metformin monotherapy in France.

Methods:

Clinical input data for the modeling analysis were taken from two randomized, controlled trials (LIRA-DPP4 and LEAD-2). Long-term (patient lifetime) projections of clinical outcomes and direct costs (2013 Euros; €) were made using a validated computer simulation model of type 2 diabetes. Costs were taken from published France-specific sources. Future costs and clinical benefits were discounted at 3% annually. Sensitivity analyses were performed.

Results:

Liraglutide was associated with an increase in quality-adjusted life expectancy of 0.25 quality-adjusted life years (QALYs) and an increase in mean direct healthcare costs of €2558 per patient compared with sitagliptin. In the comparison with glimepiride, liraglutide was associated with an increase in quality-adjusted life expectancy of 0.23 QALYs and an increase in direct costs of €4695. Based on these estimates, liraglutide was associated with an incremental cost-effectiveness ratio (ICER) of €10,275 per QALY gained vs sitagliptin and €20,709 per QALY gained vs glimepiride in France.

Conclusion:

Calculated ICERs for both comparisons fell below the commonly quoted willingness-to-pay threshold of €30,000 per QALY gained. Therefore, liraglutide is likely to be cost-effective vs sitagliptin and glimepiride from a healthcare payer perspective in France.     

Groundwater Management in a Food Security Context

This article analyzes the sustainability of market-based instruments such as tradable permits for the management of a renewable aquifer used for irrigated agriculture. In our dynamic hydro-economic model, a water agency aims at satisfying a food security constraint within a tradable permit scheme in the presence of myopic heterogeneous agents. We identify analytically the viability kernel that defines the states of the resource yielding inter-temporal feasible paths able to satisfy the set of constraints over time and the associated set of viable quota policies. We then illustrate the theoretical results of the paper with numerical simulations based on the Western La Mancha aquifer.     

Forecasting a long memory process subject to structural breaks

We develop an easy-to-implement method for forecasting a stationary autoregressive fractionally integrated moving average (ARFIMA) process subject to structural breaks with unknown break dates. We show that an ARFIMA process subject to a mean shift and a change in the long memory parameter can be well approximated by an autoregressive (AR) model and suggest using an information criterion (AIC or Mallows’ _Cp$C_p$) to choose the order of the approximate AR model. Our method avoids the issue of estimation inaccuracy of the long memory parameter and the issue of spurious breaks in finite sample. Insights from our theoretical analysis are confirmed by Monte Carlo experiments, through which we also find that our method provides a substantial improvement over existing prediction methods. An empirical application to the realized volatility of three exchange rates illustrates the usefulness of our forecasting procedure. The empirical success of the HAR-RV model can be explained, from an econometric perspective, by our theoretical and simulation results.     

Food Price Crisis,Poverty, and Inequality

This paper simulates how a doubling of food prices affects absolute poverty and the food‐price‐adjusted real income distribution. We assume unsubsidized world food prices in order to derive the cost of poverty deepening and poverty expansion. We also estimate the degree to which inequality increases if no measures are put in place to offset rising food prices. Both measures are vulnerability indicators useful for social policy planning. Our results show that low‐income countries experience dramatic increases in absolute poverty as a result of doubling food prices. Middle‐income countries experience the greatest decrease in absolute income, which contributes most to an increase in world income inequality. The paper estimates that the global dollar value of the absolute poverty gap ($1.25/day) has the potential to increase by 400%, with poverty deepening accounting for two thirds of the increase.     

Child Growth, Shocks, and Food Aid in Rural Ethiopia

Child stunting in Ethiopia has persisted at alarming rates, despite enormous amounts of food aid, often procured in response to shocks. Using nationally representative data, the study finds that while harvest failure leads to child growth faltering, food aid affected child growth positively and offset the negative effects of shocks in communities that received food aid. However, many communities that experienced shocks did not receive food aid. In sum, while food aid has helped reduce child malnutrition, inflexible food aid targeting, together with endemic poverty and limited maternal education, has left the prevalence of child stunting at alarming levels.     

Benefiting from a Clean Environment versus Undertaking Efforts to Protect the Environment

We make an important distinction between product attribute claims related to (1) the environment of the production site and (2) environmentally friendly actions. A producer using type #1 claims benefits from a clean environment, while a producer using type #2 claims undertakes efforts to protect the environment. The categorization of those claims may not be clear to consumers. Rather than focus on informational asymmetry between producers and consumers, this article deals with the way producers may support environmental claims on agrifood products using one of the two categories.     

The (evolving) role of agriculture in poverty reduction—An empirical perspective

The role of agriculture in development remains much debated. This paper takes an empirical perspective and focuses on poverty, as opposed to growth alone. The contribution of a sector to poverty reduction is shown to depend on its own growth performance, its indirect impact on growth in other sectors, the extent to which poor people participate in the sector, and the size of the sector in the overall economy. Bringing together these different effects using cross-country econometric evidence indicates that agriculture is significantly more effective in reducing poverty among the poorest of the poor (as reflected in the $1-day squared poverty gap). It is also up to 3.2 times better at reducing $1-day headcount poverty in low-income and resource rich countries (including those in Sub-Saharan Africa), at least when societies are not fundamentally unequal. However, when it comes to the better off poor (reflected in the $2-day measure), non-agriculture has the edge. These results are driven by the much larger participation of poorer households in growth from agriculture and the lower poverty reducing effect of non-agriculture in the presence of extractive industries.     

Us knows us in the UK: On director networks and CEO compensation

We analyze the relation between CEO compensation and networks of executive and non-executive directors for all listed UK companies over the period 1996-2007. We examine whether networks are built for reasons of information gathering or for the accumulation of managerial influence. Both indirect networks (enabling directors to collect information) and direct networks (leading to more managerial influence) enable the CEO to obtain higher compensation. Direct networks can harm the efficiency of the remuneration contracting in the sense that the performance sensitivity of compensation is then lower. We find that in companies with strong networks and hence busy boards the directors' monitoring effectiveness is reduced which leads to higher and less performance-sensitive CEO compensation. Our results suggest that it is important to have the ‘right’ type of network: some networks enable a firm to access valuable information whereas others can lead to strong managerial influence that may come at the detriment of the firm and its shareholders. We confirm that there are marked conflicts of interest when a CEO increases his influence by being a member of board committees (such as the remuneration committee) as we observe that his or her compensation is then significantly higher. We also find that hiring remuneration consultants with sizeable client networks also leads to higher CEO compensation especially for larger firms.     

Volatility analysis of precious metals returns and oil returns: An ICSS approach

This study examines volatility persistence on precious metals returns taking into account oil returns and the three world major stock equity indices (Dow Jones Industrial, FTSE 100, and Nikkei 225) using daily data over the sample period January 1995 to May 2008; the aim is to analyze market relationships before the global financial crisis. We first determine when large changes in the volatility of each market returns occur by identifying major global events that would increase fluctuations in these markets. The Iterated Cumulative Sums of Squares (ICSS) algorithm was used to identify the existence of structural breaks or sudden changes in the variance of returns. In each market the standardized residuals were obtained through the GARCH(1,1) mean equation. Our main results identify a clear relationship between precious metals returns and oil returns, while the interaction between precious metals and stock returns seems to be an independent one in the case of gold with mixed results for silver and platinum. In relation to volatility persistence, the results show clear evidence of high volatility persistence between these markets, especially during times when markets were affected by excessive volatility due to economic and financial shocks.