Evaluating drug cost per responder and number needed to treat associated with lixisenatide on top of glargine when compared to rapid-acting insulin intensification regimens on top of glargine,in patients with type 2 diabetes in the UK,Italy, and Spain

Objectives: This study investigated the cost per responder and number needed to treat (NNT) in type 2 diabetes mellitus (T2DM) patients for lixisenatide compared to insulin intensification regimens using composite endpoints in the UK, Italy, and Spain.

Methods: Efficacy and safety outcomes were obtained from GetGoal Duo-2, a 26-week phase 3 trial comparing lixisenatide vs insulin glulisine (IG) once daily (QD) and three times daily (TID). Response at week 26 was extrapolated to 52 weeks, assuming a maintained treatment effect, based on long-term evidence in other T2DM populations. Responders were defined using composite end-points, based on an HbA1c threshold and/or no weight gain and/or no hypoglycemia. The HbA1c threshold was varied in sensitivity analyses. Annual treatment costs were estimated in euros (1 GBP?=?1.26 EUR), including drug acquisition and resource use costs. Cost per responder was computed by dividing annual treatment costs per patient by the proportion of responders.

Results: Lixisenatide was associated with the lowest cost per responder for all composite end-points that included a weight-related component. For the main composite end-point of HbA1c ≤7.5% AND no weight gain AND no symptomatic hypoglycemia, cost per responder results were: UK: 6,867€, 8,746€, and 12,410€; Italy: 7,057€, 9,160€, and 12,844€; Spain: 8,370€, 11,365€, and 17,038€, for lixisenatide, IG QD, and TID, respectively. The NNT analysis showed that, for every 6.85 and 5.86 patients treated with lixisenatide, there was approximately one additional responder compared to IG QD and TID, respectively.

Limitations: A limitation of the clinical inputs is the lack of 52-week trial data from GetGoal Duo-2, which led to the assumption of a maintained treatment effect from week 26 to 52.

Conclusions: This analysis suggests lixisenatide is an efficient economic resource allocation in the UK, Italy, and Spain.     

Imports and TFP at the firm level: the role of absorptive capacity

This paper estimates the effect of the decision to import intermediate goods and capital equipment on Total Factor Productivity (TFP) at the firm level on a panel of Spanish firms (1991–2002). We use two alternative approaches. In the first, we estimate TFP and apply a diff‐in‐diff estimator with a control group constructed by propensity‐score matching. In the second, direct method, we estimate TFP with imported inputs as a state variable in one stage. Both approaches show that the effect of a firm's decision to source intermediates and capital equipment abroad on its TFP depends critically on its capacity to absorb technology, measured by the proportion of skilled labour.     

A discussion of the market and policy failures associated with the adoption of herbicide-tolerant crops

Weed control in the U.S. Midwest has become increasingly herbicide-centric due to the adoption of herbicide-tolerant (HT) crops in the 1990s. That integrated weed management (IWM) practices, including ecological and mechanical controls, are scarcely used is concerning. IWM would be a more sustainable form of farming for two reasons. First, it would reduce the negative health and environmental externalities associated with herbicide use. Second, it would reduce the selection pressure on weed populations and the development of weed resistance to some herbicides, thereby reducing the uncertainty of the long-term effectiveness of herbicidal weed control. In this context, we develop an economic framework to clarify the interplay among the different market failures that either contribute to the herbicidal ‘lock-in’ or make it problematic. We then analyse the evidence for and perceptions of these market failures based on twenty-four semi-structured interviews with farmers and experts conducted in 2017, as well as on discussions in the academic literature. To this end, we put into perspective the possible self-reinforcing effects in the adoption path of HT crops, such as increasing farm size, changes in farm equipment, increasing incentives for simplified crop rotations, and the loss of practical knowledge of IWM practices.     

The health insurance status of Texans: Determinants of uninsurance (summary)

This is a report of a statewide survey of the numbers and characteristics of the uninsured, giving a profile of the uninsured in Texas.     

The use of executive share-based compensation in Poland: investigating institutional and agency-based determinants in an emerging market

In this paper we investigate the under-researched topic of the use of executive share-based compensation in Poland, and we analyse empirically whether theoretical explanations developed and applied mainly in the context of developed countries also hold in this specific context. Building on agency and institutional theories we study the determinants of using executive share-based pay in 362 companies listed on the Warsaw Stock Exchange. As a result, we highlight the role of the state in Polish firms and the need to consider specifically principal–principal conflicts typical of emerging economies in post-state-socialist organisational research. Our findings not only reflect particularities of the institutional environment in the country studied but also highlight the limits of the traditional principal–agent lens applied in emerging economies.     

Classification situations: Life-chances in the neoliberal era

This article examines the stratifying effects of economic classifications. We argue that in the neoliberal era market institutions increasingly use actuarial techniques to split and sort individuals into classification situations that shape life-chances. While this is a general and increasingly pervasive process, our main empirical illustration comes from the transformation of the credit market in the United States. This market works as both as a leveling force and as a condenser of new forms of social difference. The U.S. banking and credit system has greatly broadened its scope over the past twenty years to incorporate previously excluded groups. We observe this leveling tendency in the expansion of credit amongst lower-income households, the systematization of overdraft protections, and the unexpected and rapid growth of the fringe banking sector. But while access to credit has democratized, it has also differentiated. Scoring technologies classify and price people according to credit risk. This has allowed multiple new distinctions to be made amongst the creditworthy, as scores get attached to different interest rates and loan structures. Scores have also expanded into markets beyond consumer credit, such as insurance, real estate, employment, and elsewhere. The result is a cumulative pattern of advantage and disadvantage with both objectively measured and subjectively experienced aspects. We argue these private classificatory tools are increasingly central to the generation of “market-situations”, and thus an important and overlooked force that structures individual life-chances. In short, classification situations may have become the engine of modern class situations.     

Trade,Tariffs and Total Factor Productivity: The Case of Spanish Firms

The aim of this paper is to examine the sensitivity of total factor productivity (TFP) to foreign competition in the case of a European country. Using the Olley and Pakes method, we calculate the TFP of Spanish manufacturing firms and study the impact of EU tariffs and the presence of foreign products and imports on TFP at the firm level. Applying the System‐GMM method, we find that TFP is negatively impacted by European tariffs, whereas competition in the form of the increased presence of foreign products in the domestic market and firm imports leads to improvements in the TFP. Moreover, these two effects are complementary. We also find evidence of important asymmetries among firms depending on their involvement in foreign markets.     

China’s Growth,Stability, and Use of International Reserves

Since the onset of the global financial crisis, China and the U.S. have reduced their current-account imbalances as a share of GDP to less than half their pre-crisis levels. For China, the reduction in its current-account surplus post-crisis suggests a structural change. Panel regressions for a sample of almost 100 countries over 1983–2013 confirm that the relationship between current-account balances and economic variables changed in important ways after the financial crisis. China’s rebalancing has been accompanied by a decline in its reserves-to-GDP ratio and greater outward FDI that, in turn, has mitigated reserve hoarding.