Cost effectiveness of benralizumab for severe,uncontrolled oral corticosteroid–dependent asthma in Sweden

Abstract

Aim: We investigated cost effectiveness of benralizumab vs. standard of care (SOC) plus oral corticosteroids (OCS) for patients with severe, eosinophilic OCS-dependent asthma in Sweden.

Materials and methods: A three-state, cohort-based Markov model of data from three Phase III benralizumab clinical trials (ZONDA [NCT02075255], SIROCCO [NCT01928771], and CALIMA [NCT01914757]) was used to assess the incremental cost-effectiveness ratio of benralizumab vs. SOC plus OCS. Health outcomes were estimated in terms of quality-adjusted life-years (QALYs). The model included costs and disutilities associated with extrapolated OCS-related adverse events. Patients with severe asthma were defined as those receiving OCS ≥5?mg/day.

Results: Benralizumab demonstrated a cost-effectiveness ratio vs. SOC plus OCS of 2018 Swedish Kronor (SEK) 366,855 (€34,127) per QALY gained, based on increases of 1.33 QALYs and SEK 488,742 (€45,344) per patient. Benralizumab treatment costs contributed most to incremental costs. The probability of benralizumab’s being cost-effective with willingness-to-pay (WTP) thresholds between SEK 429,972 (€40,000) and SEK 752,452 (€70,000) ranged from 75% to 99%.

Limitations: Potential limitations of these analyses include the use of combined data from three different clinical trials, a one-way sensitivity analysis that did not include mortality and transition estimates, and Observational & Pragmatic Research Institute (OPRI) data from the UK as a proxy of the Swedish health care system.

Conclusions: The results of these analyses demonstrate that benralizumab has a high probability of being cost-effective compared with SOC plus OCS for a subgroup of patients with severe, eosinophilic asthma receiving regular OCS treatment and may support clinicians, payers and patients in making treatment decisions.     

The shading and distancing of commerce: When internalization is not enough

A political economy of degradation and of sustainability should account not only for the full range of production costs but the sources of those costs. It should consider how the pursuit of wealth can, deliberately or not, lead to uncounted costs and unaccountable actors. This article explores the conditions of cost generation and externalization, especially those that are largely unintended and inadvertent. It shows how the pursuit of wealth, the expansion of markets, the mobility of capital, and the entanglements of production processes can lead to the unwitting generation and displacement of costs. It analyzes competitive business strategy and patterns of production and consumption for their contribution to such costs. Business strategy and state policy tend to create a never-ending search for frontiers, however simulated and however unecological they may be. The costs generated in those frontiers are a function of shading, that is, obscuring of costs, and distancing, the separation of production and consumption decisions, both of which impede ecological and social feedback and create cognitive, institutional, and ethical lags between initial benefits and eventual full costs. As distance increases along dimensions of geography, culture, bargaining power, or agency, negative feedback loops are severed, stakeholders expand while decision making contracts, environmental problems are displaced, and shading and cost externalization increase. The likelihood of sustainable resource use increases as distance is lowered, as institutions locate decision authority in those who receive negative ecological feedback and who have the capacity and incentives to act on that feedback, and as the burden of proof for economic interventions shifts to the interveners.     

The nature of Austrian macroeconomic time series unit root tests

It is still an open question in economic and econometric modelling whether the non-stationarity in a time series is captured by detrending or by differencing. We test thirrteen Austrian macroenconomic time series for difference versus trend stationarity using informal methods and formal procedures developed by Dickey-Fuller and Phillips-Perron. To eliminate the effects of seasonal adjustment on the tests we apply a third procedure to the unadjusted data, recently developed by Hylleberg-Engle-Granger-Yoo. Independent of the seasonal adjustment the empirical results indicate that these series are integrated of order 1.     

Unemployment insurance and union bargaining — an insider-outsider approach

A trade union is required to tax its own members to fund unemployment benefit paid to its unemployed members in an insider-outsider model of union bargaining over wages and employment. An increase in unemployment benefit imposed by the government increases employment overall but not necessarily the employment of insiders if the tax rate is exogenously fixed by the government.This paper has benefited from comments of Mick Common, Dipak Ghosh, Bob Hart, and Robin Ruffell. The comments of two anonymous referees and the advice of the Editor have greatly improved the presentation of the paper. Any remaining errors or omissions are the responsibility of the authors.     

Erratic monetary policy and price variability

This paper examines the effect of erratic monetary policy on individual behavior, as well as the aggregate economy. It is demonstrated that an increase in erratic monetary policy causes an increase in demand for inventories by individuals. This behavior by individuals in turn leads to a higher variability of the price level, as well as a higher price level in the steady state of the aggregate economy.     

Linking scenarios across geographical scales in international environmental assessments

The development and analysis of scenarios or plausible futures has evolved to be a useful approach for dealing with uncertainty about future developments in a structured and integrated manner. Commonly, scenario exercises have focussed on processes at one specific geographic scale. Recently scenario-based approaches have also been used to address multi-scale processes or to link scenarios developed at various geographical scales with each other in order to better understand the interaction of processes across scales.The level of interconnectedness across scales will vary, and depends largely on the approaches used to develop multi-scale scenarios. We distinguish five levels of interconnectedness scenarios may display across scales: (a) Equivalent, (b) Consistent, (c) Coherent, (d) Comparable, and (e) Complementary. Furthermore, we describe five different types of coupled scenario development processes: (a) Joint, (b) Parallel, (c) Iterative, (d) Consecutive, and (e) Independent.Based on this nomenclature, the relationship between the level of interconnectedness of scenarios and the degree of coupling of scenario development processes across geographical scales is discussed. Which process is best suited and how much interconnectedness is needed, will depend both on the focal issue and the primary purpose of the scenario exercise, i.e. whether the aim is education, scientific exploration, or decision-support.     

A framework for market-based organizational learning: Linking values, knowledge, and behavior

The authors review the concept of organizational learning and present a broad conceptual framework for its modeling. Within this framework, one specific process for market-based organizational learning is postulated. An empirical test of this model leads the authors to conclude that a more positive learning orientation (a value-based construct) will directly result in increased market information generation and dissemination (knowledge-based constructs), which, in turn, directly affects the degree to which an organization makes changes in its marketing strategies (a behavioral construct). Managerial implications are discussed. His research interests lie primarily in the areas of organizational information use and market-based organizational learning. His work has been published in theJournal of the Academy of Marketing Science, Journal of Advertising Research, Journal of Business Research, andJournal of Marketing. His research interests include both individual and organizational learning. He has published in the areas of consumer decision making, advertising effectiveness, and market-based organizational learning. His research interests include organizational marketing and marketing channels. His work has been published in theJournal of Marketing, Journal of Business and Economic Statistics, Journal of Business Logistics, Journal of Purchasing and Materials Management, andJournal of Health Care Marketing.     

Book Reviews

M. Arsjad Anwar, Thee Kian Wie, Iwan Jaya Azis, Pemikiran, Pdaksanaan, dan Perintisan Pembangunan Ekonomi[Concepts, Implementation, and Pioneering in Economic Development], Fakultas Ekonomi Universitas Indonesia and PT Gramedia Pustaka Utama, Jakarta, 1992, pp. xx + 700.

Adam Schwarz, A Nation in Waiting: Indonesia in the 1990s, Allen and Unwin, Sydney, and Westview, Boulder, 1994, pp. 370. Paper: A$24.95.

East Asia Analytical Unit, Expanding Horizons: Australia and Indonesia into the 22st Century,Department of Foreign Affairs and Trade, Canberra, 1994, pp. xviii + 346. A$34.95.

Sjahrir, Pikiran Politik[Political Ideas], LP3ES, Jakarta, 1994, pp. xiv + 191.

Sjahrir, Persoalan Ekonomi Indonesia: Moneter, Perkreditan dan Nenca Pembayaran[Problems of the Indonesian Economy: Money, Credit and the Balance of Payments], Pustaka Sinar Harapan, Jakarta, 1995, pp. xv + 205.

Sjahrir, Analisis Bursa Efek[Analysis of the Stock Exchange], PT Gramedia Pustaka Utama, Jakarta, 1995, pp. xiv + 169.

Sjahrir, Ekonomi Indonesia dalam Perspektif Bisnis[The Indonesian Economy in a Business Perspective], PT Jurnalindo Aksara Grafika, Jakarta, 1994, pp. xvi + 239.

Sjahrir, Kebijakan Negara Mengantisipasi Masa Depan[National Policy: Anticipating the Future], Yayasan Obor Indonesia, Jakarta, 1994, pp. xv + 251.

Sjahrir, Formasi Mikro-Makro Ekonomi Indonesia[Indonesia's Macro and Micro Economy], Penerbit Universitas Indonesia, Jakarta, 1995, pp. xii + 313

F.B.A. Bouman and Otto Hospes, Financial Landscapes Reconstructed: The Fine Art of Mapping Development,Westview, Boulder, 1994, pp. xi + 416. US$45.00

Robert Cribb (ed.), The Late Colonial State in Indonesia: Political and Economic foundations of the Netherlands Indies 1880–1942,Verhandelmgen van het Koninklijk Instituut voor Taal-, Land- en Volkenkunde 163, KITLV Press, Leiden, 1994, pp. xiii + 295.

Shinya Sugiyama and Milagros C. Guerrero (eds), International Commercial Rivalry in Southeast Asia in the Inierwar Period,Yale Southeast Asia Studies Monograph 39, Yale Center for International and Area Studies, New Haven, 1994, pp. ix + 222.

W.L. Korthals Altes, Changing Economy in Indonesia. Volume 15: Prices (Non-Rice) 1814–1940,Royal Tropical Institute, Amsterdam, 1994, pp. 175. Paper: Dfl. 48.00.     

Ethical issues confronting travel agents

This article provides an overview of current and prospective ethical issues facing commercial (as opposed to leisure) travel agents. Industry wide ethical issues include conflicting pressures from suppliers and clients, competency requirements for agents and misleading advertising and sales claims (vaporware in industry jargon). Issues with travel suppliers include calculation and payment of commissions, fare loopholes, frequent flyer plans and the use and abuse of benefits directed to individual employees. Issues with corporate clients of travel agents include hidden preferred carriers or suppliers, client pressure to use fare loopholes and hidden relationships with corporate travel consultants. Future issues include protecting client privacy, free riding, and divergent international business practices. Thomas W. Dunfee is the Kolodny Professor of Social Responsibility at The Wharton School of the University of Pennsylvania. His current research interests focus on social contract theory and business ethics and on developing ethical standards for business transactions. He has published articles in the Business Ethics Quarterly,the Journal of Business Ethics,the Business and Professional Ethics Journal,and the Journal of Social Philosophyin addition to a variety of business and legal journals. He has consulted to a number of corporate clients and to several trade associations.Bruce M. Black is founder and president of McCord Travel Management. Since founding the company in 1980, he has led its growth to one of the 30 largest travel management firms in the United States, with annual sales of more than $100 million. Black is one of the inaugural members of the University of Illinois at Chicago Entrepreneurship Hall of Fame and is on the board of the International Theatre Festival of Chicago. He is also active in the exploration of a variety of industry related issues on behalf of the Super Regional Group of agencies.