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.     

经济结构变化与经济增长

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云南花卉产业发展中若干问题的探讨

A few problems exist in flower industry development in Yunnan province. The key problem is flower production with sell set in system unqualified, product quallty problem; wrong model in specification of quality in product, undeveloped and developed technology of quality standard system hasn‘t been used. To change present condition, combining local present condition, we can enhance the macroscopic management and put forward to peasant the policy suggestion to guide the development of Yunnan province flower industry.     

高校图书馆个性化信息服务系统结构模型的构建

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基于企业价值最大化的多元化发展战略调整研究

多元化发展战略对于企业价值最大化目标的最终实现可能产生正面或负面的影响作用.当多元化发展战略可能会损害企业价值最大化目标的有效实现时,就需要对其进行有效的战略调整.本文在提出多元化发展战略调整目标是实现企业价值最大化的基础上,借鉴矛盾论思想,分析指出多元化发展战略调整机制是动态核心能力,并进一步构建了一种多元化发展战略调整的路径,即企业核心能力与业务活动的动态匹配模型.     

经济温和调整阶段要防止滑坡

我国经济增长在2001年的拐点(7.5%)之后,经历了3年上升期,现正处于一个温和调整阶段(大约在7%-9.5%区间内)。在经济温和调整阶段要使经济增长的下降是“软着陆”而不是“硬着陆”, 就必须积极发挥政府宏观调控的作用,而不能任由市场调节自由滑落。为此,政府宏观调控应找好“着力点”。     

我国第三方物流企业的合理市场定位

第三方物流企业的发展需要合理的市场定位。发展中国的第三方物流，第三方物流企业必须合理而有序的进行自身的市场定位，从而有效的规避市场风险。接受中国目前的物流市场环境约束，第三方物流企业应该参照地域优势的指标，形成业内的逆时针供应链，提高自身的服务能力。     

上海市区街道办事处功能作用调整、完善的对策与措施

本文经调查研究,从上海市区街道办事处功能作用存在的问题出发,重新定义其功能与基本职能,提出了上海街道办事处功能作用调整对策与措施。     

小企业会计制度与税务制度差异研究

由于企业会计制度与税务制度所规范的对象和目的不同,会计核算和税务核算之间始终存在着一定的差异。小企业会计制度在会计核算原则、会计假设、会计方法、会计政策及会计实务等方面都与现行的税务制度存在着较大的差异,而这些差异会导致国家税源的流失,造成纳税调整增多,并容易引起征纳双方的纠纷,甚至不能正确地确认纳税人权益,也给企业避税创造了机会。本文建议,应加快我国税收制度的改革,减少小企业会计制度与税务制度的差异,确保小企业会计核算的准确性,并能依法纳税。     

基于公司治理的企业内部会计控制研究

公司治理作为公司利益相关者的制度安排是由一系列的控制制度管理的。良好的内部会计控制是正确处理公司利益相关者关系,完善公司治理的重要保证,同时还有利于内部会计控制系统的健全。本文认为,企业必须根据公司治理的需要,建立健全企业内部会计控制系统,以促进企业持续稳定发展。