Medication adherence and persistence in the treatment of rheumatoid arthritis with adalimumab and etanercept. Six years of analysis

Objective:

The aim of this study was to evaluate medication adherence and persistence of patients treated with Etanercept and Adalimumab for Rheumatoid Arthritis, also giving economic evaluations on therapy costs for Received Daily Dose (RDD).

Materials and methods:

This retrospective study took into account 6 years from January 1, 2007 to December 31, 2012. Medication adherence was quantified utilizing the ratio between RDD and Prescribed Daily Dose (PDD). Persistence has been reckoned taking into account the actual days of therapy comparing posology with supplied dose. The persistence has been graphed according to Kaplan-Meier method. The cost per RDD was reckoned starting from the expense incurred by Pescara General Hospital.

Results:

Medication adherence gave results in values between 0.88–0.97 for Etanercept and 0.83–0.90 for Adalimumab. The value of persistence was 100% for Etanercept and 90% for Adalimumab for the first year, and 70% for Etanercept and 80% for Adalimumab for the second year. In the 3rd year the persistence for Etanercept was 50% while for Adalimumab it was 60%. In the fourth year the persistence for Etanercept was 21% while for Adalimumab it was 27%. The statistical analysis was conducted using the Log rank test. The average cost per RDD was €32.97 for Etanercept and for Adalimumab it was €32.00 as an average of 6 years.

Conclusion:

The medication adherence was good for both Etanercept and Adalimumab. The rate of persistence decreased strictly in the fourth year of treatment. This data suggests the need for continuous monitoring of patients in treatment with TNF blockers.     

Channel Management and Differentiation Strategies in the Supply Chain for Fresh Produce

The article analyses the current differentiation strategies in the market for fresh produce. The article is arranged into three parts. First a short review of the literature on channel structure and product differentiation is presented in order to identify, on a theoretical grounding, the incentives for differentiation strategies. Second, the fresh produce sector is reviewed and analysed. Finally, an empirical investigation is made of a UK channel intermediary organisation carrying out differentiation policies in the fresh produce category (on behalf of UK multiple retailer customers') supplied by a dedicated Italian grower.

Results show that in the fresh produce industry there is room for product differentiation, but with contradictory welfare effects.     

Boundary Spanning in Local Public Service Partnerships: Coaches,advocates or enforcers?

This paper analyses the role of senior civil servants who work directly with local public service partnerships in the UK. It finds that their activities are welcomed by local actors and can have a positive impact on partnership working. They add value by acting as coaches who bring new ideas and help to build trust among local agencies and as advocates through being an important channel of communication between partnerships and national government. However, they struggle to facilitate more joined up working among national government departments whose differentiated regulatory and funding procedures impede attempts to collaborate at a local level.     

Is social protection a necessity or a luxury good? New multivariate cointegration panel data results

The aim of this paper is to test the claim that social protection is a luxury good. Therefore, GDP elasticity of selected social protection expenditure is estimated using a new econometric approach developed first by Kao and Chiang (Advances in Econometrics, 15, 179–222, 2000). Time series properties of selected social expenditure in 18 OECD countries from 1981 to 1998 are examined. Using panel data cointegration tests and OLS, FMOLS and DOLS estimators, results were found which differ from previous analyses reporting substantially higher income elasticities. With the FMOLS, selected social expenditure has income elasticities smaller than one but greater than one with the DOLS. It is noteworthy that whether selected social expenditure is stationary or nonstationary may have critical implications for researchers and policy makers desiring to model and explain the impact of this expenditure on a country economic system.     

Strategic Interactions Among Central Bank and National Fiscal Authorities in a Monetary Union Subject to Asymmetric Country Shocks

In this paper we extend Nordhaus’ (Brookings Pap Econ Act (2):139–199, 1994) results to an environment which may represent the current European situation, characterised by a single monetary authority and several fiscal bodies. We show that, even assuming that the monetary and the fiscal authorities share the same ideal targets, in the presence of asymmetric shocks the “symbiosis” result found by Dixit and Lambertini (J Int Econ 60:235–247, 2003) no longer obtains. Thus, fiscal rules as those envisaged in the Maastricht Treaty and in the Stability and Growth Pact may work as monetary/fiscal coordination devices that improve welfare. The imposition of common targets, however, may work as a substitute for policy coordination only if these are made state contingent, an aspect that the recent version of the Stability and Growth Pact takes into account in a more appropriate way than its original version.

How Much Does Wind Power Reduce $$\text {CO}_{2}$$ Emissions? Evidence from the Irish Single Electricity Market

This paper evaluates the effect of wind generation on \(\text {CO}_{2}\) emissions using 2008–2012 historical data for the Irish Single Electricity Market. Wind generation displaces \(\text {CO}_{2}\) emissions, as expected, in line with the average system emissions. Over the whole period, wind generation avoided about 8.8 million tons of \(\text {CO}_{2}\), equivalent to about 12% of total system emissions. To understand what drives the level of abatement we evaluate the results by technology and determine that wind generation has similar effects on total emissions from CCGT and coal plants, due to the higher carbon content of coal. Each MWh of wind, however, replaces more generation from CCGTs than from coal plants, in proportion to their generation. We also test the hypothesis that as wind displaces baseload plants it pushes them to generate less efficiently, but find no evidence of a strong negative effect of wind on CCGT or coal plant efficiency. Finally wind displaces about 2.5% fewer emissions when the pumped storage plant is on outage, suggesting that wind is more effective when paired with a flexible system.