Cost-effectiveness of direct-acting antiviral regimen ombitasvir/paritaprevir/ritonavir in treatment-naïve and treatment-experienced patients infected with chronic hepatitis C virus genotype 1b in Japan

Objective: This study compared the cost-effectiveness of chronic hepatitis C virus (HCV) genotype 1b (GT1b) therapy ombitasvir/paritaprevir/ritonavir (OBV/PTV/r) vs daclatasvir?+?asunaprevir (DCV/ASV) and no treatment in patients without cirrhosis. Cost-effectiveness analyses (CEAs) that compared OBV/PTV/r against DCV/ASV and sofosbuvir/ledipasvir (SOF/LDV) in Y93H mutation-negative, GT1b patients with and without cirrhosis were also included.

Methods: A health state transition model was developed to capture the natural history of HCV. A CEA over a lifetime horizon was performed from the perspective of the public healthcare payer in Japan. Costs, health utilities, and rates of disease progression were derived from published studies. Sustained virologic response (SVR) rates of OBV/PTV/r and DCV/ASV were extracted from Japanese clinical trials. Analyses were performed for treatment-naïve and -experienced patients. Alternative scenarios and input parameter uncertainty on the results were tested.

Results: OBV/PTV/r exhibited superior clinical outcomes vs comparators. For OBV/PTV/r, DCV/ASV, and no treatment, the lifetime risk of decompensated cirrhosis in treatment-naïve patients without cirrhosis was 0.4%, 1.4%, and 9.2%, and hepatocellular carcinoma was 6.5%, 11.4%, and 49.9%, respectively. Quality-adjusted life years (QALYs) were higher in treatment-naïve and -experienced patients without cirrhosis treated with OBV/PTV/r (16.41 and 16.22) vs DCV/ASV (15.83 and 15.66) or no treatment (11.34 and 11.23). In treatment-naïve and -experienced patients without cirrhosis, the incremental cost-effectiveness ratios (ICERs) of OBV/PTV/r vs DCV/ASV were JPY 1,684,751/QALY and JPY 1,836,596/QALY, respectively; OBV/PTV/r was dominant compared with no treatment. In scenario analysis, including GT1b patients with and without cirrhosis who were Y93H mutation-negative, the ICER of OBV/PTV/r vs DCV/ASV was below the Japanese willingness-to-pay threshold of JPY 5 million/QALY, while the ICER of SOF/LDV vs OBV/PTV/r was above this threshold; thus, OBV/PTV/r was cost-effective.

Conclusion: OBV/PTV/r appears to be a cost-effective treatment for chronic HCV GT1b infection against DCV/ASV. OBV/PTV/r dominates no treatment in patients without cirrhosis.     

Can the W.T.O. Change Russia?

If Vladimir Put in returns as planned to the presidency in 2012,he will once again face the challenge of modernizing the Russian economy. This is something both he and his seat-warmer, Dmitri Medvedev,have failed to achieve during three consecutive presidential terms. A meeting     

Introducing public–private partnerships for metropolitan subways in China: what is the evidence?

Rapidly growing motorisation has led to high levels of traffic congestion and emissions and has encouraged large Chinese metropolitan areas to invest in subway developments. The financial burden of these projects, however, far exceeds the availability of available public funds. As a consequence, the Chinese government has started to allow local governments with public–private partnerships (PPP) and private finance to supplement the funding deficit. Analysts often claim that countries have to fulfil certain institutional and other pre-conditions before they can make effective use of PPP. In this article, China’s record in meeting those requirements is examined and conclusions are drawn as to where the remaining weaknesses lie. Seven recent PPP projects for subways in five large metropolitan areas in China (Shanghai, Beijing, Shenzhen, Chongqing and Harbin) are investigated empirically. Conclusions are drawn concerning China’s current status regarding the use of PPP, the way it has been adapted to China’s financial, institutional and geographical context and the likely prospects for PPP in China in the future.     

Inefficient policies and incumbency advantage

We present a model of (re)elections in which an incumbency advantage arises because the incumbent can manipulate issue salience by choosing inefficient policies in the policy dimension in which he is the stronger candidate. The voters are uncertain about the state of the world and the incumbent's choice of policy. Under complete information they would reelect the incumbent if and only if the state is sufficiently high. Undesirable policy outcomes may be due to either a bad state or the incumbent's choice of inefficient policies. The incumbent uses inefficient policies in intermediate states, whereby he creates uncertainty about the true state in such a way that voters are better off in expectation reelecting him. Hence the equilibrium exhibits an incumbency advantage that stems from asymmetric information and the use of inefficient policies.     

US Hegemony and the Origins of Japanese Nuclear Power: The Politics of Consent

This paper deploys the Gramscian concepts of hegemony and consent in order to explore the process whereby nuclear power was brought to Japan. The core argument is that nuclear power was brought to Japan as a consequence of US hegemony. Rather than a simple manifestation of one state exerting material ‘power over' another, bringing nuclear power to Japan involved a series of compromises worked out within and between state and civil society in both Japan and the USA. Ideologies of nationalism, imperialism and modernity underpinned the process, coalescing in post-war debates about the future trajectory of Japanese society, Japan's Cold War alliance with the USA and the role of nuclear power in both. Consent to nuclear power was secured through the generation of a psychological state in the public mind combining the fear of nuclear attack and the hope of unlimited consumption in a nuclear-fuelled post-modern world.     

Analysing retail failure from an historical perspective: A case study of A. Goldberg & Sons plc

Organisational failure has been considered from various perspectives in the academic literature, but there has been less focus on the causes of retail failure. This paper considers the case of A. Goldberg and Sons plc, a retail organisation which, prior to its demise in 1990, had grown from a single Glasgow store in 1908 to a chain of over 100 outlets. Drawing on annual reports, interviews with former directors, and the contents of a company archive, the paper provides evidence of the key factors and decisions that led to the firm's failure. Various internal and external pressures, including over-expansion into new retail space and the general economic downturn, effected Goldberg's ‘failure’.     

Social responsibility,entrepreneurship, and the goals of firms: An examination of current economic literature

It is our conclusion that Adam Smith advocated and justified policies of anticolonialism and antiprotectionism. Smith was opposed to the theory and policy of mercantilism, which involved an emphasis on the imperialistic exploitation of colonies as a method of accumulating the precious metals within the boundaries of mercantilistic nations. Smith led British public opinion into a period when little-Englandism replaced colonialism and free trade replaced protection. This period continued as long as the Industrial Revolution enabled England to dominate world trade. After 1875, however, the industrialization of the United States, Germany and Japan intensified the competitiveness of international trade and threatened to destroy British domination of world markets. These developments caused a resurgence of the new imperialism and motivated the British government to participate in the partition of Africa and to impose British hegomony over Asia. This new imperialism ran its bloody course of military aggression before it self-destructed at the end of the Second World War.