Cost-effectiveness analysis of ramucirumab treatment for patients with hepatocellular carcinoma who progressed on sorafenib with α-fetoprotein concentrations of at least 400 ng/ml

Abstract

Objective: This study aimed to compare the cost-effectiveness of ramucirumab versus placebo for patients with hepatocellular carcinoma who progressed on sorafenib with α-fetoprotein concentrations (AFP) of at least 400?ng/ml in the United States.

Methods: A Markov model was constructed to assess the cost-effectiveness of ramucirumab. Health outcomes were measured as quality-adjusted life years (QALYs). With TreeAge software, the disease process was modeled as three health states: progression-free survival (PFS), progressive disease (PD), and death. Costs were extracted from the REACH-2 trial, and utility was derived from published literature. Incremental cost-effectiveness ratios (ICERs) were calculated to compare ramucirumab with placebo. Probabilistic sensitivity analyses were developed to examine the robustness of the results.

Results: In the base case analysis, ramucirumab therapy had a cost of $55,508.41 and generated 0.54 QALYs, while placebo therapy had a cost of $761.09 and generated 0.47 QALYs, leading to an additional $54,747.32 in costs and 0.07 QALYs. The ICER was $782,104.57 per QALY, which was much higher than the willingness-to-pay threshold of $100,000 per QALY. According to sensitivity analyses, the utility of PD in the two groups was the dominant parameter influencing the ICER.

Conclusion: Although ramucirumab was associated with prolonged survival for patients with advanced hepatocellular carcinoma who progressed on sorafenib treatment with an AFP of at least 400?ng/ml, it is not a cost-effective treatment from a United States payer perspective.     

Beyond trade creation: Preferential trade agreements and trade disputes

This study investigates the effects of preferential trade agreements (PTA) on bilateral trade disputes. We construct a unique and comprehensive dataset on inter-country trade disputes from 1995 to 2007. The dataset covers 110 countries and 1,162 bilateral country-pair trade disputes. Using this dataset in a gravity-type model of trade dispute analysis, we find that countries belonging to the same PTA tend to experience fewer trade conflicts among themselves than with non-member countries. By studying various types of PTA with different dispute settlement mechanisms, we further find that the dispute-reducing effect only comes from PTA with specific provisions on dispute settlement mechanisms. Moreover, the effect is stronger if those PTA explicitly stipulate that members can also resolve their disputes via the WTO Dispute Settlement Body. However, having PTA that do not address how members should resolve their disputes may lead to more dispute initiations than in cases without PTA.     

IOS移动平台互动绘本的设计

绘本随着计算机软硬件的发展和无线网络技术的进步，正由纸质图书形式向数字化屏式过渡，其自身可以根据故事的画面与技术手段相结合，从而产生新的绘本形态---互动绘本。在这种应用背景的推动下，指出纸质绘本的优缺点，调查分析IOS移动平台互动绘本发展的前景与优势，从研究互动绘本的设计特征着手，探讨互动绘本设计在数字技术支撑下的设计要素与设计方法，可对互动绘本的设计与发展有所借鉴，并实现其艺术价值与市场应用价值。     

Board Attributes,Corporate Social Responsibility Strategy,and Corporate Environmental and Social Performance

In this paper, we draw on insights from theories in the management and corporate governance literature to develop a theoretical model that makes explicit the links between a firm’s corporate social responsibility (CSR) related board attributes, its board CSR strategy, and its environmental and social performance. We then test the model using structural equation modeling approach. We find that the greater the CSR orientation of the board (as measured by the board’s independence, gender diversity, and financial expertise on audit committee), the more proactive and comprehensive the firm’s CSR strategy, and the higher its environmental and social performance. Moreover, we find this link to be endogenous and self-reinforcing, with superior CSR performers tending to further strengthen their board CSR orientation. This result while positive is also suggestive of the widening of the gap between the leads and laggards in CSR. Therefore, the question arises as to how ‘leaders’ are using their superior CSR competencies seen by many scholars as a source of corporate (at times unfair) competitive advantage. Stakeholders of corporations therefore need to be cognizant of this aspect of CSR when evaluating a firm’s CSR activities. Policy makers also need to be cognizant of these concerns when designing regulation in this field.     

浅谈电气节能在建筑工程中的运用

本文通过介绍电气节能设计应遵循的原则,着重阐述了建筑电气节能设计中线路损耗、变压器的选择、照明节能、电动机节能、空调系统节能、给排水节能等多个方面的节能技术措施,以及在建筑工程中的应用。     

信息共享下生鲜农产品供应链库存的建模与仿真研究

针对一个动态、多级的生鲜农产品供应链库存系统,运用系统动力学的方法构建其库存模型,选取信息不共享、信息低度共享和信息高度共享等三个决策变量在Vensim PLE平台上运行系统模型,结果显示供应链各主体实现信息共享后,其库存水平都呈现明显的下降趋势,且随着信息共享程度的提高,效果更加显著。     

关于“钓鱼执法”问题的法律思考

＂钓鱼执法＂事件引发了社会各界的广泛关注。这种非理性执法行为不仅有损法律的尊严和政府公信力,还存在着极大的道德风险。我们应在深入剖析具体事件根源的基础上,从立法、财政体制、教育等层面探讨制度上的应对方法。     

WTO成立十年来的十大特征(上)

本文拟对WTO成立十年来所体现出的重要特征进行梳理、归纳和总结,并由此揭示WTO在十年风雨中取得的成就,面临的困难与挑战。     

Reformulating Environmentally Constrained Traffic Equilibrium via a Smooth Gap Function

Various government laws have recently been enacted to alleviate the environmental deterioration of transportation systems. Environmental constraint is a valid means to explicitly reflect various environmental protection requirements imposed by the government. In this paper, we examine the environmentally constrained traffic equilibrium problem (EC-TEP), which is a fundamental tool for modeling and evaluating environmental protection requirements. Specifically, we provide an equivalent reformulation for the EC-TEP. The proposed reformulation adapts the concept of gap function to simultaneously reformulate the nonlinear complementarity conditions associated with the generalized user equilibrium conditions, environmental constraints, and conservation constraints as an equivalent unconstrained optimization problem. This gap function reformulation has two desirable features: (1) it can handle a general environmental constraint structure (linear or nonlinear; link-based or area-based) and a general link and route cost structure, enhancing the modeling adaptability and flexibility; (2) it is smooth and unconstrained, permitting a number of existing efficient algorithms for its solution. A gradient-based solution algorithm with a self-regulated averaging stepsize scheme is customized to solve the reformulated unconstrained optimization problem. Numerical examples are also provided to demonstrate the modeling flexibility of the proposed EC-TEP reformulation.     

国有企业转型过程中宏观与微观权力关系的渐进式变革

随着企业转型,企业的宏观权力关系从完全附属于政府主管部门、"五龙治水"、国资委统一行使所有者职能、到海外投资者对国有股东形成制衡.在微观权力关系上,企业的经营者由政府官员性质、行政性"内部人控制"问题的产生,到海外投资者选派的独立董事代表的进入,加强了对"内部人控制"问题的约束.总的来看,这种政府主导型的改革对企业转型和宏观权力关系产生了显著影响,但微观权力格局的转换仍然相当艰难.