Cost-effectiveness of Viridal Duo compared to MUSE and Viagra in the treatment of erectile dysfunction in the UK - a preliminary model

Summary

This study estimated the cost-effectiveness of starting erectile dysfunction (ED) treatment with Viridal Duo relative to MUSE and Viagra over one year, from the perspective of the National Health Service. Decision analysis techniques were used to estimate the expected costs and consequences of managing ED, stratified by initial treatment. The model was based on estimates of clinical outcome and resource use obtained from published literature and a Delphi panel.

Viridal Duo is a registered trademark of Schwarz Pharma;

MUSE is a registered trademark of Astra Pharmaceuticals;

Viagra is a registered trademark of Pfizer Consumer Healthcare

Starting ED treatment with Viridal Duo instead of Viagra leads to an average 0.8 additional months during which a man can achieve successful erections (from 6.5 to 7.3 months) over one year, for an additional cost of £106 per patient (from £369 to £475). Starting ED treatment with Viagra instead of MUSE leads to an average 1.1 additional months during which a man can achieve successful erections (from 5.4 to 6.5 months) over one year and reduces the cost per patient by £85 (from £454 to £369).

Fifty-two percent of patients who start treatment with Viridal Duo continue successfully over one year. This compares to 38% and 18% of patients who start treatment with Viagra and MUSE respectively. Eighty-seven percent of the total success with Viridal Duo can be directly attributed to this treatment when used first-line. In contrast, 68% and 44% of the total success attributed to Viagra and MUSE respectively can be attributed to these treatments when chosen first-line. Moreover, an additional 44% and 27% of the expected total success with MUSE and Viagra is attributable to Viridal Duo.

Starting ED treatment with Viridal Duo rather than MUSE, when Viagra is either unavailable or contraindicated, increases the period during which a man can achieve successful erections by 1.8 months (from 5.5 to 7.3 months) for an additional cost of £14 per patient (from £460 to £474). Additionally, in patients who have previously failed Viagra, starting second-line treatment with Viridal Duo rather than MUSE leads to an average 1.6 additional months during which a man can achieve successful erections (from 4.0 to 5.6 months) over one year and reduces the cost per patient by £15 (from £493 to £478).

In conclusion, Viridal Duo is clinically more effective than Viagra and MUSE. Therefore, starting ED treatment with Viridal Duo instead of Viagra or MUSE increases the period during which a man can achieve successful erections, albeit for an additional cost. In patients who have previously failed first-line treatment with Viagra, starting second-line treatment with Viridal Duo instead of MUSE increases the period during which a man can achieve successful erections (by 40% at one year) and reduces healthcare costs (by £15 per patient).     

Cooperative membership and farmers’ choice of marketing channels – Evidence from apple farmers in Shaanxi and Shandong Provinces,China

Cooperatives are established to improve farmers' production conditions, to increase their bargaining power and to enable them to benefit from modern value chains. In China, farmers are members of a cooperative for multiple reasons. Little is known on whether and how cooperative membership affects farmers’ choice of marketing channels. This paper examines determinants of farmers’ choice of marketing channels, especially how cooperative membership impacts upon this choice. Our analysis is based on survey data collected in 2015 among 625 apple growing farm households in the provinces Shaanxi and Shandong. We employ endogenous switching probit models to deal with potential endogeneity of membership in estimating the determinants of marketing channel choices. We find that cooperative membership has a positive impact on selling to wholesalers and a negative impact on selling to small dealers, but no significant impact on selling to the cooperative itself. As products sold through cooperatives generally comply with relatively stringent food quality and safety standards, these results imply that policies promoting cooperative members to sell their products through cooperatives are likely to have a significant impact on food quality and food safety in China.     

浅析我国高速公路成本控制的措施

高速公路成本控制是系统的全程控制,降低成本,发挥成本优势,是高速公路企业在市场竞争中处于有利地位的重要措施。本文介绍了高速公路成本控制的内容,通过对高速公路成本控制的分析,阐述了高速公路成本控制的原则,并从高速公路的进度成本,质量成本,风险成本以及采购成本的控制四个方面对高速公路的成本控制的措施进行了说明。高速公路成本的控制对于提高高速公路企业的经济效益和社会效益有着非常重要的作用和意义。     

A Markov switching analysis of contagion in the EMS

This paper applies the multivariate version of the Forbes and Rigobon (2002) contagion test, as proposed by Dungey et al. (2005a), to detect contagion effects in the Exchange Rate Mechanism (ERM) of the European Monetary System (EMS). Crisis and non-crisis observations are determined endogenously via a Markov-switching vector autoregression (MSVAR). We show that the MSVAR is suitable for this purpose, as it does particularly well in identifying the 11 realignments of the ERM. We examine whether Denmark’s rejection of the Maastricht Treaty and Italy’s competitiveness problems affected other EMS participants and find evidence for contagion.     

Erin Anderson and the Path Breaking Work of TCE in New Areas of Business Research: Transaction Costs in Action

This review article synthesizes Erin Anderson's academic contribution, with an emphasis on two path breaking aspects of her work, namely the operationalization of TCA in different contexts and the refinement of the theory. We review the measures that she developed to reflect key TCE constructs, and identify five contexts in which Erin Anderson's application of TCE concepts broke new paths. These are employee or representative salesforces, choice of foreign entry mode, new market entry and innovation, countertrade, and ethics. We highlight a number of ways in which her research integrates other theories to transaction cost economics, thereby deepening our understanding of key issues involving make or buy decisions. Finally, we draw attention to directions for future research identified through her work.     

Cost-effectiveness implications of increased survival with anastrozole in the treatment of advanced breast cancer

Summary

Anastrozole (Arimidex*) has a survival benefit compared with megestrol acetate in postmenopausal women with advanced breast cancer who have failed on tamoxifen. It was felt appropriate that such a clinical finding should be subjected to economic evaluation.

A cost-effectiveness analysis was undertaken from the viewpoint of a third-party payer, of the data from a combined analysis of two clinical studies. The outcome measures were duration of drug treatment and life years gained. The incremental cost effectiveness ratio (ICER) of anastrozole was £1,608 per life year gained based on UK NHS drug prices in April 1998. Sensitivity analysis showed that the ICER could vary between £5 and £1,643, depending on relative drug costs in a number of countries, between £1,056 and £1,761, depending on the method used to calculate duration of treatment and survival, and could increase to £3,730, based on treatment provided during the extra period of survival.

Anastrozole is a highly cost-effective alternative to megestrol acetate for postmenopausal women with advanced breast cancer.     

物流运输运作成本控制研究分析——以某化工公司为例

从运输成本的构成入手,分析了影响运输成本因素、物流成本与运输成本之间的关系,在此基础之上,以上海某化工企业为例,分析研究了进行物流系统优化过程中运输成本控制的方法和采取的具体策略。     

Downward wage rigidity and business cycle asymmetries

The growth rates of wages, unemployment and output of a number of OECD countries have a strongly skewed distribution. In this paper we analyze to what extent downward wage rigidities can explain these empirical business cycle asymmetries. To this aim, we introduce asymmetric wage adjustment costs in a New-Keynesian DSGE model with search and matching frictions in the labor market. Increasing wages is less costly than cutting them. It follows that wages increase relatively fast and thus limit vacancy posting and employment creation, but they decline more slowly, leading to a strong reduction in vacancies and employment. The presence of downward wage rigidities strongly improves the fit of the model to the observed skewness of labor market variables and the relative length of expansions and contractions in the output and the employment cycles. The asymmetry also explains the differing transmission of positive and negative monetary policy shocks from wages to inflation.     

JUSTIFYING A POLICY MIX FOR POLLUTION CONTROL: A REVIEW OF ECONOMIC LITERATURE

Abstract This paper provides a review of economic studies analysing the use of multiple policies – a so‐called policy mix – to cope with single pollution problems. To guide and structure the review, an analytical framework is developed and applied. The framework integrates transaction costs into the analysis of pollution problems and policies to overcome them. Moreover, it understands a pollution externality not only as a market failure but more generally as the failure of private governance structures. Based on this insight, two rationales for using a policy mix are identified. First, a policy mix may help to correct for multiple reinforcing failures of private governance structures, such as pollution externalities and technological spillovers. Second, a policy mix can be employed if the implementation of single first‐best policies brings about high transaction costs, e.g. when marginal pollution damages are heterogeneous or polluters are unlikely to comply with the policy. For each rationale, the relevant literature is presented. Based on the review, avenues for future research are identified.     

The Eurozone Crisis and Emerging‐Market Expansion: Capital Switching and the Uneven Geographies of Spanish Urbanization

The theory of capitalist urbanization posits that the built form serves as a crucial sink through which overaccumulated capital is ‘switched' from industrial production into long‐term investment in urban infrastructure. Since Harvey's (1978) deployment of the theory, researchers have attempted to empirically substantiate the switching thesis with limited success. Christophers (2011) revisited the debate with new data and methods to support the claim that significant investment had switched into the built environment at the onset of the 2007/08 financial crisis. However, Christophers' study overlooks how crises are also geographically displaced. This article analyses Spanish trade data for the years 1993 to 2013, the years prior and subsequent to the housing‐induced economic crisis (1997 to 2006). Two studies are undertaken. The first replicates Christophers' methodology to assess how and to what extent a sectoral switch into property investment occurred in Spain between 1997 and 2006. The second modifies the methodology to investigate the extent to which overaccumulated capital in Spain has been geographically displaced through investment in the Moroccan building industry since 2006. These approaches situate uneven development (geographical switching) and turnover time (sectoral switching) as the twin dynamics through which capitalist urbanization is spatio‐temporally fixed.