Cost-effectiveness analysis of utidelone plus capecitabine for metastatic breast cancer in China

Abstract

Objective: To estimate the cost-effectiveness of utidelone plus capecitabine therapy compared to capecitabine alone in patients with metastatic breast cancer (MBC) resistant to anthracyclines and taxanes treatment in the Chinese context and provide a reference for the marketing of utidelone in China.

Methods: A Markov model was developed based on the NCT02253459 clinical trial to simulate the clinical course of patients with metastatic breast cancer who had received taxanes and anthracycline therapy. The quality-adjusted life years (QALYs) and Incremental Cost Effectiveness Ratio (ICER) were then analyzed to evaluate the benefits. Two-parametric Weibull distribution was conducted to fit PFS and OS curves by using R. Sensitivity analyses were performed to evaluate the stability of the model designed.

Results: The addition of utidelone increased the cost and QALYs by $13,370.25 and 0.1961, respectively, resulting in an increased ICER of $68,180.78 per QALY. The most sensitive influential parameter on ICER was the price of utidelone. At the threshold of willingness-to-pay (WTP) of $24,380 (3 per capita GDP of China), the cost of utidelone per 30?mg of less than $18.5, $33.7, and greater than $48.8 resulted in a 100%, 50%, and 0% possibility of cost-effectiveness, respectively. The addition of utidelone was not cost-effective when it was $115.4 per 30?mg—the price of its analog paclitaxel. In consideration of varied economics levels across China, cost-effectiveness could be achieved with the price of utidelone ranging from $5.2 to $35.9.

Limitations: The survival curves extended beyond the follow-up time horizon, of which data were generated not from the real analyses but from our established two-parameter Weibull survival model.

Conclusion: It is recommended that the price of utidelone would be less than $18.5 per 30?mg in order to obtain cost-effectiveness for metastatic breast cancer patients resistant to anthracyclines and taxanes treatment in China.     

The evolution of the monetary transmission channels in Turkey: evidence from a TVP-VAR model

This article investigates the evolution of the monetary transmission mechanisms in Turkey for the period from January 1986 to December 2016. To this aim, the impacts of monetary variables on the prices and economic activity are investigated with a time-varying vector autoregressive model based on. The evidences from the time-varying responses indicate that the adoption of inflation targeting policy has markedly affected the functioning of transmission channels. The results also suggest that local and global financial crises may magnify the impact of monetary policy shocks on the overall economy.     

REGIME DEPENDENT EFFECT OF OUTPUT GROWTH ON OUTPUT GROWTH UNCERTAINTY: EVIDENCE FROM OECD COUNTRIES

This paper studies the impact of output growth on output growth uncertainty by considering two important issues hitherto not properly and adequately addressed to in the existing empirical studies specifying this relationship. These are: (i) the possible existence of a threshold level of output growth, and the consequent identification of two regimes characterized by high and low output growth, and (ii) whether or not the coefficient capturing the causal link is different in these two output growth states. This paper proposes a regime switching model to study this asymmetric effect for 16 OECD countries. Based on monthly time‐series observations, our results strongly support that the impact varies significantly between the two output growth regimes with the coefficient in the high growth regime being negative for majority of the countries.     

An empirical analysis of night-time light data based on the gravity model

This article aims to explore the feasibility of applying night-time light data to the study of trade. Based on 61 countries’ panel data from 1995 to 2012, this research used night-time light data, as the substitute for GDP, to study trade development based on the traditional gravity model. The method of ordinary least squares, Poisson pseudo-maximum-likelihood and two-stage least squares were used. The results show that geographical distance, country borders and regional agreements have a significant effect on China’s trade with other Belt and Road countries, which verifies the validity of trade research based on night-time light data analysis. Additionally, comparisons reveal the trade trends predicted by night-time light data from 1996 to 2012, were highly consistent with the actual data. This article stands as the first study to apply night-time light data to the gravity model in the research on trade between China and other Belt and Road countries. Breaking new ground, this research uses night-time light data as an economic indicator to study trade, in combination with micro foundations and the latest findings of the gravity model. Thus, this article deepens the understanding of trade analysis and contributing to the field of related researches.     

The price relationship between organic and non-organic vegetables in the U.S.: evidence from Nielsen scanner data

This study investigates price relationships between organic and conventional carrots, tomatoes, and lettuce in the U.S. utilizing Nielsen scanner data from 2006–2015. We employ a threshold vector error correction model (TVECM), threshold vector autoregressive model (TVAR), and threshold cointegration test to test whether market integration exists between organic and conventional vegetables as well as the existence of asymmetric price transmission. The results find positive long-run relationships between organic and conventional prices of carrots and tomatoes and show the existence of asymmetric price transmission in price pairs of lettuce and tomatoes. Our findings suggest that the price relationship between organic and conventional vegetables varies by characteristics, such as shelf life, volatility in the price premium, and substitutability.     

How resilient is La Réunion in terms of international tourism attractiveness: an assessment from unit root tests with structural breaks from 1981-2015

Even if local policymakers increasingly claim that tourism is one of the key factors of future economic development for the French small island La Réunion, international tourist arrivals are observed to be locked in a stagnation phase since the beginning of the 2000s. Starting from this stylized fact, this article aims to study if this phenomenon results from major external events hurting this economy regularly. Next, by using univariate unit root procedures with structural breaks, we test for evidence of permanent or transitory effects of external shocks on international tourist inflows (total, by source markets, and by category) over the period 1981–2015. Finally, the empirical analysis allows us to reject the null of a unit root. Then, stagnation of tourism arrivals to La Réunion is not due to exogenous shocks but probably results from endogenous impediments within the domestic tourism industry and unsuitable public policies.     

An effective going concern prediction model for the sustainability of enterprises and capital market development

The purpose of this study is to construct a two-stage effective and innovative going concern prediction model to predict going concern doubt for the sustainability of enterprises and capital market development. Samples of this study are the companies listed on the Taiwan Stock Exchange or the Taipei Exchange, totalling 196 companies and including 49 companies with going concern doubt and 147 normal companies (with no going concern doubt). The data are taken from the Taiwan Economic Journal (TEJ) and the Market Observation Post System during the period from 2001 to 2016 (totalling 16 years). This study adopts a two-stage way to construct the going concern prediction models. In Stage I, the traditional statistical method of stepwise regression (SR) and the data mining technique artificial neural network (ANN) are applied to select the important variables. In Stage II, two decision tree algorithms (data mining techniques): classification and regression tree (CART) and C5.0 are used to establish the prediction models. The results show that the SR + CART model has the highest going concern prediction accuracy, with an overall accuracy of 87.42%.     

Institutional quality and the effectiveness of aid for trade

Trade policy barriers and high transaction costs hinder developing countries from taking the full advantages of the global trading system. In order to help developing countries overcome the problem, the World Trade Organization (WTO) launched the Aid for Trade (AFT) initiatives in its Ministerial Conference held in Hong Kong in 2005. We examine the effects of AFT inflows on bilateral trade costs facing 133 developing countries while accounting for differences in their location on the contours of various measures of institutional quality. Our results from the estimation of a mixed effects (random-intercept and random-coefficient) model indicate that institutional quality significantly affects the extent to which AFT reduces bilateral trade costs. An important policy implication of our findings is that an economically robust and sustainable reduction in bilateral trade costs facing developing countries requires the presence of both promulgated and effectively functioning institutions such as regulatory power and the rule of law.     

Dynamic causality between the U.S. stock market,the Chinese stock market and the global gold market: implications for individual investors’ diversification strategies

This paper proposes a generalization of the prior VAR and EGARCH model to explore the linkage between returns and volatility transmissions in the U.S. stock market, the Chinese stock market, and the global gold market from 10 July 1996 to 20 July 2018. We found that past returns of the U.S. stock market can predict the current returns of the other two markets, and that significant reciprocal volatility transmission existed within and across all three markets. We further implemented average out-of-sample (OOS) forecasting to show that a risk-adjusted portfolio, such as mean-variance with sample estimator, does not outperform an equal-weighted portfolio. This provides insights for individual investors and helps to explain the ongoing disagreement in the portfolio literature concerning the effectiveness of risk-adjusted portfolios and equal-weighted portfolios when the number of assets is small.     

Fiscal policy,government debt,and economic growth in the Kaleckian model of growth and distribution

This article presents the Kaleckian model of growth and distribution that sets a budget deficit ratio as an indicator of fiscal policy and examines the short- and long-run effects of an increase in budget deficits and a rise in income tax rates on the economy. The key short-run outcomes are as follows. First, expanded budget deficits have a positive effect on the rate of capacity utilization. Second, the tax rate for wage income does not affect the rate of capacity utilization, whereas the tax rate for capital income has a favorable impact on it. This result implies that raising the tax rate for capital income can be an important policy instrument for stimulating the economy. Third, we find that the economy exhibits a wage-led aggregate demand in the short run. The main long-run results are as follows. First, the effect of expanded budget deficits on the growth rate is ambiguous, since a higher debt burden negatively influences the rate of capacity utilization and hence economic growth, despite the increase in demand caused by government borrowing. A higher budget deficit ratio thus raises the growth rate only if a certain condition is satisfied. Second, the tax rate for capital income has a positive impact on the growth rate. Third, the economy shows a wage-led growth in the long run.