Budget impact analysis of secukinumab versus adalimumab in the treatment of ankylosing spondylitis

Background: Biologic treatments have enhanced the treatment outcomes of patients with active ankylosing spondylitis (AS). Until recently, TNF-alpha-inhibitors have been the only biologics approved for the treatment of active AS. The objective of this study was to assess the potential financial impact of the first non-TNF-alpha biologic secukinumab (fully human IL-17A-inhibitor) vs adalimumab (TNF-alpha-inhibitor) in the treatment of AS in Finland.

Materials and methods: In this model-based budget impact analysis, patients were treated either with secukinumab (150?mg) or adalimumab (40?mg). The number of patients and market share of different biologics were based on national reimbursement registry data. Adalimumab was the most commonly used biologic treatment for AS, and in the base case analysis all adalimumab patients are assumed to switch to secukinumab. Response rates were based on a matching-adjusted indirect comparison between secukinumab and adalimumab. Patients not achieving response were switched to another biologic treatment.

Results: Treating AS patients with secukinumab instead of adalimumab leads to potential savings of 18.2 million euros within a 5-year time period. The total costs within the follow-up time were 59.5 million euros and 77.7 million euros with and without secukinumab, respectively. According to sensitivity analyses, a higher adoption rate of secukinumab corresponds to higher potential savings.

Conclusions: Secukinumab is a cost-saving treatment option compared with adalimumab in the treatment of AS in Finland. More patients could be treated with a biologic by allocating resources more efficiently.     

Overall survival,costs, and healthcare resource use by line of therapy in Medicare patients with newly diagnosed metastatic urothelial carcinoma

Aims: Medicare patients with metastatic or surgically unresectable urothelial carcinoma (mUC) often receive platinum-based chemotherapy as first line of therapy (LOT), but invariably progress, requiring additional LOTs and healthcare resource use (HCRU). To better understand the evolving mUC treatment landscape, the economic burden of chemotherapy-based mUC treatments among US Medicare patients was estimated.

Methods: Newly diagnosed Medicare patients with mUC were identified from the Surveillance, Epidemiology, and End Results (SEER)-Medicare database. Patients were followed from diagnosis to death, disenrollment, or end of study to characterize LOTs (first [LOT1], second [LOT2], and third or greater [LOT3+]). Kaplan-Meier methods were used to estimate overall survival (OS) by LOT. HCRU and mean costs were reported over the follow-up period, LOT duration, and maximum LOT received.

Results: Among 1,873 eligible patients with mUC (median age?=?77?years; median follow-up?=?7.5?months), 1,035 (55%) received no chemotherapy. Among chemotherapy-treated patients, 61% had LOT1 only, 25% had LOT1 and LOT2 only, and 14% had LOT3+. Median OS was 8.1?months, range was 4.3 (untreated) to 29.8 (LOT3+) months. HCRU frequency increased with additional LOTs. Mean cumulative per-patient cost was $82,912 for all patients, increasing with additional LOTs (untreated?=?$57,207; LOT1?=?$99,213; LOT2?=?$125,190; LOT3+?=?$163,884). Mean per patient per month cost was $18,827 for all patients, decreasing with increasing number of LOTs received (untreated?=?$27,211; LOT1?=?$9,601; LOT2?=?$7,325; LOT3+?=?$6,017).

Limitations: Potential for treatment misclassification when using the algorithm defining LOTs and non-generalizability of results to younger patients.

Conclusions: Over 50% of Medicare patients with mUC received no chemotherapy. Among chemotherapy-treated patients, most received only one LOT. Additional LOTs led to higher mean costs and HCRU, but as patients were followed longer, monthly costs decreased. As treatments evolve to include immuno-oncology agents, these findings provide a clinically relevant economic benchmark for mUC treatment across different traditional LOTs.     

Modinomics: Design,Implementation, Outcomes,and Prospects

This paper presents an analysis of the key elements of Modinomics, defined as “everyone's participation, everyone's progress.” It investigates the reasons why Modinomics was necessary, the key elements of Modinomics, and how this policy was implemented. It argues that India's economic policy has had continuity since the economic reform package of 1991, so Modinomics has involved a high component of better implementation. Nevertheless, there have been some major policy changes as well. The paper discusses the deep structural reforms of demonetization and a Goods and Services Tax as well the new Insolvency and Bankruptcy Act. The paper examines the record of economic growth under Modi as well as new welfare and employment programs to make economic growth more inclusive. Finally, the paper examines the medium and long‐term growth prospects for India.     

India's Economic Reforms: Achievements and Next Steps

This paper reviews the impact of India's reforms since 1991 on the performance of the Indian economy. It shows that the reforms definitely achieved a significant acceleration in growth and they also succeeded in reducing poverty. However, they have been less successful in generating good quality jobs. There was progress in providing better access to education, health services ,and clean drinking water and sanitation, but less than was hoped. The area where performance has been most disappointing is environmental sustainability. The paper concludes by identifying some of the critical policy challenges in the years ahead.     

Economization of Society: Functional Differentiation and Economic Stagnation

The explanation of economization and marketization processes is typically approached in the mindset of structural superiority, primacy or hegemony of the economic subsystem over non-economic spheres of social life. However, economic primacy is an underexplored puzzle for social theory from the perspective of functional differentiation theory, which emphasizes equal autonomy of social subsystems. Schimank has paved the way for theorizing economic primacy and economization pressures coherent with functional differentiation. Economization in his theoretical solution is connected to the economy’s governance mechanism—the market which is seen as having a weak order-building capacity. The contribution of this article lies in suggesting an alternative conceptualization of the internal dynamics of the economy—the stagnation tendency for explaining economization pressures as a systematic outcome.     

Technological versus Pecuniary External Economies: The Former Should Rule the Roost

The paper endeavors to illustrate that though the existing literature emphasizes the dynamic role of Scitovskian pecuniary external economies to account for the growth of innovations, highlighting particular types of market interdependence, such interdependencies can just highlight quasi-rent-led static adjustments that do not ensure an endogenous growth of innovations; the possibility of the growth of innovations remains exogenous. In this context, the present paper highlights the importance of division of labor-led dynamic technological external economies that ensures the endogenous growth of innovations, underlining the need of reinterpretation of Allyn Young in a broader Kaldorian-Keynesian perspective. In this perspective, finance-led investment in more productive opportunities not only supports increases in market size but also begets further investment in (still) more productive opportunities. This understanding provides a more dynamic conceptualization of Keynesian pecuniary external economies that are driven by Youngian technological external economies.     

Determinants of the adjusted net saving rate in developing economies

The adjusted net saving rate, initially known as the genuine saving rate, was first published by the World Bank in the late 1990s as a more comprehensive measure of national saving and one more indicative of sustainable development. The adjusted net saving rate incorporated not just physical capital depreciation, but natural capital depletion and environmental damage, as well as including some human capital formation. In this paper, using a cross‐section of developing economies for 2001–2006, determinants of the adjusted net saving rate are estimated. For comparison, the same determinants for the gross national saving rate are estimated. Also, a basic Solow growth model is extended to incorporate natural resources and to justify a more comprehensive measure of savings, such as the adjusted net saving rate, for modeling economic growth. The two measures of savings are then compared as determinants in estimations of economic growth. Understanding the determinants of the adjusted net saving rate is useful for policies to promote sustainable development.     

The impact of more complex family structure upon marital earnings premiums

This article employs a unique data set from Trinidad and Tobago to examine the impact of their more complex family structures upon marital earnings premiums. While family structure includes the single married couple structure common in the US, families in Trinidad and Tobago often have more adults living in the household, multiple married couples living in the same family, and multigenerational families. Marital premiums for family members most likely to invest in labor market production are estimated to increase with more complex family structure. In contrast, estimated marital premiums for members most likely to invest in home production are decreased with more complex family structure. Results suggest that specialization within the larger family help explain the existence of marital premiums.     

The Infusion of Relational Market Obligations into the Austrian Agenda—Some Lessons Learned from Economic Sociology

Given its dictum of market equilibrium, economics in general obviously does poorly in shouldering market dynamics. Pervading obligatory traits of the market (other than mere dyadic contracting) is yet another area where not much attention is devoted. Whereas the Austrian agenda fills the first of these voids in a most sophisticated manner, its current discourse appears as oblivious concerning the manner in which market exchange transforms into relational interconnected obligations. That is to say, exchange is hardly understood as an indispensable facet of durable market obligations such as relationships 'constituting the market', but exclusively as immediate entrepreneurial arbitrage. Apart from an outright peculiar failure to recognize some of its own roots in this regard this omission unnecessarily delimits the manner in which Austrians can proceed and deepen their market analysis. The principal idea of this paper is to scrutinize the manner in which relational market obligations can be introduced into Austrian reasoning by drawing on ideas from within economic sociology. Max Weber's dictum on market openness takes on a particular role in this regard. An adjacent contribution strived for is to let this scrutiny foreshadow the manner in which such a partial reconciliation of market ideas from within economic sociology and Austrian economics could proceed.     

都市圈经济辐射效应的协方差分析——以上海都市圈为例

基于县级市数据,通过协方差分析等统计方法,研究了上海都市圈内中心城市对周边城市的经济辐射效应以及对相关市场的带动效应。结论表明,上海对其都市圈内的城市有显著的经济辐射效应,对相关市场的带动效应明显。