Budget impact analysis of niraparib and olaparib for maintenance treatment of platinum-sensitive,recurrent ovarian cancer in the US

Aims: This study aimed to evaluate the budget impact of niraparib and olaparib in patients with platinum-sensitive, recurrent ovarian cancer from a US third party payer perspective.

Materials and methods: A budget impact model was constructed to assess the additional per member per month (PMPM) costs associated with the introduction of niraparib and olaparib, two poly ADP-ribose polymerase ribose polymerase (PARP) inhibitors recently approved to be used in platinum-sensitive, recurrent ovarian cancer patients with and without a gBRCA mutation. The model assessed both pharmacy costs and medical costs. Pharmacy costs included adjusted drug costs, coinsurance, and dispensing fees. Medical costs included costs associated with disease monitoring and management of adverse events from the treatment. Epidemiological data from the literature were used to estimate the target population size. The analysis used 1-year time frame, and patients were assumed on treatment until disease progression or death. All costs were computed in 2017 USD. One-way sensitivity analyses were conducted to evaluate the model robustness.

Results: In a hypothetical plan of 1,000,000 members, 206 patients were estimated to be potential candidates for niraparib or olaparib maintenance treatment after applying all epidemiological parameters. At listed 30-day supply WAC prices of $14,750 for niraparib and $13,482 for olaparib, budget impacts of these two drugs were $0.169 PMPM and $0.156 PMPM, respectively, most of which were contributed by pharmacy costs. Sensitivity analyses suggested that assumptions around market share, platinum-sensitive rate after first treatment, and WAC prices affected results the most.

Limitations: In this model, it was assumed that adopting niraparib and olaparib would not affect utilization of existing medications. Also, the estimated clinical parameters from clinical trials could differ from real-world data.     

Existence of solutions to principal–agent problems with adverse selection under minimal assumptions

We prove an existence result for the principal–agent problem with adverse selection under general assumptions on preferences and allocation spaces. Instead of assuming that the allocation space is finite-dimensional or compact, we consider a more general coercivity condition which takes into account the principal’s cost and the agents’ preferences. Our existence proof is simple and flexible enough to adapt to partial participation models as well as to the case of type-dependent budget constraints.     

Economic impact of onabotulinumtoxinA for overactive bladder with urinary incontinence in Europe

Background: Overactive bladder (OAB) is a common condition that has a significant impact on patients’ health-related quality-of-life and is associated with a substantial economic burden to healthcare systems. OnabotulinumtoxinA has a well-established efficacy and safety profile as a treatment for OAB; however, the economic impact of using onabotulinumtoxinA has not been well described.

Methods: An economic model was developed to assess the budget impact associated with OAB treatment in France, Germany, Italy, Spain and the UK, using onabotulinumtoxinA alongside best supportive care (BSC)—comprising incontinence pads and/or anticholinergic use and/or clean intermittent catheterisation (CIC)—vs BSC alone. The model time horizon spanned 5 years, and included direct costs associated with treatment, BSC, and adverse events.

Results: Per 100,000 patients in each country, the use of onabotulinumtoxinA resulted in estimated cost savings of €97,200 (Italy), €71,580 (Spain), and €19,710 (UK), and cost increases of €23,840 in France and €284,760 in Germany, largely due to day-case and inpatient administration, respectively. Projecting these results to the population of individuals aged 18 years and above gave national budget saving estimates of €9,924,790, €27,458,290, and €48,270,760, for the UK, Spain, and Italy, respectively, compared to cost increases of €12,160,020 and €196,086,530 for France and Germany, respectively. Anticholinergic treatment and incontinence pads were the largest contributors to overall spending on OAB management when onabotulinumtoxinA use was not increased, and remained so in four of five scenarios where onabotulinumtoxinA use was increased. This decreased resource use was equivalent to cost offsets ranging from €106,110 to €176,600 per 100,000 population.

Conclusions: In three of five countries investigated, the use of onabotulinumtoxinA, in addition to BSC, was shown to result in healthcare budget cost savings over 5 years. Scenario analyses showed increased costs in Germany and France were largely attributable to the treatment setting rather than onabotulinumtoxinA acquisition costs.     

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.     

Optimal selling mechanisms for multiproduct monopolists: incentive compatibility in the presence of budget constraints

We analyze the nonlinear pricing problem faced by an incomplete information monopolist operating in a market populated by agents with budget constraints. We show that if other goods are available and if the monopolist's goods are nonessential relative to other goods, then there exists an optimal, individually rational, and incentive compatible selling mechanism for the monopolist (Theorem 1). Moreover, we show that a solution to all such nonlinear pricing problems exists if and only if the monopolist's goods are nonessential (Theorem 2). In the absence of nonessentiality, we show that if the monopolist's profit function is independent of quantity (e.g., if all costs are fixed), then an optimal selling mechanism exists (Theorem 3). Finally, we show that if there is reporting (of types by agents) and partial recognition of types (by the monopolist), then an optimal selling mechanism exists, even in the absence of nonessentiality, provided agents' utility functions are affine and continuous in goods (Theorem 4).     

Budget impact model of a 5-grass sublingual immunotherapy tablet for the treatment of grass pollen-induced allergic rhinitis

Abstract

Objective:

Allergic rhinitis (AR) is a chronic disease with a substantial clinical and economic burden. This study estimated the potential budget impact (BI) associated with market entry of Sweet Vernal, Orchard, Perennial Rye, Timothy, and Kentucky Blue Grass Mixed Pollens Allergen Extract Tablet for Sublingual Use (‘5-grass SLIT tablet’) for patients aged 10–65 with grass pollen-induced AR.     

公共经济学视角下的政府预算绩效管理改革思考

政府预算绩效管理是公共财政预算管理制度改革的理论探索与实践创新,其身后具有深刻的公共经济学理论背景,深入分析政府预算绩效管理与其公共经济学理论基础间的逻辑关系,必将对我国开展政府预算绩效管理改革产生积极影响。     

Organizational design of R&D after mergers and the role of budget responsibility

We consider an innovation contest between n firms in the presence of knowledge leakages from an innovating firm to its rivals. Our analysis focuses on the effects of these knowledge spillovers on merger activities between firms. In particular, we are interested in how different organizational designs of R&D after mergers affect profits of firms taking part in a merger and profits of their non-merging rivals. Three organizational arrangements are analyzed: first, a fusion of R&D departments in which the newly merged firm decides to close down one of the previously two R&D departments. Second, a profit center arrangement in which the newly merged firm keeps the old R&D departments as fully functional entities with a sovereign budget responsibility at each of the two departments. Third, a multisubsidiary organizational form in which the newly merged firm still keeps the old R&D departments but with restricted budget responsibility in the sense that they are forced to determine cooperatively their R&D budgets in order to maximize overall firm’s profits. It turns out that the different organizational designs of R&D after the merger and the budget responsibilities have major impacts on merger outcomes.     

城市性质与酒店业发展模式关系

伴随着中国旅游产业化和市场化进程的加速,中国城市酒店的发展模式正面临着整体变革,酒店业发展的本质属性使得不同性质城市酒店发展出现不同模式。文章以三类性质的城市为基础,深入研究了中国不同职能城市的酒店发展模式,即东部特大城市的"两极化总部"发展模式、中西部省会和新兴旅游城市的"经济型"发展模式以及专业镇经济发展起来的特殊城市的"东莞"发展模式,并对其模式产生原因及其演变进行了研究。     

税收结构、政府支出与经济增长

本文构建包含税收结构和政府支出的内生增长理论模型,运用我国1998-2017年31个省市自治区数据,通过固定效用面板数据模型,研究税收结构与在预算平衡下政府支出对长期经济增长影响,并详细分析了东中西部地区间的差异。主要结论有:1.将增值税纳入理论模型之中,研究发现,税收对长期经济增长没有影响,政府支出用于提供公共技术品时会有长期增长效应。2.在满足预算约束平衡时,虽然税收对长期经济增长没有影响,但税制结构具有配置效应。3.不同税种对东中西三个区域具有差异性,需要通过制定合理的税制结构政策来促进区域的经济发展。