Evaluation of the long-term cost-effectiveness of IDegLira versus liraglutide added to basal insulin for patients with type 2 diabetes failing to achieve glycemic control on basal insulin in the USA

Background and aims: IDegLira, a fixed ratio combination of insulin degludec and glucagon-like peptide-1 receptor agonist liraglutide, utilizes the complementary mechanisms of action of these two agents to improve glycemic control with low risk of hypoglycemia and avoidance of weight gain. The aim of the present analysis was to assess the long-term cost-effectiveness of IDegLira vs liraglutide added to basal insulin, for patients with type 2 diabetes not achieving glycemic control on basal insulin in the US setting.

Methods: Projections of lifetime costs and clinical outcomes were made using the IMS CORE Diabetes Model. Treatment effect data for patients receiving IDegLira and liraglutide added to basal insulin were modeled based on the outcomes of a published indirect comparison, as no head-to-head clinical trial data is currently available. Costs were accounted in 2015?US dollars ($) from a healthcare payer perspective.

Results: IDegLira was associated with small improvements in quality-adjusted life expectancy compared with liraglutide added to basal insulin (8.94 vs 8.91 discounted quality-adjusted life years [QALYs]). The key driver of improved clinical outcomes was the greater reduction in glycated hemoglobin associated with IDegLira. IDegLira was associated with mean costs savings of $17,687 over patient lifetimes vs liraglutide added to basal insulin, resulting from lower treatment costs and cost savings as a result of complications avoided.

Conclusions: The present long-term modeling analysis found that IDegLira was dominant vs liraglutide added to basal insulin for patients with type 2 diabetes failing to achieve glycemic control on basal insulin in the US, improving clinical outcomes and reducing direct costs.     

Asset pricing and energy consumption risk

This paper proposes energy consumption in the US as a new measure for the consumption capital asset pricing model. We find that (i) industrial energy growth produces reasonable values for the relative risk aversion coefficient and the implied risk-free rate; (ii) compared to alternative consumption measures, industrial energy performs well in explaining the cross-sectional variation in stock returns with the lowest implied risk aversion and pricing errors; (iii) the industrial energy consumption risk model performs equally well as the Fama–French three-factor model in the cross-sectional asset pricing tests; and (iv) total energy consumption risk is priced in the presence of the Fama–French factor risks.     

Author Index

In 1998, in response to the escalating problem of violence and its impact on all sectors of the society, the Ministry of Health (MOH), Jamaica, established a pilot violence-related injury surveillance system (VRISS) in the country's leading public hospital, the Kingston Public Hospital (KPH) situated in the nation's capital. After six months' operation, VRISS was extended to include all injuries. Nine months later, the Jamaican Injury Surveillance System (JISS) was successfully introduced to four other hospitals and has been in operation since. Extension to an additional six institutions was implemented at the end of 2001. What were the challenges faced in introducing an injury surveillance system into the Accident &; Emergency Department (A&;E) of a general hospital, how they were overcome and what were the lessons learnt in the process?     

Making tourism work for the poor: Strategies and challenges in southern Africa

This article analyses strategies for 'pro-poor tourism' (PPT), ie strategies that increase the benefits to poor people from tourism development. Based on an international review of six pro-poor tourism case studies, it outlines the wide range of pro-poor tourism strategies used and their impacts to date, with particular focus on southern African case studies. By analysing their progress, problems and the critical factors influencing them, the article identifies implications for the way forward. This review underpins four propositions. First, despite commercial constraints, much can be done to enhance the contribution of tourism to poverty reduction, and a 'PPT' perspective assists in this endeavour. Secondly, PPT strategies can, and should be, incorporated by all actors in tourism, whether in government or business, at local or policy level. Thirdly, a wide range of impacts on poor people, going well beyond jobs, need to be recognised and enhanced. Finally, PPT strategies are difficult, but particularly relevant in southern Africa given the challenges of economic and political transformation, as well as the opportunity to influence international discussions on 'sustainable tourism' at the World Summit on Sustainable Development in Johannesburg in 2002.     

Exercise test on the older patient: is it still as predictive as for the younger patient?

Exercise testing predicts both cardiac events and mortality after age 65, just as it does for younger patients. In both age groups, functional aerobic capacity itself is a potent indicator of mortality risk. In the elderly, achievement of predicted functional aerobic capacity identifies favorable mortality even in the presence of CAD and CAD risk factors.     

Coronary angiography report

Reports of coronary angiography frequently determine underwriting decisions. This report exemplifies the ideal format and content for effective clinical or insurance risk assessment.     

Recurrent PSA after prostatectomy for prostate cancer: implications of PSA doubling time

After radical prostatectomy for prostate cancer, men frequently develop detectable levels of prostate specific antigen (PSA). A slow rate of increase, as characterized by the PSA doubling time (PSADT) is the principal marker for a favorable prognosis. Data and results presented in 2 recent clinical articles studying cohorts of men with clinical stage T1/T2 prostate cancer are reviewed and used to develop mortality analyses. Life-table analysis shows a mortality ratio of 257% at 5 years for Gleason score < 8, PSA recurrence > 2 years after surgery for clinical stage T1/T2 disease, and PSA doubling time (PSADT) > 10 months. Markov modeling using transition probabilities derived from the clinical articles to develop a life table analysis yields a mortality ratio of 145% at 10 years for similar patients.     

Estimating net lottery revenues for states

Based on 1980–95 data, this paper estimates and forecasts net lottery revenues for states with and without lotteries. This study indicates that a multi-state estimation is improved when a time-series and cross-section technique is used. Forecasting results are also improved when unequal time series in the data and less-than-full first years of operating lottery are controlled. For states without lotteries, the time-series and cross-section estimation indicates that only two of 14 states without a lottery would have generated net lottery revenue of more than $100 million. The number increases to five of 14 in the cross-section estimation.     

Parallel Trade and its Ambiguous Effects on Global Welfare

The regulation of parallel trade is a fiercely debated issue in the global trading system. This paper investigates the welfare effects of parallel trade freedom for different levels of trade costs and market size. It is found that parallel trade freedom has a positive effect on global welfare if countries are sufficiently heterogeneous in terms of market size and trade costs are sufficiently low. Contrary to intuition, this result even holds in a situation where parallel trade freedom implies the closure of the smaller market. If, however, countries are virtually homogenous in terms of market size, parallel trade freedom may be detrimental to global welfare for specific levels of trade costs.