Costly state verification and debt contracts: a critical resume

This paper presents a critical review of the Costly State Verification framework starting from the basic model by Gale and Hellwig [Review of Economic Studies 52 (1985) 647] and further examining the most recent developments. It aims both at discussing the optimality of debt contract in alternative contexts and at offering a reply to the critiques usually moved to this approach within a unified framework.     

A forecasting model for the market of competitive products

The classic way of performing a market forecast for industrial products implies an econometric analysis of the historical data of consumption and their projections into the future. The present work illustrates a fresh approach to the problem; the demand for the product under study is evaluated in a mathematical model which takes into consideration the technological and commercial characteristics of this product and correlates it with competitive and substitutive products. Competitiveness is measured by assigning merit scores to the characteristics of the different products, and calculating the relevant “weights of importance” on the basis of the historical consumptions. Forecasts of consumption are made by estimating the future scores of the characteristics and extrapolating the weights of importance. An example of complete application of the model to the textile market in Italy is included.     

Cost-effectiveness of adding carfilzomib to lenalidomide and dexamethasone in relapsed multiple myeloma from a US perspective

Objective: To assess the economic value of carfilzomib (Kyprolis), this study developed the Kyprolis Global Economic Model (K-GEM), which examined from a United States (US) payer perspective the cost-effectiveness of carfilzomib-lenalidomide-dexamethasone (KRd) versus lenalidomide-dexamethasone (Rd) in relapsed multiple myeloma (RMM; 1–3 prior therapies) based on results from the phase III ASPIRE trial that directly compared these regimens.

Methods: A partitioned survival model that included three health states of progression-free (on or off treatment), post-progression, and death was developed. Using ASPIRE data, the effect of treatment regimens as administered in the trial was assessed for progression-free survival and overall survival (OS). Treatment effects were estimated with parametric regression models adjusting for baseline patient characteristics and applied over a lifetime horizon. US Surveillance, Epidemiology and End Results (1984–2014) registry data were matched to ASPIRE patients to extrapolate OS beyond the trial. Estimated survival was adjusted to account for utilities across health states. The K-GEM considered the total direct costs (pharmacy/medical) of care for patients treated with KRd and Rd.

Results: KRd was estimated to be more effective compared to Rd, providing 1.99 life year and 1.67 quality-adjusted life year (QALY) gains over the modeled horizon. KRd-treated patients incurred $179,393 in total additional costs. The incremental cost-effectiveness ratio (ICER) was $107,520 per QALY.

Limitations: Extrapolated survival functions present the greatest uncertainty in the modeled results. Utilities were derived from a combination of sources and assumed to reflect how US patients value their health state.

Conclusions: The K-GEM showed KRd is cost-effective, with an ICER of $107,520 per QALY gained against Rd for the treatment of patients with RMM (1–3 prior therapies) at a willingness-to-pay threshold of $150,000. Reimbursement of KRd for patients with RMM may represent an efficient allocation of the healthcare budget.     

A cost-effectiveness analysis of denosumab for the prevention of skeletal-related events in patients with multiple myeloma in four European countries: Austria,Belgium, Greece,and Italy

Aim: The approved indication for denosumab (120?mg) was expanded in 2018 to include skeletal-related event (SRE) prevention in patients with multiple myeloma (MM). Therefore, a cost-effectiveness analysis was conducted comparing denosumab with zoledronic acid (ZA) for SRE prevention in patients with MM from the national healthcare system perspective in a representative sample of European countries: Austria, Belgium, Greece, and Italy.

Methods: The XGEVA global economic model for patients with MM was used to calculate incremental cost-effectiveness ratios (ICERs) for denosumab vs ZA over a lifetime horizon. Clinical inputs were derived from the denosumab vs ZA randomized, phase 3 study (“20090482”) in patients newly-diagnosed with MM, and comprised real-world adjusted SRE rates, serious adverse event (SAE) rates, treatment duration, dose intensity, progression-free survival (PFS), and overall survival (OS). Economic inputs comprised country-specific denosumab and ZA acquisition and administration costs, SRE and SAE management costs, and discount rates. Health utility decrements associated with MM disease progression, SRE and SAE occurrence, and route of administration were included.

Results: Estimated ICERs (cost per quality-adjusted life-year [QALY] gained) for denosumab vs ZA in Austria, Belgium, Greece, and Italy were €26,294, €17,737, €6,982, and €27,228, respectively. Using 1–3 times gross domestic product (GDP) per capita per QALY as willingness to pay thresholds, denosumab was 69–94%, 84–96%, 79–96%, and 50–92% likely to be cost-effective vs ZA, respectively.

Limitations: Economic inputs were derived from various sources, and time to event inputs were extrapolated from 20090482 study data.

Conclusions: Denosumab is cost-effective vs ZA for SRE prevention in patients with MM in Austria, Belgium, Greece, and Italy, based on often-adopted World Health Organization thresholds. This conclusion is robust to changes in model parameters and assumptions. Cost-effectiveness estimates varied across the four countries, reflecting differences in healthcare costs and national economic evaluation guidelines.     

Two-sided communication in competing mechanism games

We consider multiple-principal multiple-agent games of incomplete information. We identify a class of two-way communication mechanisms which mirror those considered in the single principal analysis of Myerson (1982). In such mechanisms, every agent truthfully reveals her type to all principals, and obeys the private recommendations she receives from each of them. We show that there is a rationale in restricting attention to this class of mechanisms: if principals use these mechanisms, there is no unilateral incentive to deviate towards more sophisticated ones. We develop three examples to analyze possible extensions and limits of our approach. The first two examples show that the restriction to direct and incentive compatible mechanisms is not sufficient to provide a complete characterization of all pure strategy equilibria. The third one shows that private recommendations play a fundamental role in competing mechanism games, suggesting that one cannot safely restrict to one-sided communication mechanisms.     

Competing mechanism games of moral hazard: communication and robustness

We consider multiple-principal multiple-agent models of moral hazard: principals compete through mechanisms in the presence of agents who take unobservable actions. In this context, we provide a rationale for restricting principals to make use of simple mechanisms, which correspond to direct mechanisms in the standard framework of Myerson (J Math Econ 10:67–81, 1982). Our results complement those of Han (J Econ Theory 137(1):610–626, 2007) who analyzes a complete information setting where agents’ actions are fully contractible.