The cost-effectiveness of solifenacin vs. trospium in the treatment of patients with overactive bladder in the German National Health Service

Objective:

To carry out a cost–utility analysis comparing initial treatment of patients with overactive bladder (OAB) with solifenacin 5?mg/day versus either trospium 20?mg twice a day or trospium 60?mg/day from the perspective of the German National Health Service.

Methods:

A decision analytic model with a 3 month cycle was developed to follow a cohort of OAB patients treated with either solifenacin or trospium during a 1 year period. Costs and utilities were accumulated as patients transitioned through the four cycles in the model. Some of the solifenacin patients were titrated from 5?mg to 10?mg/day at 3 months. Utility values were obtained from the published literature and pad use was based on a US resource utilization study. Adherence rates for individual treatments were derived from a United Kingdom general practitioner database review. The change in the mean number of urgency urinary incontinence episodes/day from after 12 weeks was the main outcome measure. Baseline effectiveness values for solifenacin and trospium were calculated using the Poisson distribution. Patients who failed second-line therapy were referred to a specialist visit. Results were expressed in terms of incremental cost–utility ratios.

Results:

Total annual costs for solifenacin, trospium 20?mg and trospium 60?mg were €970.01, €860.05 and €875.05 respectively. Drug use represented 43%, 28% and 29% of total costs and pad use varied between 45% and 57%. Differences between cumulative utilities were small but favored solifenacin (0.6857 vs. 0.6802 to 0.6800). The baseline incremental cost–effectiveness ratio ranged from €16,657 to €19,893 per QALY.

Limitations:

The difference in cumulative utility favoring solifenacin was small (0.0055–0.0057 QALYs). A small absolute change in the cumulative utilities can have a marked impact on the overall incremental cost-effectiveness ratios (ICERs) and care should be taken when interpreting the results.

Conclusion:

Solifenacin would appear to be cost-effective with an ICER of no more than €20,000/QALY. However, small differences in utility between the alternatives means that the results are sensitive to adjustments in the values of the assigned utilities, effectiveness and discontinuation rates.     

Credit Conditions in Pakistan: Supply Constraints or Demand Deficiencies?

This paper attempts to pin down the key drivers of demand for and supply of real private sector credit in Pakistan. I use both the equilibrium and disequilibrium econometric frameworks, specifically tackling the issue of lack of consistency and/or efficiency of joint estimators in the former via the three‐stage least squares technique. On the demand side, I find that higher economic activity provides stimulus to credit whereas inflation dampens it. The stock market seems to play a dual role: as a source of alternative financing, a bullish market negatively impacts credit while, as an indicator of economic expectations, it provides a positive impetus. On the supply side, banks' lending capacity is found to be the major driver of credit while government borrowing has a crowding‐out effect. Pakistan currently faces supply constraints, which might put an additional check on capacity utilization by firms, thus damaging growth prospects. The results have important policy implications.     

Current Account Deficit in Mauritius: Risks and Prospects

Mauritius is often cited by international institutions, including the International Monetary Fund and World Bank, as a success story in economic development. The island has, since the early 1970s, adopted an export‐led growth strategy to power its economy. However, a constant decline over the last decade in the exports to gross domestic product (GDP) ratio has resulted in a worsening current account to GDP ratio, which is now a cause for concern. Using a three‐regime, self‐exciting threshold autoregressive (SETAR) model, this paper finds that the Mauritian economy may converge to either of two current account equilibria, namely a deficit of 9% or a surplus of 2.5% on a seasonally adjusted basis. A dynamic simulation exercise suggests that the Mauritian current account is more likely to switch from surplus to deficit equilibrium than from deficit to surplus equilibrium. Given that the prevailing deficit is in the vicinity of the deficit equilibrium, structural policies aiming to boost productivity and efficiency are indispensable for pulling Mauritius out of the “deficit trap,” the more so since the island has been experiencing a continuous erosion of trade preferences, which formerly enabled it to have privileged access for its exports to the EU market.     

Role of tariffs,imports substitution and investment efficiency in economic growth of Pakistan

Quality & Quantity - This paper explores the impact of tariffs, imports substitution and investment efficiency on economic growth in Pakistan. For this purpose, secondary data was collected...     

Clinical and economic impact of mirabegron compared with antimuscarinics for the treatment of overactive bladder in Canada

Background: The β₃-adrenoceptor agonist, mirabegron, and antimuscarinic agents provide similar efficacy for the treatment of overactive bladder (OAB), but mirabegron appears to be associated with better persistence, perhaps due to an absence of anticholinergic side-effects. This study estimated the expected costs associated with the management of OAB in Canada from a societal perspective by utilizing real-world evidence.

Methods: An economic model with monthly cycles and a 1-year time horizon was developed to depict a treatment pathway for a hypothetical cohort of 100 patients with OAB. At model entry, patients receive mirabegron or an antimuscarinic. Patients who do not persist may switch treatment, undergo a minimally invasive procedure, or remain symptomatic (uncontrolled). The model includes direct costs (e.g. physician visits) and indirect costs (e.g. lost productivity). A one-way univariate sensitivity analysis assessed a ±20% variation in each of the key model inputs.

Results: At 1 year, a greater proportion of patients persisted on treatment with mirabegron compared with antimuscarinics (33% vs 15–23%), and a smaller proportion switched treatment (17% vs 20–22%). The number of healthcare visits (292 vs 299–304), pads used (74,098 vs 77,878–81,669), and work hours lost (4,497 vs 5,372–6,249) were all lower for mirabegron vs antimuscarinics. The estimated total annual cost of treatment per patient with mirabegron was $2,127.46 Canadian dollars (CAD) ($5.82 CAD/day) compared with $2,150.20–$2,496.69 CAD ($5.89–$6.84 CAD/day) for antimuscarinics. The one-way sensitivity analysis indicated the results are robust.

Conclusions: Improved persistence observed in routine clinical practice with mirabegron appears to translate into benefits of reduced healthcare resource use, and lower direct and indirect costs of treatment compared with antimuscarinics. Overall, these data suggest that mirabegron may offer clinical and economic benefits for the management of patients with OAB in Canada.     

Drivers of radical and incremental creativity—A moderated mediation framework

Researchers establish that rewards play an important role in shaping employees' creative behaviors. However, little is known about the underlying mechanisms that transmit the effects of rewards for creativity on different types of creative behaviors. Drawing on the sense making perspective, this study identifies unique mediators and moderators of reward—creativity relationship. The results of this survey-based study, comprising of 220 independent employee - supervisor dyads, suggested that enjoyment in the activity mediated the relationship between intrinsic rewards and radical creative behaviors. Moreover, the interactional effects of extrinsic rewards and their perceived importance on creative behaviors were mediated through perceptions of climate for innovation. These results provide important insights and guide managers in promoting distinct types of creative behaviors.     

Transport infrastructure and tourism development

This paper investigates the significance of transport infrastructure as a factor in destination development, showing it to be part of the classical demand for international tourism functions. An application involving the island of Mauritius is presented, whereby total tourist arrivals are modeled. The findings show that tourists from Europe/America and Asia are particularly sensitive to the island’s transport infrastructure. Those from Europe/America are also sensitive to its nontransport infrastructure. Both types of infrastructure, as well as income of tourists, distance, and relative prices are important ingredients in their own respect in the tourism demand equation. Mauritius is an expanding destination, with the European and American markets being most promising.     

Testing for the Feldstein-Horioka hypothesis in Asia using wavelet analysis

We investigate the Feldstein-Horioka (1980) puzzle using a novel time-frequency approach. The wavelet-based retention and correlation coefficients are estimated for a cross-section of 15 Asian countries over the period 1972–2016. The countries are grouped as OCED countries (Japan and South Korea), least developed countries (like Bangladesh and Nepal), the large countries (like India and China), and the small countries (like Sri Lanka and Pakistan). Our approach reveals some interesting insights on the relationship between investment and saving rates and investment and current account deficits.     

An incidence model of the cost of advanced prostate cancer in Spain

Background:

Prostate cancer (PCa) is the second leading cancer diagnosed among men. In Spain the incidence of PCa was 70.75 cases per 100,000 males. Advanced PCa has spread outside of the prostate capsule and may involve other parts of the body. The aim of this study was to estimate the lifetime costs of a cohort of advanced PCa patients diagnosed in Spain in 2012.

Methods:

A partitioned economic model was developed in EXCEL incorporating Spanish incidence, mortality, and cost data supplemented with data from the international literature. Progression from Stage III to Stage IV was permitted. Costs were discounted at the standard rate of 3%. Lifetime costs were presented on an individual basis and for the entire cohort of newly diagnosed Stage III and Stage IV PCa patients.

Results:

Lifetime costs for advanced PCa were ～€19,961 per patient (mean survival of 8.4 years). Using the projected incident cases for 2012 (3047), the total cost for the incident cohort of patients in 2012 would amount to €61 million. These results were more sensitive to changes in the ongoing costs (post-initial 12 months) of Stage III PCa, the rate of progression from Stage III to Stage IV, and the discount rate applied to costs.

Conclusions:

This study provides an estimate of the lifetime costs of advanced PCa in Spain and a framework for further research. The study is limited by the availability of long-term Spanish data and the need to make inferences from international studies. However, until long-term prospective or observational data do become available in Spain, based on the assumptions, the current results indicate that the burden of advanced PCa in Spain is substantial. Any treatments that could potentially reduce the economic burden of the disease should be of interest to healthcare decision makers.