Tofacitinib in the treatment of moderate-to-severe rheumatoid arthritis: a cost-effectiveness analysis compared with adalimumab in Taiwan

Aims: Tofacitinib is an oral Janus kinase inhibitor for the treatment of rheumatoid arthritis (RA). This analysis investigated the cost-effectiveness of the second-line treatment with tofacitinib, compared with adalimumab, both plus methotrexate (MTX), in patients with moderate-to-severe RA and an inadequate response to the first-line MTX, from a Taiwan National Health Insurance Administration perspective.

Materials and methods: A patient-level simulation model was used to project lifetime costs and quality-adjusted life-years (QALYs). Base-case analysis compared second-line treatment with tofacitinib 5?mg twice daily plus MTX vs adalimumab 40?mg every 2?weeks plus MTX. Patients switched or discontinued treatment due to a lack or loss of effectiveness or a serious adverse event. Efficacy was measured by change in Health Assessment Questionnaire-Disability Index (HAQ-DI) score. HAQ-DI scores were used to predict mortality and resource utilization, and were mapped onto utility values to estimate QALYs. Efficacy and safety data were derived from clinical trials and other secondary sources. Uncertainty in model parameters was explored using one-way deterministic and probabilistic sensitivity analyses.

Results: Patients gained 0.09 more QALYs with second-line tofacitinib plus MTX compared with adalimumab plus MTX (5.13 vs 5.04, respectively) at an additional cost of New Taiwan Dollars (NT$) 12,881. The incremental cost-effectiveness ratio was NT$143,122/QALY. One-way sensitivity analysis confirmed the base-case result was robust.

Limitations: The lack of available clinical data, particularly for HAQ-DI scores, may introduce some bias in the analysis. No patients were in an early stage of RA, which may limit the generalizability of these results. Base-case results from our study are not necessarily generalizable to countries with healthcare systems that differ considerably from Taiwan.

Conclusions: From a payer perspective, second-line treatment with tofacitinib plus MTX is a cost-effective treatment strategy, compared with adalimumab plus MTX, in patients with moderate-to-severe RA in Taiwan.

Trial registration: ClinicalTrials.gov identifier: NCT00853385.     

U.S. Auditors' Perceptions of the PCAOB Inspection Process: A Behavioral Examination

This study examines U.S. auditors' observations of the PCAOB inspection process, and its impact on their work, in order to understand the current U.S. regulatory audit climate. Using 20 interviews with experienced auditors, we consider behavioral factors (e.g., perceived power of and trust in the PCAOB) that can impact the level and form of auditor compliance according to theory from the slippery slope framework on audit regulation (Kirchler et al. 2008; Dowling et al. 2018). Our participants described an audit climate with a powerful regulator. They reported that their desire to receive “clean” inspection reports has had a substantial impact on audit procedures and quality control. However, our participants do not appear to have high trust in the PCAOB, as they questioned aspects of the inspection process and its expectations. Accordingly, we conclude that U.S. public company auditors operate in an antagonistic environment in which auditors perceive the PCAOB has high coercive power. In other words, they comply due to fear of enforcement rather than agreement with the PCAOB's views on audit quality. Some auditors also indicated that they consider both the costs and benefits of compliance. Theoretical intuition implies that any future increases to perceived costs relative to perceived benefits of compliance could ultimately decrease the PCAOB's coercive power and reduce U.S. auditor compliance. Our findings have implications for regulators and researchers interested in understanding behavioral factors that may influence regulatory compliance.     

Why Do We Care What Others Pay? The Effect of Other Consumers’ Prices on Inferences of Seller (Dis)Respect and Perceptions of Deservingness Violation

Comparisons to other consumers have been identified as particularly meaningful in shaping price fairness judgments, but why they should be so is not clear. The current work argues that fairness judgments reflect both the extent to which consumers receive what they believe they deserve and inferences about seller respect. We suggest that comparisons to consumers paying lower prices are a particularly potent source of unfairness because they highlight the violation of deservingness and readily communicate information about sellers’ opinions of consumers. Three experiments investigate these ideas. Implications for fairness theory and marketing are discussed.     

Localism and the Big Society: the asset transfer of leisure centres and libraries – fighting closures or empowering communities?

This paper critically examines the ‘asset transfer’ of leisure services from the public to the voluntary sector. Asset transfer might be theorised as ‘austerity localism’, in which volunteers are obliged to fill the gaps left by retreating public provision, or as ‘progressive localism’, which represents new opportunities through the localism and Big Society agendas to develop more locally responsive, cooperative and mutualist visions. In this way, asset transfer might overcome the limitations of the United Kingdom policies in which ‘Big Government’ is replaced by civic society. Drawing on qualitative interviews with key personnel (volunteers, managers and local authority officers) at 12 leisure facilities, a grounded assessment of the nuanced balance between ‘austerity localism’ and ‘progressive localism’ is provided, including three observations. First, the main impetus for transfer was cuts in local authority budgets which stimulated the emergence of local groups of volunteers. Secondly, the transfers themselves required interaction between local government and the volunteer groups; however, the nature of the relationship and support given varied and support was limited by austerity measures. Thirdly, volunteers do not automatically fill a gap left by the state: without support transfer viability relies on the financial and social capital among volunteer groups, and this is unevenly distributed. These findings suggest that the capacity for a ‘progressive localism’ to emerge through asset transfer is limited. However, where transfer has occurred, there are some progressive benefits of volunteer empowerment and a more flexible service.     

The derived demand for faculty research

Estimation of the demands for many services supplied by government and charitable organizations are hampered by two practices common to the supply of these services. The suppliers often employ non‐price rationing of these services, and they price discriminate. The supply of college training, for example, is rationed on the basis of academic ability as well as willingness to pay, and more able students are typically quoted lower net prices (associated with scholarships) than less able students. This paper suggests a method for dealing with both practices in the analysis of cross‐sectional data. This methodology is used to investigate the question of why university faculty members are expected to do research as well as teach. One answer supported by our empirical work is that the customers (e.g., the students) demand it. Thus, controlling for price and non‐academic features, better students will choose to attend a university where more scholarly research is performed. Moreover, our empirical findings also support a strong negative link between faculty time devoted to teaching and the supply of research. Copyright © 2003 John Wiley & Sons, Ltd.     

Ethical Transparency and Economic Medicalization

This article introduces the concept of economic medicalization where non-medical problems are transformed into medical problems in order to achieve the objective of corporate shareholder wealth maximization. Following an overview of the differences in ethical norms applicable to medical ethics and business ethics, the economic medicalization of medical research practice and publication is examined in some detail. This motivates a general discussion of the problems involved in the ethical approval process for medical research that balances the interests of both business and government in the market for medical products and services.     

The service sector of Cuba: An analysis and critique

The Cuban economy has experienced a significant increase in foreign direct investment over the past decade due to the end of the Soviet Union and the establishment of more liberal trade policies. Although the U.S. embargo of trade with Cuba still exists, there has been movement lately that suggests the end of the four‐decades‐old policy. The purpose of this article is to analyze the current Cuban business environment and to identify potential entrepreneurial opportunities in the service sector. Major trade partners are also reviewed and managerial implications discussed. © 2006 Wiley Periodicals, Inc.     

Social Desirability Bias in Survey Research on Sustainable Development in Small Firms: an Exploratory Analysis of Survey Mode Effect

Survey methodology has become an increasingly popular weapon of choice in conducting research on the topic of environmental sustainability in the small firm context. However, conventional application of survey research in many empirical studies tends to ignore the inherent issues associated with the mode of administration of survey questionnaires. One of these issues is social desirability bias (SDB) arising from survey modes such as face to face, the assisted type of survey questionnaire administration and mailed or purely self‐administered survey. This study is an analysis of survey data generated by two modes: purely self‐administered and survey enumerator assisted. The paper argues that the presence of an enumerator in the workplace or actual site of the business to administer the survey will motivate the respondents to provide more accurate information about the firms' environmental sustainability knowledge and practices. The article offers suggestions to address SDB in carrying out surveys about environmental sustainability in small firms. Copyright © 2011 John Wiley & Sons, Ltd and ERP Environment.