Budget impact model in moderate-to-severe psoriasis vulgaris assessing effects of calcipotriene and betamethasone dipropionate foam on per-patient standard of care costs

Aims: To develop a budget impact model (BIM) for estimating the financial impact of formulary adoption and uptake of calcipotriene and betamethasone dipropionate (C/BD) foam (0.005%/0.064%) on the costs of biologics for treating moderate-to-severe psoriasis vulgaris in a hypothetical US healthcare plan with 1 million members.

Methods: This BIM incorporated epidemiologic data, market uptake assumptions, and drug utilization costs, simulating the treatment mix for patients who are candidates for biologics before (Scenario #1) and after (Scenario #2) the introduction of C/BD foam. Predicted outcomes were expressed in terms of the annual cost of treatment (COT) and the COT per member per month (PMPM).

Results: At year 1, C/BD foam had the lowest per-patient cost ($9,913) necessary to achieve a Psoriasis Area and Severity Index (PASI)-75 response compared with etanercept ($73,773), adalimumab ($92,871), infliximab ($34,048), ustekinumab ($83,975), secukinumab ($113,858), apremilast ($47,960), and ixekizumab ($62,707). Following addition of C/BD foam to the formulary, the annual COT for moderate-to-severe psoriasis would decrease by $36,112,572 (17.91%, from $201,621,219 to $165,508,647). The COT PMPM is expected to decrease by $3.00 (17.86%, from $16.80 to $13.80).

Limitations: Drug costs were based on Medi-Span reference pricing (January 21, 2016); differences in treatment costs for drug administration, laboratory monitoring, or adverse events were not accounted for. Potentially confounding were the definition of “moderate-to-severe” and the heterogeneous efficacy data. The per-patient cost for PASI-75 response at year 1 was estimated from short-term efficacy data for C/BD foam and apremilast only.

Conclusions: The introduction of C/BD foam is expected to decrease the annual COT for moderate-to-severe psoriasis treatable with biologics by $36,112,572 for a hypothetical US healthcare plan with 1 million plan members, and to lower the COT PMPM by $3.00.     

ECONOMIC EFFECTS OF POLITICAL MOVEMENTS IN CHINA: LOWER BOUND ESTIMATES

We construct a structural econometric model to measure partially the economic effects of political movements in China. Consumption, or equivalently investment, is determined by a central planner trying to maximize a multiperiod objective function. Political events are modeled by exogenous changes in the shocks to productivity and to investment which affect the time paths of major economic variables. Effects of the events are measured by comparing the time paths generated by the model with and without the changes in the shocks. The dynamic optimization model is estimated using data from 1952 to 1993. In contrast with our earlier work, we assume a trend-stationary process for log total productivity rather than a random walk process and estimate that without the Great Leap Forward Movement output per capita in China up to 1993 would have been on average 1.18 to 1.71 times as great. Without the Cultural Revolution the corresponding figure would have been 1.08 to 1.12 times as great.     

Social networks and spatial-temporal analyses for winter storm Jupiter in the US in 2017

Quality & Quantity - This study sheds new light on understanding human sentiment for Winter storm Jupiter according to the whole US states and different periods based on qualitative and...     

In search of FDI horizontal spillovers in China: evidence from meta-analysis

Quality & Quantity - This paper contributes to the literature on foreign direct investment (FDI) technology spillover effects, focusing on horizontal spillovers from foreign firms to their...     

Constructing the job-finding rate and separation rate of Hong Kong labour market

This paper constructs two essential time series of the aggregate labour market in Hong Kong: the job-finding rate and the separation rate. The average job-finding rate per month is 27.54% while the average separation rate per month is 1.29%. These numbers are similar to those for Nordic and Anglo-Saxon countries. Variance decomposition shows that the separation rate contributes to more than half the variation of the unemployment rate.     

Rational Expectations is not Generally Valid for Econometric Models: Evidence from Stock Market Data

In applying the rational expectations hypothesis to generate expectations in an econometric model it is assumed that (1) the model itself is capable of generating reasonable forecasts of all required expectations variables included in the model, and that (2) the economic agents whose behavior is being modeled act as if they form their psychological expectations as conditional mathematical expectations generated by the model. Both assumptions can be invalid, as demonstrated by the historical data on Hong Kong stock prices and by the successful application of the adaptive expectations hypothesis to explain panel data of prices of individual stocks and aggregate time series data on stock price indices of the United States and of Hong Kong.     

Budesonide with multi-matrix technology as second-line treatment for ulcerative colitis: evaluation of long-term cost-effectiveness in the Netherlands

Aims: Budesonide with multi-matrix technology (MMX) is an oral corticosteroid, shown to have high topical activity against ulcerative colitis (UC) while maintaining low systemic bioavailability with few adverse events. The aim of this study was to evaluate the cost-effectiveness of budesonide MMX versus commonly used corticosteroids, in the second-line treatment of active mild-to-moderate UC in the Netherlands.

Materials and methods: An eight-state Markov model with an 8 week cycle length captured remission, four distinct therapy stages, hospitalization, possible colectomy and mortality. Remission probability for budesonide MMX was based on the CORE-II study. Population characteristics were derived from the Dutch Inflammatory Bowel Disease South Limburg cohort (n?=?598) and included patients with proctitis (39%), left-sided (42%) and extensive disease (19%). Comparators (topical budesonide foam and enema, oral budesonide and prednisolone) were selected based on current Dutch clinical practice. Treatment effects were evaluated by network meta-analysis using a Bayesian framework. Cost-effectiveness analysis was performed over a 5 year time horizon from a societal perspective, with costs, health-state and adverse event utilities derived from published sources. Outcomes were weighted by disease extent distribution and corresponding comparators.

Results: Budesonide MMX was associated with comparable quality-adjusted life year (QALY) gain versus foam and oral formulations (+0.01 QALYs) in the total UC population, whilst being cost-saving (EUR 366 per patient). Probabilistic sensitivity analysis evaluated an 86.6% probability of budesonide MMX being dominant (cost-saving with QALY gain) versus these comparators. Exploratory analysis showed similar findings versus prednisolone.

Limitations: Differing definitions of trial end-points and remission across trials meant indirect comparison was not ideal. However, in the absence of head-to-head clinical data, these comparisons are reasonable alternatives and currently offer the only comparison of second-line UC treatments.

Conclusions: In the present analysis, budesonide MMX was shown to be cost-effective versus comparators in the total UC population, for the second-line treatment of active mild-to-moderate UC in the Netherlands.     

PARENTAL TIME INVESTMENT AND INTERGENERATIONAL MOBILITY

This article constructs an overlapping generations general equilibrium model to explore the extent to which heterogeneity in time investment shapes intergenerational mobility of lifetime income. The calibrated model successfully accounts for untargeted distributional aspects of income mobility. Counterfactual exercises show that removing heterogeneity in parental time investment reduces intergenerational persistence by around 7–8% for early childhood but only marginally in later childhood. Policy experiments find that an asset-tested subsidy for parental monetary investments in early childhood can raise intergenerational mobility in a cost-effective way, though it reduces mobility substantially if given to parents with older school-aged children.