Cost-effectiveness analysis of sequential biologic therapy with ixekizumab versus secukinumab as first-line treatment of moderate-to-severe psoriasis in the UK

Aims: Patients with psoriasis often undergo treatment with a sequence of biologic agents because of poor/loss of response to initial therapy. With the availability of newer agents like ixekizumab and secukinumab, there is a need for cost-effectiveness analyses to better reflect current clinical practice. This study aimed to assess the cost-effectiveness of a sequence of biologic therapies containing first-line ixekizumab vs first-line secukinumab in patients with moderate-to-severe plaque psoriasis in the UK.

Materials and methods: A Markov model with a lifetime horizon was developed to compare the cost-effectiveness of ixekizumab and secukinumab treatment sequences: ixekizumab → ustekinumab → infliximab → best supportive care (BSC) vs secukinumab → ustekinumab → infliximab → BSC. The model used monthly cycles, and included four health states: trial period, treatment maintenance, BSC, and death. At the end of the trial period, responders transitioned to maintenance therapy; non-responders transitioned to the next biologic in the sequence. An annual discontinuation rate of 20% was assumed for maintenance therapy.

Results: The ixekizumab sequence provided cost savings of £898 (£176,203 vs 177,101) [year 2015 values] and gained 0.03 more quality-adjusted life-years (QALYs: 1.45 vs 1.42) vs the secukinumab sequence over the lifetime horizon. Probabilistic sensitivity analysis showed an 89.8% likelihood that the ixekizumab sequence would be cost-effective at a threshold of £20,000 per QALY gained.

Limitations: The analysis used list prices for drugs rather than confidential, preferentially priced Patient Access Scheme costs. In addition, efficacy input data were based on a network meta-analysis, as there were no head-to-head trials comparing ixekizumab and secukinumab.

Conclusion: First-line treatment with ixekizumab as part of a specific sequential biologic therapy for moderate-to-severe plaque psoriasis in the UK provided slight advantages in cost savings and QALYs gained over a similar treatment sequence initiated with secukinumab. In view of the small magnitude of these differences, factors such as patient preferences (e.g. for number of injections) and long-term safety (e.g. related to time on the market) may also be important for clinical decision-making.     

Active engagement with nature: outdoor adventure tourism,sustainability and wellbeing

Abstract

This article draws on the conflicting arguments surrounding outdoor adventure tourism activities to determine if such activities might usefully be considered beneficial for humans and nature, and how they might offer avenues for sustainable tourism practice. Research in the field has often examined outdoor adventure activities through a lens that either highlights their negative environmental impacts or has sought to conceptualise motivations and/or experiences. In this article, we argue that through practices that are often seen as destructive, there is the possibility to think differently about human-nature relationships and pro-environmentalism. To explore these issues, we draw on data collected from a series of semi-structured interviews with outdoor adventure tourists. Our analysis highlights how outdoor adventure tourism facilitates reconnections to nature, offering potential wellbeing impacts and pro-environmental attitudes and behaviours. We conclude that outdoor adventure activities as a form of sustainable tourism have potential implications for our understanding of, and engagement with, sustainability, mental health and wellbeing.     

Tourism knowledge and neocolonialism – a systematic critical review of the literature

Despite the official end of colonialism in the twentieth century, neocolonial structures of power have kept influencing the political, socio-cultural and economic arenas worldwide. Within this scenario, the tourism academy has seen its landscape develop with its own set of power structures, which have shaped its knowledge production and dissemination. However, whether and how neocolonial forces have exerted their influence on tourism knowledge production and dissemination is still a subject of debate among scholars. This paper was conceived as an attempt to cast additional light on the nexus between tourism knowledge and neocolonialism. More specifically, through a systematic review of the articles published in tourism journals in the last decade (2007–2017), this work assesses the status of the current tourism knowledge through the lens of neocolonialist theory. Overall, this critical review highlights that with some exceptions, most of the previous reviews concerning tourism knowledge only evaluate the work published in English in highly ranked tourism journals and tend to neglect knowledge systems outside the English-speaking global centres. Furthermore, previous studies exploring structures of power affecting tourism knowledge production and dissemination present limitations in terms of the themes and perspectives identified.     

How sustainable is sustainable hospitality research? A review of sustainable restaurant literature from 1991 to 2015

This research was designed to evaluate our current state of knowledge by systematically reviewing tourism and hospitality academic literature concerning sustainability in the restaurant sector by undertaking a systematic review and content analysis. The characteristics of 76 articles are listed in a comprehensive table, presenting research design and research variables, and the articles are examined for their approach to the sustainability concept as applied to the restaurant industry (i.e. the range of responsible practices addressed in each work). The findings indicate that the majority of the literature only engages with parts of sustainability, particularly ecological, rather than holistic sustainability. This matters because it may mean we fail in our attempts to achieve more sustainable restaurant operations.

This research suggests that tourism and hospitality studies need to re-engage with the evolving conceptualisation of sustainability to ensure that best practice responses to changing requirements are undertaken. The narrow focus on ecological aspects of sustainability featuring in restaurants does not acknowledge the full meaning of sustainability and therefore may constrain efforts to secure more sustainable futures. Illuminating such gaps in knowledge is important in order to strengthen our conceptual understandings, refine our practices and thereby secure more sustainable futures through tourism and hospitality.     

Cost-effectiveness of TYRX absorbable antibacterial envelope for prevention of cardiovascular implantable electronic device infection

Aims: Infection is a major complication of cardiovascular implantable electronic device (CIED) therapy that usually requires device extraction and is associated with increased morbidity and mortality. The TYRX Antibacterial Envelope is a polypropylene mesh that stabilizes the CIED and elutes minocycline and rifampin to reduce the risk of post-operative infection.

Methods: A decision tree was developed to assess the cost-effectiveness of TYRX vs standard of care (SOC) following implantation of four CIED device types. The model was parameterized for a UK National Health Service perspective. Probabilities were derived from the literature. Resource use included drug acquisition and administration, hospitalization, adverse events, device extraction, and replacement. Incremental cost-effectiveness ratios (ICERs) were calculated from costs and quality-adjusted life-years (QALYs).

Results: Over a 12-month time horizon, TYRX was less costly and more effective than SOC when utilized in patients with an ICD or CRT-D. TYRX was associated with ICERs of £46,548 and £21,768 per QALY gained in patients with an IPG or CRT-P, respectively. TYRX was cost-effective at a £30,000 threshold at baseline probabilities of infection exceeding 1.65% (CRT-D), 1.95% (CRT-P), 1.87% (IPG), and 1.38% (ICD).

Limitations and conclusions: Device-specific infection rates for high-risk patients were not available in the literature and not used in this analysis, potentially under-estimating the impact of TYRX in certain devices. Nevertheless, TYRX is associated with a reduction in post-operative infection risk relative to SOC, resulting in reduced healthcare resource utilization at an initial cost. The ICERs are below the accepted willingness-to-pay thresholds used by UK decision-makers. TYRX, therefore, represents a cost-effective prevention option for CIED patients at high-risk of post-operative infection.     

The determinants of shareholders＇ wealth of acquiring firms in India

Corporate restructuring has become a major component in the financial and economic environment all over the world. Industrial restructuring has raised important issues for business decisions as well as for public policy formulation. Since 1991, Indian industries have been increasingly exposed to both domestic and international competition and competitiveness. The companies started restructuring there operations around their core business there M ＆ A. But M ＆ A is an area of potential good and harm in corporate strategy including manufacturing industry. Therefore, an attempt has been made to analyze the security returns and to find out the net wealth increase or decrease to the shareholders of acquiring firms. In India, there are totally 58 manufacturing companies which have undergone mergers and acquisitions during 2000, 2001 ＆ 2002. Thirty percentage from the total population was taken as sample size （i.e., 17 companies out of 58）. The present study is mainly based on secondary data. The Market Model and Market Adjusted Returns Model analysis are used as tools of analysis.     

Agricultural water management and poverty in Ethiopia

The main focus of this article is to explore whether access to selected agricultural water management (AWM) technologies has led to significant reduction in poverty and, if they did so, to identify which technologies had higher impacts. In measuring impact we estimated the average treatment effect for the treated on crop income and measured the differences in consumption expenditures per adult equivalent of those with access and without access using matched data. The estimated average treatment effect was significant and amounted to USD 82 per season. Moreover, there was 24 less poverty incidence among users of AWM technologies compared to nonusers. All technologies were found to have significant poverty reducing impacts with micro dams, deep wells, river diversions, and ponds leading to 37%, 26%, 11%, and 9% reduction in poverty incidence compared to rainfed system. Finally, our study identified the most important correlates of poverty on the basis this we made the policy recommendations to build assets (AWM technologies, livestock, etc); to enhance human resource development and improve the functioning of labor markets for enhanced impact of AWM technologies on poverty.     

Degrowing tourism: rethinking tourism

Abstract

Concerns with growth have steadily advanced since the Limits to Growth report due particularly to human impacts on the natural environment. Since that time, neoliberal capitalism has become increasingly reliant on growth exacerbating these problems. The destructive outcomes of these strategies has led to a growing interest in degrowth. Analysts are examining how we can create economies that eschew a growth imperative while still supporting human thriving. Tourism as a key facet of capitalism is implicated in these issues and recent concerns with “overtourism” are only one symptom of the problem. This article presents a conceptual consideration of issues of degrowth in tourism. It examines current tensions in international mobility and argues just and sustainable degrowth will require greater attention to equity. This analysis suggests that essential to such an agenda is redefining tourism to focus on the rights of local communities and a rebuilding of the social capacities of tourism. This article argues for the redefinition of tourism in order to place the rights of local communities above the rights of tourists for holidays and the rights of tourism corporates to make profits.