Cost effectiveness of benralizumab for severe,uncontrolled oral corticosteroid–dependent asthma in Sweden

Abstract

Aim: We investigated cost effectiveness of benralizumab vs. standard of care (SOC) plus oral corticosteroids (OCS) for patients with severe, eosinophilic OCS-dependent asthma in Sweden.

Materials and methods: A three-state, cohort-based Markov model of data from three Phase III benralizumab clinical trials (ZONDA [NCT02075255], SIROCCO [NCT01928771], and CALIMA [NCT01914757]) was used to assess the incremental cost-effectiveness ratio of benralizumab vs. SOC plus OCS. Health outcomes were estimated in terms of quality-adjusted life-years (QALYs). The model included costs and disutilities associated with extrapolated OCS-related adverse events. Patients with severe asthma were defined as those receiving OCS ≥5?mg/day.

Results: Benralizumab demonstrated a cost-effectiveness ratio vs. SOC plus OCS of 2018 Swedish Kronor (SEK) 366,855 (€34,127) per QALY gained, based on increases of 1.33 QALYs and SEK 488,742 (€45,344) per patient. Benralizumab treatment costs contributed most to incremental costs. The probability of benralizumab’s being cost-effective with willingness-to-pay (WTP) thresholds between SEK 429,972 (€40,000) and SEK 752,452 (€70,000) ranged from 75% to 99%.

Limitations: Potential limitations of these analyses include the use of combined data from three different clinical trials, a one-way sensitivity analysis that did not include mortality and transition estimates, and Observational & Pragmatic Research Institute (OPRI) data from the UK as a proxy of the Swedish health care system.

Conclusions: The results of these analyses demonstrate that benralizumab has a high probability of being cost-effective compared with SOC plus OCS for a subgroup of patients with severe, eosinophilic asthma receiving regular OCS treatment and may support clinicians, payers and patients in making treatment decisions.     

Risk externalities in a payments oligopoly

I discuss the role to be played by central banks in payment systems by way of an oligopoly model of a payments market where firms exert negative risk externalities upon each other. A central bank participating actively in this market is modelled as benign in two ways: exerting less externalities than other banks and maximizing welfare rather than profit. Because other banks react strategically to the central bank’s presence due to its low externalities, there is a risk that it backfires, with these other banks’ taking more risky positions than if the central bank were not there. The proper role of the central bank may actually be to stay out.     

Challenges for land system science

While considerable progress has been made in understanding land use change, land system science continues to face a number of grand challenges. This paper discusses these challenges with a focus on empirical land system studies, land system modelling and the analysis of future visions of land system change. Contemporary landscapes are contingent outcomes of past and present patterns, processes and decisions. Thus, empirical analysis of past and present land-use change has an important role in providing insights into the socio-economic and ecological processes that shape land use transitions. This is especially important with respect to gradual versus rapid land system dynamics and in understanding changes in land use intensity. Combining the strengths of empirical analysis with multi-scale modelling will lead to new insights into the processes driving land system change. New modelling methods that combine complex systems thinking at a local level with macro-level economic analysis of the land system would reconcile the multi-scale dynamics currently encapsulated in bottom-up and top-down modelling approaches. Developments in land use futures analysis could focus on integrating explorative scenarios that reflect possible outcomes with normative visions that identify desired outcomes. Such an approach would benefit from the broad and in-depth involvement of stakeholders in order to link scientific findings to political and societal decision-making culminating in a set of key choices and consequences. Land system models have an important role in supporting future land use policy, but model outputs require scientific interpretation rather than being presented as predictions. The future of land system science is strongly dependent on the research community's capacity to bring together the elements of research discussed in the paper, via empirical data collection and analysis of observed processes, computer simulation across scale levels and futures analysis of alternative, normative visions through stakeholder engagement.     

EDUCATED MANPOWER BEHIND NORWAY'S EXPORTS,DOMESTIC CONSUMPTION,AND INVESTMENT*

This paper contains some of the main results of an investigation into the use of educated manpower in Norwegian industries. An input-output model with labour inputs specified by education is presented. Per unit of final delivery, Norwegian exports in 1960 used relatively less labour, and less educated labour, but more capital (measured by depreciation) than the other categories of final demand. But when the use of labour is compared to the income created by the final deliveries, the differences are much smaller.     

Adverse selection, public information, and underpricing in IPOs

This paper generalizes the informational environment of the Rock model to address empirical evidence and conjectures that cannot be addressed within the standard model based on informed and uninformed investors such as underpricing being positively related to market returns observed prior to the IPO, the number of IPOs being positively related to market returns, underpricing being partly predictable based on public information, and the return to uninformed participation being negative overall but positively related to market returns observed prior to the IPO. Finally, the model suggests that a positive relation between market returns and underpricing need not represent an inefficiency in the pricing of IPOs.     

Anchoring Induced Biases in Consumer Price Negotiations

Two studies were conducted with the aim of demonstrating anchoring induced biases in consumer price negotiations.In Study 1, 96 undergraduate students of business administration who were recruited as subjects played the role of buyers of a condominium. All subjects were given the same market information. They were then asked to state whether their reservation price was higher or lower than an arbitrary price example (irrelevant anchor) that for different groups of subjects was either low or high. Finally, subjects indicated their reservation price. As would be predicted if adjustments from the anchor are insufficient, the indicated reservation price was lower when the anchor was low than when it was high.In Study 2, employing 64 undergraduate students of psychology who conducted dyad negotiations about the price of condominiums, the effect of the irrelevant anchor on the initially indicated reservation price was replicated. In addition, an anchoring effect of the seller's initial offer was observed. The results also revealed effects of both irrelevant anchor and initial offer on the purchase price.From a public policy point of view, the results imply that consumers may be strongly influenced by irrelevant anchors provided by sellers. Provision of accurate market price information may however lessen the impact of irrelevant anchors.     

Equilibrium-correction vs. differencing in macroeconometric forecasting

Recent work by Clements and Hendry elucidate why forecasting systems that are in terms of differences, dVARs, can be more accurate than econometric models that include levels variables, EqCMs. For example, dVAR forecasts are in some cases insulated from parameter non-constancies in the long run mean of the cointegration relationships. In this paper, the practical relevance of these issues are investigated for RIMINI, the quarterly macroeconometric model used in Norges Bank (Central Bank of Norway), an example of an EqCM forecasting model. We develop two dVAR versions of the full RIMINI model and compare EqCM and dVAR forecasts for the period 1992.1–1994.4. We also include forecasts from univariate dVAR type models. The results seem to confirm the relevance of the theoretical results. First, dVAR forecasts appear to provide some immunity against parameter non-constancies that could seriously bias the EqCM forecasts. Second, the misspecification resulting from omitting levels information generates substantial biases in the dVAR forecasts 8 and 12 quarters ahead.     

Time is not money

In an ultimatum bargaining experiment, we study how subjects bargain over the returns to their investments of money and time. The most notable finding is that a third of the subjects demand no compensation for their time investments, whereas almost all subjects demand compensation for equally costly monetary investments.