Cost-Effectiveness Analysis of Vedolizumab Compared With Infliximab in Anti-TNF-α-Naïve Patients With Moderate-to-Severe Ulcerative Colitis in China

Objective: To evaluate the cost effectiveness of vedolizumab vs. infliximab in the treatment of anti-tumor necrosis factor-alpha (TNF-α)-naïve patients with moderate-to-severe active ulcerative colitis (UC) in China.Methods: The costs and effectiveness of vedolizumab and infliximab in the treatment of anti-TNF-α naïve patients with moderate-to-severe active UC were compared using a hybrid decision tree model and a Markov model. From the perspective of the Chinese healthcare system, this study simulated the lifetime health benefits [quality-adjusted life-years (QALYs)] and costs (USD) for patients with UC from the induction phase to the maintenance phase, with an annual discount rate of 5%. The clinical efficacy and transition probability data were based on a previously published network meta-analysis. The health utility, surgical risk, biologic drug discontinuation rate, and mortality were derived from previous literature and the Chinese statistical yearbook. The cost data were based on China's drug purchase and biding platform and the results of a survey sent to clinicians in 18 tertiary hospitals. One-way and probabilistic sensitivity analyses (PSAs) were performed to validate the robustness of the models' assumptions and specific parameter estimates.Results: The results of the base-case analyses showed that compared with infliximab, vedolizumab led to a gain of 0.25 QALYs (9.56 vs. 9.31 QALYs) and was less expensive by $7,349 ($180,138 vs. 187,487), indicating that the use of vedolizumab was a dominant strategy. The results of one-way sensitivity analyses suggested that the annual discount rate and health-state costs had the greatest impact, but the results were otherwise consistent with those of the base-case analyses. The PSAs suggested that vedolizumab had a 98.6% probability of being effective at a threshold of 3 times the gross domestic product (GDP) per capita in China in 2020.Conclusion: Compared with infliximab, vedolizumab appears to be a more cost-effective option in the treatment of anti-TNF-α naïve adult patients with moderate-to-severe, active UC in China.

Assessing the impact of smoking on the health and productivity of the working-age Indonesian population using modelling

ObjectivesTo estimate the impact of smoking in the working-age Indonesian population in terms of costs, years of life, quality-adjusted life years (QALYs) and productivity-adjusted life years (PALYs) lost.MethodsLife table modelling of Indonesian smokers aged 15–54 years, followed up until 55 years (retirement age). Contemporary data on demographics, all-cause mortality, population attributable fractions and prevalence of smoking were derived from the Institute for Health Metrics and Evaluation. The quality of life and reduction in productivity due to smoking were derived from published sources. The analysis was repeated but with the assumption that the cohorts were non-smokers. The differences in results represented the losses incurred due to smoking. Gross domestic product (GDP) per equivalent full-time worker (US$11 765) was used for estimation of the cost of each PALY, and an annual discount rate of 3.0% was applied to all costs and outcomes.ResultsThe prevalences of smoking among Indonesian working-age men and women were 67.2% and 2.16%, respectively. This study estimated that smoking caused 846 123 excess deaths, 2.9 million years of life lost (0.40%), 41.6 million QALYs lost (5.9%) and 15.6 million PALYs lost (2.3%). The total cost of productivity loss due to smoking amounted to US$183.7 billion among the working-age population followed up until retirement. Healthcare cost was predicted to be US$1.8 trillion. Over a 1-year time horizon, US$10.2 billion was lost in GDP and 117 billion was lost in healthcare costs.ConclusionSmoking imposes significant health and economic burden in Indonesia. The findings stress the importance of developing effective tobacco control strategies at the macro and micro levels, which would benefit the country both in terms of health and wealth.

Gender Differences in Labour Losses Associated with Smoking-Related Mortality

The aim of this paper was to estimate the number of premature deaths, years of potential productive life lost (YPPLL) and labour losses attributable to tobacco smoking due to premature death by gender for the Spanish population. The human capital approach was applied. Employment, gross wage and death data were obtained from the Spanish National Institute of Statistics. Relative risks of death due to cigarette smoking and former smoking were applied. The base case used an annual discount rate of 3% and an annual labour productivity growth rate of 1%. Univariate deterministic sensitivity analysis was performed on discount rates and labour productivity growth rates. Between 2002 and 2016, smoking was estimated to cause around 13,171–13,781 annual deaths in the population under 65 years of age (legal retirement age) in Spain. This increase was mostly due to female deaths. YPPLLs for females have increased over the years, while for males they have fallen markedly. Labour losses associated with smoking mortality ranged from €2269 million in 2002 to €1541 in 2016 (base year 2016). In fact, labour productivity losses have decreased over the years for men (−39.8%) but increased sharply for women (101.6%). The evolution of monetary value of lost productivity due to smoking mortality shows clearly differentiated trends by gender.

Assessment of the Profitability of an Apartment Building Complex Using a Stochastic Cash-Flow

The economic feasibility of apartment building complexes is mainly done by using one of the economic analysis methods: present worth, future worth, annual worth, rate of return, or benefit-cost ratio. The cash-flow used is based on the assumption that a certain fraction of the apartments will be sold during the construction period, and the rest equally sold annually over a certain period of time. This model may work sometimes, but its estimated profitability is inaccurate. The actual cash-flow to be used is stochastic. In this paper, we shall use a cash-flow with random separation time between successive sales of apartments after the construction period. We shall find a compact form of the expected present worth, and determine a range for the annual discount rate so that the project is profitable.

Russia’s Human Capital: What Is It Worth? Part II.

After discussing in the first part of the paper alternative approaches to measuring the value of the stocks of human capital its second part provides empirical estimates of Russia’s human capital based on the lifetime income approach. The results show that using an annual discount rate of 4 per cent and assuming annual growth in real earnings of 5.2 per cent, the market value of Russia’s human capital stock in 2010 was more than 600 trillion rubles, or nearly 40 trillion US$ by PPP. In 2002—2010 its stock doubled in real terms. Ratio of human capital to GDP was around 13 and its ratio to physical capital was more than five. In 2010, the average human capital stock per head of working age population amounted to 6 million rubles, or about 380,000 US$ by PPP.

Optimal culling strategy in relation to biological and economic efficiency and annualized net revenue in the Japanese Black cow–calf production system

SUMMARYThe objective of the present study was to determine the optimal culling strategy in relation to biological and economic efficiency (BE and EE, respectively) and annualized net revenue (AN) in the Japanese Black cow–calf production system with special reference to the beef quality of culled cows. The herd model focused on two ways of mating: one-mating trial system (ONE) and continuous-mating trial system (CON). ONE assumed that heifers that fail to conceive are culled and cows that fail to conceive are culled at weaning of their calves, while CON assumed that mating continues until all females theoretically conceive. Least square means of carcass data of Japanese Black cows collected from a cooperative farm in Japan were used to estimate the carcass price of a cow by parity and Beef Marbling Standard (BMS) number. The simulation, assuming the current production situation in Japan, indicated that sales of culled cows accounted for 0·10–0·20 of total sales and was an important element in total production. Comparisons between ONE and CON showed that production efficiency in the current situation is higher in CON. The BE, EE and AN were higher in CON than in ONE. The two economic indicators were less sensitive to changes in annual discount rate but highly sensitive to changes in female calf price and BMS number of cows, indicating the importance of considering fluctuations in calf price and potential quality of culled cows’ carcasses when estimating the economically optimal parity of culling. The three indicators derived different optimal solutions even in the same mating trial systems, stressing the importance of choice of production indicators when determining the culling strategy and evaluating animal production.