Entecavir for the treatment of chronic hepatitis B infection

This paper presents a summary of the evidence review group (ERG) report into the clinical and cost-effectiveness of entecavir for the treatment of chronic hepatitis B (CHB) in adults based upon a review of the manufacturer's submission to the National Institute for Health and Clinical Excellence (NICE) as part of the single technology appraisal (STA) process. The submission's evidence came from five randomised controlled trials (RCTs), of good methodological quality and measuring a range of clinically relevant outcomes, comparing entecavir with lamivudine. After 1 year of treatment entecavir was statistically superior to lamivudine in terms of the proportion of patients achieving hepatitis B virus (HBV) DNA suppression, alanine aminotransferase (ALT) normalisation and histological improvement, but not in terms of the proportion of patients achieving hepatitis B e antigen (HBeAg) seroconversion. The incidence of adverse or serious adverse events was similar for both treatments. The results of the manufacturer's mixed treatment comparison (MTC) model to compare entecavir with the comparator drugs in nucleoside-naive patients were considered to be uncertain because of concerns over its conduct and reporting. For the economic evaluation the manufacturer constructed two Markov state transition models, one in HBeAg-positive and one in HBeAg-negative patients. The modelling approach was considered reasonable subject to some uncertainties and concerns over some of the structural assumptions. In HBeAg-positive patients the base-case incremental cost-effectiveness ratios (ICER) for entecavir compared with lamivudine and pegylated interferon alpha-2a were 14,329 pounds and 8403 pounds per quality-adjusted life-year (QALY) respectively. Entecavir was dominated by telbivudine. In HBeAg-negative patients the base-case ICERs for entecavir compared with lamivudine, pegylated interferon alpha-2a and telbivudine were 13,208 pounds, 7511 pounds and 6907 pounds per QALY respectively. In HBeAg-positive lamivudine-refractory patients entecavir dominated adefovir added to lamivudine. In one-way deterministic sensitivity analysis on all key input parameters for entecavir compared with lamivudine in nucleoside-naive patients, ICERs generally remained under 30,000 pounds per QALY. In probabilistic sensitivity analysis in nucleoside-naive HBeAg-positive patients the probability of the ICER for entecavir being below 20,000 pounds per QALY was 57%, 82% and 45% compared with lamivudine, pegylated interferon alpha-2a and telbivudine respectively. In nucleoside-naive HBeAg-negative patients the probabilities were 90%, 100% and 96% respectively. The manufacturer's lifetime treatment scenario for HBeAg-negative patients and the ERG's 20-year treatment scenario for HBeAg-positive patients increased the ICERs, particularly in the latter case. Amending the HBeAg-negative model so that patients with compensated cirrhosis would also receive lifetime treatment gave probabilities of entecavir being cost-effective at a willingness to pay of 20,000 pounds and 30,000 pounds of 4% and 40% respectively. The NICE guidance issued in August 2008 as a result of the STA states that entecavir is recommended as an option for the treatment of people with chronic HBeAg-positive or HBeAg-negative hepatitis B in whom antiviral treatment is indicated.

Sex-biased space-use response to urbanization in an endemic urban adapter

Urbanization impacts on the composition and distribution of wildlife. The tawny frogmouth (Podargus strigoides) is an endemic, nocturnal bird species widespread throughout Australia with recent research highlighting high densities within urban environments. The aim of this study was to investigate homerange size and land-use in response to a gradient of urbanization by determining (a) the key land-use types influencing home-range size and location in the urban landscape (b) whether urbanization impacts on home-range size; and (c) whether the response to urbanization is gender specific. Twelve birds, seven male and five female were radio-tracked within a study zone located in Melbourne, Australia. We used minimum convex polygons (MCP) 95% and 50% fixed-kernel isopleths to calculate home-range size and areas of core use within each home-range. In both the landscape and core areas of their home-range, birds positioned their home-range in areas with more trees, avoiding impervious surfaces and utilizing grassed areas. Male mean kernel home-range was 17.65 ± 4.35 ha and female 6.55 ± 1.40 ha. Male home-ranges contained higher levels of impervious surfaces than females. Modelling demonstrated that as urbanization intensified the home-range size of males increased whereas female home-ranges remained static in size. This research identifies land-use selection and highlights the possibility that spatial behaviour in the species is sex-biased in response to a gradient of urbanization. © 2014 Elsevier B.V.

Burden of epilepsy: a prevalence-based cost of illness study of direct, indirect and intangible costs for epilepsy

OBJECTIVES: We aimed to gauge the burden of epilepsy in China from a societal perspective by estimating the direct, indirect and intangible costs. METHODS: Patients with epilepsy and controls were enrolled from two tertiary hospitals in China. Patients were asked to complete a Cost-of-Illness (COI), Willingness-to-Pay (WTP) questionnaires, two utility elicitation instruments and Mini Mental State Examination (MMSE). Healthy controls only completed WTP questionnaire, and utility instruments. Univariate analyses were performed to investigate the differences in cost on the basis of different variables, while multivariate analysis was undertaken to explore the predictors of cost/cost component. RESULTS: In total, 141 epilepsy patients and 323 healthy controls were recruited. The median total cost, direct cost and indirect cost due to epilepsy were US$949.29, 501.34 and 276.72, respectively. Particularly, cost of anti-epileptic drugs (AEDs) (US$394.53) followed by cost of investigations (US$59.34), cost of inpatient and outpatient care (US$9.62) accounted for the majority of the direct medical costs. While patients' (US$103.77) and caregivers' productivity costs (US$103.77) constituted the major component of indirect cost. The intangible costs in terms of WTP value (US$266.07 vs. 88.22) and utility (EQ-5D, 0.828 vs. 0.923; QWB-SA, 0.657 vs. 0.802) were both substantially higher compared to the healthy subjects. CONCLUSIONS: Epilepsy is a cost intensive disease in China. According to the prognostic groups, drug-resistant epilepsy generated the highest total cost whereas patients in seizure remission had the lowest cost. AED is the most costly component of direct medical cost probably due to 83% of patients being treated by new generation of AEDs.

It's time to determine the cost of a healthy diet in Australia

Economic factors are important determinants of food security. In terms of food access, financial resources determine an individual’s ability to procure food; on the supply side, the cost of food is equally important. The interplay of these two factors, financial resources and cost, is perhaps the most immediate and important determinant of what people do (or do not) put into their shopping trolleys or purchase at the takeaway and ultimately eat – if you cannot afford it you cannot eat it even if you want to!

Improving Indigenous Access to Early Childhood Services in Urban and Regional Areas

The literature on how to improve Indigenous access to early childhood services consists mainly of program descriptions and documented practice experience, with a limited number of formal program evaluations. Accessible early childhood services fulfil four overlapping dimensions. They are physically accessible; economically accessible (affordable); appropriate (comprehensive and non-discriminatory); and acceptable (respect and acknowledge culture).The literature suggests that there are five types of barriers to accessible early childhood services: individual; program; provider; social and neighbourhood; and cultural.It is not sufficient to just improve access—engagement strategies are also necessary to get families involved in the services that may benefit them.

Job satisfaction and response to incentives among China's urban workforce

This article examines job satisfaction and incentive structures among China's urban workforce. The main determinants of job satisfaction are found to be age, education, occupation and personal income. The criteria that Chinese urban employees considered most important when choosing a job were job stability, a high income and professional development. Employees who considered job stability, high income, professional development opportunities, work/life balance and provision of social insurance as being important when selecting a job were more likely to have higher levels of job satisfaction. © 2008 Elsevier Inc. All rights reserved.

Who wants safer cities? Perceptions of public safety and attitudes to migrants among China's urban population

Most extant research in the economics of crime literature has focused on explaining variations in crime rates. Public action to prevent crime, however, is often dependent on the level of concern about public safety that is expressed in public perceptions surveys. The economics of crime literature has largely overlooked responses to such surveys as data sources and therefore it has not accounted for the role that public opinion might have in mobilizing public action against crime. We use a unique survey administered in 2003 in 32 Chinese cities to examine the determinants of perceptions of public safety among China's urban population. One of our major findings is that individuals who have a negative perception of rural-urban migrants living in their city have a poor perception of public safety. We also find that the unemployment rate, the masculinity ratio and expenditure on armed police in the city in which the individual resides, whether the individual lives in the coastal region as opposed to the central or western region and average changes in housing prices and average changes in rental prices in the city in which the individual lives are important predictors of perceptions of public safety. © 2007 Elsevier Inc. All rights reserved.

Cost analysis error? Exploring issues relating to whole-life cost estimation in sustainable housing

Purpose: The main purpose of the study is to promote consideration of the issues and approaches available for costing sustainable buildings with a view to minimising cost overruns, occasioned by conservative whole-life cost estimates. The paper primarily looks at the impact of adopting continuity in whole-life cost models for zero carbon houses. Design/methodology/approach: The study embraces a mathematically based risk procedure based on the binomial theorem for analysing the cost implication of the Lighthouse zero-carbon house project. A practical application of the continuous whole-life cost model is developed and results are compared with existing whole-life cost techniques using finite element methods and Monte Carlo analysis. Findings: With standard whole-life costing, discounted present-value analysis tends to underestimate the cost of a project. Adopting continuity in whole-life cost models presents a clearer picture and profile of the economic realities and decision-choices confronting clients and policy-makers. It also expands the informative scope on the costs of zero-carbon housing projects. Research limitations/implications: A primary limitation in this work is its focus on just one property type as the unit of analysis. This research is also limited in its consideration of initial and running cost categories only. The capital cost figures for the Lighthouse are indicative rather than definitive. Practical implications: The continuous whole-life cost technique is a novel and innovative approach in financial appraisal [...] Benefits of an improved costing framework will be far-reaching in establishing effective policies aimed at client acceptance and optimally performing supply chain networks. Originality/value: The continuous whole-life costing pioneers an experimental departure from the stereo-typical discounting mechanism in standard whole-life costing procedures.

Nonmarket valuation in developing countries: Incorporating labour contributions in environmental benefits estimates

There are limitations associated with the application of nonmarket valuation techniques, including choice experiments, in subsistence economies. In part, this is due to the concern that using money as a mode of contribution may not capture the potential contribution of low-income households. To address this limitation, respondents in this study were provided with the option of contributing towards the management of invasive plants in labour terms if they were unwilling to contribute in monetary terms. The results show that the existing practice of using dollar values to estimate willingness to contribute may disproportionately exclude the concerns of some groups within the community. The analysis also indicates that allowing respondents to express their willingness to contribute in labour increases their participation in environmental decision-making processes and hence increases the estimated value of forest ecosystem services. This study contributes to the limited empirical literature on the development of nonmarket valuation surveys, particularly choice experiments, in low-income countries in general and rural areas in particular. © 2014 Australian Agricultural and Resource Economics Society Inc.

Research methodologies for planning ecotourism and nature conservation

Ecotourism is an important niche market in the world tourism industry. It is becoming increasingly popular as an alternative to mass tourism. The emergence of ecotourism was facilitated by the environmental damage associated with mass tourism. Ecotourism is defined in many ways and there is no consensus as to its exact meaning. However, a number of salient elements, such as environmental conservation, maintenance of biodiversity, a satisfying experience for the visitors, study and appreciation of nature and sustainable community development, are included in many definitions. Tourism creates negative environmental externalities in the form of environmental damage. Such adverse effects can have serious implications for the tourism industry because they damage the very natural resource that forms the raw material for ecotourism. Ecotourism ventures should thus be properly planned and implemented and carefully monitored. Proper planning of ecotourism is hampered by the paucity of relevant qualitative and quantitative information. The use of analytical tools such as the Contingent Valuation Method, carrying capacity, decision analysis techniques with which multiobjective and uncertain consequences can be analysed, and other management strategies, such as the Safe Minimum Standard, can be useful in enabling better planning of ecotourism. Ecotourism can thus enhance the opportunities for better management of natural resources while providing a satisfying experience for the visitor.

Valuation and incentive effects of hurdle rate executive stock options

Traditional executive stock options are often criticized for inherently weak links between pay and performance. Hurdle rate executive stock options represent a viable improvement. However, valuing these options presents extraordinary analytic difficulties. With a constant dividend yield the strike price becomes a path-dependent function of the stock price and exact analytic valuation is intractable. To solve this problem, we apply the Monte Carlo valuation approach developed by Longstaff and Schwartz (Rev Financ Stud 4:113–147, 2001) to estimate the value of path-dependent American options. We also extend the methodology to incorporate the theoretical framework by Ingersoll (J Bus 79:453–487, 2006) to permit subjective valuation influenced by an executive’s risk aversion.