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Citation - WoS: 25
Citation - Scopus: 25
Impact of Switching From an Initial Tumor Necrosis Factor Inhibitor on Health Care Resource Utilization and Costs Among Patients With Rheumatoid Arthritis
(Elsevier, 2015-07-01) Roy, Sanjoy; Ganguli, Arijit; Xie, Lin; Başer, Onur; Cifaldi, Mary
Purpose: Despite improved clinical outcomes for the majority of patients, nearly 30% of patients with rheumatoid arthritis (RA) who initiate tumor necrosis factor antagonist (anti-TNF) biologic agents fail to respond to their first-line anti-TNF and switch to another anti-TNF or a non-TNF biologic. How this change affects health care costs and resource utilization is unknown. We therefore compared RA patients taking first-line anti-TNFs who switched to a second anti-TNF versus those patients who switched to an alternate biologic. Methods: Health care claims data were obtained from a large US database for eligible adults with confirmed RA diagnoses who initiated anti-TNF treatment and switched to another biologic. Health care costs and utilization during the first 12 months' postswitch were compared. Generalized linear models were used to adjust for differences in demographic and clinical characteristics before switching. Findings: Patients who switched to a second anti-TNF rather than a non-TNF biologic were generally younger (53.0 vs. 55.3 years; P < 0.0001) and less likely to be female (79.7% vs. 82.7%; P = 0.0490). Of the 3497 eligible patients who switched from first-line anti-TNFs, 2563 (73.3%) switched to another anti-TNF and 934 (26.7%) switched to a non-TNF. Adalimumab was the most frequently prescribed (43.4%) second-line anti-TNF, and abatacept was the most common non anti-TNF (71.4%). Patients who switched to a second anti-TNF remained on their first medication for a significantly shorter period (342.5 vs 420.6 days; P < 0.0001) and had lower comorbidity indices and higher disease severity at baseline than those who switched to a non anti-TNF. After adjusting for baseline differences, patients who switched to second anti-TNFs versus a non-TNF incurred lower RA-related costs ($20,938.9 vs $22,645.2; P = 0.0010) and total health care costs ($34,894.6 vs $38,437.2; P = 0.0010) 1 year postswitch. These differences were driven by increased physician office visit costs among the non-TNF group. Implications: Among the anti-TNF initiators who switched therapy, more patients switched to a second anti-TNF than to a non-TNF. Switching to a second anti-TNF treatment was associated with lower all-cause and RA-related health care costs and resource utilization than switching to a non-TNF. Because switching therapy may be unavoidable, finding a treatment algorithm mitigating this increase to any extent should be considered. These data are limited by their retrospective design. Additional confounding variables that could not be controlled for may affect results. (C) 2015 The Authors. Published by Elsevier HS journals, Inc.
Citation - WoS: 7
Citation - Scopus: 7
Exchange Rates and Firm Survival: an Examination With Turkish Firm-Level Data
(Elsevier, 2016-09-01) Toraganlı, Nazlı; Yazgan, Mustafa Ege
Micro-level empirical research has begun to obtain important results on the effects of currency variations on firms’ survival. The literature has, however, lacked a detailed analysis of the effects of exchange rates on firms’ survival behavior in emerging markets due to a scarcity of firm-level information. Using a firm-level dataset, we investigate the impact of currency appreciation on the survival behavior of Turkish firms in the manufacturing industries for 2002–2009. Our results suggest that real exchange rate appreciation decreases the probability of survival in the manufacturing industries. We also find that high-productivity firms have a higher probability of survival than low- productivity firms following an appreciation of the exchange rate. Our findings indicate that the negative effect of a 1% real appreciation of the domestic currency on the survival probability of a given firm ranges from 4.5 to 9%, providing evidence for the vulnerability of developing countries to exchange rate movements. This evidence indicates that, especially for emerging market economies, economic events and policies leading to an appreciation in the domestic currency should be managed cautiously.
Citation - WoS: 11
Citation - Scopus: 13
Contagion Effects of U.s. Dollar and Chinese Yuan in Forward and Spot Foreign Exchange Markets
(Elsevier, 2017-04-01) Kılıç, Erdem
Financial contagion in forex markets is modeled by the application of a bivariate Hawkes stochastic jumpprocess. The self-exciting and mutually exciting properties of the jump-clustering model allow for illustratinginternal and cross-sectional transmission processes. The results obtained suggest stronger effects from US tomutual markets than in the reverse case. Cross-sectional excitation dynamics in the spot markets are larger thanin the forward markets. As a central result, we can observe that the results for the Hawkes-model parameters aremore significant in the forward markets. Transmission dynamics beyond volatility determine the likelihood ofcontagion occurrence. The significance of the decay parameters towards the long term jump intensities supportsthe importance of abrupt fluctuations in the contagion discourse.

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