Book review

Built by Japan: Competitive Straegies of the Japanese Construction Industry, Fumio Hasegawa & Shimizu Group FS New York, John Wiley & amp; Sons, 1988, 204 pp., US$25.00.

Technological Change at Work Ian McLouglin & Jon Clark Milton Keynes, Open University Press, 1988, 202 pp., Pb £9.00, Hb £25.00.

Enterprising Innovation: An Alternative Approach Veronica Mole & Dave Elliott London, Frances Pinter, 1987, pp. 180.

Flexible Automation: The Global Diffusion of New Technology in the Engineering Industry Charles Edquist Jacobsson Oxford, Basil Blackwell, 1988, Hb £35.00.

Expert Systems: Strategic Implications and Applications A. Beerel Chichester, Ellis Horwood Ltd, 1988, 173 pp., £22.50.     

Book reviews

Innovation and Industrial Strength in the UK, West Germany, United States and Japan Joan Cox &; Herbert Kriegbaum London, Policy Studies Institute, 1989, 168pp. Industrial Societies After the Stagnation of the 1970s. Taking Stock from an Interdisciplinary Perspective Burkhard Strumpel (ed.) Berlin, de Gruyter, 1989, 313pp.

The Social Basis of the Microelectronics Revolution Alfonso Hernan Molina Edinburgh, Edinburgh University Press, 1989, xxi + 260pp., £25.00 h/b (also avail-able in p/b)

Innovation and Technology Transfer in Japan and Europe: Industry-Academic Relations Glynn 0. Philips (assisted by Michael Hughes) London, Routledge, 1990, 282pp.) £45.00

Banking 1992-A Eurostudy Special Report Ian Gillespie (ed.) I,ondon, Eurostudy Publishing, 1990, 162pp., $£60 ($99)     

News and notes

New Perspectives on Technology and Organization.

Innovative Banking: Competition and the Management of a New Networks Technology J. Howells &; J . Hines Eds) Ldon, Routledge, 1992, 252pp., £40.00 (hbk), ISB-V 0-415-05941-0. Technology and Organization: Power, Meaning and Design H. Scarborough &; J.M. Corbett London. Routledge. 1992, 178pp., ,£15.00, (pbk), ISBN 0-415-05941-0.

Beyond Partnership-Strategies for Innovation &; Lean Supply Richard Lamming Hemel Hempstead, Prentice-Hall International, 1993, ix + 299pp., £19.95 (hbk).

From Anticipation to Action: A handbook of Strategic Perspective Michel Godet.     

Technology analysis as ancestral ritual and power politics

John von Neumann and the Origins of Modern Computing W. Aspray London and Cambridge, MA, MIT Press, 1990 337, pp., $35 (US).

Science, Technology and Socxety: new directions A. J. Webster London und Basingstoke, Macmillan, 1991, 181 pp.,£35 hbk and £9.99 pbk.     

Review Article

Linda Clarke, Peter de Gijsel & Jörn Janssen (eds) (2000) The Dynamics of Wage Relations in the New Europe (Dordrecht, Kluwer Academic)ISBN 0-7923-7742-7 £83 368 pp.     

Book reviews

New Technology and Industrial Relations R. Hyman & W. Streeck Oxford, Basil Blackwell, 1988.

Strategic Planning: Development and Implementation. Bonita H. Melcher & Harold Kerzner Blue Ridge Summit, PA, TAB Books, 1988, 404 pp., £23.65.

Science and Corporate Strategy: Du Pont R & D, 1902-1980 D.A. Hounshell & J.K. Smith New York, Cambridged University Press, 1988.

Sharpbenders: The Secrets of Unleashing Corporate Potential Pete H. Grinyer, David G. Mayes & Peter McKiernan Oxford, Basil Blackwell, 1988, 287 pp., £25.00.

Small and Medium Size Enterprises and Regional Development Maria Giaoutzi, Peter Nijkamp & David J. Storey (Eds.) London, Routledge 1988, 314 pp.     

Book reviews

Powering Apollo: James E. Webb of NASA W. Henry Lambright Baltimore, MD, The Johns Hopkins University Press, 1995, 271 pp, £30.00 (hbk), ISBN 0-8019-4902-0.

Managers and Innovation: Strategies for a Biotechnology John Howells London, Routledge, 1994, £40, ISBN 0-415-08590-X.

Mastering the Dynamics of Innovation James Utterback Boston, MA, Harvard University Press, 1994, $24.95, ISBN0-87584-342-5.

Leadership in Action Helmut Mauche McGraw Hill, 1994, £19.95, ISBN 0-07-041041-0.

International Business: Environments and Operationsf John D. Daniels &; Lee H. Readbaugh Addison-Wesley, 7th Edn, 1995, 788 pp, £25.95, ISBN 0-201-59293-2.

Intenational Business: A Strategic Managment Approach Alan M. Rugman &; Richard M. Hodgetts McGraw-Hill, 1995, 630 pp, £21.95, ISBN 0-07-113635-5.

International Business: Competing in the Global Marketplace Charles W.L. Hill Irwin, 1994, 615 pp, £ 26.95, ISBN 0-256-15682-4.     

Review

Peter Young & Paul Reynolds, The Amnesia of Reform. A Review of Post‐Communist Privatization. London: Adam Smith Research Trust, 1994, 40 pp., p/b.

Michael Kaser, Privatization in the CIS. London: Royal Institute of International Affairs, 1995, 62 pp., p/b.     

Book Reviews

Louis Baeck. The Mediterranean Tradition in Economic Thought. London and New York: Routledge, 1994. Pp. IX, 241. £40. ISBN 0–415–09301–5.

Vivienne Brown. Adam Smith's Discourse. Canonicity, Commerce and Conscience. London and New York: Routledge, 1994. Pp. 243. £13.99. ISBN 0–415–09593.

Peter Groenewegen (ed.). Feminism and Political Economy in Victorian England. Aldershot: Edward Elgar, 1994. Pp. 208. £39.95. ISBN 1–85278–928‐X.

Terence Hutchison. The Uses and Abuses of Economics. Contentious Essays on History and Method. London and New York: Roudedge, 1994. Pp. XIII, 314. £45. ISBN 0–415–09404–6.

Jan Keppler. Monopolistic Competition Theory. Origins, Results, and Implications. Baltimore and London: The Johns Hopkins University Press, 1994. Pp. x, 220. US$45. ISBN 0–8018–4813‐X.

Lars Magnusson (ed.). Evolutionary and Neo‐Schumpeterian Approaches to Economics. Boston, Dordrecht, London: Kluwer Academic Publishers, 1994. Pp. VIII, 326. £74.95. ISBN 0–7923–9385–6.

Alessandro Marzola and Francesco Silva (eds). John Maynard Keynes. Language and Method. Aldershof. Edward Elgar, 1994. Pp. XY 247. £39.95 ISBN 1–85278–923–9.

Ferdinando Meacci. Luigi Einaudi e i Principi del Capitate. Turin: Giappichelli, 1993. Pp. x, 176. IL. 28,000. ISBN 88–348–3093–8.

Gerald M. Meier (ed.). From Classical Economics to Development Economics. New York: St Martin's Press, 1994. Pp. xiii, 262. US$45. ISBN 0–312–12033–8.

Takashi Negishi. The History of Economics. The Collected Essays of Takashi Negishi, vol. 2. Aldershot: Edward Elgar, 1994. Pp. XXIV, 242. £45. ISBN 1–85278–938–7.

Cosimo Perrota and Vitantonio Gioia (eds). Where is Economics Going? Historical Viewpoints. Lecce: Università degli Studi di Lecce and Congedo Editore, 1994. Pp. 131. Price not indicated. ISBN 88–808–6079–8.

Warren J. Samuels, Jeff Biddle and Thomas W. Patchak‐Schuster. Economic Thought and Discourse in the 20th Century. Aldershot: Edward Elgar, 1993. Pp. x, 288. £45. ISBN 1–85278–724–4.

Mario Sebastiani. Kalecki and Unemployment Equilibrium. London: Macmillan, 1994. Pp. 213, ISBN 0–312–10585–1

John Vint. Capital and Wages. A Lakatosian History of the Wages Fund Doctrine. Aldershot: Edward Elgar, 1994. Pp. x, 278. £45. ISBN 1–85278–864‐X.     

Cost-effectiveness of continuous subcutaneous apomorphine in the treatment of Parkinson’s disease in the UK and Germany

Abstract

Background:

Parkinson’s disease (PD) is the second most common neurodegenerative disease, affecting ～5.2 million people worldwide. Continuous subcutaneous apomorphine (CSAI) represents an alternative treatment option for advanced PD with motor fluctuation. The purpose of this analysis was to estimate the cost-effectiveness of CSAI compared with Levodopa/carbidopa intestinal gel (LCIG), Deep-Brain-Stimulation (DBS) and Standard-of-care (SOC).

Methods:

A multi-country Markov-Model to simulate the long-term consequences, disease progression (Hoehn & Yahr stages 3–5, percentage of waking-time in the OFF-state), complications, and adverse events was developed. Monte-Carlo simulation accounted for uncertainty. Probabilities were derived from RCT and open-label studies. Costs were estimated from the UK and German healthcare provider’s perspective. QALYs, life-years (LYs), and costs were projected over a life-time horizon.

Results:

UK lifetime costs associated with CSAI amounts to £78,251.49 and generates 2.85 QALYs and 6.28 LYs (€104,500.08, 2.92 QALYs and 6.49 LYs for Germany). Costs associated with LCIG are £130,011.34, achieves 3.06 QALYs and 6.93 LYs (€175,004.43, 3.18 QALYs and 7.18 LYs for Germany). The incremental-cost per QALY gained (ICER) was £244,684.69 (€272,914.58). Costs for DBS are £87,730.22, associated with 2.75 QALYs and 6.38 LYs (€105,737.08, 2.85 QALYs and 6.61 LYs for Germany). CSAI dominates DBS. SOC associated UK costs are £76,793.49; 2.62 QALYs and 5.76 LYs were reached (€90,011.91, 2.73 QALYs and 6 LYs for Germany).

Conclusions:

From a health economic perspective, CSAI is a cost-effective therapy and could be seen as an alternative treatment to LCIG or DBS for patients with advanced PD.     

A cost-effectiveness analysis of levodopa/carbidopa intestinal gel compared to standard care in late stage Parkinson’s disease in the UK

Abstract

Objective:

Evaluation of cost-effectiveness of levodopa/carbidopa intestinal gel (LCIG), compared to standard care (SC) in patients with advanced Parkinson’s disease (aPD) in the UK.

Design:

Markov model to quantify costs and outcomes associated with LCIG versus SC in aPD patients at Hoehn and Yahr (H&Y) stages 3, 4 or 5 experiencing >50% OFF time per day. Time horizon was lifetime, LCIG treatment was assumed to last maximal 5 years after which patients revert to SC. Model comprised 12 aPD health states according to H&Y status and daily time spent in OFF state. Cost analyses are reported from a UK NHS and Personal Social Services perspective. Uncertainties were assessed through one-way sensitivity analyses.

Comparators:

LCIG, providing patients with continuous dopaminergic stimulation to maximise functional ON time during the day and SC, defined as medically determined best available oral medication.

Main outcome measures:

Cost-effectiveness, based on quality adjusted life years gained, presented as an incremental cost-effectiveness ratio.

Results:

Lifetime analysis yields an incremental cost per QALY of £36,024 for LCIG compared to SC (incremental cost £39,644, QALY gain 1.1). Results were sensitive to time on treatment, health state on treatment initiation, and estimates of long term benefit (OWSA results from £32,127 to £66,421 per QALY). Findings must be considered in the context of the study limitations which were mainly due to data availability constraints.

Conclusions:

LCIG is an effective treatment, reducing OFF time and improving quality of life in advanced PD. It provides value for money in levodopa-responsive aPD patients with severe motor fluctuations when no other treatment options are effective or suitable. Given LCIG is an orphan drug, it is reasonable to suggest that it may be considered cost-effective in the UK setting. However, further research is needed to complete current data gaps and increase robustness of the model.     

The cost-effectiveness of onabotulinumtoxinA for the prophylaxis of headache in adults with chronic migraine in the UK

Abstract

Background:

Although chronic migraine is associated with substantial disability and costs, few treatments have been shown to be effective. OnabotulinumtoxinA (Botox, Allergan Inc., Irvine, CA) is the first treatment to be licensed in the UK for the prophylaxis of headaches in adults with chronic migraine. This study aims to evaluate the cost-effectiveness of onabotulinumtoxinA in this indication in the UK.

Methods:

A state-transition (Markov) model was developed comparing onabotulinumtoxinA to placebo. Efficacy data and utility values were taken from the pooled Phase III REsearch Evaluating Migraine Prophylaxis Therapy (PREEMPT) clinical trials program (n?=?1384). Estimates of resource utilisation were taken from the International Burden of Migraine Study (IBMS), and stopping rules were informed by published medical guidelines and clinical data. This study estimated 2-year discounted costs and quality-adjusted life years (QALYs) from the UK National Health Service perspective.

Results:

At 2 years, treatment with onabotulinumtoxinA was associated with an increase in costs of £1367 and an increase in QALYs of 0.1 compared to placebo, resulting in an incremental cost-effectiveness ratio (ICER) of £15,028. Treatment with onabotulinumtoxinA reduced headache days by an estimated 38 days per year at a cost of £18 per headache day avoided. Sensitivity analysis showed that utility values had the greatest influence on model results. The ICER remained cost-effective at a willingness to pay threshold of £20,000–£30,000/QALY in the majority of scenario analyses as well as in probabilistic sensitivity analysis, where onabotulinumtoxinA was cost-effective on 96% of occasions at a threshold of £20,000/QALY and 98% of occasions at £30,000/QALY.

Conclusion:

OnabotulinumtoxinA has been shown to reduce the frequency of headaches in patients with chronic migraine and can be considered a cost-effective use of resources in the UK National Health Service. The uncertainties in the model relate to the extrapolation of clinical data beyond the 56-week trial.     

Assessment of Resource Use and Costs Associated with Parathyroidectomy for Secondary Hyperparathyroidism in End Stage Renal Disease in the UK

Introduction:

Secondary hyperparathyroidism (SHPT) is a major complication of end stage renal disease (ESRD). For the National Health Service (NHS) to make appropriate choices between medical and surgical management, it needs to understand the cost implications of each. A recent pilot study suggested that the current NHS healthcare resource group tariff for parathyroidectomy (PTX) (£2071 and £1859 in patients with and without complications, respectively) is not representative of the true costs of surgery in patients with SHPT.

Objective:

This study aims to provide an estimate of healthcare resources used to manage patients and estimate the cost of PTX in a UK tertiary care centre.

Methods:

Resource use was identified by combining data from the Proton renal database and routine hospital data for adults undergoing PTX for SHPT at the University Hospital of Wales, Cardiff, from 2000–2008. Data were supplemented by a questionnaire, completed by clinicians in six centres across the UK. Costs were obtained from NHS reference costs, British National Formulary and published literature. Costs were applied for the pre-surgical, surgical, peri-surgical, and post-surgical periods so as to calculate the total cost associated with PTX.

Results:

One hundred and twenty-four patients (mean age?=?51.0 years) were identified in the database and 79 from the questionnaires. The main costs identified in the database were the surgical stay (mean?=?£4066, SD?=?£,130), the first month post-discharge (£465, SD?=?£176), and 3 months prior to surgery (£399, SD?=?£188); the average total cost was £4932 (SD?=?£4129). From the questionnaires the total cost was £5459 (SD?=?£943). It is possible that the study was limited due to missing data within the database, as well as the possibility of recall bias associated with the clinicians completing the questionnaires.

Conclusion:

This analysis suggests that the costs associated with PTX in SHPT exceed the current NHS tariffs for PTX. The cost implications associated with PTX need to be considered in the context of clinical assessment and decision-making, but healthcare policy and planning may warrant review in the light of these results.     

Recent books on globalisation

Thomas Friedman, The Lexus and the Olive Tree: Understanding Globalization. New York: Farrar, Straus, Giroux 1999). Pp.xix, 394.

James Mittelman, The Globalization Syndrome: Transformation and Resistance. Princeton: Princeton University Press, 2000. Pp.xiv + 282.#

Richard Rosecrance, The Rise of the Virtual State: Wealth and Power in the Coming Century. New York: Basic Books, 2000. Pp.xvi + 285.

William Shawcross, Deliver Us From Evil: Peacekeepers, Warlords, and a World of Endless Conflict. New York: Simon & Shuster. Pp.445.     

A cost comparison of long-acting insulin analogs vs NPH insulin-based treatment in patients with type 2 diabetes using routinely collected primary care data from the UK

Abstract

Aim:

The aim of this analysis was to investigate total healthcare costs, HbA1c, and weight changes over a 36-month period in patients with type 2 diabetes initiated on NPH or long-acting insulin analogs.

Methods:

Electronic patient data from 479 general practices in the UK (THIN database) were examined for new users of glargine (n?=?794), detemir (n?=?252), or NPH insulin (n?=?430). Annualized healthcare costs and clinical outcomes in years 1, 2, and 3 following insulin initiation were quantified and compared with baseline, using ANOVA and linear regression models.

Results:

A significant difference (p?<?0.05) in total healthcare costs increases at year 1 vs baseline was observed between glargine and detemir, detemir and NPH, but not between glargine and NPH (increase: +£486, +£635, and +£420 for glargine, detemir, and NPH users, respectively). However, increases by year 3 were not significantly different between the insulins. A propensity score analysis comparing analog and NPH insulin showed that, following insulin initiation, increases in costs were higher with insulin analogs at year one (+£220), but this difference decreased over time in each year following insulin initiation (+£168 and +£146, respectively, for years 2 and 3). HbA1c reductions were not significantly different between the groups at all time points. Differences in weight gain between glargine and NPH were statistically significant at year 1 (0.87?kg vs 1.11?kg) and year 3 (1.15?kg vs 1.57?kg), but other estimates of between-group differences in weight gain were non-significant.

Conclusions:

Following insulin initiation, the difference in healthcare costs of long-acting analogs compared to NPH insulin was transient. By year 3, the cost differences were not significantly different between the two cohorts, driven by an observed reduction in the cost of self-monitoring of blood glucose (SMBG) in the analog group and an increase in the cost of bolus insulin in the NPH group.     

The economic burden of advanced Parkinson’s disease: an analysis of a UK patient dataset

Abstract

Background:

To evaluate the cost burden of patients with advanced Parkinson’s disease (PD) according to the waking hours per day spent in OFF state. An analysis of resource use comprising medical services, professional care and informal care data from an observational, cross-sectional study was conducted.

Methods:

A total of 60 physicians comprising 40 neurologists and 20 geriatricians across the UK participating in the Adelphi PD Disease Specific Programme took part. There were 302 PD patients at H&Y stages 3–5. Patients were characterised according to the percentage of time per day spent in OFF state (<25%, 26–50%, 51–75%, >75%).

Results:

Average 12-monthly total costs increased according to the time spent in OFF state from £25,630 in patients spending less than 25% of their waking hours in OFF to £62,147 for patients spending more than 75% of their time in OFF. Overall, 7% of costs were attributed to direct medical care, while 93% were split between direct non-medical professional care (50%) and indirect informal care (43%).

Limitations:

Low patient numbers in the more advanced disease stages of PD led to very little or no data to directly inform some of the severe health states of the analysis. Data gaps were filled in with data derived from a regression analysis which may affect the robustness of the analysis.

Conclusion:

This study illustrates the increasing costs of advancing PD, in particular related to the time spent in OFF state, and identifies that the foremost cost burden is associated with the care needs of the patient rather than medical services.     

A comparison of healthcare resource use for rotavirus and RSV between vulnerable children with co-morbidities and healthy children: a case control study

Abstract

Objective:

To quantify the differences in hospital length of stay (LOS) and cost between healthy and vulnerable children with cystic fibrosis (CF), insulin-dependent diabetes mellitus (IDDM), cancer, and epilepsy who contract rotavirus (RVGE) or respiratory syncytial virus (RSV).

Methods:

Hospital Episode Statistics (HES) data were collected for England, for children <5 years old, admitted between April 2001 and March 2008, using ICD-10 codes for RVGE and RSV. Cases were identified as having RVGE and/or RSV plus CF, IDDM, cancer, or epilepsy. Healthy controls had RVGE and/or RSV only, additional controls had eczema only. Cost, hospital LOS, and demographics were collected.

Results:

Four hundred and eighty-six (0.5%) cases and 101,784 (99.5%) healthy controls were admitted with RVGE or RSV, with 17,420 eczema controls. RVGE was present in 153 (31.5%) cases and 7532 (7.4%) healthy controls, and RSV in 333 (68.5%) cases and 94,252 (92.6%) healthy controls. Cases were older (1.1 years, SD?=?1.3 years), had greater LOS (9.9 days, SD?=?19.9), and cost more (£3477, SD?=?£7765) than healthy controls (age?=?0.2, SD?=?0.5, p?<?0.001; LOS?=?1.9 days, SD?=?3.1, p?<?0.001; cost?=?£595, SD?=?£727, p?<?0.001). Cost for cases was 6-times greater than healthy controls (p?<?0.001). Controls had a 0.3 day greater LOS (p?<?0.001) with RSV, but a £17 (p?=?0.085) lower mean cost than RVGE.

Conclusion:

RVGE and RSV are more serious diseases in vulnerable children, requiring more intense resource use. The importance of preventing infection in vulnerable children is underlined by hygiene and appropriate isolation and vaccination strategies. When universal vaccination is under consideration, as for rotavirus vaccines, evaluation of a vaccination programme should consider the potentially positive impact on vulnerable children.

Limitations:

Limitations of the study include a dependency on accurate coding, an expectation that patients are identified through laboratory testing, and the possibility of unidentified underlying conditions affecting the burden.     

Techno‐cultural integration

K. Kelly, New Rules for the New Economy (NY: Viking 1998 ISBN 014028060 X, pp.179).

D. Morris, Vote.com: How Big‐Money Lobbyists and the Media are Losing Their Influence, and the Internet is Giving Power Back to the People (LA: Renaissance Books 1999 ISBN 158063163 0, pp.236).

G. Rochlin, Trapped in the Net: The Unanticipated Consequences of Computerization (Princeton, NJ: Princeton University Press 1997, ISBN 0691002479, pp.310).