Cost reduction from resolution/improvement of carcinoid syndrome symptoms following treatment with above-standard dose of octreotide LAR

Aims: To calculate the cost reduction associated with diarrhea/flushing symptom resolution/improvement following treatment with above-standard dose octreotide-LAR from the commercial payor’s perspective.

Materials and methods: Diarrhea and flushing are two major carcinoid syndrome symptoms of neuroendocrine tumor (NET). Previously, a study of NET patients from three US tertiary oncology centers (NET 3-Center Study) demonstrated that dose escalation of octreotide LAR to above-standard dose resolved/improved diarrhea/flushing in 79% of the patients within 1 year. Time course of diarrhea/flushing symptom data were collected from the NET 3-Center Study. Daily healthcare costs were calculated from a commercial claims database analysis. For the patient cohort experiencing any diarrhea/flushing symptom resolution/improvement, their observation period was divided into days of symptom resolution/improvement or no improvement, which were then multiplied by the respective daily healthcare cost and summed over 1 year to yield the blended mean annual cost per patient. For patients who experienced no diarrhea/flushing symptom improvement, mean annual daily healthcare cost of diarrhea/flushing over a 1-year period was calculated.

Results: The economic model found that 108 NET patients who experienced diarrhea/flushing symptom resolution/improvement within 1 year had statistically significantly lower mean annual healthcare cost/patient than patients with no symptom improvement, by $14,766 (p?=?.03). For the sub-set of 85 patients experiencing resolution/improvement of diarrhea, their cost reduction was more pronounced, at $18,740 (p?=?.01), statistically significantly lower than those with no improvement; outpatient costs accounted for 56% of the cost reduction (p?=?.02); inpatient costs, emergency department costs, and pharmacy costs accounted for the remaining 44%.

Limitations: The economic model relied on two different sources of data, with some heterogeneity in the prior treatment and disease status of patients.

Conclusions: Symptom resolution/improvement of diarrhea/flushing after treatment with an above-standard dose of octreotide-LAR in NET was associated with a statistically significant healthcare cost decrease compared to a scenario of no symptom improvement.     

Economics of the public sector

Likierman, A. 1988: Public Expenditure: Who Really Controls it and How? London: Penguin, £4.99.

Helm, D. (ed) 1989: The Economic Borders of the State. Oxford: Oxford University Press, £35.00 cloth, £15.00 paper.

Collard, D. (ed) 1989: Fiscal Policy: Essays in Honour of Cedric Sandford. Aldershot: Avebury, £35.00 cloth.

Hare, P. (ed) 1988: Surveys in Public Sector Economics. Oxford: Blackwell, £37.50 cloth.     

A Note from the Editor

This issue brings us a tragic reminder of the too     

Multinational corporations and economic nationalism: Conflict over resource development in Canada

Faced with rising Third World nationalism, multinational corporations engaged in resource exploitation are turning back to higher cost but apparently politically more secure investments in the industrialized states. To what extent does the dynamic of government– resource industry relations in an industrialized setting differ from the pattern observed in the Third World? To answer this question the article analyses the decision to nationalize the potash industry in the Canadian province of Saskatchewan using models of host government–MNC conflict developed by Vernon, Mikesell and Moran to study Third World cases. The research suggests that the dynamic logic of government-industry conflict in a developed country setting is very similar to the pattern observed in the Third World. The decentralized Canadian federation, the ideology of the party in power in Saskatchewan and the nature of the potash industry combine to structure a situation in which coercive nationalization of a resource industry was seen as the only policy option.     

Women's travel writing and the legacy of Romanticism

Women's travel writing reveals how literary and artistic discourses influence the way we read and write about journeys. This paper considers the way women's travel writing has adapted to, and adopted, the discourse of Romanticism, from its beginnings as a philosophy of political and sexual revolution, individual freedom and escape, to a more diffuse sense which has infiltrated modern attitudes to travel. We consider a classic travel text from the Romantic period, and discuss its legacy. Adopting Buzard's argument [(1993). The Beaten track: European tourism, literature and the ways to ‘Culture’ 1800–1918. Oxford: OUP], we consider how travel changed through the long nineteenth century. We discuss how the twentieth-century Romantic attraction of travel is marketed through the tourist industry as one of the main reasons to get away from it all and discover the ‘authentic’: this desire is reflected in travel texts. Recent writing reflects the influence of Romanticism by celebrating the individual as a wandering free spirit on a self-quest, whose writing is ‘authentic’, spontaneous and confessional: that is, the legacy of sensibility. We conclude that Romanticism has left a dual legacy for travellers, of political commitment and inner journey. Authors discussed include Mary Wollstonecraft, Gertrude Bell, Isabella Bird and Sara Wheeler.     

When the Underwriter Is the Market Maker: An Examination of Trading in the IPO Aftermarket

This paper examines aftermarket trading of underwriters and unaffiliated market makers in the three-month period after an IPO. We find that the lead underwriter is always the dominant market maker; he takes substantial inventory positions in the aftermarket trading, and co-managers play a negligible role in aftermarket trading. The lead underwriter engages in stabilization activity for less successful IPOs, and uses the overallotment option to reduce his inventory risk. Compensation to the underwriter arises primarily from fees, but aftermarket trading does generate positive profits, which are positively related to the degree of underpricing.     

A Study of the Relationship Between Personal Values and Moral Reasoning of Undergraduate Business Students

This study examines values and value types as well as scores in levels of moral reasoning for␣students enrolled in a business program. These two factors are measured using the Schwartz Personal Values␣Questionnaire and the Defining Issues Test 2. No statistically significant differences in levels of moral␣reasoning, rankings of values, and value types could be attributed to gender. However, eight significant correlations between value types and levels of moral reasoning provide evidence that a systematic relationship exists. The relationships are not only internally consistent but also consistent with the model of values based on motivational goals (Schwartz S. H. and K. Boenke: 2004, Journal of Research in Personality, 38 230–255). Dr. George Lan, (Ph.D. Management, Queen’s University, Canada) is an Associate Professor of Accounting and a member of the Certified General Accountants of Ontario. His research interest and publications are in the area of business ethics and governance, accounting education and earnings management. Dr. Maureen P. Gowing (Ph.D. Management, Queen’s University, Canada) is an Assistant Professor of Accounting. She is a co-author of both a financial and managerial accounting text and has published articles on ethics and cost control, efficacy of health systems management, and gender differences in oral communication. Dr. Sharon McMahon (Ed.D. Wayne State University, Detroit, Michigan in Curriculum Development and Counseling is an Associate Professor, Faculty of Nursing. Research interests include health and wellness of children and families, health behavior outcomes, and learner’s satisfaction. Author and co-author of publications related to nonprofit governance she integrates her lived experience as a board member on several nonprofit boards and professional organizations. Dr. Fritz Rieger (Ph.D. in Management, McGill University, Canada) is an Associate Professor of Business Policy and Strategy. His research interests and publications are in the areas of ethics, organizational behavior, systems theory, modeling, culture, and immigrant entrepreneurship. Dr. Norman King (Ph.D. in Religious Studies, University of St. Michael’s College, Canada) is a Full Professor (retired) in the department of Languages, Literatures and Cultures. He has authored and co-authored many publications in contemporary spirituality and Western religious thought and remains an active board member of the Children’s Aid Society.     

An empirical study of e-government diffusion in Fiji: a holistic and integrative approach

Pacific Island countries (PICs) are facing certain unique challenges in e-government diffusion due to their geographic, cultural, social, and economic environments. However, very few rigorous empirical studies have been published about e-government diffusion issues in the region. To address the knowledge gap, we conducted a case study of Fiji. Drawing on Fountain’s technology enactment framework as a theoretical lens, we identified and investigated in a holistic and integrative way the major issues and challenges which influenced e-government diffusion and outcomes in Fiji. The study has significant implications both for research and practices not only in Fiji but also in the PICs.     

The plurality of co-existing business models: Investigating the complexity of value drivers

Business models are key tools to provide a means of operationalizing theories about firm and industry level strategies, and to understand the nature of value drivers and the role of marketing in these processes. In this paper we assess empirical evidence for a plurality of co-existing business models within firms by developing a typology of business models in a single industry, the New Zealand Wine industry. We examine the co-existence of the types of models using in-depth analysis of seven case firms that vary in size and ownership. Our findings show how value creation is done in the context of interactions and they provide support for multiple business models that co-exist alongside each other with varying degrees of separation. Plurality better explains the complexity of value drivers and strategies for firms in this rapidly changing industry environment, where businesses are under extreme financial pressure. Our findings challenge assumptions that firms have (or should have) a single business model thus allowing a plurality of approaches within a single firm or industry that shifts the focus from implementing strategy A or B or C, to implementing strategy A and B and/or C.