Economic outcomes of sequences which include monoclonal antibodies against vascular endothelial growth factor and/or epidermal growth factor receptor for the treatment of unresectable metastatic colorectal cancer

Background:

Patients with unresectable, metastatic colorectal cancer with wild type Kirsten ras mutational status are eligible for sequential treatments which include monoclonal antibodies as first line (1L), second line (2L), or third line (3L) regimens.

Objective:

To compare the economic outcomes of different sequences which include monoclonal antibodies for the treatment of unresectable metastatic colorectal cancer.

Methods:

Individual drug regimens for 1L, 2L, and 3L treatments were compiled according to the clinical studies in the Summary of Product Characteristics for monoclonal antibodies. They were combined into plausible treatment sequences. Health outcomes were approximated using additive median PFS benefit, and economic outcomes were calculated with a treatment sequencing costing tool. Limitations of the analysis include the clinical trial data sources, cost assumptions, and the additive PFS approach.

Results:

Seventeen sequences were evaluated. Results of the analysis show that sequences including 1L anti-EGFRs generally have relatively low-to-medium health outcomes at the highest comparative sequence costs compared to sequences including 2L anti-EGFRs, which have lower health outcomes at the lowest cost. Sequences including 3L anti-EGFRs (sequential bevazicumab-based 1L and 2L) have the highest health outcomes, with potential cost savings of €5972–€11,676 if replacing 2L anti-EGFRs or an additional cost of €5909–€12,708 if replacing 1L anti-EGFR regimens.

Conclusion:

Clinical sequences consisting of 1L and 2L line bevacizumab followed by 3L anti-EGFR potentially yield the greatest health outcomes associated with a reasonable trade-off in additional cost when replacing 1L anti-EGFRs and are potentially cost-saving if replacing 2L anti-EGFRs, per patient per lifetime. To maximize health outcomes, optimal sequences include anti-EGFRs as 3L regimen, with an approximately equivalent trade-off in costs between the most costly (anti-EGFR 2L) and least costly (anti-EGFR 1L) sequences.     

Conformist innovation: an institutional logics perspective on how HR executives construct business school reputations

In this paper, we explore whether Legge’s classic 1970s criticism of human resource (HR) executives as ‘conformist innovators’ is still relevant. Drawing on institutional logics, we analyse HR managers’ rationales for choosing particular university business schools to provide senior executive development. Our mixed-methods study demonstrates that senior HR managers socially construct and enact business school reputations by drawing on strategic rationales. These rationales are embedded in societal, field and organizational logics, especially the extant reputational rankings of international business schools and an ‘ideal’ template of elite business schools. We find that these rationales, and the decisions they evince, tend to confirm the traditional picture of conformist innovation among HR executives. We discuss the implications for the reputation of HR as a profession, their employers and business schools.     

‘A deeply troubled organization’: Organizational satire in the BBC’s W1A comedy series

This paper analyses the ways in which a media organization implicated in a series of reputational scandals represents its own management in a comedy series. The organization in question is the BBC (British Broadcasting Corporation) and the comedy series is W1A, a mockumentary commissioned and screened by the BBC in 2014–17. Firstly, I discuss the ways in which W1A as a ‘text’ uses satirical devices to ridicule its own management as well as management fads and fashions. Secondly, I analyse W1A as the ‘intertext’, and consider the satirical representations of management in W1A against the backdrop of the BBC’s reputational scandals. I put forward an interpretation that the intertextual references in the comedy series break down the distance between ‘us’ and ‘the troubled organization’. I also argue that intertextual reading of the series (e.g. the analysis of allusions, cameo appearances, and parallels with the real BBC) throws an entirely different light on organizational wrongdoing, opening new possibilities for organizational reintegration and the repair of broken trust. Not only does the reading of W1A change when the audience considers what is happening in the real BBC, but also our interpretation of what is happening in the BBC may change when we watch W1A.     

A model of the socialist firm in transition to a market economy

This paper models the dynamic adjustment path of a socialist firm in transition to a market economy by a price shock that renders old capital obsolete. The firm can adjust with investment in more productive capital equipments. The optimal time paths of investment, output, and employment are analyzed and the impact of fiscal incentives like investment subsidies and a reduced corporate income tax rate are studied. Like output, the aggregate capital stock follows a J-curve. The conditions for viability of firms and the impact of variables such as wage increases on the value of the firm are discussed.     

The Social Charter: Whatever Next?

This paper traces the development of the Social Charter since its adoption in December 1989. We examine and evaluate the more important policy instruments. It is shown that the mandatory and often ambitious 'minimum standards' set by the Commission are difficult to justify in efficiency terms by reference to market failure. Furthermore, the imposition of uniformity on states that are diverse in their patterns of regulation will retard competition between social systems. It is also likely that the countervailing moves taken by firms in reaction to the imposition of arbitrary standards will frustrate the redistributive aims of the policy.     

Sector structure in an open economy

Zusammenfassung Sektorale Struktur einer offenen Volkswirtschaft. — In einem Zwei-L?nder-Zwei-Sektoren-Modell wird untersucht, wie die sektorale Struk-tur des Inlands durch sektorale Ver?nderungen im Ausland bei flexiblen und bei festen Wechselkursen beeinfluβt wird. Das Modell zeigt, wie sich der flexible Wechsel-kurs anpassen muβ, um sektorale ?nderungen von einem Land in das andere zu übertragen, wenn die Importnachfrage im Inland elastisch und wenn sie unelastisch ist. Im Falle unelastischer Nachfrage kann — selbst wenn die Robinson-Bedingung gilt — statt einer Aufwertung eine Abwertung eintreten, mit interessanten Folge-rungen. Das Modell deutet an, daβ feste Wechselkurse sektorale Ver?nderungen in die falsche Richtung anregen und dadurch zu Zahlungsbilanzproblemen führen. Da die Zahlungsbilanzprobleme gegebenenfalls durch Wechselkursanpassungen und durch unverzerrte Preissignale gel?st werden müssen, erfordert die Politik fester Wechselkurse eine gr?βere Reallokation von Ressourcen. Da diese auf kurze Sicht immobil sind, erweisen sich feste Wechselkurse als eine der Ursachen für strukturelle Arbeitslosigkeit.

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Résumé La structure de secteur dans une économie ouverte. — Nous dis-cutons dans un modèle de deux-pays-deux-secteurs comment la structure sectorielle dans le pays d’origine est effectuée par des changes sectoriels à l’étranger sous un système des taux des changes flexibles et fixes. Le modèle démontre comment le taux de change flexible doit s’ajuster pour transferer le change sectoriel d’un pays à l’autre si la démande d’importation du pays d’origine soit élastique ou non-élastique. En cas non élastique même sous la condition de Robinson une dévaluation devrait se passer au lieu d’une révalorisation avec des implications intéressantes. Le modèle indique que les taux de change fixes stimulent des changes sectoriels en direction fausse en conduisant aux problèmes de balance de commerce extérieur. Parce qu’on doit résoudre les problèmes de balance de commerce extérieur éventuellement en ajustant le taux de change et en donnant des signals des prix pas déformés, la poli-tique de taux de change fixes a besoin d’une quantité plus grande des ressources qu’on doit rédistribuer. Comme les ressources sont immobiles en court terme les taux de change fixes sont une cause implicite du ch?mage structurel.

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Resumen Estructura sectorial en una economía abierta. — En un modelo de dos países con dos sectores se discute cómo la estructura sectorial de un país es afectada por cambios sectoriales en el exterior bajo un sistema con tasas de cambio flexibles y variables. E1 modelo muestra cómo la tasa de cambio flexible debe ajus-tarse para transferir cambios sectoriales de un país a otro, si la demanda por im-portaciones del país considerado es elástica o inelàstica. En el caso de demanda elástica, incluso cuando la condición de Robinson es válida, puede ocurrir una devaluación con implicaciones interessantes en vez de una revaluatión. E1 modelo indica que tasas de cambio fijas estimulan cambios sectoriales en la dirección equi-vocada llevando a problemas de balanza de pagos. Debido a que los problemas de balanza comercial deberán ser resueltos eventualmente por medio de un ajuste de la tasa de cambio y la impositión de precios guías no destorcionados, la política de tasas de cambio fijas hace necesaria la realocación de una mayor cantidad de recursos. Debido a que los recursos son inmóviles en el corto plazo, las tasas de cambio fijas son una de las causas subyacentes a un desempleo estructural.

     

Buchbesprechungen

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