When does economic model type become a decisive factor in health technology appraisals? Learning from the expanding treatment options for relapsing–remitting multiple sclerosis

Objectives: Specific economic model types often become de facto standard for health technology appraisal over time. Markov and discrete event simulation (DES) models were compared to investigate the impact of innovative modeling on the cost-effectiveness of disease-modifying therapies (DMTs) in relapsing–remitting multiple sclerosis (RRMS). Fingolimod was compared to dimethyl fumarate (DMF; in highly active [HA] RRMS), alemtuzumab (in HA RRMS) and natalizumab (in rapidly evolving severe RRMS). Comparator DMTs were chosen to reflect different dosing regimens.

Materials and methods: Markov and DES models used have been published previously. Inputs were aligned in all relevant respects, with differences in the modeling of event-triggered attributes, such as relapse-related retreatment, which is inherently difficult with a memoryless Markov approach. Outcomes were compared, with and without different attributes.

Results: All results used list prices. For fingolimod and DMF, incremental cost-effectiveness ratios (ICERs) were comparable (Markov: £4206/quality-adjusted life year [QALY] gained versus DES: £3910/QALY gained). Deviations were observed when long-term adverse events (AEs) were incorporated in the DES (Markov: £25,412 saved/QALY lost, versus DES: £34,209 saved/QALY lost, fingolimod versus natalizumab; higher ICERs indicate greater cost-effectiveness). For fingolimod versus alemtuzumab, when relapse-triggered retreatment was included in the DES, large cost differences were observed (difference between incremental cost is £35,410 and QALY is 0.10).

Limitations: UK payer perspective, therefore societal approach was not considered. Resource utilization and utilities for both models were not derived from the subpopulations; as the focus is on model type, input limitations that apply to both models are less relevant.

Conclusions: Whilst no model can fully represent a disease, a DES allows an opportunity to include features excluded in a Markov structure. A DES may be more suitable for modeling in RRMS for health technology assessment purposes given the complexity of some DMTs. This analysis highlights the capabilities of different model structures to model event-triggered attributes.     

Competition and Appraisal Inflation

The Journal of Real Estate Finance and Economics - In mortgage debt contracts, real property serves as collateral and the terms of mortgage financing are largely conditional on the certification of...     

Modern Slavery and the Discursive Construction of a Propertied Freedom: Evidence from Australian Business

Journal of Business Ethics - This paper examines the ethics of the Australian business community’s responses to the phenomenon of modern slavery. Engaging a critical discourse approach, we...     

全球化：前景、潜力与问题

本文扼要阐述了经济全球化发展的前景和潜力,并运用李嘉图模型对全球化可能导致的经济损害作出论证分析进而说明,尽管经济学家在极大程度上趋向于将全球化视为基本良性的现象,但全球化仍然对某些国家（包括发达国家）带来经济损害,及对部分人群可能造成极其痛苦的后果。不过,源自于全球化的不断增长的竞争压力,会加强创新和增长,从长远来看,的确对每个国家有利。     

Connecting National Safety Nets: The Dialectics of the Basel II Contracting Process

Basel II consists of supervisory guidelines negotiated by representatives of central banks and national regulatory commissions that were members of the Basel committee on Banking Supervision (BCBS). The BCBS is itself a regulatory response to globalization, which is connecting national safety nets in market-driven ways. A country’s financial safety net is a social contract established by short-lived agents for principals in long-lived economic sectors. Restraints placed on the authority of the BCBS members to contract for their principals by domestic politics explains: why Basel II authorizes individual countries to implement the agreement in markedly different ways; why US implementation of Basel II ran into so much doubt, controversy, and delay; and how the implementation debate set small and large banks and the Federal Reserve and other federal regulators against one another.

Reflections on discriminant validity: Reexamining the Bove et al. (2009) findings

Bove, Pervan, Beatty and Shiu (2009) develop and test a latent variable model of the role of service workers in encouraging helpful behaviors by customers towards the service business (OCBs). Farrell (2010) questions these findings due to an incorrect application of the Fornell and Larcker (1981) discriminant validity test. The authors respond to Farrell's criticism by discussing the options available for assessing discriminant validity, the current use of these options in top journals, the underlying assumptions of these assessments, and the appropriateness of the alternative assessments under different types of situations. Finally, the authors address the specific concerns raised in Farrell (2010) in regard to Bove et al. (2009).     

Green marketing strategies: an examination of stakeholders and the opportunities they present

As green marketing strategies become increasingly more important to firms adhering to a triple-bottom line performance evaluation, the present research seeks to better understand the role of “green” as a marketing strategy. Through an integration of the marketing, management, and operations literatures, an investigative framework is generated that identifies the various stakeholders potentially impacted through the environmentally friendly efforts of a firm. Specifically, the inter-connected nature of the core business disciplines of marketing, management (both strategy and human resources), and operations are examined as controllable functions within an organization from which strategies can be enacted to affect a firm’s stakeholders. The prior research in these areas is examined to identify potential research opportunities in marketing while also offering a series of representative research questions that can help guide future research in marketing.     

Urban economic base as a catalyst for movements in real estate prices

We examine the relation between housing prices in an MSA and its urban economic base. We create and employ new forward-looking employment growth indices that measure the urban economic strength of an MSA and find that it accounts for a significant and sizeable portion of the house price movements in that MSA. We argue that the forward looking measure is an indicator of future agglomeration growth for the MSAs. We further partition the urban economic growth into growth by various industries and track the attribution of their growth to housing prices over time. We find that for some MSAs, home prices are driven by the same set of industries over time, whereas for others, home prices are driven by a totally new set of industries in the later quarters, due to the birth of new industries. We also analyze the impact of the diversification of an urban economic base on home price volatility and observe that diversification decreases home price volatility. The result has larger implications for urban policymakers in selecting the appropriate type of industries relative to their existing mix of industries.