A cost-utility analysis of prolonged-release tacrolimus relative to immediate-release tacrolimus and ciclosporin in liver transplant recipients in the UK

Background: Calcineurin inhibitors (CNIs) represent the cornerstone of immunosuppressive therapy after liver transplantation. A recent network meta-analysis (NMA) evaluated the relative efficacy of CNIs ciclosporin, prolonged-release (PR) tacrolimus, and immediate-release (IR) tacrolimus in adult liver transplant recipients based on randomized and large observational trials published since 2000. Based on the NMA findings, the present study evaluated the cost-utility of PR tacrolimus relative to ciclosporin or IR tacrolimus in liver transplant recipients in the UK.

Methods: A Markov model was developed to evaluate the cost-utility of immunosuppressive regimens in liver transplant recipients, capturing costs associated with immunosuppression, retransplantation, acute rejection (AR), and cytomegalovirus infection. Mortality, graft loss, and AR odds ratios were derived from the NMA. Costs were taken from the British National Formulary and the NHS National Tariff and expressed in 2016 pounds sterling. Future costs and effects were discounted at 3.5% annually.

Results: Over 25 years, PR tacrolimus resulted in increased life expectancy and quality-adjusted life expectancy (QALE) relative to IR tacrolimus and ciclosporin. Relative to ciclosporin, QALE increased by 1.17 quality-adjusted life years (QALYs) with PR tacrolimus while costs increased by GBP £4645, yielding an incremental cost-effectiveness ratio (ICER) of £3962 per QALY gained. Relative to IR tacrolimus, QALE increased by 0.78 QALYs and costs by £1474, resulting in an ICER of £1889 per QALY gained. Sensitivity analysis showed the analysis to be most sensitive to dosing assumptions.

Conclusions: Based on a UK-specific analysis of the projected cost-utility of PR tacrolimus relative to IR tacrolimus and ciclosporin, PR tacrolimus was cost-effective, improving life expectancy and QALE relative to both IR tacrolimus and ciclosporin, yielding ICERs below £20 000 per QALY gained. The main limitations of the study were data source heterogeneity and omitting the economic and clinical effects of treating aspects of recurrent liver disease.     

Factors affecting the effectiveness and acceptance of electronic selection systems

There has been a rise in the use of electronic selection (e-selection) systems in organizations. Given the widespread use of these systems, this article reviews the factors that affect their effectiveness and acceptance by job applicants (applicant acceptance), and offers directions for future research on the topic. In particular, we examine the effectiveness and acceptance of these systems at each stage of the selection process including (a) job analysis, (b) job application, (c) pre-employment testing, (d) interviewing, (e) selection decision-making, and (f) evaluation and validation. We also consider their potential for adverse impact and invasion of privacy. Finally, we present some implications for e-selection system design and implementation.     

Credit-rationing and entrepreneurial experience: Evidence from a resource deficit context

This study explores the following novel research question: Do attributes relating to the resources and signals of lead entrepreneurs, particularly prior business ownership experience quality signals, reduce the probability that entrepreneurs will be chronic credit-rationed entrepreneurs in a developing economy context with resource deficiencies? Guided by insights from signalling, resource-based view of the firm and human capital theory, profiles of credit-rationed entrepreneurs (i.e. debt finance obtained but below the amount requested) are highlighted. The length of the debt finance gap was considered with regard to temporary (over one year), major (over two years) and chronic (over three years) finance gaps. We find support for our hypotheses relating to entrepreneurs whose firms are more innovative being more likely to be chronically credit-rationed, whilst firms with partners, entrepreneurs with longer prior business ownership experience and habitual entrepreneurs are less likely to be credit-rationed. The interaction with serial or portfolio entrepreneur reduces the chronic credit-rationing problem faced by innovative firms. A case for developing linkages between inexperienced novice entrepreneurs and habitual entrepreneurs, particularly successful portfolio entrepreneurs, is made. Notably, we suggest that building upon the experienced entrepreneurs who do exist may be particularly beneficial in resource deficit contexts such as Ghana     

Retailer Categorization: How Store-Format Price Image Influences Expected Prices and Consumer Choices

Prior research indicates that consumers may base their retail decisions (e.g., store choice, purchase quantity) on price image, which has been defined as consumer perceptions “of the aggregate price level of a retailer” (Hamilton and Chernev 2013, p. 2). The present research shows that consumers associate different price images not only with specific retailers, but more broadly with various store formats — such as grocery stores, convenience stores, and specialty stores. Six studies provide evidence that store-format price image exerts influence on consumer price expectations and store choice decisions, and that these retailer categorization effects are distinct from the effects of retailer price image.     

Beyond the journey: the lasting impact of culinary tourism activities

In general, food tourism research has focused on tourist behaviour prior to or during trips, as well as food tourism development and marketing from a destination perspective. This exploratory study investigates food tourism from a broader context to determine if food tourism activities may impact attitudes and future behaviours. Data from a nine-country survey indicate that food activities likely impact trip satisfaction and influence intention to return and likelihood to recommend a destination. Food experiences are connected with memory, and these food experiences and souvenirs may influence destination image and lead to future purchases. Suggestions are provided for further research.     

Injustice in Mobile Leisure: A Conceptual Exploration of Pokémon Go

In augmented reality, video games and the physical world converge as individuals participate in digital leisure overlaid on physical spaces. In Pokémon Go, game play in the physical world is impacted by constraints that limit access and play of marginalized groups. The global popularity of Pokémon Go created an opportunity to explore experiences of marginalized groups participating in augmented reality game play. Grey literature surrounding Pokémon Go is rich with accounts of constraints experienced by marginalized groups, particularly individuals self-identifying as White women, Black women, or Black men. Their experiences with Pokémon Go illustrate the need for social justice in digital leisure. Because the lifespan of mobile applications is limited, the gradual process from research to social change may be insufficient in addressing ever-evolving digital platforms. Researchers need to strategically work with industry partners to identify needs for social justice during the planning and designing stages.     

SMEs’ Financing and Banks’ Profitability: A “Good Date” for Banks in Ghana?

Small and medium enterprises (SMEs) are the core of most economies and are a major source of economic growth. In recent times, banks have been actively involved in the financing of SMEs through the provision of loans to this sector. This paper investigates the impact of SMEs financing on banks’ profitability in Ghana. The study employed the fixed effect model as the main regression tool. The study result reveals that SMEs significantly contribute to banks’ profitability in Ghana. Interestingly, transaction cost in administering SME loans was insignificant in all the models. Higher inflation reduces the real value of the loan and erodes the interest returns on the total credit to the SMEs. Conversely, growth of GDP enhances the growth of the bank profit.     

Concrete U(dys)topia in Bethlehem: a city of two tales

The aim of this article is to deconstruct the utopian character of Israel by analysing the case of Rachel's Tomb in Bethlehem. In this illustration of how cultural heritage became dominated by Israel's utopia, this article proposes to create an inspirational alternative. Therefore, two tales of Bethlehem will be juxtaposed. Participatory observation and interviews were conducted in order to examine the context of Rachel's Tomb as well as the family of Claire Anastas. On this platform, different groups of people were invited to discuss complex political issues within the context of alternative tourism. By using Arendt's concept of the ‘agora’ and Habermas' theoretical framework, the lifeworld situation of the Palestinians has been addressed seriously. This creates the necessary condition in order to create hope in a highly politically unstable situation, such as the occupation and colonisation of the Palestinian territories. A critical value-laden perspective supports a stronger concept of communicative action in controversial areas. This concept functions as a structured approach to find an escape from the utopian supremacy of the Israeli ideology. It is an inclusive attempt to create room for a plural dialogue between all the lifeworlds of this region, Palestinians and Israelis.     

Choosing a discount point/contract rate combination

Confronted with an array of contract rate/discount point combinations from which to choose, a mortgagor must evaluate his/her wealth with respect to each choice. The future path of the cost of mortgage capital will affect the wealth of the mortgagor to a different degree depending on which contract rate/discount point combination he/she chooses. Using the Expected Monetary Value algorithm, we show that variation of marginal income tax rates and expectations about the future path of the cost of mortgage capital across mortgagors can explain the demand for different contract rate/discount point combinations. Our results provide a rationale for a mortgagor choosing an intermediate point/contract rate combination.Paper presented at the annual meeting of the A.R.E.U.E.A., 1989, Atlanta.