Economic evaluation of BST-CarGel as an adjunct to microfracture vs microfracture alone in knee cartilage surgery

Objectives:

Knee cartilage damage is a common cause of referral for orthopedic surgery. Treatment aims to reduce pain and symptoms by repairing cartilage. Microfracture, the current standard of care, yields good short-term clinical outcomes; however, treatment might fail after 2–3 years. A Chitosan-Beta glycerolphosphate-based medical device (BST-CarGel) is used as an adjunct to microfracture and demonstrates improvements in quantity and quality of repaired tissue, potentially reducing the risk of treatment failure. This study aimed to establish the economic value of BST-CarGel vs microfracture alone in knee cartilage repair from the societal perspective, using Germany as the reference market.

Methods:

A decision tree with a 20-year time-horizon was constructed, in which undesirable clinical events were inferred following initial surgery. These events consisted of pain management, surgery, and total knee replacement. Clinical outcomes were taken from the pivotal clinical trial, supplemented by other literature. Data and assumptions were validated by a Delphi panel. All relevant resource use and costs for procedures and events were considered.

Results:

In a group of patients with all lesion sizes, the model inferred that BST-CarGel yields a positive return on investment at year 4 (with 20-year cumulative cost savings of €6448). Reducing the incremental risk of treatment failure gap between the device and microfracture by 25–50% does not alter this conclusion. Cost savings are greatest for patients with large lesions; results for patients with small lesions are more modest.

Limitations:

Clinical evidence for microfracture and other interventions varies in quality. Comparative long-term data are lacking. The comparison is limited to microfracture and looks only at costs without considering quality-of-life.

Conclusion:

BST-CarGel potentially represents a cost-saving alternative for patients with knee cartilage injury by reducing the risk of clinical events through regeneration of chondral tissue with hyaline characteristics. Since the burden of this condition is high, both to the patient and society, an effective and economically viable alternative is of importance.     

Performance of acquirers of divested assets: Evidence from the U.S. software industry

We provide a comparative analysis of acquirer returns in acquisitions of public firms, private firms, and divested assets. On the basis of a sample of 5,079 acquisitions by U.S. software industry companies during 1988–2008, we find that acquisitions of divested assets outperform acquisitions of privately held firms, which in turn outperform acquisitions of publicly held firms. While the higher returns for acquisitions of divested assets relative to stand‐alone acquisition targets can be explained by market efficiency arguments, seller distress and improved asset fit further enhance the positive returns of acquirers of divested assets consistent with the relative bargaining power explanation. Finally, we find that the effects of these buyer bargaining advantages are mutually strengthening and that they also hold for longer‐term acquirer performance Copyright © 2013 John Wiley & Sons, Ltd.     

The relevance of reputation in the nonprofit sector: the moderating effect of socio-demographic characteristics

This paper extends prior research on the reputation of nonprofit organizations (NPOs) by investigating the moderating role of socio-demographic characteristics in forming NPO reputation and reputation's effects on donating and volunteering behavior. The findings offer new insights into the role an NPO's reputation plays and its effects on key outcomes such as willingness to donate and work as a voluntary member in specific subgroups. The results show that successful reputation management is specifically important for male, older, highly educated, and affluent respondents. Communicational measures aimed at strengthening an organization's social responsibility are particularly promising regarding triggering favorable donor behavior and voluntary support. Copyright © 2014 John Wiley & Sons, Ltd.     

Strategic Practice Drift: How Open Strategy Infiltrates the Strategy Process

This paper builds theory on the process of open-strategy infiltration through an ethnographic study investigating how open strategy entered a financial services firm's strategy process behind the backs of top managers. Based on our analysis, we show how open strategy infiltrates the strategy process through a ‘strategic practice drift’, i.e., a gradual and partly unnoticed shift towards open strategy that occurs through ‘accommodating’ and ‘legitimizing’ the performance of transparency and inclusion in the strategy process. We show how the ‘goal-based ambiguity’ and ‘procedural certainty’ of initiatives that latently imply the performance of transparency and inclusion in the strategy process enable open-strategy infiltration. Furthermore, we show how top managers' ‘goal-based rationalization’ and ‘procedural renegotiation’ of practising transparency and inclusion contribute to the eventual reproduction of open strategy in the strategy process. Our model generates an understanding of how and why open strategy can enter the strategy process behind the backs of top managers and adds nuance to extant understandings of the role of top managers in this process. In addition, our findings contribute to research on strategy as practice by theorizing ‘strategic practice drifts’ and extending our understanding of the role of ambiguity therein.     

Agglomeration,tax competition,and fiscal equalization

This paper analyzes the impact of fiscal equalization on asymmetric tax competition when positive agglomeration externalities are present. It uses a model focusing on the strategic reason for capital taxes to demonstrate that per capita fiscal capacity equalization improves the spatial allocation of capital provided a sufficiently rich (marginally) larger region and sufficiently strong agglomeration externalities. If tax revenue is used to finance public goods, per capita fiscal capacity equalization generally cannot simultaneously eliminate public good inefficiency and spatial inefficiency. However, the achievement of full efficiency for ex ante identical regions requires excessive (full) equalization in the presence (absence) of agglomeration externalities.     

Foreign Direct Investment,Regulations and Growth

The paper explores the linkage between income growth rates and foreign direct investment (FDI) inflows. So far the evidence is rather mixed, as no robust relationship between FDI and income growth has been established. We argue that countries need a sound business environment in the form of good government regulations to be able to benefit from FDI. Using a comprehensive data set for regulations, we test this hypothesis and find evidence that excessive regulations restrict growth through FDI only in the most regulated economies. This result is robust to different specifications of the econometric model.     

R&D spillovers and strategic delegation in oligopolistic contests

Considering oligopolistic contests with R&D spillovers and strategic delegation three results can be obtained: (1) There exist multiple asymmetric equilibria where one owner highly favors sales as a basis for his manager's incentives which drives the other firm out of the market. (2) If R&D spillovers are zero, a managerial firm will have a strong strategic advantage when competing with an entrepreneurial firm. If both owners endogenously decide about delegation, each owner's dominant strategy will be to delegate, given that the manager's reservation value is not too large. (3) If R&D spillovers are maximal, collusive market outcomes become very likely, which makes strategic delegation less important. Copyright © 2004 John Wiley & Sons, Ltd.