Evaluating the impact of service user involvement on research: a prospective case study

As service user involvement in health and social care research has become more firmly embedded in health policies, both in the UK and internationally, there is increasing interest in evaluating its potential benefits and outcomes. Impact studies have highlighted a range of different types of service user involvement, using diverse research methods, within various research topics and involving different stakeholders. Potential benefits to research, researchers and the service users actively involved in research have been identified, along with the possibility of some negative consequences. Many impact studies have been criticized for being based on informal retrospective accounts of researchers and service users working together. Few have been underpinned by conceptual models, and there is a paucity of detailed accounts of the process of involvement that would enable replication. This paper reports an account of a prospective, qualitative exploration of service user involvement within a study, where the aims of the evaluation were agreed beforehand. Reflective discussions about the process and progress of service user involvement at different stages of the study were recorded, transcribed and analysed. The qualitative analysis identified perceived benefits to research, researchers and service user researchers that endorsed previous findings. The analysis also highlighted subjective and interpersonal aspects of service user involvement that have seldom been reported. This evaluation demonstrates the benefits of allowing time for structured reflection and adds to the understanding of the process and meaning of service user involvement in research.     

A behavioral theory of governments’ ability to make credible commitments to firms: The case of the East Asian paradox

An expansive literature exists linking institutional constraints, credible commitments, and economic growth. Yet, this literature runs into difficulty when it tries to explain the East Asian “paradox:” rapid economic growth achieved by countries with low levels of formal constraints on government discretion. We use a behavioral theory of commitment to argue that the characteristics of the salient actors (governments) and their actions (policies) affect the credibility of their behaviors in ways independent of the structural underpinnings of a country’s political institutions. This behavioral theory of commitment provides a distinct but complementary lens through which to view the apparent paradox presented by these East Asian countries, and more generally provides an alternative theoretical mechanism to explain and predict governments’ ability to credibly signal their commitment to a course of action to investing firms. The success of East Asian countries in encouraging investment from both domestic and foreign firms implies that firms interpret governments’ actions as credible signals of their intention to honor their commitments to firms, consistent with the behavioral theory of commitment.     

Trust in management: the role of employee voice arrangements and perceived managerial opposition to unions

This study examines the relationship between employee voice arrangements and employees' trust in management using data from the 2007 Australian Worker Representation and Participation Survey of 1,022 employees. Drawing on social exchange theory and employee relations literature, we test hypotheses concerning the relationships between direct and union voice arrangements, perceived managerial opposition to unions and employees' trust in management. Consistent with our predictions, after controlling for a range of personal, job and workplace characteristics, regression analyses indicated that direct voice arrangements were positively related to employees' trust in management. Union voice arrangements and perceived managerial opposition to unions were negatively related to trust in management. The article concludes by highlighting the study's implications for management practice and avenues for further research.     

Pensions: theories of underfunding

The widespread underfunding of private defined benefit pensions has generated concern over the viability of employers' promises of retirement benefits. Years ago, similar concerns led to the creation of pension benefit insurance plans by governments in the United States and a number of other countries. This paper studies the causes of underfunding in an environment without pension benefit insurance. We find that the optimal level of retirement benefits will be offered and fully funded if the employer has sufficient internal funds or is able to borrow all it needs. If loans are not enforceable, an employer with limited resources will generally underfund pensions. Further, if pension investments earn lower returns than other investments, pensions will be underfunded. Thus, the paper highlights the link between financial markets and the underfunding of pensions.     

Exploring the potential value of improved care for secondary hyperparathyroidism with a novel calcimimetic therapy

Aims: This study explored the use of a value-based pricing approach for the new calcimimetic etelcalcetide indicated for the treatment of secondary hyperparathyroidism (SHPT) in patients receiving hemodialysis. It used the US payer perspective and applied the cost-effectiveness framework. Because etelcalcetide is an intravenous therapy that can be titrated for individual patients, and because its utilization is yet to be assessed in real world settings, a range of plausible doses were estimated for etelcalcetide to define a range of prices. These were either in relation to the existing oral calcimimetic cinacalcet or compared to no calcimimetic treatment.

Materials and methods: The value-based price of etelcalcetide was determined via a Markov model. This model combined data from the etelcalcetide trials and previously published cost-effectiveness models in SHPT, and allowed extrapolation of treatment effects on mortality, cardiovascular events, fracture, and parathyroidectomy. Several dosing scenarios were explored covering the dose ranges of 30.0–64.18?mg per day for cinacalcet and 1.07–3.11?mg per day for etelcalcetide. These included the mean dose from the etelcalcetide trials, the preliminary defined daily dose, and the expected most common dose in real world. An acceptable price range for etelcalcetide was assessed by comparing the incremental cost-effectiveness ratios obtained with the willingness-to-pay threshold range of $100,000–$300,000/quality-adjusted life-years.

Results: Cost-effectiveness analysis supported value-based prices for etelcalcetide ranging from $21.15–$49.97/mg vs cinacalcet, and $13.79–$119.45/mg vs no calcimimetics.

Limitations: There is uncertainty around what the real-world dosing will be for etelcalcetide. Another important nuance is that no studies have examined etelcalcetide effects on hard outcomes and, therefore, this modeling exercise relied on an extrapolation approach.

Conclusions: This cost-effectiveness analysis, including scenarios to address uncertainties, allowed estimation of a value-based price range to aid reimbursement decisions in the US.