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.     

Estimating Trade Misinvoicing from Bilateral Trade Statistics: The Devil is in the Details

Trade misinvoicing, an important channel of illicit financial flows, is frequently estimated by the partner-country trade data comparison method. However, this method relies on a critical but incorrect assumption that the trade statistics in partner countries exhibit no misinvoicing. This study proves that the assumption of no misinvoicing in partner countries cannot be supported, raising serious doubts about the reliability of the method and a possibility that inappropriate policy decisions may be made based on the erroneous estimates of trade misinvoicing. We introduce an alternative method to estimate trade misinvoicing which does not rely on the trade statistics of partner countries.     

The variable effects of dynamic capability by firm size: the interaction of innovation and marketing capabilities in competitive industries

Although investments in marketing and innovation capabilities theoretically help firms to compete in dynamic markets and enhance performance, company size has a strong influence on whether this is the case. In a test of a proposed conceptual model, this study of 692 small, medium, and large enterprises found that large firms prospered from building dynamic capabilities under conditions of high industry competitiveness, while investments in innovation and marketing individually diminished small firms’ performance. The effect was mixed for medium-size firms. In small enterprises, however, dynamic capability proved to be crucial in order to withstand competition. Therefore, taking into account these firms’ limited resources, managerial efforts should be focused on the integration of marketing and innovation capabilities, because each capability alone does not have a significant positive impact on performance. In medium-sized enterprises, the support of marketing capability is required to raise profitability under conditions of high industry competitiveness; otherwise, innovation would not lead to actual profits. For large enterprises, industry competitiveness was found to be a less serious threat to performance, and instead is a catalyst to the development of capabilities, suggesting that managers of such firms should focus on building long-term strategic advantages.     

THE EFFECT OF TECHNOLOGICAL IMPROVEMENT ON CAPACITY EXPANSION FOR UNCERTAIN EXPONENTIAL DEMAND WITH LEAD TIMES

We formulate a model of capacity expansion that is relevant to a service provider for whom the cost of capacity shortages would be considerable but difficult to quantify exactly. Due to demand uncertainty and a lead time for adding capacity, not all shortages are avoidable. In addition, technological innovations will reduce the cost of adding capacity but may not be completely predictable. Analytical expressions for the infinite horizon expansion cost and shortages are optimized numerically. Sensitivity analyses allow us to determine the impact of technological change on the optimal timing and sizes of capacity expansions to account for economies of scale, the time value of money and penalties for insufficient capacity.     

Greenwash: Corporate Environmental Disclosure under Threat of Audit

We develop an economic model of “greenwash,” in which a firm strategically discloses environmental information and an activist may audit and penalize the firm for disclosing positive but not negative aspects of its environmental profile. We fully characterize the model's equilibria, and derive a variety of predictions about disclosure behavior. We rationalize conflicting results in the empirical literature, finding a nonmonotonic relationship between a firm's expected environmental performance and its environmental disclosures. Greater activist pressure deters greenwash, but induces some firms to disclose less about their environmental performance. Environmental management systems discourage firms with poor expected environmental performance from greenwashing, which may justify public policies encouraging firms to adopt them.     

Correlated equilibrium existence for infinite games with type-dependent strategies

Under study are games in which players receive private signals and then simultaneously choose actions from compact sets. Payoffs are measurable in signals and jointly continuous in actions. This paper gives a counter-example to the main step in Cotter?s [K. Cotter, Correlated equilibrium in games with type-dependent strategies, J. Econ. Theory 54 (1991) 48-69] argument for correlated equilibrium existence for this class of games, and supplies an alternative proof.     

Divas of the Wassoulou Sound: Transformations in the Matrix of Cultural Production,Globalization, and Identity

This paper examines the role of popular music performance in a context of urban change, globalization, and gender. Through an in-depth examination of the Malian music style Wassoulou and its reigning star Oumou Sangaré, issues of gender, interpretation, and cultural production are discussed. Ethnographic data presented indicate that wassoulou performance provides much needed space for Malian youth to negotiate changing notions of identity and community without openly challenging the status quo of women and youth in traditional Mande social hierarchy. These new identities convey multiple and sometimes paradoxical symbolic meaning for Malian and world-music listeners. Viewing vocal performance in Mali as a verbal mode of communication and social display, wassoulou divas are particularly excellent sites for the study of emergent identities in the context of globalization.