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.     

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.     

The Impact of Consumers’ Need for Uniqueness and Nationality on Generation Y's Retail Patronage Behaviors: Investigating American and Taiwanese Consumers

ABSTRACT

Generation Y (Gen Y) consumers are now one of the most influential buying segments in U.S. history. This article empirically assesses the extent to which American Gen Y consumers and same-aged Taiwanese consumers’ need for uniqueness serves as a meaningful discriminant across retail patronage behaviors for branded apparel products. Results indicate a great deal of similarity between the two cultures’ need for uniqueness. Empirical findings reveal that consumers’ need for uniqueness does influence retail patronage behaviors. The implications of the similarities and differences between American Gen Y consumers and their Taiwanese counterparts serve as potential managerial mechanisms for building and sustaining retail patronage in a globalization era.     

A point optimal test for heteroscedastic disturbances

A new test for additive heteroscedasticity in the disturbances of the linear regression model is proposed. Power functions of various forms of the new test are compared empirically with those of currently favoured tests for a range of heteroscedastic models. The results highlight the power advantage of a test which is MP1 at a central point in the alternative hypothesis parameter space. The main conclusion is that the recommended version of the new test is generally more powerful than existing tests against medium and severe heteroscedasticity, whereas the King and Szroeter tests perform better against weak heteroscedasticity.     

The Impact of Industry Structure and Penalty Policies on Incentives for Compliance and Regulatory Enforcement

This paper examines the optimal fine for violations of environmental regulations, taking into account financial constraints facing regulated firms and the hierarchical structure of regulatory enforcement. Contrary to the existing literature, which suggests that maximal fines are sub-optimal, we find that the optimal fine is either the maximum amount the firm can afford to pay or zero (i.e., no regulation). The impact of a change in industry structure on the optimal fine, firm compliance and regulatory resource strategies is considered. We identify conditions under which the equilibrium level of regulatory resources decreases with an increase in the number of firms in the industry.