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.     

From Mad to Mindful: Corporate Control Through Corporate Spirituality

Abstract:

Capitalism has always and will always depend on a compliant workforce. Maintaining the delicate balance between a worker who is just “not-unhappy” enough or desperate enough to continue working while also cutting costs to the bone presents a continuous challenge for business interests. This pursuit to squeeze more productivity out of workers while also managing worker discontent in the cheapest way possible has spawned innovations in labor management which reflect the institutional milieu of the respective time. This research focuses on those labor management techniques particular to neoliberalism and the ways in which cultural movements and trends of the neoliberal period are mined and deployed as yet another useful resource in the disciplining of workers. Corporate mindfulness is the favorite labor management technique of the neoliberal period. The formalized packaging of corporate mindfulness began in the late 1970s but was built on a long tradition of attempts to hack the minds and mindsets of workers. Corporate mindfulness reinforces neoliberalism through the corporate individual, the transformation of the self of the corporate individual, and the creation of the corporation as a community and means of social connection for the corporate individual.     

Hunger games: or how the Allied blockade in the First World War deprived German children of nutrition,and Allied food aid subsequently saved them

At the onset of the First World War, Germany was subject to a shipping embargo by the Allied forces. Ostensibly military in nature, the blockade prevented not only armaments but also food and fertilizers from entering Germany. The impact of that blockade on civilian populations has been debated ever since. Germans protested that the Allies had wielded hunger as a weapon against women and children with devastating results, a claim that was hotly denied by the Allies. The impact of what the Germans termed the Hungerblockade on childhood nutrition can now be assessed using a newly discovered dataset based on heights and weights of nearly 600,000 German schoolchildren measured between 1914 and 1924. Statistical analysis reveals a grim truth: German children suffered severe malnutrition due to the blockade. Social class impacted risk of deprivation, with working‐class children suffering the most. Surprisingly, they were the quickest to recover after the war. Their rescue was fuelled by massive food aid organized by the former enemies of Germany, and delivered cooperatively with both government and civil society. The ability of former belligerents to work together after an exceptionally bitter war to feed impoverished children may hold hope for the future.     

Mortgage lending,monetary policy,and prudential measures in small euro‐area economies: Evidence from Ireland and the Netherlands

This paper examines whether the increased use of macroprudential policies since the global financial crisis has affected the impact of (euro‐area and foreign) monetary policy on mortgage lending in Ireland and the Netherlands, which are both small open economies in the euro area. Using quarterly bank‐level data on domestic lending in both countries for 2003–2018, we find that restrictive euro‐area monetary policy shocks reduce the growth of mortgage lending. We find evidence that stricter domestic prudential regulation mitigates this effect in Ireland, but not so in the Netherlands. There is some weak evidence for an international bank lending channel that can be mitigated by stricter lender‐based domestic prudential regulation.     

The SEC and Improving Sustainability Reporting

In this discussion that took place at the SASB 2016 Symposium, the former Chair of the Securities and Exchange Commission explores recent developments in corporate sustainability reporting with three Directors—two past and one current—of the SEC's Division of Corporation Finance (or “CorpFin”). The consensus of the panelists was that investors want companies to provide more and better disclosure of their ESG exposures, particularly climate change, and their plans to manage those exposures. According to the current director of CorpFin, the most common demand expressed in the thousands of “comment letters” elicited by the SEC's recent concept release was for more and better sustainability information. And among the many issues cited by investors in those letters, including economic inequality, corruption, indigenous rights, and community relations, the subject of greatest interest by far was climate change. While none of the panelists claimed to see private‐sector demand for SEC action and a new set of mandatory requirements, all seemed to agree that many companies would welcome the establishment of voluntary guidelines and standards for providing ESG information—and that the guidelines recently developed by the Sustainability Accounting Standards Board are a promising model. For companies in each of 79 different industries, the SASB has identified a specific set of “material” concerns along with metrics or KPIs that can be used to evaluate corporate performance in responding to those concerns. Perhaps the most important advantage of this approach is that, by limiting such reporting to material exposures (and so adhering to a principle that has long informed SEC requirements), the SASB guidelines should significantly increase the relevance and value to investors—while possibly holding down the costs—of the sustainability reports that large companies in the U.S. and abroad have been producing for decades. But, as the former SEC Chair also notes in closing, the adoption of such guidelines by companies should be viewed as just a first step toward improving disclosure. To help companies develop the most useful and cost‐effective disclosure practices, investors themselves will have to become more active in communicating their own demands and preferences for information.     

The role of the entrepreneurial encounter in the emergence of opportunities: Vallée’s Dallas Buyers Club

ABSTRACT

This paper aims to explore the conceptual potential of the Deleuzian notion of the encounter in order to better understand the genealogy of opportunities. We adopt a processual perspective of opportunities. In order to translate this notion to the domain of entrepreneurship, we analysed and interpreted Jean-Marc Vallée’s Dallas Buyers Club. This film follows the creation of the first club in the United States that illegally allowed HIV-positive people to supply themselves with foreign antiretroviral drugs from Mexico or Japan. The article highlights encounters in this process that disturb the entrepreneur’s belief systems and allow him or her to be open to potential opportunity. It finally explores how the encounter may improve our understanding of the political becoming of opportunities within the entrepreneurial process.     

Rationality of weather predictions and insurance purchases: testing the gambler’s and hot hand fallacies

Deviations from the rational behaviour assumed in many economic models have been found in a variety of settings. Two such deviations, the gambler’s and hot hand fallacies have been found in lab settings, as well as in consequential real-world decisions. Previous economic experiments have shown that the behaviour of professionals can differ from that of the general population. In this paper, we use data from two experiments conducted with a particular group of professionals who make yearly high-stakes decisions in the face of uncertain weather and market conditions: agricultural producers. In the experiments, participants were asked to make predictions about the coming year’s weather and market conditions and make decisions in a familiar decision context. Results indicate evidence of the gambler’s fallacy, such that participants were less likely to predict a good outcome if the previous outcome(s) were good. We also observe that participants were more likely to gamble if a previous gamble was successful, but find no impact on two successful gambles. These combined results indicate that even professionals with many years of experience can exhibit behaviours that deviate from those assumed by classical models.