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.     

The BoP business paradigm: what it promotes and what it conceals

The Bottom of the Pyramid (BoP) is a popular paradigm within management circles concerning those in poverty. In this paper, we develop a critical analysis of BoP discourse and practice, drawing particularly on the works of Laclau and Mouffe, and enriched by post-development thinking as expressed in the works of Esteva and Escobar, among others. We argue that the BoP paradigm functions to reinforce market capitalist hegemony and – vitally – to conceal economic alternatives. Using the concepts of ‘discourse’, ‘hegemony’ and ‘performativity’, we analyse the politics of language and representation in the BoP discourse. Finally, we point to modes of scholarship that contribute to the nurturing and performance of diverse, non-capitalist economic worlds.     

Skill transferability and the earnings of immigrants

Using data on immigrants from the Canadian Census, we compare immigrants who received a bachelor's degree from a Canadian university to immigrants who receive a bachelor's degree in their home country, in order to investigate the returns to skills acquired in Canada versus skills acquired abroad. Our measure of skill is based on postsecondary fields of study linked to the O*NET matrix of skills and competencies. We find that immigrants educated in Canada receive higher returns to their communication skills than those educated abroad. To a lesser degree, they also receive higher returns to their logical and technical skills. These gaps in skill returns explain the entirety of Canadian-educated immigrant's 10% earnings advantage. Our results are robust to controlling for the quality of universities in the immigrant's country of study and for occupation and industry choice. The gaps are stable across time and across quantiles of the immigrant earnings distribution.     

The Effectiveness of Unconventional Monetary Policy in Japan

Since the global financial crisis of 2007–2008, central bankers around the world have been forced to abandon conventional monetary policy tools in favor of unconventional policies such as quantitative easing, forward guidance, and even lowering the interest rate paid on bank reserves into negative territory. Japan, which faced a crisis in its banking sector and came up against the theoretical zero lower bound on interest rates nearly a decade earlier, was a pioneer in the use of many of these unconventional policy tools. This article analyzes the effectiveness of Japan’s bold experiment with unconventional monetary policy. Using a panel of bi-annual bank data covering the full universe of Japanese commercial banks over a fifteen-year period, this study analyzes the effectiveness of quantitative easing policy on the bank lending channel of monetary policy transmission. Our findings suggest that Japan’s unconventional monetary policy worked: there is a bank lending channel of monetary policy transmission in Japan. These results are robust to the inclusion of time fixed effects and generalized method of moments analysis.     

Stochastic Generational Accounting Applied to Reforms of Dutch Occupational Pensions

This paper examines stochastic or ‘value based’ generational accounting as a method to assess the intergenerational redistributive impact of pension reform. The analysis is applied to three policy changes to the regulation of Dutch occupational pensions during the years 2012 and 2013 that mark the transition from defined benefit pensions to ‘defined ambition’ pension schemes.     

One village,one product: Agro‐industrial village corporatism in contemporary China

This paper investigates the implementation of “one village, one product” (OVOP) in four peri‐urban villages in China's Yangtze River Delta. China's agricultural transformation, including the introduction of new corporate actors and the growing pressure of market discipline, has challenged the relevance of villages in the organization of agricultural production. In response, village cadres in thousands of Chinese villages have used OVOP to transform their villages into agro‐industrial firms and re‐exert their control over the agricultural surplus, echoing earlier examples of village corporatism. Rooted in agricultural specialization, OVOP encompasses a diversity of strategies for the production of locality‐based value. I disaggregate these strategies into four sociospatial dimensions that comprise locality—place, network, territory, and scale. Place‐based branding is the dominant strategy, but village cadres also pursue complementary sociospatial strategies to ensure their control over the realization of the brand's value and reconstitute their redistributive and administrative powers.     

Forays into the backstage: volunteer tourism and the pursuit of object authenticity

Volunteer tourism is a form of travel that combines traditional leisure pursuits with opportunities to volunteer in an organized fashion. The popularity of volunteer tourism stems from many factors, but the one motivation that appears in virtually every study is a desire for object authenticity, defined as the authenticity of toured objects, people, and settings. The purpose of this paper is to explore the role played by object authenticity in the motivations and experiences of volunteer tourists in the province of Chiang Mai in northern Thailand. Based on interviews with 62 volunteers and 15 directors, managers, and staff members from volunteer tourism organizations based in Chiang Mai, this paper argues that volunteer tourists conceive of object authenticity both as a package of cultural stereotypes focused on authentic people, and as authentic backstage settings where ‘real’ Thai reside. Aside from demonstrating that the desire for object authenticity is the central motivation for international volunteers in northern Thailand, this study indicates that the pursuit of object authenticity is complicated by language barriers, the potential staging of authenticity on the part of locals, and the need to balance familiarity with alterity in the carefully selected ‘voluntourscapes’ in which volunteer tourism takes place.