A cost analysis of SIR-Spheres yttrium-90 resin microspheres versus tyrosine kinase inhibitors in the treatment of unresectable hepatocellular carcinoma in France,Italy, Spain and the UK

Abstract

Background and aims: A wide range of treatment options are available for hepatocellular carcinoma (HCC), including systemic treatment with tyrosine kinase inhibitors (TKIs) such as sorafenib and lenvatinib, immunotherapies, locoregional therapies such as selective internal radiation therapy (SIRT) and treatments with curative intent such as resection, radiofrequency ablation and liver transplantation. Given the substantial economic burden associated with HCC treatment, the aim of the present analysis was to establish the cost of using SIRT with SIR-Spheres yttrium-90 (Y-90) resin microspheres versus TKIs from healthcare payer perspectives in France, Italy, Spain and the United Kingdom (UK).

Methods: A cost model was developed to capture the costs of initial systemic treatment with sorafenib (95%) or lenvatinib (5%) versus SIRT in patients with HCC in Barcelona Clinic Liver Cancer (BCLC) stages B and C. A nested Markov model was utilized to model transitions between progression-free survival (PFS), progression and death, in addition to transitions between subsequent treatment lines. Cost and resource use data were identified from published sources in each of the four countries.

Results: Relative to TKIs, SIRT with SIR-Spheres Y-90 resin microspheres were found to be cost saving in all four country settings, with the additional costs of the microspheres and the SIRT procedure being more than offset by reductions in drug and drug administration costs, and treatment of adverse events. Across the four country settings, total cost savings with SIR-Spheres Y-90 resin microspheres fell within the range 5.4–24.9% and SIRT resulted in more patients ultimately receiving treatments with curative intent (4.6 vs. 1.4% of eligible patients).

Conclusion: SIR-Spheres Y-90 resin microspheres resulted in cost savings relative to TKIs in the treatment of unresectable HCC in all four country settings, while increasing the proportion of patients who become eligible for treatments with curative intent.     

The Political Economy of Rental Housing in Spain: The Dialectics of Exploitation(s) and Regulations

ABSTRACT

This paper analyses how the exploitation of tenants in Spain is boosting income for banks, hedge funds and pension funds. It does so by tracing the origins of the money invested in a Tres Cantos housing project in Madrid. The paper makes the following claims: First, the exploitation taking place in households -referred in this paper as secondary- is increasingly related to worker exploitation, and thus this particular type of exploitation is increasingly relevant to the dynamics of capital accumulation. Second, the key role of secondary exploitation of tenants in the revenue-making strategies of pension funds, hedge funds and banks is augmented and mediated by a myriad of regulations being implemented at the national and supranational scales. Theoretically, the paper contests the Marxian claim that household exploitation is ‘secondary’ to the exploitation taking place in the production process.     

Accounting regulation, inertia and organisational self-perception: Double-entry adoption in a Spanish casa de comercio (1829-1852)

This paper analyses the influence exerted by compulsory mechanisms and cognitive and social factors on the adoption and implementation of double-entry bookkeeping. The study focuses on a small, commercial and family owned company located in Spain in the period 1829-1852. As our main conclusion we suggest that the adoption of double-entry bookkeeping in 1851 was influenced more by the managers' self-perception as traders, and the belief (internal and environmental) that the company must employ an accounting method appropriate to its new commercial status, than by State pressures derived from the enactment of a new accounting regulation in 1829.     

THE RELATIONSHIP BETWEEN EXPORT STATUS AND PRODUCTIVITY IN SERVICES: A FIRM‐LEVEL ANALYSIS FOR SPAIN

This paper analyses the relationship between export status and productivity in a major service exporter, Spain, during 2001–07. I find that exporters in the services sector are 45 percent more productive than non‐exporters. This productivity premium is larger for firms that supply non‐internet‐related services than for firms that supply internet‐related services. The results show that exporters were more productive than non‐exporters before beginning to export, and also that exporting increases productivity growth; however, this positive shock vanishes quickly.     

The relationship between multinationality and performance: Knowledge-intensive vs. capital-intensive service micro-multinational enterprises

This research explores the relationship between multinationality and firm performance (M-P) in the context of micro-multinational enterprises (mMNEs) within the service sector. We examine the moderating effects of industry characteristics using a data set of 1082 Spanish service mMNEs over an eight-year period. The empirical results provide statistical evidence that knowledge-intensive service mMNEs exhibit an inverted U-shaped M-P relationship, while capital-intensive service mMNEs present a U-shaped relationship. Our findings demonstrate that knowledge-intensive service mMNEs increase their performance in the initial stage of multinationality, encounter a threshold of internationalization at relatively low levels of multinationality and have a propensity to over-internationalize. By comparison, capital-intensive service mMNEs experience negative performance effects at low levels of multinationality and positive ones as they further internationalize. Given that their operations are scale-sensitive, they tend to expand internationally by concentrating their operations in few foreign markets as a means to overcome the liabilities of internationalization and smallness. We contribute to the literatures on multinationality research in the service sector and on SME internationalization by showing that the effects of multinationality on the performance of mMNEs depend on industry characteristics and that such contextual factors provide a better understanding of the M-P relationship.     

Risk management and reinsurance strategies in the Spanish insurance market (1880–1940)

Reinsurance allows insurance companies to diversify their risks. However, from this original role, insurance companies have developed various reinsurance strategies in order to expand their market share. From the last decades of the nineteenth century to the 1940s, Spanish insurance companies used reinsurance in a largely unregulated context. This article analyses the reinsurance practices and their adaptation to the singularities of the Spanish market, namely: the difficulties for the consolidation of a core of pure reinsurers; the management of reinsurance in the internationalisation process; and the use of reinsurance by mutual societies to overcome their lack of equity capital.     

Analysing the provision of agricultural public goods: The case of irrigated olive groves in Southern Spain

Analysis of the joint production of private and public goods (PGs) by farming activities is a fertile research field. These joint production processes are typically characterised by a high level of complexity derived from the intense relationship between the production of both kinds of outputs. An integrated approach is strongly recommended for the study of the provision of agricultural PGs and the design of public intervention in this sector. Here, we propose a theoretical framework to apply an integrated approach using the analytic network process (ANP) to analyse the production of PGs by agricultural systems to support public decision-making concerning the design and implementation of agricultural policies. We introduce a novel approach in applying ANP along both directions of the influences among elements, allowing us to identify the most influenced PGs and the farmers’ most influential decisions. This methodological approach is empirically applied to a particular farming system: the irrigated olive groves (IOG) of Southern Spain. Results show that the PGs most influenced by olive growers’ decisions are soil fertility, the visual quality of agricultural landscapes and farmland biodiversity. In addition, the most influential factors affecting the provision of PGs are the structural ones, namely farm size and tree density, and, to a lesser extent, management factors dealing with fertilisation, soil and irrigation management. These results are useful for supporting agricultural policy decision-making to enhance adequate management of this farming system regarding PGs production.     

The Spanish Textile Industry Sans ATC Quota Protection

The Spanish textile and apparel manufacturing sectors have been badly impacted by the global recession as well as the removal of quotas that were in place with the Agreement on Textiles and Clothing (ATC). This study employs a cost function to investigate the presence of scale economies and the interrelationships among inputs of domestic capital, labor, and intermediate goods as well as outsourced (imported) intermediate products for the Spanish textile industry in a global environment that has become increasingly competitive. While there is evidence of scale economies at low output levels, there is also some evidence consistent with diseconomies of scale at the highest output levels. All of the inputs appear to be substitutes for one another except for domestic capital and outsourced intermediate goods. An important finding is that the demands for both labor and domestic intermediate goods have become increasingly sensitive to the prices of outsourced inputs. The estimated coefficients of dummy variables indicate that reduced international trade restrictions have put downward pressure on unit cost for the industry in recent years. These results suggest that the Spanish textile industry and its domestic suppliers will be increasingly challenged by international competitive pressures.     

Role of food neophilia in food market tourists’ motivational construct: The case of La Boqueria in Barcelona,Spain

In this paper we advocate the study of local food markets to explore fundamental issues about the relationship between these urban tourist attractions and visitors’ motivation and satisfaction. Based on a survey in La Boqueria Market in Barcelona, Spain, we test the direct effect of escape from routine, cultural experience, prestige, and food market involvement on satisfaction, and also the moderator role of food neophilia in this relationship. We conclude that tourists visiting food markets are motivated mainly by cultural experience and interaction with local producers, while food neophilia plays a significant moderator role.     

Sustainability accounting regulation in Spanish public sector organizations

In 2011, the Spanish government made sustainability accounting mandatory for public sector organizations. This paper documents why, despite the new legislation, the quantity and quality of sustainability accounting practices remains low.