Cost-effectiveness of hydrophilic-coated intermittent catheters compared with uncoated catheters in Canada: a public payer perspective

Study design: A Markov model was used to analyze cost-effectiveness over a lifetime horizon.

Objective: To investigate the cost-effectiveness of hydrophilic-coated intermittent catheters (HCICs) compared with uncoated catheters (UCs) among individuals with neurogenic bladder dysfunction (NB) due to spinal cord injury (SCI).

Setting: A Canadian public payer perspective based on data from Ontario; including a scenario analysis from the societal perspective.

Methods: A previously published Markov decision model was modified to compare the lifetime costs and quality-adjusted life years (QALYs) for the two interventions. Three renal function and three urinary tract infection (UTI) health states as well as other catheter-related events were included. Scenario analyses, including utility gain from compact catheter and phthalate free catheter use, were performed. Deterministic and probabilistic sensitivity analyses were conducted to evaluate the robustness of the model.

Results: The model predicted that a 50-year-old patient with SCI would gain an additional 0.72 QALYs if HCICs were used instead of UCs at an incremental cost of $48,016, leading to an incremental cost-effectiveness ratio (ICER) of $66,634/QALY. Moreover, using HCICs could reduce the lifetime number of UTI events by 11%. From the societal perspective, HCICs cost less than UCs, while providing superior outcomes in terms of QALYs, life years gained (LYG), and UTIs. The cost per QALY further decreased when health-related quality-of-life (HRQoL) gains associated with compact HCICs or catheters not containing phthalates were included.

Conclusion: In general, ICERs in the range of CAD$50–100,000 could be considered cost-effective. The ICERs for the base case and sensitivity analyses suggest that HCICs could be cost-effective. From the societal perspective, HCICs were associated with potential cost savings in our model. The results suggest that reimbursement of HCICs should be considered in these settings.     

The impact of different scenarios for intermittent bladder catheterization on health state utilities: results from an internet-based time trade-off survey

Aims: Intermittent catheterization (IC) is the gold standard for bladder management in patients with chronic urinary retention. Despite its medical benefits, IC users experience a negative impact on their quality of life (QoL). For health economics based decision making, this impact is normally measured using generic QoL measures (such as EQ-5D) that estimate a single utility score which can be used to calculate quality-adjusted life years (QALYs). But these generic measures may not be sensitive to all relevant aspects of QoL affected by intermittent catheters. This study used alternative methods to estimate the health state utilities associated with different scenarios: using a multiple-use catheter, one-time-use catheter, pre-lubricated one-time-use catheter and pre-lubricated one-time-use catheter with one less urinary tract infection (UTI) per year.

Methods: Health state utilities were elicited through an internet-based time trade-off (TTO) survey in adult volunteers representing the general population in Canada and the UK. Health states were developed to represent the catheters based on the following four attributes: steps and time needed for IC process, pain and the frequency of UTIs.

Results: The survey was completed by 956 respondents. One-time-use catheters, pre-lubricated one-time-use catheters and ready-to-use catheters were preferred to multiple-use catheters. The utility gains were associated with the following features: one time use (Canada: +0.013, UK: +0.021), ready to use (all: +0.017) and one less UTI/year (all: +0.011).

Limitations: Internet-based survey responders may have valued health states differently from the rest of the population: this might be a source of bias.

Conclusion: Steps and time needed for the IC process, pain related to IC and the frequency of UTIs have a significant impact on IC related utilities. These values could be incorporated into a cost utility analysis.     

Return predictability in emerging equity market sectors

This article investigates the predictive power of technical trading rules in the emerging equity market sector portfolios and finds that trading strategies based on technical indicators significantly outperform the buy-and-hold benchmark. Combination of data snooping bias, data measurement errors in the form of non-synchronicity bias and fluctuations in currency exchange rates is unable to explain the observed outperformance. The introduction of transaction costs tempers the results but technical analysis still possesses significant predictive power for a number of sectors. The performance of technical analysis in the emerging equity market sectors does not conform to historical trends observed in the developed equity markets as well as in the emerging equity markets when broadly diversified portfolios are considered, where predictive power of technical trading rules has been shown to decline over time.     

Using Real Activities to Avoid Goodwill Impairment Losses: Evidence and Effect on Future Performance

We examine whether managers postpone the recognition of goodwill impairment by manipulating cash flows and the consequences of such a strategy on future performance. According to SFAS 142, an impairment loss must be recognized if the reporting unit's total fair value to which goodwill has been allocated is less than its book value. A growing body of empirical evidence shows that managers delay the recognition of goodwill impairment in accounting books. However, past literature is silent on how managers convince various gatekeepers (e.g., auditors, financial analysts) that recognizing an impairment loss is unnecessary although it seems economically justified. SFAS 142 requires managers to forecast future cash flows to justify the decision to recognize, or not, an impairment loss. Therefore, we predict that managers manipulate upward current cash flows to support their choice to avoid reporting an impairment loss. We also test whether or not this real earnings management is detrimental to future performance. Based on a sample of US firms over the period 2003–2011, we document that firms suspected of postponing goodwill impairment losses exhibit significantly positive discretionary cash flows compared to various control groups. We also find that this real activities manipulation is detrimental to future performance.     

Asymmetric Information and the Russian Individual Savings Market

The article considers the influence of informational imperfections on the performance of the Russian financial market. The focus is on the individual savings market, which exhibits inefficiencies, including those associated with the market power of a dominant agent—Sberbank. Reinforcement of Sberbank's dominance on the market in the period 1994‐98 (before the August default combined with financial crisis) is explained as a consequence of asymmetric information about the probability of bankruptcy of a new bank. Under asymmetric information a new private bank has to provide specific quality signals in order to attract depositors. Two major lines of inquiry are the criteria for choosing forms of savings, including that of a bank in which to deposit money, by Russian citizens, and banks' advertising strategies to confirm the factual risk of default. Within the conceptual framework of a game with separating equilibrium, we analyse the behaviour of the agents on both supply and demand sides in the market. We find that there is evidence of using advertising as a tool of quality signalling at a certain phase of the Russian individual savings market's development.     

Historical simulation approach to the estimation of stochastic discount factor models

We propose an approach to the estimation of the parameters of stochastic discount factor (SDF) models which is based on the idea that the next period joint distribution of the variables in a SDF and asset returns can be well approximated by their joint historical distribution. The estimates of the SDF parameters may therefore be found as the values of the parameters at which the mean of the historical distribution of the product of the SDF with an asset return equals one. Each time period, the estimates are updated using the most recent periods of data and hence can change over time. This method can be viewed as an alternative to the approaches that specify a particular functional form relating the SDF parameters to proxies for the state of the world.     

Pluralism or isolation of Civilisations? Russia's foreign policy discourse and the reception of Huntington's paradigm of the post‐cold war world

This paper studies the effects of Samuel Huntington's ‘Clash of Civilisations’ thesis on Russian foreign policy discourse. In response to Huntington's thesis, two major currents of Russia's foreign policy thinking ‐ Liberals and Nationalists ‐ are identified, both of which are critical of the thesis. The two groups offer diametrically opposed alternatives to Huntington's paradigm of the post‐Cold War world. The Liberal‐Nationalist controversy reflects Russia's debates about its own political identity and provides us with a rich and informative understanding of the process of identity formation. By identifying Russia's various reactions to the ‘Clash of Civilisations’ thesis, the paper identifies potential influences of various currents in Russian foreign policy thinking on the country's future foreign policy. It also suggests some implications for further studies of cultures/civilisations in international politics.     

Analysis of a threshold dividend strategy for a MAP risk model

We consider a class of Markovian risk models in which the insurer collects premiums at rate c₁(c₂) whenever the surplus level is below (above) a constant threshold level b. We derive the Laplace-Stieltjes transform (LST) of the distribution of the time to ruin as well as the LST (with respect to time) of the joint distribution of the time to ruin, the surplus prior to ruin, and the deficit at ruin. By interpreting that the insurer pays dividends continuously at rate c₁?c₂ whenever the surplus level is above b, we also derive the expected discounted value of total dividend payments made prior to ruin. Our results are obtained by making use of an existing connection which links an insurer's surplus process to an embedded fluid flow process.     

Computer-assisted analysis of public discourse: a case study of the precautionary principle in the US and UK press

Content analysis of newspaper publications has become a major scientific method of the analysis of public discourse. Within the framework of content analysis, we suggest a computer-assisted method to extract the most important topics of this discourse in an objective, quantifiable manner. The method combines frequency and proximity analysis of the text population, selection of the key words, text modification based on a key word dictionary, factor analysis of the modified text population, and factor interpretation. We illustrate the concept by applying the method to study the major topics discussed in the US and UK prestige press that relate to the precautionary principle. Precautionary principle is a concept of preventing environmental damage under scientific uncertainty. The analysis demonstrates the difference between the major topics of the precautionary principle discussion in the US and UK press. In the US, it revolves around an emphasis on the action on global warming, international trade on genetically modified food, environment pollution, the risks of new technologies, and cost-benefit analysis (CBA). In the UK, the major discussion topics include threats to agriculture and farmers, climate change economics, national and EU regulations, and commercial fishing. Other discussion topics, such as health and pollution, water safety regulations, meat safety and trade, and GMO regulations are shared between the countries. The US sample demonstrates more negative views towards the precautionary principle, which is presented as a threat to the US economic interests.