Cost-effectiveness of sorafenib versus best supportive care in advanced hepatocellular carcinoma in Egypt

Background: In light of constrained budgets and the need to fund efficient treatment options, this study set out to assess the cost-effectiveness of sorafenib as a first-line treatment of hepatocellular carcinoma (HCC) compared to best supportive care (BSC) from the military hospital perspective in Egypt.

Methods: A decision analytic Markov model simulated disease progression with clinical parameters and utility values derived from published data. Data on direct medical costs were collected from the local healthcare system or payer. Costs and effects were discounted at 3.5% annually and reported in USD using purchasing power parity adjustments. Deterministic and probabilistic sensitivity analyses were conducted.

Results: Mortality occurred less frequently in the sorafenib group (sorafenib group: 99.96%, BSC group: 99.99%). The total quality-adjusted life years (QALYs) of the sorafenib cohort were estimated to be 46.24 compared with 42.27 for the BSC cohort, which resulted in an incremental gain of 3.96 QALYs. The total costs for the sorafenib and BSC cohorts were USD 4,229,940 and USD 3,092,886, respectively (incremental cost = $1,137,054), resulting in an incremental cost-effectiveness ratio (ICER) of USD 286,776 per QALY gained for the sorafenib cohort. One-way sensitivity analyses that addressed the uncertainty of the BSC estimates indicated that the progression-free survival for BSC and utility value of progression had the greatest effects on the results.

Conclusion: This study concluded that sorafenib does offer increased survival and quality-of-life at an increased cost but at an ICER that exceeds the nationally accepted cost-effectiveness threshold. The findings support healthcare decision-making of the efficient allocation of healthcare system resources to improve the health of the Egyptian population. Whether sorafenib is cost-effective in specific sub-groups with additional risk factors needs to be addressed in future studies.     

Recasting Urban Governance through Leeds City Lab: Developing Alternatives to Neoliberal Urban Austerity in Co‐production Laboratories

This article reports on a research project, Leeds City Lab, that brought together partner organizations to explore the meanings and practices of co‐production in the context of urban change. Our intention is to offer a response to the crisis in urban governance by combining the growing academic and practitioner debates on co‐production and urban laboratories in order to explore radically different institutional personae that can respond to deficits in contemporary urban governance, especially relating to participation and disenfranchisement, and ultimately unlock improved ways of designing, managing and living in cities. Our analysis has identified four key ways in which co‐production labs can recast urban governance to more progressive ends: by moving beyond traditional organizational identities and working practices, embracing grey spaces of new civic interfaces, foregrounding emotions and power and committing to durable solutions. Ultimately, what we point towards is that urban governance can be more effectively enacted in co‐production labs that bring together universities and the public, private and civil society sectors on a basis of equality, trust and openness. These spaces have the potential to unlock a city's knowledge, resources and assets, to unpack complex challenges and to build capacity to deliver improved city‐wide solutions.     

Conquering or mapping? Textbooks and the dissemination of human capital theory in applied economics

Textbooks are an important subject for the study of science in general and economics in particular. In this paper, we analyse at the process of the acceptance of human capital theory through its inclusion in economics textbooks by looking at two specialized fields to which this theory became highly influential: labour economics and the economics of education. The analysis will compare the patterns of the dissemination of these new theoretical developments in a more consolidated field and in an emergent field of economics research with a particular focus in the early stages of that dissemination process.     

Estimation of Dynamic Nonlinear Random Effects Models with Unbalanced Panels

This paper presents estimation methods for dynamic nonlinear models with correlated random effects (CRE) when having unbalanced panels. Unbalancedness is often encountered in applied work and ignoring it in dynamic nonlinear models produces inconsistent estimates even if the unbalancedness process is completely at random. We show that selecting a balanced panel from the sample can produce efficiency losses or even inconsistent estimates of the average marginal effects. We allow the process that determines the unbalancedness structure of the data to be correlated with the permanent unobserved heterogeneity. We discuss how to address the estimation by maximizing the likelihood function for the whole sample and also propose a Minimum Distance approach, which is computationally simpler and asymptotically equivalent to the Maximum Likelihood estimation. Our Monte Carlo experiments and empirical illustration show that the issue is relevant. Our proposed solutions perform better both in terms of bias and RMSE than the approaches that ignore the unbalancedness or that balance the sample.     

Celso Furtado and the Myth of Economic Development: Rethinking Development from Exile

ABSTRACT

This article introduces two previously unpublished working papers by the Brazilian economist Celso Furtado (1920–2004). Following a brief outline of his life and ideas, the arguments in the two papers are examined, taking into account their context and place in Furtado’s evolving body of work. These two papers represent a crucial turning point in Furtado’s thinking, highlighting his critical perspective on (under)development and laying the basis for four books that he would publish in rapid sequence. We stress Furtado’s growing scepticism with the prospects for international development and global convergence, and his attempt to reimagine the meaning of development and the potential paths to development by peripheral countries. Furtado’s approach to global capitalism in these two papers shed an even more critical light on its structure and evolution than his better-known works from the 1950s. Finally, the contemporary relevance of his ideas is illustrated by reference to their relationship with the current heterodox literature.     

Correction to: A multi-country,multi-sector replication challenge to the validity of the cultural tightness-looseness measure

Asia Pacific Journal of Management - The original version of this article unfortunately contained mistakes. Appendix heading was misplaced and first entry of the Appendix table was incorrectly...     

Capital requirements,risk-taking and welfare in a growing economy

Journal of Regulatory Economics - The effects of capital requirements on risk-taking and welfare are studied in an overlapping generations model of endogenous growth with banking, limited...     

Renegotiation in Public–Private Partnerships: An Incentive Mechanism Approach

Game theory is an important analytical tool for measuring problems caused by behaviors that deviate from contractual ethics. However, the PPP literature still does little to explore this research topic. This paper analyzes and improves the equilibrium conditions of a renegotiation model of PPPs by introducing the asymmetry of information in the contract. To achieve this goal, the Mechanism Design Theory is used to demonstrate how the correct tracking of the investor directly influences the payoffs of the renegotiation. The study concludes that the lack of incentive constraints in the bidding document, as an ex ante condition, does not provide sufficient information on investor management capability. In this way, this information is only revealed in the renegotiation phase. Consequently, this contract failure results in high political costs to the government due to excessive subsidies.     

Equilibrium price dynamics in an overlapping-generations exchange economy

An extension to the Yaari (1965)–Blanchard (1985) continuous time overlapping generations model for an endowment Arrow–Debreu economy with an age-structured population is presented. It is proved that Arrow–Debreu equilibrium prices are represented by a double linear integral equation, and depend on the age-distributions of population and endowments. For an economy with a balanced growth, and logarithmic utility, we prove that bubbles may exist if endowments are distributed earlier than some critical age.     

A tourism research agenda for Portugal

The need to direct research towards the tourism industry is related to the increasingly competitive environment it finds itself in, especially in terms of services rendered, having grown more complex in the features and critique that comprise the tourist experience, and as economic and social agents become more selective regarding both demand and supply. Possessing information and the proper understanding of the real needs of information users and those responsible for public and private decision‐making processes at the action and intervention levels becomes a fundamental issue for sustainable tourism growth and its statement for international competitiveness. This paper proposes a tourism research agenda for Portugal in order to guide future developments towards the industry's needs. Copyright © 2009 John Wiley & Sons, Ltd.