A review and validation of overall survival extrapolation in health technology assessments of cancer immunotherapy by the National Institute for Health and Care Excellence: how did the initial best estimate compare to trial data subsequently made available?

Background: Validation of overall survival (OS) extrapolations of immune-checkpoint inhibitors (ICIs) during the National Institute for Health and Care Excellence (NICE) Single Technology Assessment (STA) process is limited due to data still maturing at the time of submission. Inaccurate extrapolation may lead to inappropriate decision-making. The availability of more mature trial data facilitates a retrospective analysis of the plausibility and validity of initial extrapolations. This study compares these extrapolations to subsequently available longer-term data.

Methods: A systematic search of completed NICE appraisals of ICIs from March 2000 to December 2017 was performed. A targeted search was also undertaken to procure published OS data from the pivotal clinical trials for each identified STA made available post-submission to NICE. Initial Kaplan-Meier curves and associated extrapolations from NICE documentation were extracted to compare the accuracy of OS projections versus the most mature data.

Results: The review identified 11 STAs, of which 10 provided OS data upon submission to NICE. The extrapolations undertaken considered parametric or piecewise survival models. Additional data cut-offs provided a mean of 18 months of OS beyond the end of the original data. Initial extrapolations typically under-estimated OS from the most mature data cut-off by 0.4–2.7%, depending on the choice of assessment method and use of the manufacturer- or ERG-preferred extrapolation.

Conclusion: Long-term extrapolation of OS is required for NICE STAs based on initial immature OS data. The results of this study demonstrate that the initial OS extrapolations employed by manufacturers and ERGs generally predicted OS reasonably well when compared to more mature data (when available), although on average they appeared to underestimate OS. This review and validation shows that, while the choice of OS extrapolation is uncertain, the methods adopted are generally aligned with later-published follow-up data and appear appropriate for informing HTA decisions.     

Sexual Selection and Economic Positioning

Synopsis In their recent survey of Darwinian aesthetics, Grammer et al. (2003) note the surprising lack of a connection between studies related to human beauty and the theory of sexual selection. Understanding this missing link sheds new light on recent research that indicates positional concerns Pingle & Mitchell 2002, Solnick & Hemenway 1998, are important factors in the decision-making process. Integrating the theory of sexual selection into the decision framework found in economics makes it possible to explain why individuals are potentially willing to accept less, as long as it places them in a superior position relative to others.     

Do Teachers Matter? Measuring the Variation in Teacher Effectiveness in England*

Using a unique primary dataset for the UK, we estimate the effect of individual teachers on student outcomes, and the variability in teacher quality. This links 7,305 pupils to the individual teachers who taught them, in each of their compulsory subjects in the high‐stakes exams at age 16. We use point‐in‐time fixed effects and prior attainment to control for pupil heterogeneity. We find considerable variability in teacher effectiveness, a little higher than the estimates found in the few US studies. We also corroborate recent findings that observed teachers’ characteristics explain very little of the differences in estimated teacher effectiveness.     

An Evaluation of the Value Relevance of Consolidated versus Unconsolidated Accounting Information: Evidence from Quoted Spanish Firms

In this paper we investigate the value-relevance of consolidated versus parent company accounting information. In particular we investigate the value relevance of the minority interest components of net total assets and earnings as currently reported and under the full entity approach to consolidated reporting. An Edwards-Bell-Ohlson valuation framework is used to generate results. By this means we cast light on the suitability of accounting regulation being developed based upon the entity or parent company theories of consolidation. We carry out the analysis in the Spanish context and the sample contains 474 observations of non-financial firms quoted in the Madrid Stock Exchange for the period 1991–97. The results from this analysis not only have domestic relevance but provide guidance of a more international nature relating to the impact of group definition, concepts of control and the most value relevant method of consolidated disclosure. The results show that, from a valuation perspective, consolidated information dominates non-consolidated, or parent company, information. However, neither the currently reported minority interest components of net total assets and earnings, nor their values under the full equity method of consolidation, are found to be value relevant. These results raise the question of whether group definitions based on the equity theory of consolidation are the most useful to investors.     

Ambidexterity and Knowledge Strategy in Major Projects: A Framework and Illustrative Case Study

We develop a framework to analyze the multi‐level knowledge requirements of complex, major projects in terms of ambidexterity—the ability to exploit (refine existing knowledge) and explore (develop new knowledge). This is an important theme within the wider literature, yet practical operationalization methods for managers and researchers are not evident. We demonstrate the ambidexterity view through an illustrative case study of telecommunications delivery for the London 2012 Olympic Games and show how these concepts can be used to create an effective knowledge strategy. We offer a structure for the analysis of knowledge utilization in projects.     

Diffusion of an Accounting Innovation: Fixed Asset Accounting in the NHS in Wales

As part of ‘New Public Management’ in the UK, changes have been made to the accounting regime. These changes typically involve the adoption of private sector accounting and budgeting approaches using accruals accounting. The process by which new ideas are spread is known as diffusion; this paper deals with the aspect of diffusion relating to the imposition of a new idea, accruals accounting, and how it is absorbed by the organisation, in this case the NHS in Wales. In particular, the paper questions whether the lack of secondary diffusion is limiting the influence of the new accounting approach. To analyse the level of diffusion we have focused on one aspect, namely, information on capital assets. The paper uses a mixture of qualitative and quantitative research methods including in-depth interviews with senior managers at two NHS Trusts and a questionnaire survey with responses from senior finance staff in all NHS Trusts in Wales. We conclude that the diffusion of accruals accounting for fixed assets has been restricted to the primary level at the top layer of management and has not penetrated below that level. There is evidence of continuing managerial indifference to the accruals accounting consequences of owning fixed assets.     

Is Decoupling Possible? Association between Affluence and Household Carbon Emissions in the Philippines

This paper investigates whether or not affluence is associated with carbon emissions at the household level in the Philippines. While there is abundant literature on this issue, limited studies are available for developing countries. We estimate household carbon emissions by combining input–output analysis with household expenditure. The results suggest that household carbon emissions are increasing non‐monotonically with a non‐existent turning point as households accumulate more assets. This is further supported by quintile estimates showing huge disparity in emissions between poor and rich households. Although household carbon emissions in the Philippines are not alarming, evidence suggests that it is likely households will lead a carbon‐intensive lifestyle as they become more affluent.     

The effect of experience with a brand imitator on the original brand

Imitating the look of an existing successful brand is a common occurrence in today's crowded marketplace. It was found that a negative experience with an imitator brand increased the evaluations of the original brand. A positive experience with the imitator was shown to have the opposite effect, and there was a decrease in the evaluations of the original brand. Subjects also indicated they would be likely to purchase the positive imitator over the original at only a 10 percent price reduction.