Is transcatheter aortic valve implantation (TAVI) a cost-effective treatment in patients who are ineligible for surgical aortic valve replacement? A systematic review of economic evaluations

Objectives:

Health Technology Assessment (HTA) agencies often undertake a review of economic evaluations of an intervention during an appraisal in order to identify published estimates of cost-effectiveness, to elicit comparisons with the results of their own model, and to support local reimbursement decision-making. The aim of this research is to determine whether Transcatheter Aortic Valve Implantation (TAVI) compared to medical management (MM) is cost-effective in patients ineligible for surgical aortic valve replacement (SAVR), across different jurisdictions and country-specific evaluations.

Methods:

A systematic review of the literature from 2007–2012 was performed in the MEDLINE, MEDLINE in-process, EMBASE, and UK NHS EED databases according to standard methods, supplemented by a search of published HTA models. All identified publications were reviewed independently by two health economists. The British Medical Journal (BMJ) 35-point checklist for economic evaluations was used to assess study reporting. To compare results, incremental cost effectiveness ratios (ICERs) were converted to 2012 dollars using purchasing power parity (PPP) techniques.

Results:

Six studies were identified representing five reimbursement jurisdictions (England/Wales, Scotland, the US, Canada, and Belgium) and different modeling techniques. The identified economic evaluations represent different willingness-to-pay thresholds, discount rates, medical costs, and healthcare systems. In addition, the model structures, time horizons, and cycle lengths varied. When adjusting for differences in currencies, the ICERs ranged from $27K–$65K per QALY gained.

Conclusions:

Despite notable differences in modeling approach, under the thresholds defined by using either the local threshold value or that recommended by the World Health Organization (WHO) threshold value, each study showed that TAVI was likely to be a cost-effective intervention for patients ineligible for SAVR.     

Some principles for a system of socio-demographic statistics

The changing volume and composition of demand for social statistics indicates a need to so arrange statistical products that important interrelations among major population characteristics and institutional operations can be more effectively reflected. The System of Social and Demographic Statistics (or SSDS) concentrates upon the major characteristics and activities of Canadians as they pass through the life cycle, and upon the operations, costs and benefits of the social institutions that partly regulate such passage. Essentially SSDS is a collection of related data files, concepts, classification schemes, accounts or other measures dealing with socio-economic and demographic processes for Canada and its important sub-populations. A data file, and its associated concepts, statistical accounts or other measures, and its storage-retrieval system, form a module of SSDS. The organization of data will facilitate the estimation of appropriate coefficients reflecting relations among relevant statistical series both within and between modules. The subject-matter scope of SSDS is seen as forming three spheres of observation. The first contains data on individuals, families and households. The second refers to observations concerning the operations, costs and benefits of major social institutions that partly regulate the manner of life-cycle passage by individuals and families. The third sphere deals with inventories of the nature and conditions of important facilities created for social benefit by the above-mentioned institutions. Considerable emphasis is placed on mapping patterns of change in important demographic and socio-economic characteristics; particularly in the fields of migration, fertility, marital status, education, labour force status, occupation, industry and health.     

The Nature of Unemployment among Young Men in Urban Ethiopia

This paper investigates the nature of unemployment among young men in urban Ethiopia and finds that it is concentrated among relatively well‐educated first‐time job seekers who aspire to a public sector job and spend on average close to four years in unemployment. This is consistent with a segmented labor market model where youngsters queue in unemployment for a good job, as confirmed by an empirical test of the theoretical prediction. We observe a negative (causal) relationship between household welfare and both the incidence and duration of unemployment, indicating that unemployment is concentrated among the relatively worse off urban households, which from a national perspective represent the middle classes, and find suggestive evidence that part of this effect is due to malnutrition during childhood. Job search through social networks is only effective after one has become unemployed, suggesting that networks provide insurance only after exposure to the risk.     

MODES OF GOVERNANCE IN THE DUTCH SOCIAL HOUSING SECTOR

ABSTRACT ** :  We describe and analyze five consecutive modes of governance in the Dutch social housing sector. We compare these institutional forms with the five policy values that the sector was assumed to realize. For that purpose we propose and use a new, analytical framework based on a separation principle that is applied to the coercion domain (the governance of transactions) as well as to the interaction domain (the welfare values). The consecutive modes of governance were introduced to cope with the changing welfare policies, but with varying results. In this paper we show that the implemented modes of governance in the Dutch social housing sector did not always realize the values that the sector was supposed to deliver. The framework we propose also facilitates the discussion about the concept of a social enterprise and the embedding of a service of general interest in the European Union.     

The Labour Market Participation of Humanitarian Migrants in Sweden: An Overview

The aim of this article was twofold: first, to provide an overview of immigration and integration policies in Sweden, and second, to analyse the labour market integration of humanitarian migrants who arrived in Sweden between 1998 and 2012 relative to other migrants and natives.     

The Worth of Values – A Literature Review on the Relation Between Corporate Social and Financial Performance

One of the older questions in the debate about Corporate Social Responsibility (CSR) is whether it is worthwhile for organizations to pay attention to societal demands. This debate was emotionally, normatively, and ideologically loaded. Up to the present, this question has been an important trigger for empirical research in CSR. However, the answer to the question has apparently not been found yet, at least that is what many researchers state. This apparent ambivalence in CSR consequences invites a literature study that can clarify the debate and allow for the drawing of conclusions. The results of the literature study performed here reveal that there is indeed clear empirical evidence for a positive correlation between corporate social and financial performance. Voices that state the opposite refer to out-dated material. Since the beginnings of the CSR debate, societies have changed. We can therefore clearly state that, for the present Western society, “Good Ethics is Good Business.”