The economic value of INTUITY in aortic valve replacement

Objective: The recent development of the EDWARDS INTUITY Elite? (EIE) valve system enables the rapid deployment of a prosthetic surgical heart valve in an aortic valve replacement (AVR) procedure via both the minimally invasive (MISAVR) and conventional (CAVR) approaches. In order to understand its economic value, this study performed a cost evaluation of the EIE valve system used in a MIS rapid-deployment approach (MIS-RDAVR) vs MISAVR and CAVR, respectively, compared to standard prosthetic aortic valves.

Methods: A simulation model was developed using TreeAge (and validated with MS Excel) to compare the inpatient utilization and complication costs for each treatment arm. Thirty-day clinical end-points for the MIS-RDAVR (mortality and complications) were taken from the TRANSFORM trial; and a best evidence review of the published literature was used for the MISAVR and CAVR approaches. Studies were pooled and parameter estimates were weighted by sample size in order to compare the TRANSFORM patients. Cost data (2016 USD) were taken from the Premier database. Incremental cost and cost-effectiveness was assessed and one-way/probabilistic sensitivity analyses performed to gauge the robustness of the results.

Results: MIS-RDAVR costs $2,621 less than CAVR and had lower mortality rates, making it a superior (dominant) technology relative to CAVR. MIS-RDAVR costs $4,560 more than MISAVR, but was associated with an additional 0.20 life years-per-patient. This implies a cost-effectiveness ratio of $22,903 per-life-year-gained. Thus, MIS-RDAVR is cost-effective compared to MISAVR.

Conclusions: The EIE valve system deployed in a MIS approach appears to be a cost-effective technology compared to MISAVR and CAVR. When compared to CAVR it may achieve cost savings as well. These results suggest that MIS-RDAVR confers superior economic value compared to both standard MISAVR and CAVR via lowered key complication rates (re-operation, renal complications, wound infection, TIA, endocarditis) and utilization (cross-clamp time, hospital ward days).     

New Narratives from the EU External Border – Humane Refoulement?

This article discusses changes in the discourse and practice of the EU external border. Findings of a small-scale research project looking at UNHCR’S Border Management and Protection of Refugees (BMPR) programme will discuss developments taking place at the EU external border and will show a new kind of narrative. Institutional cooperation, access to territory and compliance with the principle of non-refoulement seem to have improved. A more empathetic narrative of border security has found its way into institutions of enforcement authorities that primarily follow their mandate of protecting the state’s border and territory. This new narrative is, however, highly politicised and institutionally driven. By taking a more critical view, I introduce the concept of humane refoulement towards the end of the article describing the consequences of this new narrative and denoting it as hypocritical in its nature.     

Selection on performance and tracking

Tracking is widely used in secondary schools around the world. Some countries put more emphasis on the use of performance to place students into tracks (e.g. the Netherlands), while in other countries parents have more influence on the track their child will go to (e.g. Germany). This article examines whether selection into tracks based on performance has an effect on the relation between tracking and student performance and educational opportunities. Using data from the Programme for International Student Assessment for around 185 000 students in 31 countries, different estimation models are compared. The results indicate that a highly differentiated system is best for performance when schools always consider prior performance when deciding on student acceptance. In systems with a few tracks, there is no such impact. Equality of opportunity is best provided for in a system with many tracks when schools always consider prior performance.     

Forecasting development outcomes under alternative surplus labour assumptions

Economic forecasts are useful to policymakers both as aids to planning, and as baselines against which counterfactual scenarios can be compared. However, policy makers should be aware that assumptions relating to model structure can influence forecast results. We explore the sensitivity of forecasts to one aspect of model structure important in modelling developing economies: surplus agricultural labour. We outline a framework for modelling surplus agricultural labour that relies on average product remuneration. We embed this within a model of a developing economy (the Philippines) characterized by surplus agricultural labour. We compare the results of two forecasts that differ in their treatment of the agricultural labour market. In the first, the surplus labour theory is activated, establishing average product remuneration in agriculture. In the second, the surplus labour theory is not activated, creating a failure to recognize average product remuneration in agriculture. By comparing the two simulations, we show that failure to model the presence of average product remuneration, when it would be appropriate to do so, has an impact that would be material to economic planners, leading them to: under-estimate agricultural employment; over-estimate GDP growth; and, over-estimate important policy variables (like tax revenue) that are related to GDP growth.     

Cointegration as an explanation for the Meese–Rogoff puzzle

Some economists suggest that the failure of exchange-rate models to outperform the random walk in exchange rate forecasting out of sample can be attributed to failure to take into account cointegration when it is present. We attempt to find out if cointegration matters for forecasting accuracy by examining the relation between the stationarity and size of the forecasting error. Results based on three macroeconomic models of exchange rates do not provide strong support for the proposition that cointegration matters for forecasting accuracy. The simulation results show that while stationary errors tend to be smaller than non-stationary errors, this is not a universal rule. Irrespective of the presence or absence of cointegration, none of the three models can outperform the random walk in out-of-sample forecasting, which means that cointegration cannot solve the Meese–Rogoff puzzle.     

Strategic framework for commercialisation of fly ash innovations

Numerous innovative applications have been developed to utilise large quantity of fly ash generated at coal fired thermal power plants (TPPs) worldwide. However, this requires power plants to undertake the role of third-party innovation intermediaries, that is, commercialising technological innovations developed by others. As commercialising an innovation requires considerable resources, a well-considered selection and promotion are desired. The paper presents a strategic framework for commercialisation of fly ash innovations. Explanation for step-by-step implementation and generic pointers for strategy formulation for typical problems are suggested. The proposed framework is expected to assist coal-fired TPPs in formulating strategies to commercialise innovative utilisation of fly ash. The study contributes to scarcely addressed aspects of an open innovation paradigm, that is, challenges faced by third-party intermediaries.     

Creatine and entrepreneurship

Creatine is a nitrogenous organic acid which supplies energy to body cells and enhances physical performance. Using the Young Finns Study combined with the Finnish Linked employer-employee data we show that quantities of creatine measured in 1980 prior to labour market entry affect entrepreneurial success as measured by capital income accumulation over the period 1993–2010 (in particular for females). However, we do not find evidence that creatine affects the propensity to become an entrepreneur. Our study contributes to the emerging literature on biomarkers and entrepreneurship.