The cost-effectiveness of 5-FU-SA in the treatment of actinic keratoses of the face and scalp in the UK secondary care setting

Objective: The objective of this analysis was to estimate the relative cost-effectiveness of Actikerall¹ (5-FU-SA) vs cryotherapy in a secondary care setting in the UK, for lesion-directed treatment in patients with actinic keratoses (AK) of the face and scalp.

Methods: The model was a simple decision tree, with a 6-month time horizon. The perspective was that of the UK National Health Service (NHS). Modeled treatment effects included reported per-patient histological clearance and recurrence rates. Cost inputs comprised professional consultation time and cost of medication. Health-related utility estimation followed previously published methodology. Adverse events were not modeled. The key data and model structural assumptions followed expected UK practice. One-way and probabilistic sensitivity analyses were conducted to assess structural and parameter uncertainty.

Results: 5-FU-SA was found to be less costly (?£204) and more effective (+0.001 QALY) in base case and sensitivity analyses. In the probabilistic analysis there was 100% probability of being cost-effective over cryotherapy at £20,000 willingness to pay. Cost of professional time was a key driver of the model outcome. 5-FU-SA remained dominant across a range of scenario analyses, including exploration of assumptions around setting of care.

Limitations: The time horizon of the analysis was short and data were not extrapolated beyond the duration of the clinical trial; however, this approach is consistent with likely follow-up of an AK patient. The clinical outcomes observed in the trial were based on a large proportion of cryotherapy patients undergoing an additional cycle of treatment; this may not occur or be required in an experienced secondary care setting.

Conclusion: 5-FU-SA could be considered as a cost-effective choice for treatment of AK lesions of the face and scalp in secondary and mixed care settings in the UK. Use of 5-FU-SA in patients who would otherwise be managed with cryotherapy has the potential to result in cost savings.     

A Micro‐Econometric Analysis of the Antipoverty Effect of Social Cash Transfers in Italy

We analyze the anti‐poverty effect of social cash transfers using a micro‐econometric approach. Aggregate analyses, based on comparing average poverty indicators before and after public transfers, fail to address who receives the transfers and how the transfers are distributed among the poor. We consider three dichotomous outcome variables: (i) poverty status before the receipt of transfers; (ii) the receipt of transfers; and (iii) poverty status after the receipt of transfers. We use a trivariate probit model with sample selection, connecting the outcome variables to the characteristics of the household and its head. Our empirical results highlight that the Italian social transfers system overprotects certain household typologies at the expense of others, as social transfers are primarily awarded to employees with permanent positions and the elderly, while the system is not generous enough to large households with dependant children, the self‐employed, temporary contract workers, and the unemployed.     

Microfinance and income inequality: New macrolevel evidence

This paper addresses the empirical question of whether microfinance has any impact on income inequality at the macrolevel. Very little research has been conducted on the relationship between the macrolevel scale of microfinance and income inequality over time in a country and across countries. Based on panel‐data techniques, with annual data from 85 countries from 2001 to 2012 and a broad theoretical framework on microfinance and inequality, we provide empirical evidence that suggests that increases in the macrolevel scale of microcredit in a country contribute to reducing income inequality within that country over time. Finally, since microfinance may be endogenous, we used instruments from the existing literature to control for this problem.     

Addiction and interaction between alcohol and tobacco consumption

This paper adopts a multi-commodity habit formation model to study whether unhealthy behaviors are related, i.e. whether there are contemporaneous and inter-temporal complementarities between alcohol and tobacco consumptions in Italy. To this aim time series data of per-capita expenditures and prices during the period 1960 to 2002 are used. Own price elasticities are negative and tobacco appears to be more responsive than alcohol demand, although both responses are less than unity. Cross price elasticities are also negative and asymmetric thus suggesting complementarity. A “double dividend” could then be exploited, because public policy needs to tackle the consumption of only one good to control the demand of both. These results show that the optimal strategy for maximizing public revenues would be to raise alcohol taxation more than tobacco taxation. Finally, past consumption of one addictive good does not significantly reinforce current consumption of the other. We thank participants to the Annual Conference of the European Society for Population Economics, Verona June 2006; the 61st European Meeting of the Econometric Society, Vienna August 2006, and participants of the conference “Individual and Collective Choices in Health Protection”, Genoa November 2005 for helpful comments. We would also like to thank, without implicating, Pier Luigi Rizzi and two anonymous referees for helpful comments. Financial support from the University of Siena, PAR grant (Atheneum Research Grant), is gratefully acknowledged.     

About “strategy” and “strategies” in supply management

This article addresses the context and content of a generic supply strategy and discusses its strategy-making process. Building mostly on fundamental strategic management theories, the authors explain the role of supply strategy in its managerial context. In so doing, some light is shed on the meaning and use of the terms “strategy” and “strategies”. Also, a practical conceptual framework for supply strategy formulation is provided. The generic checklist, built by segmenting supply management decisions, is intended to guide supply professionals in addressing strategic issues to create value to customers, avoiding confusion and optimising resource allocation.     

Determinants of obesity in Brazil: the effects of trade liberalization and socio-economic variables

This article aims to evaluate a possible relation between increased Brazilian trade openness and increasing observed rates of overweight and obesity during the last 25 years. We develop an economic model where formal trade barriers are eliminated, and resulting sociocultural outcomes such as the adoption of westernized lifestyle in traditional non-western countries prevails, which could imply a health externality. In order to empirically analyse the influence of trade flows on overweight and obesity in Brazil, a balanced fixed-effects panel model has been estimated. Data for the 26 Brazilian states plus the Federal District are run for 1988/1989, 2002 and 2008. We found that an increase in trade openness leads to an increase in overweight and obesity ratios in Brazil. Hence results seem to point that there is a health externality in Brazil due to trade liberalization. However, more consistent evidence may be necessary to convince politicians and policymakers that any interference will be necessary to correct this externality.     

Stakeholder engagement is evolving: Do investors play a main role?

Stakeholder engagement, an essential component of the sustainability reporting strategy, is changing, as is the position of the different stakeholders in this evolving scenario. In this paper, we explore the effect of the pressure that a specific group of stakeholders, investors, exerts on the quality of the sustainability information disclosed. We intend to analyze if there has been a change in the role that investors play in sustainability reporting. By focusing on investors, we are paying attention to one of the less studied groups within the sustainability stakeholders. To this aim, we carry out a content analysis of the sustainability information disclosed by U.S. (shareholder-oriented country) and Spanish (stakeholder-oriented country) listed companies during the years 2013 to 2016. Our findings confirm the key role that investors play in the companies' sustainability strategies, demanding more and better sustainability information. We also find a reduction in the quality of sustainability disclosures in Spanish companies in the last year of our sample, showing a relevant change in this country that has been leading the sustainability rankings until now. The results of this paper are useful to investors and companies, as they reflect the changes on the information they demand, and for regulators, in order to create the adequate legal framework that will improve the quality of reporting. Regulators and financial agents should acknowledge this new scenario to adapt norms and actions accordingly.     

The effects of company offshoring strategies on consumer responses

This paper develops a unique theoretical framework for explaining consumer reactions to corporate offshoring by testing the impact of the decision to offshore or to maintain domestic activities on two dependent variables: consumer attitudes toward the company and word-of-mouth communication. We conduct two controlled experiments administered in the field with adult consumers. Study 1 analyzes the processes underlying consumer reactions to corporate offshoring from the perspective of the perceived moral harm and good that offshoring produces. Results verify the mediating role of positive and negative moral emotions (i.e., gratitude and righteous anger) felt by consumers. Study 2 demonstrates the moderating role of consumer perceived risk of offshoring on the linkage between company offshoring and the same moral emotions and through these moral emotions on consumer attitudes toward the company and word-of-mouth communication. An unexpected finding is the mediation of the positive moral emotion of elevation on consumer attitudes.