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.     

Experience Rating and the Inflow into Disability Insurance

This paper examines the effects of experience rating on the inflow into disability insurance (DI) in the Netherlands, using unique longitudinal administrative data from the social benefit administration. We follow a difference-in-differences approach to identify the impact of changes in DI premiums. Due to unawareness of the experience rating system, employers seem to have been triggered to increase preventative activities, once they have experienced increases in DI premium rates. We find this impact to be substantial, amounting to a 15% reduction of the DI inflow.     

The effect of home-ownership on labor mobility in the Netherlands

In various macro-studies, home-ownership is found to hamper job mobility and to increase unemployment. This paper addresses similar issues, but uses a micro-econometric framework where both individual job mobility, as well as the probability of being homeowner are modeled simultaneously. Using a panel of individual labor and housing market histories for the period 1989–1998, we estimate a nonparametric model of both job durations and home-ownership. We do not find homeowners to change less from jobs than tenants. Instead, our results suggest that the housing decision is driven by job commitment, and not the reverse. We do however find homeowners to be less vulnerable to unemployment.     

The Virtual IELab – an exercise in replicating part of the EXIOBASE V.2 production pipeline in a virtual laboratory

ABSTRACT

We explore options to replicate the EXIOBASE2 multi-region input–output (MRIO) database in the Virtual IELab cloud-computing laboratory environment. Whereas EXIOBASE2 is constructed using a multi-process reconciliation procedure, we present an alternative compilation technique that uses EXIOBASE2's pre-processed data and final tables in reconciling the IELab MRIO with conflicting raw data information. This approach skips the labour-intensive step of detailing and harmonising country tables. Adherence metrics reveal the EXIOBASE2-based IELab table to be considerably less balanced than the original but with stronger adherence to other constraints data. However, these metrics are not comparable to the original EXIOBASE2 statistics due to the distinctive implementation of constraint sets in the two platforms. IELab's main value-added is its flexibility in tailoring EXIOBASE2-based MRIOs beyond the original recipe. Finally, IELab's global carbon, water and material footprints are shown to be comparable with previously reported resource footprints. In contrast, deviations in land footprints warrant further investigation.     

Working Capital Management and Firm Performance: Some Evidence from Europe

International Advances in Economic Research -     

Modeling the relation between students’ implicit beliefs about their abilities and their educational STEM choices

Despite the large body of research on students’ educational and career choices in the field of technology, design, and science, we still lack a clear understanding of how to stimulate more students to opt for a study path or career within the STEM fields (Science, Technology, Engineering, Mathematics). In this article, we outline a new theoretical framework to describe how students’ implicit belief about the malleability of their intelligence can be an important precursor of their STEM educational and career choice behavior. Based on the different bodies of literature about STEM choices and about students’ implicit beliefs about their abilities, we present three hypothetical pathways, in the form of testable models, that describe potential relations between the implicit theories that students may hold regarding the malleability of their STEM ability and students’ intentions to pursue a STEM career. Each pathway outlines a specific mediating factor influencing this relation: (a) self-efficacy beliefs, (b) stereotypical thinking, and (c) motivational beliefs. These pathways provide more insight into the underlying mechanisms that may affect STEM choice behavior. In our view, such a theoretical underpinning is a necessary prerequisite for further scientific investigation into the potential relations between students’ implicit beliefs about their potential development, relevant psychological variables, and STEM choice behavior. Furthermore, we believe it provides a theoretical foundation for practical interventions that aim to stimulate STEM choice behavior.     

Effects of company visits on Dutch primary school children’s attitudes toward technical professions

Technology-oriented company visits could potentially provide children with a stimulating ‘real-world’ setting to develop more broad and positive images of and attitudes toward technology and technical professions. The present study was the first to explore whether children’s images of and attitudes toward technology, technical competencies and technical professions could be affected by technology-oriented company visits, as they are presently carried out in the Netherlands. A previously validated measurement instrument was used to measure children’s images and attitudes prior to and after the visits and results were compared to similar measurements among children who did not take part in the visits. In addition, based on recent review studies about school visits to science centers, we derived several key theoretical guidelines for organizing effective school visits. Based on these guidelines, structured interviews were carried out with all teachers prior to the company visits. Results indicated that children’s images and attitudes remained mostly unaffected by the company visits, a finding that could be explained by the fact that the level of in-school preparation, follow-up activities and teachers’ level of involvement during the visits was generally low. In addition, observations during the visits showed that the activities at the technical companies were mostly ‘hands-on’ and stereotypical (e.g., working with machines). Based on these findings, we formulate a set of new guidelines for technology-oriented company visits that could improve the desired attitudinal effects.