A cost–utility analysis of degarelix in the treatment of advanced hormone-dependent prostate cancer in the United Kingdom

Objective:

To determine the cost-effectiveness of the treatment of advanced hormone-dependent prostate cancer with degarelix compared to luteinizing hormone-releasing hormone (LHRH) agonists in the UK using the latest available evidence and the model submitted to AWMSG.

Methods:

A cost-effectiveness model was developed from the perspective of the UK National Health Service evaluating monthly injection of degarelix against 3-monthly leuprorelin therapy plus anti-androgen flare cover for the first-line treatment of patients with advanced (locally advanced or metastatic) hormone-dependent prostate cancer. A Markov process model was constructed using the patient population characteristics and efficacy information from the CS21 Phase III clinical trial and associated extension study (CS21A). The intention-to-treat (ITT) population and a high-risk sub-group with a PSA level >20?ng/mL were modeled.

Results:

In the base-case analysis using the patient access scheme (PAS) price, degarelix was dominant compared to leuprorelin with cost savings of £3633 in the ITT population and £4310 in the PSA?>?20?ng/mL sub-group. The chance of being cost-effective was 95% in the ITT population and 96% in the PSA?>?20?ng/mL sub-group at a threshold of £20,000 per quality-adjusted life-year (QALY). In addition, degarelix remained dominant when PSA progression was assumed equal and only the benefits of preventing testosterone flare were taken into account. Treatment with degarelix also remained dominant in both populations when the list price was used. The additional investment required to treat patients with degarelix could be offset in 19 months for the ITT population and 13 months for the PSA?>?20?ng/mL population. The model was most sensitive to the hazard ratio assumed for PSA progression between degarelix and leuprorelin and the quality-of-life (utility) of patients receiving palliative care.

Conclusion:

Degarelix is likely to be cost-effective compared to leuprorelin plus anti-androgen flare cover in the first-line treatment of advanced hormone-dependent prostate cancer.     

Virtual companies reconsidered

An important recent report recommends the creation of 'rirtual companies'-companies formed from electronically linked workers who rfmain employees o f their regular firms . This paper criticizes that model, instead suggesting that uirtual companies have their o m employees. The assessment of the implications of both ppes of virtual compay points to the need for majar national poliy changes with respect to employment practices and mechanisms to conty wealth to people.     

Changes in National Technological Competitiveness: 1990, 1993, 1996 and 1999

Georgia Tech's Technology Policy and Assessment Center, with support from the US National Science Foundation, has been generating High-Tech Indicators (HTI) — measures of national technology-based export competitiveness since 1987. This paper reports the HTI results for 33 nations in 1999 in comparison with those of 1990, 1993 and 1996. HTI includes four 'input indicators' and a key 'output indicator' — technological standing. We construct a new composite input indicator here and examine its predictive capability. Input indicators for 1990 and 1993 show intriguing relationships to 1999 technological standing. We compare the indicators for various groups — leading and emerging Western economies, rapidly developing Asian economies, former Eastern Bloc nations and lagging Latin American countries. The USA presently exhibits a dominant position, but signs strongly point toward increasingly broad-based competition in technology-based products.     

A technology opportunities analysis model: applied to dye-sensitised solar cells for China

Technology opportunities analysis (TOA) can support policy-makers or managers in making strategic technical decisions so as to enhance their technological innovation capability and international competitiveness. This paper presents a multi-level framework to support and systematically identify technological opportunities. Patent data as a key component of technology innovation are used to enable TOA within the framework in the present research. At the research and development (R&D) level, we anticipate the directions of technology development based on technology morphology. Countries’ development emphases can also be investigated in order to help identify their R&D strengths and weaknesses and to seek promising development pathways. At the level of competition, we devise the assignee-technology analysis to obtain insight into competitive participants’ technical emphases and intents. It is also used to explore possible collaboration opportunities among them. At the market level, we apply patent family analysis to understand countries’ target markets and to assess prospects for the commercialisation of their technology. We pursue TOA to explore China's opportunities and challenges in dye-sensitised solar cells. The empirical case analysis supports the effectiveness of the TOA model. We believe it can be adapted well to fit other emerging technologies.     

An End to China's Imbalances?

As early as 2005,analysts and academics became concerned about the prospects for,and sustainability of,growing current account imbalances in the world's largest economies.In the United States,low savings rates and growing household consumption,fueled in part by what later turned out to be a bubble in the property market,sucked in imports from abroad,causing the trade and current account deficit to balloon.Of course,this deficit had a counterpart among the United States' principal trading partners.     

The Effects of Vertical Pay Dispersion: Experimental Evidence in a Budget Setting

Vertical pay dispersion is the difference in pay across different hierarchical levels within an organization (Milkovich and Newman 1996 ). While vertical pay dispersion may be useful in attracting, retaining, and motivating highly skilled employees (Lazear and Rosen 1981 ; Lazear 1995 ; Prendergast 1999 ), our study investigates a potential disadvantage; specifically, the negative impact of perceived unfairness of vertical pay dispersion on employees' budgeting decisions. We predict and find that high vertical pay dispersion motivates subordinates to misreport costs to a greater extent than low vertical pay dispersion. Furthermore, we predict and find that superiors, on average, exercise more lenient cost controls when vertical pay dispersion is high rather than low. Supplemental analysis indicates superiors are more lenient on average because of their aversion to inequity caused by vertical pay dispersion. Our results suggest that high vertical pay dispersion can compromise the overall corporate budgeting environment, where higher levels of misreporting by subordinates goes unchecked by superiors.     

THE PRODUCTIVE EFFICIENCY OF US MILK PROCESSING CO-OPERATIVES

While co-operative organisations fare well in agricultural markets in the United States, this paper argues that co-operatives are theoretically an inherently inferior form of organisation. Empirically, we apply a nonparametric frontier production model to a sample of co-operative and non-co-operative US fluid-milk processors to determine the relative productive efficiency of these two forms of organisation. Our empirical results support the hypothesis that US milk processing co-operatives are less efficient than their proprietary counterparts.