From geopolitics to geoeconomics: Transnational state effects in the borderlands

This article reads Ohmae's arguments about ‘the end of the nation‐state’ against the arguments of Luttwak about the centrality of ‘geoeconomics’ in the new world order. By exploring the limits of both their arguments, the article develops a much more critical account of geoeconomics, suggesting that it can be used by scholars of boundaries and geopolitics to come to terms with the development of cross‐border regionalism and associated transnational state effects (i.e. transnational governance imperatives) in the context of free trade. Geoeconomics is thus argued to describe the localised changes in governance imperatives implicated in a series of economically‐driven and quite quotidian challenges to national borders on the ground in both North America and Europe. The article outlines how an examination of localised strategies to create cross‐border regions in the context of globalised economic interdependencies offers a research window onto processes currently challenging the nation‐state from the ground up. As such, it is argued that the case studies discussed here also offer a way of empirically evaluating the geoeconomic influence of discourses about ‘the end of the nation‐state’ promoted by writers such as Ohmae.     

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).     

Presidentialism, Parliamentarism, and the Provision of Collective Goods in Less-Developed Countries

Parliamentary systems are more likely, ceteris paribus, than presidential systems to give politicians the incentive to provide policies aimed at broad national constituencies rather than at particularistic sectoral or regional constituencies, because a parlimentary constitutional design encourages legislators to subordinate their pursuits to their parties' broader interests. However, less-developed countries often lack the conditions for the nationally oriented parties that parliamentarism requires in order to thrive, due to such factors as sharp disparities in development across regions and income groups. Thus the provision of collective goods in such countries may be facilitated by the establishment of presidential executives, which can be delegated independent constitutional authority to structure the national policy process. Policy-making in these cases thus can be stylized as a presidency elected nationally and granted strong powers over legislation that partially counteract the particularistic tendencies of a fragmented legislature whose members remain close to their regional constituencies.