Health technology assessment in Japan: a work in progress

Abstract

Background: In Japan, pharmacoeconomic requirements for list-price adjustment were institutionalized in April 2019 following provisional implementation of a new Health Technology Assessment (HTA) program 2016–2019. Since April 2019, submission of cost-effectiveness evidence to the Central Social Insurance Medical Council (Chuikyo) as part of the Japanese Ministry of Health, Labour, and Welfare has been mandatory for selected pharmaceuticals and medical devices.

Methods: Based on a review of publications and commentaries since April 2019, together with views from a group of experts on key issues to be addressed, this report provides an update on recent HTA developments and key challenges still to be addressed.

Results and Discussion: Japan’s new HTA program is a first step toward development of a universal healthcare system that can be sustainable for many years into the future. Currently, Japan’s HTA program requires provision of incremental cost-effectiveness ratios (ICERs) as evidence, with quality-adjusted life years as the preferred outcome measure. Prices can be adjusted both upward and downward according to the degree of the ICER estimate. Japan is the first country to have adopted an algorithmic method for “ICER-based” pricing; however, HTA measures that extend beyond a single ICER estimate are needed to take full advantage of HTA in the future. In particular, generation of evidence of value should support changes to the healthcare system so that incentives for innovation are not diminished while industry and government are not overburdened by the generation or assessment of evidence. There is a need to ensure scientifically sound HTA expertise across all sectors in Japan, and therefore enhancement of HTA literacy and capability among healthcare professionals, academia, government, and industry should be a priority.     

How to gain image and positioning on social media: Spanish agribusiness firm image and position on social media

ABSTRACT

The aim of this article is to obtain insights into how agribusiness firms can gain image recognition and positioning on SM and, in doing so, determine the images that can increase or diminish their positions on SM and predict the frequency of an image’s visibility on SM. This article uses data collected from a large number of Spanish agribusiness firms of the agrarian, agrifood and wine subsectors, located in rural peripheral areas or urban cores, to identify their images and positioning on social media. We use the Tagxedo digital tool to show the distinctive images of agribusiness firms on SM. Using the Howsociable digital tool and observing the SM key performance indicators (KPI), we measure the traffic and visibility of agribusiness firms on social media, and we find that a lot of agribusiness firms leave the potential of SM unused. The agribusiness firms upstream in the value chain and located in rural peripheral areas could take more advantages of SM visibility. We then create a model of image and positioning on SM using a binary logistic regression. We predict that more than two messages of sales per week on SM can diminish the visibility of agribusiness firm on SM.     

Political contestability and public contracting

Do public agents undertake socially inefficient activities to protect themselves? In politically contestable markets, part of the lack of flexibility in the design and implementation of the public procurement process reflects public agents' risk adaptations to limit the political hazards from opportunistic third parties—political opponents, competitors, and interest groups. Reduced flexibility limits the likelihood of opportunistic challenges, while externalizing the associated adaptation costs to the public at large. We study this matter and provide a comprehensive theoretical framework with empirically testable predictions.     

Economic and quality of life burden of anemia on patients with CKD on dialysis: a systematic review

Abstract

Aims: The overall cost and health-related quality of life (HRQoL) associated with current treatments for chronic kidney disease (CKD)-related anemia are not well characterized. A systematic literature review (SLR) was conducted on the costs and HRQoL associated with current treatments for CKD-related anemia among dialysis-dependent (DD) patients.

Materials and methods: The authors searched the Cochrane Library, MEDLINE, EMBASE, NHS EED, and NHS HTA for English-language publications. Original studies published between January 1, 2000 and March 17, 2017 meeting the following criteria were included: adult population; study focus was CKD-related anemia; included results on patients receiving iron supplementation, red blood cell transfusion, or erythropoiesis stimulating agents (ESAs); reported results on HRQoL and/or costs. Studies which included patients with DD-CKD, did not directly compare different treatments, and had designs relevant to the objective were retained. HRQoL and cost outcomes, including healthcare resource utilization (HRU), were extracted and summarized in a narrative synthesis.

Results: A total of 1,625 publications were retrieved, 15 of which met all inclusion criteria. All identified studies included ESAs as a treatment of interest. Two randomized controlled trials reported that ESA treatment improves HRQoL relative to placebo. Across eight studies comparing HRQoL of patients achieving high vs low hemoglobin (Hb) targets, aiming for higher Hb targets with ESAs generally led to modest HRQoL improvements. Two studies reported that ESA-treated patients had lower costs and HRU compared to untreated patients. One study found that aiming for higher vs lower Hb targets led to reduced HRU, while two other reported that this led to a reduction in cost-effectiveness.

Limitations: Heterogeneity of study designs and outcomes; a meta-analysis could not be performed.

Conclusions: ESA-treated patients undergoing dialysis incurred lower costs, lower HRU, and had better HRQoL relative to ESA-untreated patients. However, treatment to higher Hb targets led to modest HRQoL improvements compared to lower Hb targets.     

The effect of regional factors in the development of eco‐innovations in the firm

This research addresses the study of the effect of regional factors in the development of eco‐innovations in the firm. We assume the hypothesis of regional heterogeneity, that is, geographical factors and the regional heterogeneity play an important role in determining the innovations in the firms. In this line, we will approach our study from the perspective of regional innovation systems (RISs). Therefore, our research question involves the evaluation of regional factors as determinants of eco‐innovation developing in the firm. To examine these questions, the PITEC database that covers the period 2011–2013 was used. Overall, 5,461 firms have been employed for the ordinal logit regression model. This research contributes to the studies of eco‐innovation, extending the investigation into drivers of eco‐innovation, and highlights the impact that RIS has on the eco‐innovative development in the firm. We find that regional interaction and regional characteristics are key elements for the development of eco‐innovation in firms. Thus, the density of companies in the region, the regional per capita income, and the existence of financing mechanisms are key elements for the eco‐innovative development in the firm.     

The digital transformation of work: A relational view

Conversation about the current and potential effects of digital technologies on the nature of work is raging within scholarly and practitioner communities. Artificial intelligence, robotics, data analytics, digital platforms, and automation, among other technologies, are prompting a swift and profound transformation of work. Building on Pierpaolo Donati's relational sociology, we examine the changes these technologies are likely to bring about in work as a human relation. Despite the very real threats of unemployment, job insecurity, precariousness, and surveillance, technology may also encourage the emergence of a work culture that shifts the scales toward a relational realm rather than a transactional one. To this end, we argue that work should be understood as a social relation with four dimensions: exchange value, intrinsic extra‐economic purpose, communication for reciprocal services, and correspondence with primary human needs according to use values. Understanding the digital transformation of work from this point of view requires comprehending the differentiation and integration of these four dimensions.     

U.S. R&D internationalization in less‐developed countries: Determinants and insights from Brazil,China, and India

The growing U.S. R&D internationalization has historically been concentrated in developed countries. However, in the past few decades, the internationalization has moved toward less‐developed countries (LDCs), particularly Brazil, China, and India. What location factors are making some LDCs more “inviting” for U.S. R&D offshore? To answer this first question, we constructed a panel data using secondary data from the U.S. Bureau of Economic Analysis regarding the R&D investment made by the majority‐owned foreign affiliates of U.S. parent companies in 71 countries. We then applied a Heckman two‐step correction for selection bias test. The results highlight some important differences between developed countries’ and LDCs’ attractiveness. Based on these initial results, we conducted a detailed analysis of the determinants of U.S. R&D investments in Brazil, China, and India, which revealed that China’s determinants mostly match those found in more developed countries.     

Subordinated Financial Integration and Financialisation in Emerging Capitalist Economies: The Brazilian Experience

This paper analyses the recent changes in financial practices and relations in emerging capitalist economies (ECEs) using the example of Brazil. It argues that in ECEs these financial transformations, akin to the financialisation phenomena observed in Core Capitalist Economies (CCEs), are fundamentally shaped by their subordinated integration into a financialised and structured world economy. To analyse this subordinated financialisation, the paper draws on the framework of international currency hierarchies. It shows by means of two specific processes how the existence of a hierarchic international monetary system has changed the financial behaviour of domestic economic agents, and with it the structure of the financial system. The first process highlights the phenomenon of reserve accumulation and the changing behaviour of domestic banks. The second points to ECEs’ sustained external vulnerability and its impact on the operations of Brazilian non-financial corporations. The paper also shows that not only were these financial transformations shaped by ECEs’ subordinated financial integration, but also that it was these financialisation tendencies themselves which contributed to cementing existing hierarchies and further deepened existing asymmetries between ECEs and CCEs.