Cost-effectiveness analysis of standalone trabecular micro-bypass stents in patients with mild-to-moderate open-angle glaucoma in Canada

Objectives: To estimate the cost-utility of two trabecular micro-bypass stents (TBS) implantation vs standard of care (SOC) in patients with mild-to-moderate open-angle glaucoma (OAG) in the Canadian healthcare setting.

Methods: The deterioration in visual field (VF) defect over a 15-year time horizon was tracked using a Markov model with Hodapp-Parrish-Anderson stages of glaucoma (mild, moderate, advanced, severe/blind) and death as health states. Meta-analyses of randomized clinical trials were conducted to estimate the pooled reduction in intraocular pressure (IOP) and medication use due to TBS and SOC. The rate of decline in VF loss was adjusted by the extent of IOP reduction to estimate transition probabilities. Healthcare resource utilization, unit costs (2017 CAD), and progression-related utility scores were obtained by literature review, and medication costs with wastage were obtained from IMS Brogan PharmaStat. The impact of parameter and methodological uncertainty on costs and quality-adjusted life years (QALYs) was examined using probabilistic and 1-way sensitivity analyses.

Results: The meta-analysis showed an additional reduction of 1.13 medications/patient and an additional decrease in IOP of –1.10?mmHg at 36?months favoring TBS. TBS strongly dominated medication alone, due to higher improvement in quality-of-life (0.068 QALYs), fewer blind eyes (–0.0031), and a decrease in total healthcare costs of C$2,908.3 per patient over the time horizon (C$9,394.1 TBS vs C$12,302.4 medication alone). Sensitivity analyses showed that results were robust to the uncertainties in model inputs and assumptions. Time-to-dominance was 44?months (3.7?years).

Conclusions: The TBS procedure was cost-effective over SOC in a 15-year time horizon, with quality-of-life gains.     

Growth and convergence in a multi-country empirical stochastic Solow model

The paper considers international per capita output and its growth using a panel of data for 102 countries between 1960 and 1989. It sets out an explicitly stochastic Solow growth model and shows that this has quite different properties from the standard approach where the output equation is obtained by adding an error term to the linearized solution of a deterministic Solow model. It examines the econometric properties of estimates of beta convergence as traditionally defined in the literature and shows that all these estimates are subject to substantial biases. Our empirical estimates clearly reflect the nature and the magnitude of these biases as predicted by econometric theory. Steady state growth rates differ significantly across countries and once this heterogeneity is allowed for the estimates of beta are substantially higher than the consensus in the literature. But they are very imprecisely estimated and difficult to interpret. The paper also discusses the economic implications of these results for sigma convergence. © 1997 John Wiley & Sons, Ltd.     

At the Center of the Action: Innovation and Technology Strategy Research in the Small Business Setting

In this essay, we offer perspectives on the future of small business research. These comments cover a range of issues unique to the future of small-business-focused research from "somewhat-broad" to "more-narrow," and address: (1) the problems and promise of better theory building, (2) the range of opportunities for theory-building research, (3) new vantage points for theory-building using the "social responsibility" of small business as a research lens, and (4) the future direction of research in technological entrepreneurship. We conclude with a summary of this "look to the future," and call for the innovative and provocative research that can keep contemporary small business management research at the center of the academic action.     

Truthful mechanism design for multidimensional scheduling via cycle monotonicity

We consider the makespan-minimization problem on unrelated machines in the context of algorithmic mechanism design. No truthful mechanisms with non-trivial approximation guarantees are known for this multidimensional domain. We study a well-motivated special case (also a multidimensional domain), where the processing time of a job on each machine is either “low” or “high.” We give a general technique to convert any c-approximation algorithm (in a black-box fashion) to a 3c-approximation truthful-in-expectation mechanism. Our construction uses fractional truthful mechanisms as a building block, and builds upon a technique of Lavi and Swamy [Lavi, R., Swamy, C., 2005. Truthful and near-optimal mechanism design via linear programming. In: Proc. 46th FOCS, pp. 595–604]. When all jobs have identical low and high values, we devise a deterministic 2-approximation truthful mechanism. The chief novelty of our results is that we do not utilize explicit price definitions to prove truthfulness. Instead we design algorithms that satisfy cycle monotonicity [Rochet, J., 1987. A necessary and sufficient condition for rationalizability in a quasilinear context. J. Math. Econ. 16, 191–200], a necessary and sufficient condition for truthfulness in multidimensional settings; this is the first work that leverages this characterization.     

Transitional economy tourism: German travel consumers' perceptions of Lithuania

This paper examines the current status of tourism in Lithuania as well as potential German tourists' perceptions of Lithuania as a tourist destination. As tourism is an important source of foreign exchange and provides jobs for a large number of people, the Lithuanian Government is quite interested in increasing the number of tourists visiting the country. Data gathered at the International Tourism Exchange in Berlin was analysed and recommendations made concerning marketing techniques that could be used to increase tourism from the European Union and other western countries. Copyright © 2003 John Wiley &Sons, Ltd.     

Sustainable locating of different forest uses

This study describes an approach whereby it is possible to promote social, ecological and economic sustainability by paying attention to the effectiveness of locating different forest uses and to anticipating conflict situations. It introduces a geographic information system (GIS) based method enabling the user to evaluate certain sub-areas in accordance with the requirements of each forest use to be practised in them. Moreover, the method enables the user to combine compatible forms of use and thereby to locate the areas most important from the point of view of the group of compatible forms of use. This information can be utilised when selecting small set-aside areas in commercial forests where wood production is not the main use form. Areas subject to use pressures from two or more incompatible forest uses can be found by comparing suitability maps of incompatible uses. Coming to a head of conflict situations can often be prevented by identifying those areas, which are subject to conflicting objectives. This method makes use of GIS tools when evaluating the sub-areas for the purpose of producing the required knowledge, and for combining and describing sub-areas in the form of suitability maps. The methods of multi-criteria evaluation (MCE) are used in evaluating and making commensurable the different objectives. The method produces theme maps describing (i) the best sub-areas from the point of view of compatible forest uses within a certain area and (ii) in the case of incompatible forest uses those sub-areas where the biggest conflicts can be expected. The method is illustrated by a case study in which the compatibility of the forms of use to be practised within a certain forest area are clarified and targets involving potential conflict situations are sought.     

Can flexible agricultural microfinance loans limit the repayment risk of low diversified farmers?

Using a unique data set from a commercial microfinance institution in Madagascar, this article investigates the credit risk of microfinance loans with flexible repayment schedules for crop farmers. Flexible repayment schedules allow a redistribution of principal payments during periods with low agricultural returns to periods when agricultural returns are high through predefined grace periods. We apply propensity score matching to investigate how different numbers of grace periods reflecting different levels of production diversification affect the credit risk of crop farmers. In this attempt, three delinquency categories reflecting various levels of credit risk are assessed. Moreover, we consider the specifics of the regions where loans were disbursed. Our results reveal that loans with predefined grace periods show significantly higher delinquencies. This effect is significant over all three delinquency categories for loans disbursed to low diversified crop farmers. For the more diversified farmers, this effect is only significant for the lowest delinquency category. Hence, predefined grace periods might bridge periods with low agricultural returns but come at the cost of higher credit risk for the lender. The magnitude of these effects is, however, small.     

The value and consequences of using public health technology assessments for private payer decision-making in Canada: one size does not fit all

Background: Both public and private insurers provide drug coverage in Canada. All payers are under pressure to contain costs. It has recently been proposed that private plans leverage the public health technology assessment (HTA) evaluation process in their decision-making.

Objectives: The objectives of the current study were to examine use of public health technology assessments (HTAs) for private payer decision-making in the literature, to gather the perspectives of experts from both public and private insurers on this practice, and to summarize which value parameters of public evaluations can be used for private payer decision-making.

Methods: A targeted literature review was conducted to identify publications on the use of public HTA or cost-effectiveness data for private payer decision-making on pharmaceutical reimbursement. Concurrently, a roundtable meeting was organized with invited panelists, including private payer representatives and health economic consultants (total n?=?9). The findings from both were synthesized and expressed in qualitative terms using the PICO framework.

Results: The targeted review identified 20 studies meeting the inclusion criteria, primarily originating from the US and Canada. The panelists felt that, despite some similarities, there were substantial differences between both systems. The PICO framework highlighted the issues with transferability between the two systems. Most of the value parameters were either not applicable, needed to be added, needed to be adjusted, or their applicability to private payer systems needed to be confirmed.

Conclusion: Some components of public HTA may be relevant for private payers, however there are reservations that still exist on whether the HTA process in Canada, designed for a public system, can address the informational needs of private payers. Private insurers need to use caution in assessing which value parameters from public HTAs can be used and which need to be confirmed, ignored, enhanced, or adjusted. One size HTA does not fit all applications.     

Tests of Policy Interventions in DSGE Models

This paper considers tests of the effectiveness of a policy intervention, defined as a change in the parameters of a policy rule, in the context of a macroeconometric dynamic stochastic general equilibrium (DSGE) model. We consider two types of intervention, first the standard case of a parameter change that does not alter the steady state, and second one that does alter the steady state, e.g. the target rate of inflation. We consider two types of test, one a multi‐horizon test, where the postintervention policy horizon, H, is small and fixed, and a mean policy effect test where H is allowed to increase without bounds. The multi‐horizon test requires Gaussian errors, but the mean policy effect test does not. It is shown that neither of these two tests are consistent, in the sense that the power of the tests does not tend to unity as H→∞, unless the intervention alters the steady state. This follows directly from the fact that DSGE variables are measured as deviations from the steady state, and the effects of policy change on target variables decay exponentially fast. We investigate the size and power of the proposed mean effect test by simulating a standard three equation New Keynesian DSGE model. The simulation results are in line with our theoretical findings and show that in all applications the tests have the correct size; but unless the intervention alters the steady state, their power does not go to unity with H.