Bendamustine-rituximab: a cost-utility analysis in first-line treatment of indolent non-Hodgkin’s lymphoma in England and Wales

Objective:

To evaluate the cost-effectiveness of bendamustine-rituximab (B-R) compared with CHOP-R (cyclophosphamide, doxorubicin, vincristine, prednisone, rituximab) and CVP-R (cyclophosphamide, vincristine, prednisone, rituximab) as first-line treatment for patients with advanced indolent non-Hodgkin’s lymphoma (NHL).

Methods:

A patient-level simulation was adapted from the model used by the University of Sheffield School of Health and Related Research (ScHARR) in a health technology appraisal of rituximab for first-line treatment of follicular lymphoma. This approach allowed modelling of the complex treatment pathways in indolent NHL. Data from a Phase 3 randomized, open-label trial were used to compare B-R with CHOP-R. The relative efficacy of CHOP-R and CVP-R was estimated using an indirect treatment comparison similar to the original ScHARR approach. The analysis was conducted from the perspective of the National Health Service in England and Wales, using a lifetime time horizon. A number of one-way sensitivity and scenario analyses were conducted, including one using recently published data comparing CVP-R with CHOP-R.

Results:

The deterministic incremental cost-effectiveness ratio (ICER) was £5249 per quality adjusted life year (QALY) for B-R vs CHOP-R, and £8092 per QALY for B-R vs CVP-R. The alternative scenario using direct data comparing CVP-R with CHOP-R approximately halved the ICER for B-R vs CVP-R to £4733. Owing to its better toxicity profile, B-R reduced the cost of treating adverse events by over £1000 per patient vs CHOP-R.

Limitations:

The main limitations were: immaturity of overall survival data from the Phase 3 trial; reliance on quality-of-life data from previous health technology appraisals (as this was not collected in the trial); and a lack of direct evidence or a network of connected evidence comparing B-R with CVP-R.

Conclusions:

The ICERs for B-R vs CHOP-R and CVP-R were considerably below the thresholds normally regarded as cost-effective in England and Wales (£20,000–30,000 per QALY).     

Quantifying the defensive medicine contribution to primary care costs

Background:

Defensive medicine represents one cause of economic losses in healthcare. Studies that measured its cost have produced conflicting results.

Objective:

To directly measure the proportion of primary care costs attributable to defensive medicine.

Research design and methods:

Six-week prospective study of primary care physicians from four outpatient practices. On 3 distinct days, participants were asked to rate each order placed the day before on the extent to which it represented defensive medicine, using a 5-point scale from 0 (not at all defensive) to 4 (entirely defensive).

Main outcome measures:

This study calculated the order defensiveness score for each order (the defensiveness/4) and the physician defensive score (the mean of all orders defensiveness scores). Each order was assigned a weighted cost by multiplying the total cost of that order (based on Medicare reimbursement rates) by the order defensiveness score. The proportion of total cost attributable to defensive medicine was calculated by dividing the weighted cost of defensive orders by the total cost of all orders.

Results:

Of 50 eligible physicians, 23 agreed to participate; 21 returned the surveys and rated 1234 individual orders on 347 patients. Physicians wrote an average of 3.6?±?1.0 orders/visit with an associated total cost of $72.60?±?18.5 per order. Across physicians, the median physician defensive score was 0.018 (IQR?=?[0.008, 0.049]) and the proportion of costs attributable to defensive medicine was 3.1% (IQR?=?[0.5%, 7.2%]). Physicians with defensive scores above vs below the median had a similar number of orders and total costs per visit. Physicians were more likely to place defensive orders if trained in community hospitals vs academic centers (OR?=?4.29; 95% CI?=?1.55–11.86; p?=?0.01).

Conclusions:

This study describes a new method to directly quantify the cost of defensive medicine. Defensive medicine appears to have minimal impact on primary care costs.     

Adapting a book to make a film: how strategy is adapted through professional practices of marketing middle managers

Abstract

For an organisation to be competitive its strategy must be highly responsive to both environmental challenges and customers continuously shifting demands. Yet many organisations treat strategy making as an exclusively top management concern, even though the top management team is often remote from the daily interactions and communications taking place at the organisation, market, and customer interface. We challenge the assumption that strategy making ‘belongs’ to top managers and argue that marketing middle managers, possessing expert market and customer knowledge and insights, adapt top manager’s strategy to shifting customer demands in a changing environment. We explore this argument by adopting a strategy-as-practice perspective and analysing marketing middle manager’s practices across three case companies operating in a dynamic retail environment. Our research enables two key contributions. Our primary confirmation is to demonstrate that marketers are not passive implementers, but active adapters of top management strategy through three critical practices of sensing, challenging, and transmitting. We use the novel analogy of how adapting a book to make a film involves minor changes to the story line and characters to suit the new medium and to illustrate the strategically relevant and influential role marketing plays in adapting the strategy developed by the top management team for implementation. By demonstrating the value of the strategic practices of functional middle managers we also contribute to the growing debate of the need for greater inclusion and transparency in strategy making.     

The influence of co-location in higher education institutions on small firms’ perspectives of knowledge transfer

Since 1980, the UK has experienced a dramatic growth in firms and employment in information–intensive business services, such as management consultancy and market research. Recent expansion of new and small firms operating in these sectors is the focus of a major ESRC–sponsored research project currently under way at Cambridge University Small Business Research Centre.

Small business service firms are able to compete successfully with large firms due to the imperfect nature of the market which characterizes business services demand and supply, together with specialization of expertise. The success of small business service firms depends on informal person–to–person networks, word–of–mouth recommendation and repeal business based on successful earlier assignments or personal contacts acquired, for example, while working in a large consultancy or market research company. This paper examines the types of networks utilized by small business service firms and argues that two distinct types exist: demand– and supply–related networks; the former involves links with clients, the latter links and co–operation between complementary small business service firms.     

A longitudinal meta-analysis of corruption in international business and trade: Bridging the isolated themes

ABSTRACT

This article chronicles the academic debate on corruption in international business and trade. It identifies three themes: contributing factors, consequences, and combating corruption. We found convergence in the literature and that authors tend to remain loyal to their chosen theme. As a result, we found a distressing dearth of research that transcends, integrates, or validates the interrelationships between them. Through our work, we propose the bridging of themes, demonstrating how they interrelate, thereby validating their interdependencies and the broader lens needed through which to observe corruption in international business.     

What goes up must come down: an evaluation of a zoo conservation-education program for balloon litter on visitor understanding,attitudes, and behaviour

Abstract

Balloons used outdoors can fly away, posing ingestion and entanglement hazards to wildlife. “When Balloons Fly” (WBF) conservation-education program seeks to educate zoo visitors about these threats and encourage the use of wildlife-friendly bubbles at outdoor events. We examined the effect of WBF on visitor knowledge, attitudes, and behaviours (intentions and actions) over 6?months (N?=?624). We compared outcomes among visitors who viewed a presentation and exhibit, to viewing the exhibit-only, and investigated the priming influence of completing a survey before entering the exhibit (pre-survey). Visitors had greater depth of understanding about the impact of balloons immediately following the visit, but post-visit message recall was low. General Linear Models revealed that over 6?months WBF significantly (p < .05) influenced positive attitudes concerning balloon use, increased likelihood to use bubbles, and reduced likelihood to use balloons. Completion of a pre-survey significantly influenced positive attitudes and reduced likelihood to use balloons. WBF is promoting conservation behaviour, with two-thirds of the follow-up sample reporting that behaviours they changed while hosting or attending an outdoor event since their visit were influenced by the zoo experience. Future work can investigate materials that might mimic a priming effect (e.g., worksheets).     

The community brand paradigm: A response to brand management's dilemma in the digital era

Abstract

The consumer adoption of digital media has warranted much attention over the last decade. However, relatively little has been written about how digital media has impacted upon brand management perspectives and practices. The digital era has resulted in changes in how consumers interact with brands and each other, and this shift in behaviour requires a reappraisal of how brands should be managed. The current relational paradigm is no longer sufficient. Therefore this conceptual paper calls for brand management to develop and embody a deeper understanding of this shift by adopting a revised paradigm. Current brand management issues not addressed by the relational paradigm are outlined, the new community paradigm follows, and examples of community paradigm practice are provided as a guide for brand management.     

A different perspective on consumer engagement: exploring the experience of using health apps to support healthier food purchasing

ABSTRACT

Healthy food purchasing behaviour may be facilitated through the use of health apps if used for the necessary time period. However, little is known on the factors that influence the user experience and facilitate or impede their continued use. The purpose of the present research is to explore the lived experience of using a health app to support healthier food purchasing behaviour. Findings identify the presence of behaviour change motivation and anticipated effort levels as drivers of app engagement. It appeared that behavioural, cognitive and emotional dimensions of engagement may influence one another, driven by contextual influences, to simultaneously contribute to the intrinsic experience of engagement. The research makes practical and theoretical contributions to the consumer engagement literature and highlights the need to focus on understanding and capturing the specific engagement context to better understand engagement.     

Stake Management in Men's Online Cosmetics Testimonials

Although the Internet has opened up new avenues for identity expression, many web‐based sources have yet to be examined. Online testimonials as a form word‐of‐mouth advertising are a relatively new development. The present study examines the construction of masculinities in men's cosmetics adverting testimonials presented on the website of a leading brand. The dataset is examined using discursive psychology and membership categorization analysis methodologies. The findings indicate that when men write facial cosmetics testimonials they still justify the use of these non‐typical masculine products even in the absence of others’ responses. The analysis highlights the continued difficulty men report in using typically feminized products, frequently accounting for their cosmetic use as a "corrective" measure rather than for beautification. The implications for the marketing of masculine products are discussed.