Cost-effectiveness of denosumab versus zoledronic acid for preventing skeletal-related events in the Czech Republic

Aims: This study assessed the cost-effectiveness of the subcutaneous RANKL inhibitor, denosumab, vs the intravenous bisphosphonate, zoledronic acid, for the prevention of skeletal-related events (SREs) in patients with prostate cancer, breast cancer, and other solid tumors (OST) in the Czech Republic.

Materials and methods: A lifetime Markov model was developed to compare the effects of denosumab and zoledronic acid on costs (including drug costs and administration, patient management, SREs, and adverse events), quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios from a national payer perspective. Different discount rates, time horizons, SRE rates, distributions, and nature (asymptomatic vs all SREs), and the inclusion of treatment discontinuation were considered in scenario analyses. The robustness of the model was tested using deterministic and probabilistic sensitivity analyses.

Results: Across tumor types, denosumab was associated with fewer SREs, improved QALYs, and higher total costs over a lifetime. The incremental cost per QALY gained for denosumab vs zoledronic acid was 382,673 CZK for prostate cancer, 408,450 CZK for breast cancer, and 608,133 CZK for OST. Incremental costs per SRE avoided for the same tumor type were 54,007 CZK, 51,765 CZK, and 94,426 CZK, respectively. In scenario analyses, the results remained similar to baseline, when different discount rates and time horizons were considered. At a non-official willingness-to-pay threshold of 1.2 million CZK, the probabilities of denosumab being cost-effective vs zoledronic acid were 0.64, 0.67, and 0.49 for prostate cancer, breast cancer, and OST, respectively.

Limitations: The SRE rates used were obtained from clinical trials; studies suggest rates may be higher in clinical practice. Additional evidence on real-world SRE rates could further improve the accuracy of the modeling.

Conclusions: Compared with zoledronic acid, denosumab provides a cost-effective treatment option for the prevention of SREs in patients with prostate cancer, breast cancer, and OST in the Czech Republic.     

The role of frames,numbers and risk in the frequency of cooperation

We report on a simple experiment that addresses three factors in the frequency of cooperation: (1) framing, (2) the number of players and (3) the perceived risk of cooperating. We work with a (two-player) Prisoner’s Dilemma and with a three-player, two-strategy Public Good Game. We also consider a payoff schedule isomorphic with the latter but in a nonsocial setup. These themes have been separately studied by a large number of experimental papers, using diverse methodologies. Our experiment targets them in a common, clear-cut framework that minimizes confusion. We find three strong effects (a) framing; (b) the number of players (there is less cooperation in the three-person games than in the two-person ones); (c) the neutralization of risk (about 50% of participants cooperate when risk is neutralized). Both (a) and (c) go in the expected direction, but, in all three cases, the strength of the effect is surprising. Cooperators appear to be more motivated by efficiency or by Kantian reasoning than by altruism.     

Voluntariness and efficiency in the provision of public goods

This paper presents a characterization of Lindahl allocations which makes no reference to personalized prices. Lindahl equilibria are characterized here by two conditions: Pareto efficiency and a voluntariness condition. Voluntariness requires that no consumer may benefit from a reduction in his contribution if this means that the vector of public goods must be reduced in the same proportion. The intersection of the (large) set of voluntary allocations and that of efficient ones turns out to be (under differentiability) the set of Lindahl allocations.     

Growth,reform indicators and policy complementarities1

In order to assess the growth implications of policy complementarities, this paper applies second‐best results to reform indicators. During the transition from central planning to EU integration, which corresponds to a policy cycle, a complementarity index based on structural indicators compiled by the European Bank for Reconstruction and Development (EBRD) decreases and then increases while the level of reforms tends to rise throughout. Corrected for initial conditions, the extent of macroeconomic stabilization and endogeneity, the level of reforms and changes in their complementarity are found to be positively related to output growth. The study uses panel data for 27 countries between 1989 and 2004.     

Short-term market impact of Black Sea Grain Initiative on four grain markets

This paper examines the short-term market reaction of four agricultural commodities to the Russian–Ukraine war and various stages of the Black Sea Grain Initiative Agreement. Using an event study, the results show a positive abnormal return for the agricultural grain markets with the outbreak of the war and the nonrenewal of the Black Sea Grain Agreement. These two events by causing supply-side constraints, led to an increase in the price of grains. The results also show negative and statistically significant abnormal returns around the signing of the Black Sea Grain Agreement, its implementation through the departure of the first ship loaded with Ukrainian grain after the beginning of the war and the successive extensions of the agreement. These disruptions not only affect Ukraine and Russia but also have critical implications for world food security. Policy implications of our findings are provided.     

Minsky’s financial fragility: an empirical analysis of electricity distribution firms in Brazil (2007–2015)

This article applies Hyman P. Minsky’s insights on financial fragility to analyze the behavior of electricity distribution firms in Brazil from 2007 to 2015. More specifically, it builds an analytical framework to classify these firms into Minskyan risk categories and assess how financial fragility evolved over time, in each firm and in the sector as a whole. This work adapts Minsky’s financial fragility indicators and taxonomy to the conditions of the electricity distribution sector and applies them to regulatory accounting data for more than 60 firms. This empirical application of Minsky’s theory for analyzing firms engaged in the provision of public goods and services is a novelty. The results show an increase in the financial fragility of those firms as well as of the sector throughout the period, especially between 2008 and 2013.     

The framework of ‘local productive and innovation systems’ and its influence on STI policy in Brazil

ABSTRACT

Throughout its twenty years of existence, a Brazilian research network, RedeSist, has developed and improved the theoretical and methodological framework of National Systems of Innovation. The first aim of this article is to present RedeSist’s focusing device of Local Innovation and Production Systems (LIPS), a combination of the Systems of Innovation framework with the contributions of the Latin American Structuralist Approach and to explain the main tools devised to capture collective and systemic processes of production and innovation, taking into account that every LIPS is inserted in specific, local, regional, national and global systems. The second objective is to discuss the Brazilian experience in designing and implementing LIPS policies as part of its industrial and innovation policies. The concluding remarks attempt at recuperating the most important arguments of the discussion and at highlighting the advantages of creating and using contextualized and systemic theories, concepts, indicators and policy models.     

Unleashing proactive low-carbon strategies through behavioral factors in biodiversity-intensive sustainable supply chains: Mixed methodology

The aim of this research is to understand the complex and relatively understudied relationship between human and behavioral factors and low-carbon management practices from the perspective of the resource-based view (RBV). Research application is in the “biodiversity sector” and consists of a survey and multiple-case study in Brazil, the richest country globally in terms of biodiversity but a country that also faces challenges in protecting biodiversity. The research problem considers the relationship between human critical success factors and the adoption of low-carbon management practices. Quantitative analysis through structural equation modeling shows the three branches of hypothesis to be accepted—the first with a higher coefficient than the second and the second with a higher coefficient than the third. It was observed that human factors influence low-carbon product management practices the most, followed by process practices and finally logistics practices. Qualitative multiple-case study research shows that companies are at different stages of maturity in relation to low-carbon management organizational practices, ranging from the highest stage to the lowest. It was found that the intensity of the presence of human critical success factors was higher where organizations had greater adoption of low-carbon management practices.     

Structural change: Pace,patterns and determinants

This paper provides a comprehensive assessment of structural change in the world economy. The analysis relies on a newly constructed dataset comprising 169 countries and covering the period from 1991 to 2013. Shapley decompositions are employed to evaluate the pace and pattern of structural change across regions and sub‐regions. Country‐level estimates are then used to conduct an original empirical exercise on the determinants of structural change. The results suggest that labor reallocations (structural change) have played a critical role in enhancing economic performance since the early 2000s, even if they remain comparatively less important than within‐sector productivity improvements. The widespread reallocation of labor from agriculture to the services sectors has been the key driver of structural change. Finally, we find robust evidence that the pace of structural change is significantly shaped by human and physical capital. The policy implication is that investments in education and economic infrastructure are crucial to accelerating structural change.     

Worthiness versus Self‐Interest in Charitable Giving: Evidence from a Low‐Income,Minority Neighborhood

We examine the impact of perceived worthiness and financial self‐interest on charitable giving. Both participants and recipients come from a low‐income, predominantly African‐American community in the United States. To examine this issue, we introduce a “Comparative Dictator Game,” where participants make dictator allocations for four possible recipients, each with different characteristics. We find higher charitable giving toward more “worthy” (i.e., disabled, females who are head of household, and individuals with more children) recipients when individuals donate money to different recipients. Additionally, subjects then select their preferred recipient/allocation. When only one recipient must be selected for a donation, individuals select recipients to whom they provided smaller donations and recipients with children. The results highlight the trade‐off between a desire to engage in philanthropy, supporting those who are deserving, and financial self‐interest.