James Buchanan’s contractarian individualism: A personal account

This is a personal account of my relationship with James M. Buchanan, his significance for my academic career and the influence of his work on my own research.     

Cost-effectiveness of osimertinib in the UK for advanced EGFR-T790M non-small cell lung cancer

Aim: This study presents the cost-utility analysis that was developed to inform the NICE health technology assessment of osimertinib vs platinum-based doublet chemotherapy (PDC) in patients with EGFR-T790M mutation-positive non-small cell lung cancer (NSCLC) who have progressed on epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) therapy.

Methods and materials: A partitioned survival model with three health states (progression-free, progressed disease, and death) from a UK payer perspective and over lifetime (15 years) was developed. Direct costs included disease management, treatment-related (acquisition, administration, monitoring, adverse events), and T790M testing costs. Efficacy and safety data were taken from clinical trials AURA extension and AURA2 for osimertinib and IMPRESS for PDC. An adjusted indirect treatment comparison was applied to reduce the potential bias in the non-randomized comparison. Parametric functions were utilized to extrapolate survival beyond the observed period. Health state utility values were calculated from EQ-5D data collected in the trials and valued using UK tariffs. Resource use and costs were based on published sources.

Results: Osimertinib was associated with a gain of 1.541 quality-adjusted life-years (QALYs) at an incremental cost of £64,283 vs PDC (incremental cost-effectiveness ratio [ICER]: £41,705/QALY gained). Scenario analyses showed that none of the plausible scenarios produced an ICER above £44,000 per QALY gained, and probabilistic sensitivity analyses demonstrated a 63.4% probability that osimertinib will be cost-effective at a willingness-to-pay threshold of £50,000.

Limitations: The analysis is subject to some level of uncertainty inherent to phase 2 single-arm data and the immaturity of the currently available survival data for osimertinib.

Conclusions: Osimertinib may be considered a cost-effective treatment option compared with PDC in the second-line setting in patients with EGFR-T790M mutation-positive NSCLC from a UK payer perspective. Further data from the ongoing AURA clinical trial program will reduce the inherent uncertainty in the analysis.     

Parent universities and the location of academic startups

Academic startups are thought to locate in their parent university’s home region because being in the vicinity of a university provides cost advantages in accessing academic knowledge and resources. In this paper we analyze the importance of a different mechanism, namely, social ties between academic entrepreneurs and university researchers, for enabling and facilitating the access to academic knowledge and resources, and therefore for the location of academic startups. We employ unique data on academic startups from regions with more than one university and find that only the parent university influences academic entrepreneurs’ decisions to stay in the region while other universities in the same region play no role. Our findings suggest that the mere local availability of a university may not per se guarantee access to knowledge and resources; social ties are additionally required. The importance of social ties implies that academic knowledge and resources are not necessarily local public good. This holds implications for universities’ role in stimulating regional development.     

Organizations as constitutional systems

Four theoretical approaches to the study of organizations that can be identified in the relevant literature are compared: Thegoal paradigm, theexchange paradigm, thenexus of contracts paradigm, and theconstitutional paradigm. It is argued that the latter provides the more fruitful theoretical perspective in that it reconciles an individualist methodology with an account of organisations as corporate actors, as units of collective action. I would like to thank Richard E. Wagner for helpful comments and suggestions on an earlier draft.     

Long-term unemployment,heterogeneity, and state dependence

Zusammenfassung In dieser Arbeit wird zur Erklärung individueller Wiederbeschäftigungschancen von Arbeitslosen mittels Individualdaten für österreich ein Abgangsratenmodell geschätzt, wobei unter Berücksichtigung von unbeobachteter Populationsheterogenität auf verschiedene Formen von state dependence getestet wird. Die Abgangsrate in Beschäftigung steigt mit zunehmender Arbeitslosigkeitsdauer an und hängt primär von bestimmten persönlichen Charakteristika der Arbeitslosen und der Zahl der erhaltenen Arbeitsangebote ab. Die individuellen (Wieder-)Beschäftigungschancen von Personen, die neu oder wieder in das Erwerbsleben eintreten, sind relativ gering und werden außerdem durch vergangene langfristige Arbeitslosigkeit stark reduziert.

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I thank my collegues G. Flaig and G. Licht, G. Arminger, University of Wuppertal, A. Hamerle, University of Konstanz, R. Winter-Ebmer, University of Linz, and the referees for helpful comments. Support from the Austrian Fonds zur Förderung der wissenschaftlichen Forschung is gratefully acknowleged. Of course, the usual caveats apply.     

FROM BOTTOM TO TOP: THE ENTIRE INCOME DISTRIBUTION IN GERMANY, 1992–2003

We analyze the distribution of market income in Germany in the period 1992 to 2003 on the basis of an integrated dataset that encompasses the whole spectrum of the population, from the very poor to the very rich. We find a modest increase of the Gini coefficient, a substantial drop of median income and a remarkable growth of the income share accruing to the economic elite, which we define as the richest 0.001 percent of persons in the population. While the elite mainly obtains its income from business and capital, the income share that it receives in the form of wage income has been increasing. We also show that the dramatic decline of market income in the bottom half of the distribution is very much mitigated by income transfers within private households and by governmental redistribution.     

Capital flows under moral hazard

I analyze a model with moral hazard and limited enforcement in a small open economy. I find that when state contingent contracting is allowed adding the moral hazard friction improves the model's predictions along several dimensions. First, it justifies why non-contingent debt is an optimal way to finance an emerging economy. Second, it explains the limited consumption risk-sharing and high, volatile and counter-cyclical interest rates. Third, it generates realistic crisis-like dynamics in which capital inflows are brought to a halt and interest rates sky-rocket. The model also has a strong internal propagation mechanism.