A systematic review of cost-effectiveness modeling of pharmaceutical therapies in neuropathic pain: variation in practice,key challenges,and recommendations for the future

Objectives: Complexities in the neuropathic-pain care pathway make the condition difficult to manage and difficult to capture in cost-effectiveness models. The aim of this study is to understand, through a systematic review of previous cost-effectiveness studies, some of the key strengths and limitations in data and modeling practices in neuropathic pain. Thus, the aim is to guide future research and practice to improve resource allocation decisions and encourage continued investment to find novel and effective treatments for patients with neuropathic pain.

Methods: The search strategy was designed to identify peer-reviewed cost-effectiveness evaluations of non-surgical, pharmaceutical therapies for neuropathic pain published since January 2000, accessing five key databases. All identified publications were reviewed and screened according to pre-defined eligibility criteria. Data extraction was designed to reflect key data challenges and approaches to modeling in neuropathic pain and based on published guidelines.

Results: The search strategy identified 20 cost-effectiveness analyses meeting the inclusion criteria, of which 14 had original model structures. Cost-effectiveness modeling in neuropathic pain is established and increasing across multiple jurisdictions; however, amongst these studies, there is substantial variation in modeling approach, and there are common limitations. Capturing the effect of treatments upon health outcomes, particularly health-related quality-of-life, is challenging, and the health effects of multiple lines of ineffective treatment, common for patients with neuropathic pain, have not been consistently or robustly modeled.

Conclusions: To improve future economic modeling in neuropathic pain, further research is suggested into the effect of multiple lines of treatment and treatment failure upon patient outcomes and subsequent treatment effectiveness; the impact of treatment-emergent adverse events upon patient outcomes; and consistent and appropriate pain measures to inform models. The authors further encourage transparent reporting of inputs used to inform cost-effectiveness models, with robust, comprehensive and clear uncertainty analysis and, where feasible, open-source modeling is encouraged.     

Where is the balance? Implications of adopting Special Products and Sensitive Products in Doha negotiations for world and China's agriculture

This paper analyzes the potential impacts of the agreements of Special Products and Sensitive Products (SPs) in Doha negotiations on world and China's Agriculture. By linking a global trade model to a national policy model which itself is connected to a set of disaggregated household data, we are able to assess the effects of the inclusion of SPs into a Doha agreement on agriculture in China and the rest of the world and different farmers across China. Our results show that since the inclusion of SPs in a Doha agreement adds more protection in agriculture, the total quantity of resources used in world agriculture increases. Although increasing, it is important to note that the total rise is only a fraction of a percent of agricultural value added and the gains to rural income per capita are likewise small. Moreover, an important difference between the apparent benefits of SPs is highlighted when they are considered for one country alone and when they are made available to all WTO members. The benefits to agriculture in China (and other countries) from increases in protection resulting from SPs are typically offset when these flexibilities are made available to all countries. While there are some positive benefits for certain vulnerable groups in society (in China), we show that there are adverse effects on equity and the impacts differ largely among regions.     

Confirmatory tetrad analysis in PLS path modeling

The authors propose a CTA-PLS assessment routine for measurement models. This routine applies confirmatory tetrad analysis (CTA) in a manner which is consistent with partial least squares (PLS) path modeling assumptions. The conceptualization employs a bootstrapping procedure to accomplish an appropriate statistical test examining vanishing tetrads in CTA-PLS. The approach allows distinguishing a formative indicator specification from a reflective indicator specification. Applications using experimental and empirical data demonstrate the usefulness and effectiveness of CTA-PLS. As a means of evaluating PLS path modeling results, the routine assists researchers in avoiding potentially unrepresentative consequences of measurement model misspecification.     

A LONGITUDINAL ANALYSIS OF THE CONTEXT AND STRUCTURE OF A LARGE BRITISH FINANCIAL INSTITUTION

This study represents an analysis of the changes in the environment, context and structure of an organization, using the full Aston Interview Schedule.² The limitations of generalizing from a single case are acknowledged, but the longitudinal analysis provides support for the notion that organizations can and do develop self-evaluative capacities when threatened by external change. The results of the process of self-evaluation on the part of the organization are shown as changes in the organization's scores on the various scales of organizational context and structure developed by the Aston school, at two points in time. These changes provide support for a number of conjectures arising from previous analyses of the relationships among the structural dimensions of organizational form displayed by the Aston methodology; notably the relationship between size/standardization and centralization/standardization. The analysis also suggests that the centralization scale can be viewed as having two components – one related to policy decisions, the other to operational decisions.