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.     

Work–family enrichment and satisfaction: the mediating role of self-efficacy and work–life balance

Although the direct effects of work–family enrichment on satisfaction are well-documented, previous theoretical predictions and empirical findings of the relationship have been inconsistent. Drawing on social cognitive theory, the current research examined how work–family enrichment contributes to job and family satisfaction by exploring the mediating mechanisms of self-efficacy and work–life balance. This study also empirically validated a new self-efficacy measure using the work–life interface nomological network. A heterogeneous sample of Australian employees (N = 234) from four different organisations responded to two waves of data collection separated by a 12-month interval. Using structural equation modelling, the results of the statistical analysis provided preliminary support for the hypothesised chain mediation model and the newly developed five-item self-efficacy to regulate work and life scale. Specifically, work-to-family enrichment and family-to-work enrichment were positively related to self-efficacy, which in turn had a positive effect on work–life balance. Similarly, work–life balance had a positive impact on job and family satisfaction. Evidence of these relationships over time was demonstrated, thereby emphasising the importance of person–cognitive resources (e.g. self-efficacy) in influencing life outcomes. Validation of the self-efficacy scale also demonstrated robust psychometric properties and criterion validity. Implications of these results were subsequently discussed.     

Better him than me: social comparison theory and service recovery

We conduct two studies to examine if, when, and why communication strategies using social comparisons can effectively restore emotional equilibrium after a service failure, and thus aid recovery efforts. In our first study, we find that after a service failure, like compensation, downward social comparisons reduce anger and improve post-purchase behavioral intentions (including exiting, complaining to management, engaging in negative word-of-mouth, and complaining to a third party). However, when two recovery tools, compensation and downward social comparisons are used together they do not have an additive effect. Additionally, we show that anger mediates the social comparison effect. In a second study, we further explore the social comparison effect and the financial compensation effect using complete and incomplete downward social comparisons and multiple levels of financial compensation. Our findings indicate that complete downward social comparisons are particularly effective at improving all four types of post-purchase behavioral intentions when financial compensation is non-existent or relatively low. Finally, we discuss implications for theory and practice. The authors would like to thank Irwin Levin, Jim Sinkula, the anonymous reviewers, and David Stewart for their insightful comments and invaluable guidance related to this article.     

PROFESSIONALIZATION AND BRITISH MANAGEMENT PRACTICEPROFESSIONALIZATION AND BRITISH MANAGEMENT PRACTICE: CASE EVIDENCE FROM MEDIUM-SIZED FIRMS IN TWO INDUSTRIAL SECTORS*

High levels of occupational specialization, problems of cross-functional integration and distinct bureaucratic tendencies have traditionally been seen as problems endemic to British management practice. Over the last decade, these problems are expected to have disappeared - or at least diminished - as major developments in management and organizational theory, as well as changing economic circumstances, have redirected management thinking towards ‘new’ ideas of flatter, simpler organizational structures, increased flexibility and decentralization, improvements in the quality of inter-functional relations and the like. Yet, despite these developments, there is comparatively little research that has investigated actual patterns of change within management and, in particular, what is happening in what could be regarded as the mainstream of British industry - namely, ‘ordinary’, medium-sized firms operating in ‘traditional’ industrial sectors. Moreover, rarely does such research focus upon the implications of management change for the strategies of professionalization adopted by competing specialist occupational groups within management. This paper sets out to help fill these gaps, by reporting the findings from case studies of four such firms, taking into account the particular contexts and historical circumstances that have helped shape any such change and drawing out the key influences on changed management practice.     

Leadership in your midst: tapping the hidden strengths of minority executives

All companies value leadership-some of them enough to invest dearly in cultivating it. But few management teams seem to value one engine of leadership development that is right under their noses, churning out the kind of talent they need most. It's the complicated, overburdened but very rich lives of their minority managers. Minority professionals-particularly women of color-are called upon inordinately to lend their skills and guidance to activities outside their jobs. Sylvia Ann Hewlett, who heads the Center for Work-Life Policy, and her coauthors, Carolyn Buck Luce of Ernst & Young and Cornel West of Princeton, present new research on the extent to which minority professionals take on community service and other responsibilities outside the workplace and more than their share of recruiting, mentoring, and committee work within the workplace. These invisible lives, argue the authors, can be a source of competitive strength if companies can learn to recognize and further cultivate the cultural capital they represent. But it's hard to convince minority professionals that their employer respects and values their off-hours responsibilities. A lack of trust keeps many people from revealing much about their personal lives. The authors outline four ways companies can leverage hidden skills: Develop a new level of awareness of minority professionals' invisible lives; appreciate the outsize burdens these professionals carry and try to lighten them; build trust by putting teeth into diversity goals; and, to finish the job of leadership development, help minorities reflect on their off-hours experiences, extract and generalize the lessons, and apply what's been learned in other settings.     

An Empirical Test of the Institutionalist View on Income Inequality

This paper analyzes the relationship between income inequality and economic growth within the United States using state level data. It describes income inequality in the U.S. since 1960, then employs a two‐step causal model to test the institutionalist contention that income inequality leads to socio‐political instability, which has a negative impact on economic progress. The empirical results offer support for the institutionalist view.     

Dominant stakeholders,activity and accountability discharge in the CSO sector

Civil society organisations (CSOs) comprise a diverse range of associations, including non‐governmental organisations (NGOs), community groups, political parties and social networks. Nevertheless, despite heterogeneity, regulators, funders and donors often treat CSOs as homogeneous when demanding accountability. This paper highlights differences in to whom CSOs across different categories (or types) perceive themselves to be accountable, what for and the different practices they undertake to discharge accountability. It calls for stakeholders to acknowledge diversity in accountability across different CSO types. This survey‐based research finds CSOs weight upwards and downwards stakeholders equally, and undertake voluminous reporting. They would benefit from negotiating multiple‐use mechanisms, especially with dominant stakeholders. In combining stakeholder and accountability theory, the research highlights specific CSO types needing further study.     

Housing Density and the Effect of Proximity to Public Open Space in Aberdeen, Scotland

We consider whether public recreational open space is a substitute for private open space by testing whether price effects from proximity to an urban park are increasing in housing density. Aberdeen, Scotland features three owner-occupied residential property types: detached housing, nondetached housing and flats. We examine property sales within 800 m of five city parks. We find flat prices increase with additional proximity to parks, but there are generally no price effects from park proximity for lower density housing types. The results suggest that open space policy must consider the scale and density of surrounding urban development.     

A Model of “Tax-Free” Exchange of Farmland

This study considers the alternatives available for transferring agricultural property on the urban periphery. The model examines the conditions under which market participants sell or exchange farmland. Contrary to popular opinion, we find that simultaneous exchanges are still feasible in the presence of delayed exchanges, particularly when the relinquished property is very large. The model also explains the observed phenomenon that the sellers of agricultural property get replacement properties of lesser market value in exchanges.