The economic value of INTUITY in aortic valve replacement

Objective: The recent development of the EDWARDS INTUITY Elite? (EIE) valve system enables the rapid deployment of a prosthetic surgical heart valve in an aortic valve replacement (AVR) procedure via both the minimally invasive (MISAVR) and conventional (CAVR) approaches. In order to understand its economic value, this study performed a cost evaluation of the EIE valve system used in a MIS rapid-deployment approach (MIS-RDAVR) vs MISAVR and CAVR, respectively, compared to standard prosthetic aortic valves.

Methods: A simulation model was developed using TreeAge (and validated with MS Excel) to compare the inpatient utilization and complication costs for each treatment arm. Thirty-day clinical end-points for the MIS-RDAVR (mortality and complications) were taken from the TRANSFORM trial; and a best evidence review of the published literature was used for the MISAVR and CAVR approaches. Studies were pooled and parameter estimates were weighted by sample size in order to compare the TRANSFORM patients. Cost data (2016 USD) were taken from the Premier database. Incremental cost and cost-effectiveness was assessed and one-way/probabilistic sensitivity analyses performed to gauge the robustness of the results.

Results: MIS-RDAVR costs $2,621 less than CAVR and had lower mortality rates, making it a superior (dominant) technology relative to CAVR. MIS-RDAVR costs $4,560 more than MISAVR, but was associated with an additional 0.20 life years-per-patient. This implies a cost-effectiveness ratio of $22,903 per-life-year-gained. Thus, MIS-RDAVR is cost-effective compared to MISAVR.

Conclusions: The EIE valve system deployed in a MIS approach appears to be a cost-effective technology compared to MISAVR and CAVR. When compared to CAVR it may achieve cost savings as well. These results suggest that MIS-RDAVR confers superior economic value compared to both standard MISAVR and CAVR via lowered key complication rates (re-operation, renal complications, wound infection, TIA, endocarditis) and utilization (cross-clamp time, hospital ward days).     

Artisan Flowers Inc.: A Framework‐Based Approach to IFRS Leasing Standards

Artisan Flowers Inc.'s (AFI) business is centered on importing and selling cut flowers. The company has entered into a number of lease transactions that have the president of AFI perplexed with their accounting treatment and implications. Now, the audit firm needs to explain to AFI's president the appropriate treatment and implications of these lease transactions using current IFRS (IAS 17) and (optionally) the 2013 Lease Exposure Draft. The purpose of this case is for students to gain an understanding and appreciation of the intricacies of IAS 17 as well as the proposed Lease Exposure Draft and the implication of these standards on debt covenants. Students are asked for an explanation of the conceptual basis for the standards and for an analysis of the impact of the standards on AFI's statement of financial position.     

Internationalisation Processes,Networking and Local Embeddedness in Technology-Intensive Small Firms

The paper argues that technology-intensive small firms often need to internationalise their activities, and especially sales, at a very early stage of their development because of the limited and global nature of the technological market niche which they have been set up to exploit. From a survey of 100 such firms in the Cambridge and Oxford regions, it demonstrates that many technology-based smaller firms are engaged in a range of international networks and internationalisation processes, including internationalisation of markets, research collaboration, labour recruitment, ownership and facilities location. Technology-intensive firms reporting high levels of internationalisation also differ significantly from those which are more nationally-oriented, for example in terms of size, age, research intensity, university links, and innovativeness. There are also differences with respect to recent growth rates. Finally, the paper demonstrates that far from substituting international for local networks, technology-intensive firms which have achieved high levels of internationalisation in fact also exhibit above-average levels of local networking with respect to research collaboration and intra-industry links. Internationalisation therefore appears to be grounded or embedded in successful local networking and research and technology collaboration.     

A Comparison of Conjoint Methods When There Are Many Attributes

This paper compares several methods of performing conjoint analysis when there is a large number of attributes. National parks were described in terms of 17 attributes and 56 levels. Subjects were randomly assigned to one of four groups and each person responded to a calibration questionnaire that allowed the estimation of one of the following conjoint analysis models: full profile, ACA, individual-level hybrid, or full profile on the person's eight stated most important attributes. Validations were performed in terms of individual choices and aggregate choice shares. Reliabilities were assessed on both ratings and choices.Surprisingly even with a large number of attributes, the full profile method consistently validated best. Second was a full profile model estimated on the respondent's stated eight most important attributes. ACA and individual hybrid conjoint analysis performed similarly, but worse than these two methods on most measures. Validation differences were more strongly related to differences in attribute importances than desirabilities for levels within an attribute. It appears that these respondents were not able to accurately report self-explicated importances with a large number of attributes.     

Foundations of Incomplete Contracts

In the last few years, a new area has emerged in economic theory, which goes under the heading of "incomplete contracting". However, almost since its inception, the theory has been under attack for its lack of rigorous foundations. In this paper, we evaluate some of the criticisms that have been made of the theory, in particular, those in Maskin and Tirole (1999 a ). In doing so, we develop a model that provides a rigorous foundation for the idea that contracts are incomplete.     

Simulated Attention-Tracking Methodologies: An Examination of Measurement Efficacy

This study introduces and examines a simulated attention-tracking methodology as an emerging technique to improve the study of in-store shopper behavior and decision making. To assess the viability of this new methodology, we examine its efficacy in producing consumer behavior data consistent with results predicted by the marketing literature. Empirical data across five grocery categories are used to examine the influence of personal, product, and situational differences on external information search. Findings show that the attention-tracking methodology is able to demonstrate expected results in almost all cases. The methodology is also able to provide a more complete view of external information search through tracing the observed search behavior preceding decision making. This proof of methodology responds directly to calls in the marketing and retailing literature to test new and emerging methodologies in support of research on in-store marketing and shopper behavior. Findings also provide managers with a methodology to examine the actual impact of marketing actions intended to capture shoppers’ attention at the retail shelf and to influence behavior.     

Where can obesity management policy make the largest impact? Evaluating sub-populations through a microsimulation approach

Background: There is a critical need to focus limited resources on sub-groups of patients with obesity where we expect the largest return on investment. This paper identifies patient sub-groups where an investment may result in larger positive economic and health outcomes.

Methods: The baseline population with obesity was derived from a public survey database and divided into sub-populations defined by demographics and disease status. In 2016, a validated model was used to simulate the incidence of diabetes, absenteeism, and direct medical cost in five care settings. Research findings were derived from the difference in population outcomes with and without weight loss over 15 years. Modeled weight loss scenarios included initial 5% or 12% reduction in body mass index followed by a gradual weight regain. Additional simulations were conducted to show alternative outcomes from different time courses and maintenance scenarios.

Results: Univariate analyses showed that age 45–64, pre-diabetes, female, or obesity class III are independently predictive of larger savings. After considering the correlation between these factors, multivariate analyses projected young females with obesity class I as the optimal sub-group to control obesity-related medical expenditures. In contrast, the population aged 20–35 with obesity class III will yield the best health outcomes. Also, the sub-group aged 45–54 with obesity class I will produce the biggest productivity improvement. Each additional year of weight loss maintained showed increased financial benefits.

Conclusions: This paper studied the heterogeneity between many sub-populations affected by obesity and recommended different priorities for decision-makers in economic, productivity, and health realms.     

Other financial institutions' portfolio behaviour and policy implications: A study of India

Abstract

Applied literature has largely neglected the asset decision of other financial institutions (OFIs), though it may possess important policy implications. In this paper, portfolio behaviour of OFIs in India is modelled by using the annual flow of funds data for 1951/52 to 1993/94. The long-run model of the Almost Ideal Demand System and the allied concepts of cointegration generated economically and statistically plausible results. We find a strong influence of interest rates on portfolio behavior, thereby the role of interest rates on resource allocation. The paper concludes that the macroeconomic management through monetary policy actions may not be unnecessarily limited through the channel of OFIs in the post-financial reform regime in India.