An economic evaluation attached to a single-centre,parallel group,unmasked, randomized controlled trial of a 3-day intensive social cognitive treatment (can do treatment) in patients with relapsing remitting multiple sclerosis and low disability

Abstract

Aims: This trial-based economic evaluation (EE) assesses from a societal perspective the cost-effectiveness of an intensive 3-day cognitive theory-based intervention (CDT), compared to care-as-usual, in patients with relapsing remitting multiple sclerosis (RRMS) and low disability (Expanded Disability Status Scale [EDDS] score < 4.0).

Materials and methods: The trial of the EE was registered in the Dutch Trial Register: Trial NL5158 (NTR5298). The incremental cost-effectiveness ratio (ICER) was expressed in cost on the Control sub-scale of the Multiple Sclerosis Self-Efficacy Scale (MSSES) and the incremental cost-utility ratio (ICUR) in the cost per Quality Adjusted Life Years (QALY) using the EQ-5D-5L. Bootstrap, sensitivity, and sub-group analyses were performed to determine the robustness of the findings.

Results: The two groups of 79 patients were similar in baseline characteristics. The base case ICER is situated in the northeast quadrant (€72 (40.74/€2,948)) due to a higher MSSES Control score and higher societal costs in the CDT group. The ICUR is situated in the northwest (inferior) quadrant due to losses in QALY and higher societal costs for the CDT group (?0.02/€2,948). Overall, bootstrap, sensitivity, and sub-group analyses confirm the base case findings. However, when the SF-6D is used as a study outcome, there is a high probability that the ICUR is situated in the northeast quadrant.

Limitations: The relative short follow-up time (6?months) and the unexpected increase in MSSES Control in the control group.

Conclusions: When using the EQ-5D-5L to calculate a QALY, CDT is not a cost-effective alternative in comparison to care as usual. However, when using self-efficacy or SF-6D as outcomes, there is a probability that CDT is cost-effective. Based on the current results, CDT for patients with RRMS clearly show its potential. However, an extended follow-up for the economic evaluation is warranted before a final decision on implementation can be made.     

The implications of private tutoring on the school education in LDCs

In many LDCs, we observe that the public school teachers receive low wages, expend less than their full effort at school, and provide private tutoring to the students for a fee. To capture this institutional arrangement, we develop a theoretical model which shows that in comparison with ‘no-tutoring’, ‘tutoring’ is welfare reducing for all students in the economy. However, if the government considers only the students in the public system, then ‘tutoring’ can be welfare improving. In that case, the government would set a lower tax rate to pay wages to the teachers and let them provide tutoring to the students for a fee.     

Technological Innovativeness and Firm Performance in Slovenia and Romania

This study contributes to a better understanding of performance induced by technological innovativeness by developing and testing a model. The model clarifies the nature of the influence of technological innovativeness and its organisational and inter-organisational antecedents (organisational support for innovativeness and technological alliances) on firm growth, profitability and wealth creation. Survey data were collected from firms in two countries: Slovenia and Romania; structural equation modelling was employed to test the model and the hypothesised relationships. Support for most of the model hypotheses was found. Among the control elements in the model, country, industry technological opportunities and firm age were found to be the most influential.     

Finding a Civilisational Idea: “West,” Eurasia,” and “Euro-East” in Russia's Foreign Policy

Civilisations are imagined, ratherm than real, and nations undergoing identity crises typically represent themselves through multiple civilisational visions. Scholars of geopolitics can hardly understand foreign policy without analysing those visions and social contexts, in which they rise and fall. This article selects for analysis three distinct civilisational ideas of Russia – “West,” “Eurasia” and “Euro-East” – associated with Boris Yeltsin, Yevgeni Primakov and Vladimir Putin, respectively. Russia's foreign policy is best understood as reflecting those civilisational ideas rather than merely material power conditions.     

Complementarities between organisational strategies and innovation

The purpose of this paper is to determine whether organizational strategies in various manufacturing industries are complementary with innovation. In particular, our interest is to discover which organizational strategies are complementary with major innovations (world-first and Canada-first). Knowledge of complementarity should pave the way for creating sustainable competitive advantage because the use of a complex strategy may be difficult to imitate. In other words, competitive advantage increases as the complexity of the strategy increases (i.e. because the number of strategy combinations follows a power law), which acts as a barrier to potential imitators (Rivkin, J.W. (2000) Imitation of Complex Strategies. Management Science, 46(6), 824–844.).

Because of the static nature of our results (productivity and profit are for 1997), their interpretation can only be tentative. Thus, our research is really a first step along the road to understanding the (potential) importance of complementarities among firm strategies. Caveats aside, managers may want to compare their own firm’s emphasis on particular strategies against what is empirically determined to be complementary with innovation and high-performance within their industry. The frequency of complementary pairs that involve innovation range from 40 to 50% depending on whether we are talking about profit, productivity, or strategies. This result is important—as it means that innovation outcomes are statistically significant for both increased productivity and increased profit. Furthermore, innovation was found to be complementary with many organizational strategies. The complementary strategies across industries were quite different, but this was expected to occur.     

R&D Activities In a Peripheral Region: an Empirical Study with Special Reference to the North East Region of the UK

This study examines the incidence of research and development (R&D) activities, type of R&D undertaken and the incidence of R&D co-operation among manufacturing firms located in a key urban area of the North East England, a peripheral region of the UK. We have found that over 62% of manufacturing firms in this urban growth area to be R&D active, suggesting that R&D active firms tend to be concentrated in urban area s in a peripheral region, as it is the case in the leading regions. However, the incidence of R&D co-operation was found to be relatively low among R&D active firms. It is also found that the key determinants of undertaking R&D to be the existence of a core competence/product and exporting activities. These findings might be of interest to policy makers promoting economic growth via firm’s R&D activities.     

TO ADMIT OR NOT TO ADMIT: THE QUESTION OF RESEARCH PARK SIZE

A theoretical model is used to explore the determinants of the optimum size of a private research park and the effect of university affiliation on that optimum size. Parks are assumed to operate as cooperatives where costs are equally shared among the member firms, and optimality occurs when the firms’ average net benefits are maximized. To achieve this, existing members of a park will limit the park's size, denying entry to firms who wish to join and are willing to share the costs. University affiliation may either increase or decrease the optimum size of a park.     

TACKLING THE ENDOGENEITY OF FERTILITY IN THE STUDY OF WOMEN'S EMPLOYMENT IN DEVELOPING COUNTRIES: ALTERNATIVE ESTIMATION STRATEGIES USING DATA FROM URBAN BRAZIL

Abstract

Opinions differ about whether family structure, especially fertility, should be considered endogenous in models of behavior in developing countries. Faced with a dearth of good instruments, mainstream researchers often urge working in reduced form and, therefore, losing variables of policy interest or limiting the type of questions they ask to those where good instruments are available. Rather than treating endogeneity as a yes or no characteristic, we suggest instead that researchers consider the likely magnitude of endogeneity bias before moving to reduced form. Facing a situation where endogeneity bias is often presented as a concern but where we expect little endogeneity bias, we tackle endogeneity using multiple econometric techniques not available to the average researcher. We find support for our hypothesis that little bias arises due to the assumption of exogeneity of recent fertility in a model of women's employment.     

Information flow between prediction markets,polls and media: Evidence from the 2008 presidential primaries

Are the forecast errors of election-eve polls themselves forecastable? We present evidence from the 2008 Democratic Party nomination race between Barack Obama and Hillary Clinton showing that the answer is yes. Both cross-sectional and time series evidence suggests that market prices contain information about election outcomes that polls taken shortly before the contests do not. Conversely, election surprises relative to polls too Granger cause subsequent price movements. We then investigate whether the additional information in prices could come from the media coverage of these campaigns, and uncover a set of complex relationships between pollster’s surprise, price movements, and various aspects of media coverage. Prices anticipate the balance and content of media coverage, but not the volume. On the other hand, it is the volume of media coverage, not the balance or content, that anticipates the surprise element in election outcomes. Moreover, Granger causality between prices and election surprises barely changes after controlling for media coverage, and causality from media volume to surprises persists too after controlling for price movements. Taken together, the results suggest that both prices and the volume of media coverage contain independent election-relevant information that is not captured in polls.     

On the terminology of economic design: a critical assessment and some proposals

The purpose of this paper is to provide a critical examination of some of the terminology that is common in economic design and to suggest ways in which it can be improved.