Cost-effectiveness analysis of mechanical thrombectomy with stent retriever in the treatment of acute ischemic stroke in Italy

Background: Stroke has a significant disease burden in terms of acute and long-term disability in Italy and throughout the world. Endovascular treatments for the management of a stroke event have been coupled in the past years with the possibility to mechanically remove the occlusion by means of specially designed thrombectomy devices, and their exclusive use showed levels of effectiveness in line with those of the existing pharmacological treatments.

Objective: To assess the cost-effectiveness of mechanical thrombectomy (MT) with the Solitaire Revascularization Device (stent retriever) for the treatment of acute ischemic stroke (AIS) in patients with large vessel occlusions (LVOs), comparing MT plus intravenous tissue plasminogen activation (MT plus IV t-PA) vs IV t-PA alone, in Italy.

Methods: A Markov model was used to simulate costs and benefits of MT plus IV t-PA and IV t-PA alone over a 5-year time horizon and considering the perspective of the Italian National Health Service (NHS). Results are reported in terms of Incremental Cost Effectiveness Ratio (ICER). Deterministic and probabilistic sensitivity analyses are carried out in order to test the robustness of the results.

Results: Total costs of MT plus IV t-PA and IV t-PA alone are equal to €31,798 and €34,855, respectively. The MT allows incremental QALYs for 0.77, determining a dominant ICER. The utilities associated to the mRS health states are the parameters with the highest impact on the results. Multiway sensitivity analyses determined a 90% probability of dominance.

Conclusions: MT plus IV t-PA for AIS patients with LVO is cost-effective from year 1 through year 3, and cost-saving from year 4 onward in the Italian context, achieving better results, both in terms of efficacy and in terms of resource consumption.     

Growth‐Friendly Tax Structures: An Indicator‐Based Approach

This paper designs a horizontal indicator‐based assessment methodology aimed at identifying those EU countries presenting a potential need and scope for shifting taxation away from labour to other tax bases less detrimental to growth. The assessment methodology, as a first step, selects a set of indicators measuring specific aspects of tax policy. Subsequently, for each individual indicator, performance thresholds are calculated based on a benchmarking approach. Finally, a screening algorithm based on commonly accepted findings from the relevant economic literature is used to assess the overall performance of a country in two policy areas, namely the need for a tax shift and the scope for it. Various robustness checks are performed.     

The EU policy for a plastic economy: Reflections on a sectoral implementation strategy

After reviewing the main EU policy documents on the plastic waste issue, this work conceptualises an analysis framework to investigate farmers' attitudes to market‐based tools (i.e., subsidies, tax‐credits, and payback mechanisms in extended producer responsibility schemes) through which the introduction of an operational scheme for a better management of their plastic waste can be incentivised in line with the 2018 European Strategy for Plastics in a Circular Economy. A total number of 1,783 farmers responded to a purpose‐built questionnaire. Results show that most of the plastic waste they produce is piping and packaging and that tax credit represents their most favoured incentivising tool.     

Childhood and capability deprivation in Italy: a multidimensional and fuzzy set approach

In the last decades, starting with the United Nations Convention on the Rights of the Children in 1989, children’s quality of life have received a growing attention in scientific research, as well as in politics. This work aims to gain insights into Italian children’s living conditions and deprivation of capabilities using the Capability Approach, an alternative normative framework for the evaluation of human development, well-being and freedom by thinking in terms of human functionings and capabilities. From a methodological point of view we present an approach based on a fuzzy methodology applied to data from the EU-SILC 2009 ad-hoc module on children. The use of this methodology makes it possible to preserve the richness of the data available from the EU-SILC survey, that include both monetary and non monetary aspects of children deprivation. To get more insides into Italian children living conditions we also combine the fuzzy methodology with the capability approach at a disaggregated level of analysis by three social economic factors (single parent household, household educational level, macro-region of residence). Besides the well-known Italian North/South disparity of financial indicators—confirmed also for households with children—our findings suggest a new duality for Italian children quality of life, given by the multidimensional domains of deprivation internal or external to children’s households.     

Tax competition and fiscal equalization under corporate income taxation

This paper challenges the view that tax base equalization by the so-called representative tax system (RTS) removes inefficient undertaxation in corporate tax competition. The innovation of the paper is that it focuses on a tax on corporate income, instead of the unit tax on capital considered in previous studies. We employ a tax competition model with fiscal equalization and show that the RTS fails to fully internalize pecuniary and fiscal externalities. As a consequence, the RTS yields inefficiently low tax rates in the Nash equilibrium of the tax competition game between governments. Tax revenue equalization performs even worse, but combined with equalization of private income it implements the efficient tax rates on corporate income.     

New trends in mergers and acquisitions: Idiosyncrasies of the European market

While policy makers link the recent increase of M&A activity in Europe to the benefits of European legislation and European institutions to create a fertile ground for acquisitions in Europe, others deny the benefit of regional integration. This study evaluates the characteristics and the key determinants of the likelihood of completion of M&As in the European Union between 1997 and 2007. The results of this study suggest that M&As in Europe feature unique characteristics, while still suffering from country-specific challenges. In Europe the deal attitude and the presence of competing bids are more important for the completion of a deal than the deal origin, the payment method, or industry regulation. The reported idiosyncrasies of M&A in Europe seem to arise not merely from European regulations about acquisitions, but mostly from the structural characteristics of the European business environment.     

Asymptotically Optimal Response‐Adaptive Designs for Allocating the Best Treatment: An Overview

Response‐adaptive designs are being used increasingly in applications, and this is especially so in early phase clinical trials. This paper reviews a particular class of response‐adaptive designs that have the property of picking the superior treatment with probability tending to one. This is a desirable property from an ethical point of view in clinical trials. The model underlying such designs is a randomly reinforced urn. This paper provides an overview of results for these designs, starting from the early paper of Durham and Yu (1990) until the recent work by Flournoy, May, Moler and Plo (2010).     

A bibliometric analysis of the scientific literature on Fairtrade labelling

Since its foundation, the Fairtrade movement has attracted the attention of consumers, practitioners, media and scholars. Discussing the role that Fairtrade can play on a global yet locally rooted scale is very complex, as research reports contrasting results about its usefulness and effectiveness. This study examines scientific research on Fairtrade over the last decades by conducting a bibliometric analysis of the literature published on the ISI Web of Knowledge Core Collection, which included 876 papers by 1,293 authors in 432 journals. Results show that despite this being a relatively recent field of study, Fairtrade has been approached from different disciplines with different methodologies and objectives. The structured quantitative study of the literature enabled us to inspect how research has evolved over the years in the light of the changes faced by Fairtrade, to explore its scope in the broader field of the global market, to detect current research schools and perspectives within the network and to identify hitherto unaddressed issues and unconnected subfields.