Economic impact of onabotulinumtoxinA for overactive bladder with urinary incontinence in Europe

Background: Overactive bladder (OAB) is a common condition that has a significant impact on patients’ health-related quality-of-life and is associated with a substantial economic burden to healthcare systems. OnabotulinumtoxinA has a well-established efficacy and safety profile as a treatment for OAB; however, the economic impact of using onabotulinumtoxinA has not been well described.

Methods: An economic model was developed to assess the budget impact associated with OAB treatment in France, Germany, Italy, Spain and the UK, using onabotulinumtoxinA alongside best supportive care (BSC)—comprising incontinence pads and/or anticholinergic use and/or clean intermittent catheterisation (CIC)—vs BSC alone. The model time horizon spanned 5 years, and included direct costs associated with treatment, BSC, and adverse events.

Results: Per 100,000 patients in each country, the use of onabotulinumtoxinA resulted in estimated cost savings of €97,200 (Italy), €71,580 (Spain), and €19,710 (UK), and cost increases of €23,840 in France and €284,760 in Germany, largely due to day-case and inpatient administration, respectively. Projecting these results to the population of individuals aged 18 years and above gave national budget saving estimates of €9,924,790, €27,458,290, and €48,270,760, for the UK, Spain, and Italy, respectively, compared to cost increases of €12,160,020 and €196,086,530 for France and Germany, respectively. Anticholinergic treatment and incontinence pads were the largest contributors to overall spending on OAB management when onabotulinumtoxinA use was not increased, and remained so in four of five scenarios where onabotulinumtoxinA use was increased. This decreased resource use was equivalent to cost offsets ranging from €106,110 to €176,600 per 100,000 population.

Conclusions: In three of five countries investigated, the use of onabotulinumtoxinA, in addition to BSC, was shown to result in healthcare budget cost savings over 5 years. Scenario analyses showed increased costs in Germany and France were largely attributable to the treatment setting rather than onabotulinumtoxinA acquisition costs.     

A General Method of Deriving the Inefficiencies of Banks from a Profit Function

This article develops a new method of estimating inefficiencies in joint production and shows that unlike the approaches utilized in the previous studies of inefficiency, this method maintains a consistent relationship between the error term of a profit function and the error terms of its price derivatives. A useful by-product of the method is a proof of a Hotelling-like lemma that relates stochastic input demand and output supply functions to stochastic profit functions. While the previous studies fit a single frontier to data on all firms, this paper estimates a frontier unique to every observed firm to allow each one to have a different potential of achieving maximal levels of profit. The new method is applied in the analysis of annual data, 1984–1989, for U.S. commercial banks. Both the analytical and numerical results of the paper show that the residual that the previous studies attribute to inefficiency includes the effects of excluded variables and of inaccuracies in the specified functional forms. Once accurate estimates of these effects are subtracted from the residual, the distortions in the measured inefficiencies should be considerably reduced. Consequently, this article considers how such estimates might be obtained.     

Where hukou status matters: analyzing the linkage between supervisor perceptions of HR practices and employee work engagement

This paper highlights the interaction between intended human resource (HR) practices as perceived by supervisors and status similarity between supervisors and employees as a key source of variation in employee work engagement among 298 employees reporting to 54 supervisors at a luxury Chinese hotel. Using a multi-level, process-oriented approach to examine the relationship between intended HR practices by supervisors and engagement as perceived by employees, we show (1) that the interaction of supervisor perceptions of HR practices and supervisor–subordinate hukou (place of origin) status similarity is positively related to employee reports of Leader–member exchange (LMX), HR practices and work engagement; (2) that the interaction of supervisor perceptions of HR practices and hukou status similarity influences employee perceptions of HR practices through LMX; and (3) that the interaction of supervisor perceptions of HR practices and hukou status similarity influences work engagement through employee perceptions of LMX and HR practices. Theoretical and practical implications are discussed.     

Real Geographies,Real Economies and Soft Spatial Imaginaries: Creating a ‘More than Manchester’ Region

This article develops a framework for analysing region‐building processes as spatiotemporal constructs, involving competing spatial imaginaries and attempts at consolidating these through institution building. Central here is the performative role of what we refer to as ‘soft space imaginaries’ in the ‘phased’ building of regions for planning and economic development over time. We demonstrate how this understanding can be used to examine the phased enactment of successive waves of region‐building by tracing the evolution of multiple soft spatial imaginaries in north‐west England. The analysis exposes the variable logics, alliances of actors, and tactics used to build momentum and secure legitimacy around preferred imaginaries which advocates often promoted on the grounds that they somehow reflected ‘real geographies’ or ‘real economies’. In this context, soft space imaginaries are seen to play an integral role in intellectual case making about the contemporaneous form and purpose of subnational governance. Yet our analysis also exposes the durability of past soft space imaginaries and their continued impact on efforts to build new soft spaces. What emerges is an understanding of soft space imaginaries as more than just superficial representations. They can help determine where government investment is channelled and into what kinds of policies.     

The Unbounded Gatherer: Possibilities for posthuman writing-reading

This article develops a posthuman approach to authorship to challenge implied distinctions and superiorities between the social and material worlds, which can detach academics and their writing from societies and ecosystems. By reimagining academic texts that are open for richer interpretation and accessible to diverse audiences, this article offers two main contributions. Firstly, I develop a conceptualisation of the posthuman author as an 'unbounded gatherer', adding to others' attempts to destabilise predominant humanistic ways of writing about managing and organizing that view authors as autonomous agents. Secondly, by developing the idea of 'mediators' as a means to explore how the sociomaterial is implicated in writing, debates about materiality in writing are extended. Through an illustration of posthuman writing, five emergent categories of mediators are analysed, and three textual practices are performed and examined.     

Regularity conditions and scope estimates: The case of large-sized U.S. banks

We consider economies and diseconomies of scope for large U.S. banks by employing ordinary and hybrid translog cost functions. We examine the regularity conditions in output space where scope estimates are calculated and reject all models for which these conditions fail. The translog model always possesses violations. For the hybrid translog, violations occur in every case except one. In this one case, we find economies of scope.     

Nationwide information services using data broadcasting

Data broadcasting offers significant advantages over conventional computer and communications networks, as a nationwide, low cost, high speed system of data distribution. Focusing on the UK, this article highlights these advantages, with particular reference to the BBC's Datacast service. Future developments in data broadcasting, such as the introduction of satellite-compatible systems, are discussed. Finally, the article analyses policy considerations on a national and international scale.     

Taxpayer resistance,guarantee uncertainty,and housing finance subsidies

In the absence of external guarantees, a private firm's debt trades in the market at rates reflective of its private default risk. Not all firms go it alone, however. There are entities, government-sponsored enterprises (GSEs), whose debt obligations enjoy federal guarantees. Federal guarantees affect housing finance indirectly in that they tend to enhance the creditworthiness of the debt obligations of the housing intermediary which lessens the debtholder's exposure to default. The market investor then becomes a willing buyer of GSE debt at a lower (subsidized) rate as a result of the government guarantee.Due to the fact that the subsidy rests on the presumption that the GSE debt will be bailed out by the government it can be seen that the subsidy in turn rests upon the presumption by the GSE debtholder that the taxpayers will honor the guarantee in the event of a GSE default. Hence, government subsidies to the housing intermediaries rest not on ongoing government outlays but rather on the confidence that the taxpayers will be willing, if called upon, to cover GSE losses, i.e., the confidence of a bailout.This article analyzes the effects on the GSE subsidy and on the taxpayer, if the debt markets charge for bailout risk. Bailout risk pricing is an economic event. When debtholders seek to protect themselves by pricing for bailout risk, this increases GSE borrowing costs and cuts into both GSE borrowers' subsidies and stockholder earnings. Higher borrowing costs leave the GSE in a weakened condition and increase the ex ante bailout cost to the taxpayer. When bailout risk premiums become priced by the market, it substantially lessens the government's ability to subsidize housing finance or other GSE activities.     

Earnings management and firm valuation under asymmetric information

This paper seeks to provide an explanation for why corporate officers manage the disclosure of accounting information. We show that earnings management affects firm value when value-maximizing managers and investors are asymmetrically informed. In equilibrium, the strategic management of reported earnings influences investors' assessments of the market values of companies' shares.