Developing a preference-based utility scoring algorithm for the Psoriasis Area Severity Index (PASI)

Abstract

Introduction: It is challenging to identify health state utilities associated with psoriasis because generic preference-based measures may not capture the impact of dermatological symptoms. The Psoriasis Area Severity Index (PASI) is one of the most commonly used psoriasis rating scales in clinical trials. The purpose of this study was to develop a utility scoring algorithm for the PASI.

Methods: Forty health states were developed based on PASI scores of 40 clinical trial patients. Health states were valued in time trade-off interviews with UK general population participants. Regression models were conducted to crosswalk from PASI scores to utilities (e.g. OLS linear, random effects, mean, robust, spline, quadratic).

Results: A total of 245 participants completed utility interviews (51.4% female; mean age?=?45.3?years). Models predicting utility based on the four PASI location scores (head, upper limbs, trunk, lower limbs) had better fit/accuracy (e.g. R², mean absolute error [MAE]) than models using the PASI total score. Head/upper limb scores were more strongly associated with utility than trunk/lower limb. The recommended model is the OLS linear model based on the four PASI location scores (R²?=?0.13; MAE?=?0.03). An alternative is recommended for situations when it is necessary to estimate utility based on the PASI total score.

Conclusions: The derived scoring algorithm may be used to estimate utilities based on PASI scores of any treatment group with psoriasis. Because the PASI is commonly used in psoriasis clinical trials, this scoring algorithm greatly expands options for quantifying treatment outcomes in cost-effectiveness analyses of psoriasis therapies. Results indicate that psoriasis of the head/upper limbs could be more important than trunk/lower limbs, suggesting reconsideration of the standard PASI scoring approach.     

Re-scaling risk governance using local appraisal and community involvement

This paper describes a risk governance model applied on a local scale, showing the advantages and constraints found during its application. The risk governance model, built on a municipal scale, results from the application of the International Risk Governance Council framework. The model is characterised by the cyclicity between the assessment and management spheres, assuming communication to be essential in all stages. Its application in central Portugal is rooted in a specific knowledge of hazards and their impacts, the human and financial constraints, and the expectations of citizens and stakeholders. The results show that preformatted management solutions derived from national civil protection stakeholders can be adapted to a local physical, social and institutional context. It was found that this depends significantly on the stakeholders’ concerns assessment, as this allows the subsequent risk management options to be adapted and legitimised. As a result, more appropriate land-use regulations and mitigation strategies are being designed, which are related to urban planning, road design, risk sensitisation and communication tools. However, two features are likely to lead to an overlapping of competences and conflicts concerning responsibility for decision-making in the actual civil protection structure: the current constraints on resources on an operational level and the potentially inadequate representation of stakeholders on a strategic level.     

Lesbian and gay expatriation: opportunities,barriers and challenges for global mobility

The research presented in this paper addresses an important gap in the expatriation literature in examining perceptions of opportunities, barriers and challenges for expatriation of lesbian and gay (LG) expatriates. This is an area that is under-researched despite such individuals representing a growing sector of the global talent pool. Based on an analysis of interviews with 20 LG expatriates, the study draws on social capital theory as a lens for highlighting LG expatriates' unique attributes and networks. The research is significant in suggesting that the expatriates' sexual minority status is viewed as both a disabler and enabler in expatriation. We suggest that there is a corporate ceiling for LG expatriates, and that they experience discrimination and stereotyping, and oftentimes limited organizational and host-country support. Significantly, the findings also extend research in suggesting that LG workers may have more opportunities in global staffing than previously thought and a valuable role in contributing to inclusivity debates and policy development on the global business stage. Furthermore, LG expatriates may be accepted in host countries when homosexuality is deemed legally or socially unacceptable for locals, and legal and financial independence within LG partnerships may provide them with more mobility than their heterosexual counterparts.     

Public–Private Sector Comparisons of Nurses’ Work Harassment Using Set: Italy and Australia

Using Social Exchange Theory, this study compared the impact of nurses’ workplace relationships with management and colleagues upon nurses’ work harassment, psychological well-being, and engagement within the public and private sectors in both Australia and Italy. Using survey data from 1,587 nurses, SEM findings indicated that public sector nurses in Australia had the lowest satisfaction with supervision, higher work harassment, and lower engagement and psychological well-being, than the other groups. The implications include that poor workplace relationships enable work harassment and therefore management upskilling is required along with changes in performance measures to ensure greater nurse well-being and engagement.     

Workplace bullying,workplace relationships and job outcomes for police officers in Australia

One alleged consequence of new public management (NPM) methods and practices, bullying, is seriously under-researched. The authors examined the impact of workplace relationships on police officer bullying and job outcomes. The quality of supervisor relationships seemed to buffer officers’ perceptions of bullying and, hence, their job outcomes. The consequences of the present post-NPM management practices are problematic, with negative implications for police officers in forming effective workplace relationships, which then negatively impact job outcomes, thereby affecting the quality of services delivered to the public.     

Negative network effects and asymmetric pure price equilibria

Portuguese Economic Journal - We show that in finite settings with identical firms and consumers, asymmetric pure price equilibria with positive profits exist. We consider a price competition...     

Algeria: A three-sector macrofiscal model for debt sustainability and growth policy analysis

In this paper, we present a dynamic general equilibrium (DGE) model to address the macrofiscal vulnerabilities and the effects of fiscal policy on growth and employment in Algeria. We first discuss the baseline scenario over the period 2021–2040. According to our baseline results, without fundamental changes in fiscal policies, even relatively high growth will not be sufficient to put public debt on a sustainable path. We then conduct four experiments and assess their impact on fiscal accounts, growth, and unemployment: an increase in the efficiency of public spending on infrastructure investment, a gradual reduction in the share of noninterest government spending in GDP, the same gradual reduction in spending combined with a permanent increase in the share of investment in infrastructure in total noninterest government expenditure, and a composite fiscal reform program that combines these individual policies, respectively. The results suggest that public debt sustainability can be achieved, and growth and employment can be promoted, as long as an ambitious fiscal reform program involving tax, spending, and governance reforms is implemented. Importantly, our quantitative analysis shows that, with a well-designed fiscal program, there may be no trade-off between fiscal consolidation and economic growth.     

Are covered bonds different from securitization bonds? A comparative analysis of credit spreads

This study compares credit spreads and pricing determinants of securitization vis-à-vis covered bonds. Our analysis reveals that although ratings are the most important pricing determinant for asset-backed securities (ABS) and mortgage-backed securities (MBS) investors place relatively more importance on contractual, macroeconomic and banks' characteristics rather than ratings in pricing covered bonds. We find evidence of a mispricing effect in structured finance markets: ABS and MBS have higher credit spreads than similarly rated public-covered bonds and mortgage-covered bonds and security prices reflect information beyond credit ratings. We find no evidence of borrowing costs affecting banks' choice between securitization and covered bonds.     

Affective commitment,home-based working and the blurring of work–home boundaries: Evidence from Germany

Analysis of data from the representative German Linked Personnel Panel revealed that, overall, the use of home-based working is associated with a higher affective organisational commitment on the part of employees. However, this is less often the case when the use of home-based working involves the blurring of work–home boundaries. Perceived trust and fairness on the part of supervisors mediates the association between employees' experiences with working from home and their affective commitment. These results show that experiences with home-based working shape employees' perceptions of trust and fairness in their exchange relations with supervisors and thus their affective commitment to the organisation. Employees' experiences with home-based working that reflect its supportive implementation by their employers and supervisors are critical for their commitment. Our results provide the first evidence that in exchange relations between employees and supervisors, perceived fairness is as important as perceived trust.