An empirical evaluation of two assessment methods for utility measurement for life years

Measurements of utility functions over life years provide useful information for decision making in the health care field. However, biases in the assessment procedures of utility functions is a well-known and documented phenomenon. In this paper we investigate possible biases in the assessment of utility functions when two different methods (direct and indirect assessment) are used. More specifically, we examine the estimation of utility functions over different lengths of life. The main findings, obtained from an empirical investigation in which the two assessment techniques were applied to a sample of students, are: (a) the use of the different methods does not lead to significant differences in the utility evaluation from a social point of view (health program evaluation); (b) the use of the different methods does lead to significant differences in the utility evaluation from an individual point of view (clinical decision making); (c) in both methods risk aversion was found to be common for shorter periods of time while risk prone behavior, when it exists, was found mainly for longer periods of time.     

The regulation of audiovisual content: quotas and conflicting objectives

Governments use a range of instruments to influence television content. The paper finds that under plausible conditions, content measures ostensibly designed to increase the production of certain programs may, paradoxically, reduce the size of the audience watching them. As well, quotas seemingly intended to boost the audience of certain programs, may in fact reduce their production and lower the number of viewers of these programs.      

How many karats is gold: Welfare effects of easing a denomination standard

Most consumers benefit from a lowering of the required amount of aurous metal which jewellers must include in products sold as gold. However, profits of producers of gold-plated adornments fall. The net welfare effect depends on whether the principal difference between consumers is their appreciation of the gold content, or their valuation of designation gold or gold-plate.     

Using data envelopment analysis to evaluate efficiency in the economic performance of Chinese cities

This paper studies the use of DEA (data envelopment analysis) as a tool for possible use in evaluating and planning the economic performance of China's cities (28 in all) which play a critical role in the government's program of economic development. DEA promises advantages which include the absence of any need for the assignment of weights on an a priori basis (to reflect the supposed relative importance of various outputs or inputs) when evaluating technical efficiency. It is also unnecessary to explicitly specify underlying functions that are intended to prescribe the analytical form of the relations between inputs and outputs. Finally, as is illustrated in the paper, DEA can be used to identify sources, and estimate amounts of inefficiencies in each city's performance as well as to identify returns-to-scale possibilities in ways that seem well-suited to the mixture of centralized and decentralized planning and performance that China is currently trying to use.     

Analysing the stakes of stakeholders in research and development project management: a systems approach

Research and development (R&D) project management involves managing multiple stakeholders with conflicting stakes. This article proposes a systems approach to capture such conflicting stakes of multiple stakeholders in controversial R&D projects. The approach is illustrated using a New Zealand case study related to the use of 1080 chemical for pest management. Initially, the problem situation was structured systemically by analysing the behaviour of the main variables and by conducting a stakeholder analysis. Further, a participative systems model related to the problem situation was developed using a group model‐building process. The analysis of the model revealed a set of feedback loops operating in the system identified as constituting and responsible for the complexity of the problem situation relating to 1080 use. In conclusion, the paper highlights some strategies suggested by the stakeholders to manage conflict.     

Cash Flow Risk Management in the Property/Liability Insurance Industry: A Dynamic Factor Modeling Approach

This study proposes and demonstrates a dynamic factor model that can be empirically carried out by the utilization of a factor-augmented autoregressive technique to explain and forecast the time-varying patterns of cash flows of insurance companies in the United States. A principal component approach is employed in the Factor-Augmented Autoregressive Model (FAARM) to capture the augmented factors that are to be utilized for forecasting. We describe the cash flow statistical model by a dimension-reduction technique that can depict the dynamic patterns of the cash flows of insurance firms and then measure the FAARM model. Results from the first step (principal component analysis) help capture the macroeconomic variables and the variables pertaining to insurance companies' cash flows, namely, cash flows from investment, underwriting, and risk management activities. Results from the second step offer evidence supporting that the FAARM improves the out-of-sample forecasting accuracy assessed by a forecasted root-mean-squared error (FRMSE). This article presents a set of feasible FAAR models from which an insurance firm can choose one that can be a better fit to the firm corresponding to its specific firm characteristics, such as firm size. Consequently, the chosen FAARM(s) can improve the accuracy of cash flow forecasting and thus can help insurers to manage risk via cash-flow–matching techniques.     

Capture,governance, and resilience: strategy implications from the history of Rome

Organizational resilience is a subject of great interest to management and strategy scholars. Drawing on over 1,000 years of historical data on the Republic of Rome, and focusing primarily on the period of its establishment (509 BC–338 BC), we identify two generic strategies, capture and governance, that together are essential for organizational resilience. Capture strategy relates to market expansions, while governance strategy refers to the capacity of an organization to assimilate, retain, defend, and increase its dominance within annexed markets. The history of Rome also reveals four supporting tactics—saving power, maintaining a stronghold base, isolating and weakening adversaries, and creating forward outposts—that shore up and reinforce the capture and governance strategies, to create a more enduring and resilient enterprise. Interestingly, a system‐wide view of the strategy‐tactic framework also offers insights on resilience through smallness, thus illustrating its conceptual utility to organizations of all sizes including small enterprises. Copyright © 2010 John Wiley & Sons, Ltd.     

Cost-effectiveness model of abiraterone plus prednisone,cabazitaxel plus prednisone and enzalutamide for visceral metastatic castration resistant prostate cancer therapy after docetaxel therapy resistance

Abstract

Aims: Among patients diagnosed with prostate cancer, 10–20% will develop castration-resistant prostate cancer (CRPC) within 5?years; for 70%, CRPC will metastasize, mostly to the lungs and/or liver. We performed a cost-effectiveness model comparing abiraterone plus prednisone (ABI?+?PRD), cabazitaxel plus prednisone (CAB?+?PRD) and enzalutamide (ENZ) for visceral metastatic CRPC post-docetaxel therapy resistance.

Methods: A three-state (Progression-Free, Progression, Death) lifetime Markov model was constructed to compare ABI?+?PRD, CAB?+?PRD, and ENZ from a United States healthcare payer perspective (2019?US$; discount rate 3%/yr.). Effectiveness was measured in life-years (LYs) and quality-adjusted life years (QALYs). Inputs included treatment costs, grade III/IV adverse events with incidence ≥5%, physician follow-up, lab and imaging tests. Phase III trial Kaplan-Meier curves were extrapolated to estimate overall survival and Progression-Free transition probabilities. Incremental cost-effectiveness ratios (ICERs) and utility ratios (ICURs), probabilistic sensitivity analyses (PSAs) and cost-effectiveness acceptability curves at willingness-to-pay (WTP) thresholds were estimated.

Results: Models estimated 3-year overall survival rates of 1.3% for patients treated with ABI?+?PRD, 16.2% for CAB?+?PRD, and 13.2% for ENZ. Estimated Progression-Free rates at 1.5?years were 0.51% for ABI?+?PRD, 0.27% for CAB?+?PRD, and 14.47% for ENZ. LYs and QALYs were 1.20 and 0.58 respectively for ABI?+?PRD, 1.48 and 0.56 for CAB?+?PRD, and 1.58 and 0.79 for ENZ. Total treatment costs were: $115,433 for ABI?+?PRD, $85,337 for CAB?+?PRD and $109,213 for ENZ. CAB?+?PRD and ENZ dominated ABI?+?PRD due to higher LYs gained. Incremental QALYs for ENZ vs. CAB?+?PRD were larger than incremental LYs. The ICUR for ENZ was $103,674/QALY compared to CAB?+?PRD.

Conclusions: This analysis found ENZ provided greater LYs and QALYs than both ABI?+?PRD and CAB?+?PRD, at a lower cost than ABI?+?PRD, but at a higher cost compared to CAB?+?PRD. For patients with visceral mCRPC after docetaxel therapy resistance, ENZ was cost-effective 92% of the time with a WTP threshold of $100,000/QALY.