A cost analysis of SIR-Spheres yttrium-90 resin microspheres versus tyrosine kinase inhibitors in the treatment of unresectable hepatocellular carcinoma in France,Italy, Spain and the UK

Abstract

Background and aims: A wide range of treatment options are available for hepatocellular carcinoma (HCC), including systemic treatment with tyrosine kinase inhibitors (TKIs) such as sorafenib and lenvatinib, immunotherapies, locoregional therapies such as selective internal radiation therapy (SIRT) and treatments with curative intent such as resection, radiofrequency ablation and liver transplantation. Given the substantial economic burden associated with HCC treatment, the aim of the present analysis was to establish the cost of using SIRT with SIR-Spheres yttrium-90 (Y-90) resin microspheres versus TKIs from healthcare payer perspectives in France, Italy, Spain and the United Kingdom (UK).

Methods: A cost model was developed to capture the costs of initial systemic treatment with sorafenib (95%) or lenvatinib (5%) versus SIRT in patients with HCC in Barcelona Clinic Liver Cancer (BCLC) stages B and C. A nested Markov model was utilized to model transitions between progression-free survival (PFS), progression and death, in addition to transitions between subsequent treatment lines. Cost and resource use data were identified from published sources in each of the four countries.

Results: Relative to TKIs, SIRT with SIR-Spheres Y-90 resin microspheres were found to be cost saving in all four country settings, with the additional costs of the microspheres and the SIRT procedure being more than offset by reductions in drug and drug administration costs, and treatment of adverse events. Across the four country settings, total cost savings with SIR-Spheres Y-90 resin microspheres fell within the range 5.4–24.9% and SIRT resulted in more patients ultimately receiving treatments with curative intent (4.6 vs. 1.4% of eligible patients).

Conclusion: SIR-Spheres Y-90 resin microspheres resulted in cost savings relative to TKIs in the treatment of unresectable HCC in all four country settings, while increasing the proportion of patients who become eligible for treatments with curative intent.     

The Political Economy of Rental Housing in Spain: The Dialectics of Exploitation(s) and Regulations

ABSTRACT

This paper analyses how the exploitation of tenants in Spain is boosting income for banks, hedge funds and pension funds. It does so by tracing the origins of the money invested in a Tres Cantos housing project in Madrid. The paper makes the following claims: First, the exploitation taking place in households -referred in this paper as secondary- is increasingly related to worker exploitation, and thus this particular type of exploitation is increasingly relevant to the dynamics of capital accumulation. Second, the key role of secondary exploitation of tenants in the revenue-making strategies of pension funds, hedge funds and banks is augmented and mediated by a myriad of regulations being implemented at the national and supranational scales. Theoretically, the paper contests the Marxian claim that household exploitation is ‘secondary’ to the exploitation taking place in the production process.     

Accounting regulation, inertia and organisational self-perception: Double-entry adoption in a Spanish casa de comercio (1829-1852)

This paper analyses the influence exerted by compulsory mechanisms and cognitive and social factors on the adoption and implementation of double-entry bookkeeping. The study focuses on a small, commercial and family owned company located in Spain in the period 1829-1852. As our main conclusion we suggest that the adoption of double-entry bookkeeping in 1851 was influenced more by the managers' self-perception as traders, and the belief (internal and environmental) that the company must employ an accounting method appropriate to its new commercial status, than by State pressures derived from the enactment of a new accounting regulation in 1829.     

Smart city networks' governance: The Spanish smart city network case study

The governance of smart city networks emerges as a new research area intersecting smart governance and public networks studies. This work aims to contribute to the literature on smart cities governance by studying councillor's governance in complex networks and on network performance. To carry out this analysis, the Spanish Network of Smart Cities (RECI), one of the first of its kind and an international reference for city networks, is reviewed as a case study, with the main objective of establishing a theory on its global innovation capacity and operations, together with the local level spurring influenced on its members. A PEST (Political, Economic, Social and Technological) analysis was carried out in order to assess the impact of the smart city network both at local, national and international level. This research was completed with a consultation carried out among some of RECI's municipalities. The analysis of the results shows how RECI can be considered an example of a well organised network with quantifiable savings for its members, capable of configuring future policies in local administration, necessarily related to efficiency, digitalization and citizen-centricity and with key topics to build the future. The study also suggests recommendations oriented to potential improvements that smart city networks could undertake.     

Cyclically‐Neutral Generational Accounting

This paper introduces a key methodological innovation into generational accounting. By incorporating cyclically‐adjusted balances into the forward‐looking budget projections underlying the concept, we isolate pure policy effects, which render comparisons of the fiscal sustainability indicators obtained across time and countries truly meaningful. We also show that a demographic effect and a debt effect may drive fiscal sustainability measures over time, and establish a routine to control for these effects in the generational accounting framework. An empirical application for Spain illustrates that our proposed decomposition of indicators is empirically relevant. Standard generational accounting suggests that fiscal sustainability in Spain improved substantially in preparing for EMU. However, calculation of the pure policy effects reveals that this has not been the case.     

THE RELATIONSHIP BETWEEN EXPORT STATUS AND PRODUCTIVITY IN SERVICES: A FIRM‐LEVEL ANALYSIS FOR SPAIN

This paper analyses the relationship between export status and productivity in a major service exporter, Spain, during 2001–07. I find that exporters in the services sector are 45 percent more productive than non‐exporters. This productivity premium is larger for firms that supply non‐internet‐related services than for firms that supply internet‐related services. The results show that exporters were more productive than non‐exporters before beginning to export, and also that exporting increases productivity growth; however, this positive shock vanishes quickly.     

Strategic policy revisited: The origins of mass production in the motor industry of Argentina,Korea and Spain, 1945–87

During the postwar ‘golden age’ of economic growth, Argentina, Korea and Spain promoted the development of their motor industries by restricting imports, licensing investment, imposing a high level of local sourcing for parts, and supporting their own national champions. These strategic policies took advantage of economies of scale, achieving significant increases in output, and creating dynamic competitive advantage. Sudden liberalisation or the high volatility of the macroeconomic environment could jeopardise the process of structural change. Gradual evolution of policy-making and the cumulative learning of capabilities by the national champions were crucial for long-term success. The present research supports both List's classical defence of protection for infant industries in medium–large economies and more recent claims in favour of strategic policy.     

The contribution of social tourism to sustainable tourism: a case study of seasonally adjusted programmes in Spain

Recent policy from the European Union has attempted to justify social tourism initiatives on the basis that they lead to a more sustainable tourism industry. However, the majority of latest research in the field has been focused on the benefits for participants, with the addition of some evidence on the economic impacts of such programmes on destinations, which have pointed towards sustainability outcomes including: a longer tourism season, more even spread of demand, and longer periods of employment for tourism workers. Yet there is a lack of direct evidence linking such programme to these outcomes. This paper aimed to explore this important disconnect between policy assumptions and evidence-based outcomes through an analysis of the deseasonalising effects of the Spanish social tourism programme for older people. The research found that this programme does have an effect on the seasonal nature of employment and economic activity in most regions studied, but that the huge volume of demand from international tourists in the high seasons masks the quantitative effects in the regions with the highest seasonal concentration of international tourists. Recommendations for policy and practice in sustainable tourism are made that are transferable to many countries and regions that adopt social tourism programmes.     

Gender and regional inequality in human development: the case of Spain1

In this paper, we present estimates of the Human Development Index and the Gender-Related Development Index in the Autonomous Communities of Spain. Our case study of Spain, a developed country with clear gender and regional differences, demonstrates the importance of adjusting human development indices in accordance with gender discrimination and regional inequalities. We also show the significance of the income component in assessing the development level of women in countries like Spain, where lack of employment or low remuneration are the chief characteristics of women's inequality. Our analysis makes clear that the Gender-Related Human Development Index has limited applicability in developed countries; it also illustrates the need for alternative variables or models to assess inequality in those countries.