A short-term cost-effectiveness study comparing robot-assisted laparoscopic and open retropubic radical prostatectomy

Abstract

Objective:

To evaluate cost effectiveness and cost utility comparing robot-assisted laparoscopic prostatectomy (RALP) versus retropubic radical prostatectomy (RRP).

Methods:

In a retrospective cohort study a total of 231 men between the age of 50 and 69 years and with clinically localised prostate cancer underwent radical prostatectomy (RP) at the Department of Urology, Aarhus University Hospital, Skejby from 1 January 2004 to 31 December 2007, were included.

The RALP and RRP patients were matched 1:2 on the basis of age and the D’Amico Risk Classification of Prostate Cancer; 77 RALP and 154 RRP.

An economic evaluation was made to estimate direct costs of the first postoperative year and an incremental cost-effectiveness ratio (ICER) per successful surgical treatment and per quality-adjusted life-year (QALY). A successful RP was defined as: no residual cancer (PSA <0.2?ng/ml, preserved urinary continence and erectile function. A one-way sensitivity analysis was made to investigate the impact of changing one variable at a time.

Results:

The ICER per extra successful treatment was €64,343 using RALP. For indirect costs, the ICER per extra successful treatment was €13,514 using RALP. The difference in effectiveness between RALP and RRP procedures was 7% in favour of RALP. In the present study no QALY was gained 1 year after RALP, however this result is uncertain due to a high degree of missing data. The sensitivity analysis did not change the results noticeably.

Limitations:

The study was limited by the design resulting in a low percentage of information on the effect of medication for erectile dysfunction and only short-term quality of life was measured at 1 year postoperatively.

Conclusion:

RALP was more effective and more costly. A way to improve the cost effectiveness may be to perform RALP at fewer high volume urology centres and utilise the full potential of each robot.     

组织职业生涯管理激励机制探析

组织职业生涯管理作为激励员工的有效途径,具有多重激励机制。主要表现在：提高员工角色扮演能力、满足员工个性化需要、保证员工公平权、帮助员工明确目标、增强员工可雇佣能力等方面。组织职业生涯管理的多重激励机制分析对我国现阶段人力资源开发具有一定的启示。     

在BSV模型下矫正投资者对信息的认知偏差

Barberis、Shleifer和Vishny(1998)基于投资者认知市场信息过程中出现的心理偏差，解释了过度反应和反应不足现象，并在BSV模型的框架下，进一步引入了一个心理矫正中介来矫正投资者对市场信息的认知偏差。通过建立市场管理者与中介机构之间的委托一代理体制，发现确实有可能存在此类中介。市场管理者可以制定出一套针对此类中介的最优激励机制，对其进行监督管理。     

Investment decision-making under economic policy uncertainty

It is widely established that economic policy uncertainty (EPU) affects investment decisions and performance, yet research in this area has overlooked the direct property investment market. This article seeks to rectify this and proposes a multistage multilevel analytical framework to offer new insights and a richness of findings. Using a news-based measure of EPU in the United Kingdom, and controlling for economic conditions, a national-level analysis reveals some evidence of Granger-Causality between EPU and total returns, indicating that pricing is responsive to uncertainty. These findings suggest that EPU is an important risk factor for direct property investments, with pricing implications. Differences in data and performance measure are important, however, with income returns unresponsive. A micro-level investigation begins to reveal some of the asset-pricing decisions underpinning the national results, indicating investors’ concerns for income streams are consistently high, regardless of varying EPU. Pricing can also cause changes in EPU, such as in the retail and industrial markets (increasingly linked through logistics) reflecting sector-specific stakeholder groups and newsworthy issues. This evidence highlights how important it is for policy-makers to understand the complex and bi-directional relationship, that indecision can undermine investment confidence and cause investment market volatility, in turn raising EPU.     

The impacts of international tourism demand on economic growth of small economies dependent on tourism

This paper studies the impacts on economic growth of a small tourism-driven economy caused by an increase in the growth rate of international tourism demand. We present a formal model and empirical evidence. The ingredients of the dynamic model are a large population of intertemporally optimizing agents and an AK technology representing tourism production. The model shows that an increase in the growth of tourism demand leads to transitional dynamics with gradually increasing economic growth and increasing terms of trade. In our empirical application, an econometric methodology is applied to annual data of Antigua and Barbuda from 1970 to 2008. We perform a cointegration analysis to look for the existence of a long-run relationship among variables of economic growth, international tourism earnings and the real exchange rate. The exercise confirms the theoretical findings.     

浅谈经济利润对企业绩效的评价

在现实生活中,企业的经营目标是多元化的,而利润是最具有代表性的,它对企业经营绩效和决策的评价有着重要影响。本文从经济学的角度比较会计利润和经济利润对企业经营绩效和决策的评价。     

基于委托代理模型的销售人员报酬激励机制分析

以委托代理理论为基础,建立了销售人员激励的委托代理模型,通过推导,得出销售人员努力程度可以观测和不可观测下的最优激励合同,分析了销售人员激励程度的影响因素,具体探讨了企业外部环境不确定性、企业的销售管理水平和品牌影响力、销售人员的经验、能力和风险规避程度等因素对销售人员报酬激励机制设计的影响.     

A comparative multidimensional evaluation of conservation agriculture systems: A case study from a Mediterranean area of Southern Italy

To avoid the current paradoxes of the global agro-food system it is necessary to define and implement a viable agricultural sustainable model, combining satisfaction of food needs and land preservation. A possible solution can be found in a holistic production system consistent with a sustainable development model, designed to satisfy diverse “local” economies. The conservation agriculture (CA) could be a part of this model, as it includes a set of best practices available to preserve agrarian soil and its biodiversity. Briefly, we cover the CA background in Europe followed by the evaluation of its impact in terms of private/public interest, using the sustainability’s metric.To test the viability of a model based on CA in “local conditions”, we compare economic performance of different conservation practices (i.e. minimum and no tillage) to that of conventional agriculture in a typical Mediterranean environment – Collina Materana – in Southern Italy (Basilicata region). Our findings suggest that: i) CA can actually be a viable alternative to conventional systems; ii) in Mediterranean agricultural areas CA has yield advantages especially during dry years, when conservation techniques increase water supply to crops; iii) public support is needed to direct farming choices in fact without financial incentives these practices would be not widely accepted and diffused; iv) European policy makers have to recognized the positive benefits of CA and pay them as ecosystem services in the framework of Good Agricultural Environmental Conditions and the present CAP subsidies.     

Openness to trade as a determinant of the macroeconomic elasticity of substitution

Several theoretical and empirical studies on economic growth consider the macroeconomic elasticity of substitution between capital and labor as a measure of economic flexibility that depends on technological as well as institutional aspects. One institutional aspect of economic flexibility is openness to trade. I examine in a Heckscher–Ohlin model with two large countries trading intermediate goods how openness affects the elasticity of substitution. If the technology has a constant elasticity of substitution in a closed economy, opening up to trade raises the elasticity of substitution only in the country that accumulates capital at a faster rate.     

产业集聚技术溢出与创新效应的经济学分析

溢出效应表现为从外部对经济主体带来利益或损失.本文讨论了产业集聚企业间技术创新相对溢出的问题,分析了产业集聚企业技术创新溢出效应,技术溢出与企业技术创新等问题,从而探求技术溢出与保护的博弈均衡途径.