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 conservative equal costs rule, the serial cost sharing rule and the pivotal mechanism: asymptotic welfare loss comparisons for the case of an excludable public project

We examine the asymptotic behavior of two strategyproof mechanisms discussed by Moulin for public goods – the conservative equal costs rule (CER) and the serial cost sharing rule (SCSR) – and compare their performance to that of the pivotal mechanism (PM) from the Clarke–Groves family. Allowing the individuals’ valuations for an excludable public project to be random variables, we show under very general assumptions that expected welfare loss generated by the CER, as the size of the population increases, becomes arbitrarily large. However, all moments of the SCSR’s random welfare loss asymptotically converge to zero. The PM does better than the SCSR, with its welfare loss converging even more rapidly to zero.     

Un modello matriciale per la dominanza stocastica e stocastico-temporale

In questa nota si estendono alcuni precedenti risultati dovuti a Beccacece-Castagnoli [1]–[2] e Levi [7], sulla dominanza temporale, stocastica e stocastico-temporale tra flussi finanziari, certi o aleatori, nel caso discreto e finito. Largo spazio viene anche dato ad esempi critici e controesempi.

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Summary This paper extends previous results by Beccacece-Castagnoli [1]–[2] and Levi [7] on time dominance, stochastic dominance, time-stochastic dominance for discrete, finite, deterministic or stochastic, cashflows. Last sections are devoted to critical examples and counterexamples.

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Ricerca parzialmente finanziata dal M.U.R.S.T. e dall'Università Bocconi.     

Time,space and accounting at Nonantola Abbey (1350–1449)

Accounting historians have provided several accounts of monastic life and accounting's role in it, considering important settings such as Montecassino and San Pietro abbeys in Italy and Durham Cathedral Priory in England. Research has shown how their governance arrangements and common values enabled the Benedictines to manage their monasteries in an efficient manner which was essential in tackling the misappropriation of resources by organisational actors, including abbots. Other studies have shed light on the use of practical and effective accounting practices by the Benedictines to manage their considerable wealth and pursue their spiritual and temporal goals. Nevertheless, this body of literature is yet to explicitly consider the dimensions of time and space and their relationship with accounting practices. This study begins to address this oversight by analysing the surviving accounting records of the Benedictine abbey of Nonantola in northern Italy from 1350 to 1449. In the accounting books of Nonantola Abbey linear and cyclical conceptions of time coexisted and had an impact on the way in which transactions were reflected in the accounts. At the same time, the abbey was at the centre of a complex network of accountabilities which included lay accountants, farmers and the lessees of the abbey's properties. The main characteristic of this system was not the accuracy of the records in detailing the assets, liabilities, expenses and revenue of the abbey but the maintenance of a control system to administer an extensive agricultural network and the identification of the relationships between the abbey and the stakeholders inhabiting its space.     

A new take on voice: the influence of BlackRock’s ‘Dear CEO’ letters

Review of Accounting Studies - Abstract We examine whether broad-based public engagement by institutional investors influences the behavior of portfolio firms. We investigate this question in the...     

The consequences to analyst involvement in the IPO process: Evidence surrounding the JOBS Act

The JOBS Act allows certain analysts to be more involved in the IPO process, but does not relax restrictions on analyst compensation structure. We find that these analysts initiate coverage that is more optimistically biased, less accurate, and generates smaller stock market reactions. Investors purchasing shares following these initiations lose over 3% of their investment by the firm's subsequent earnings release. By contrast, issuers, analysts, and investment banks appear to benefit from this increased bias, as optimism is more positively associated with proxies for firm visibility and investment banking revenues when analysts are involved in the IPO process.     

Identity narratives under threat: A study of former members of Arthur Andersen

This paper examines the processes by which individuals work their sense of organizational and professional identity in the aftermath of a professional failure. Drawing on twenty-five interviews carried out with former members of Arthur Andersen who mostly worked for the firm in Canada and the United Kingdom, we investigate interviewees’ identity work ensuing from the breakdown of the firm. Specifically, identity work comprises processes by which individuals reflectively seek to maintain or revise their sense of identification with the AA organization and also with the public accounting profession, along with developing self-understandings regarding causes and consequences ensuing from the firm’s collapse. Our analysis indicates that four interpretive schemes or patterns mainly characterize interviewees’ identity work: disillusion; resentfulness; rationalization; and hopefulness. Each of these patterns can be viewed as conveying a distinct representation of what “truly” happened within AA. In this sense, identity work, sense-making and truth contests are inextricably linked altogether. Moreover, the present paper underlines the pertinence of studying entangled processes of identity work and sense-making in order to better understand how broader social forces or discourses (e.g., commercialization and risk) are experienced and translated by the self in the context of identity-threatening events. That is, the identity work/sense-making nexus constitutes a relevant theoretical anchoring to study the circulation of discourses in society.