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.     

INTEREG: A Twenty-region Input–Output Model for Italy

Since the regional scale turns out to be the scale at which fiscal devolution is likely to be accomplished in Italy, and that at which trade and growth interdependencies as well as regional convergence can be most conveniently investigated, a new 20-region input–output model for Italy seems to be a useful tool of analysis. Although various regional and interregional models have been constructed since the 1950s, none has been implemented for the whole system of 20 Italian administrative regions considered in their tight mutual dependence; also, the pool approach has not been greatly favoured, even in situations where direct information on regional trade is lacking. The main purpose of this paper is to report on the structure of the model, the rather complex procedure used in the model construction and the adopted solution technique. Some space is devoted to the problems encountered in handling regional trade endogenously in an input–output setting and to a comparison between the pool approach, used in the Italian model, and other current techniques. The paper also reports on some preliminary results regarding the regional impact of fiscal policy.     

The rise of cost accounting: evidence from Italy

Accounting historians link the origins of cost accounting to the rise of manufacturing firms and, in a more detailed way, to efficiency control, pricing and decision-making problems faced in those organizations. To date, the international debate has mainly focused on practices in the USA, Great Britain and France, with little evidence available of developments in other countries, such as Italy. In this paper, the authors analyse the development of cost accounting in an Italian firm, 'La Magona d'Italia'. This iron, steel and tinplate firm, situated in Piombino, is observed over the period 1865-1940, i.e. during the central phase of the industrial revolution in Italy. We find that several factors influenced the implementation of a cost accounting system at Magona, including efficiency control, strategic decision making, and stock valuation. We also find a strong British influence on Magona's strategy, organization and information system, particularly in respect of finance, managers, technology and accounting practices. There is little evidence that Italian accounting traditions and practice played much of a role.     

Flypaper Effect and Sluggishness: Evidence from Regional Health Expenditure in Italy

In Italy, public expenditure reduction is achieved through a revision of social security and health care programs. In particular, public health expenditure control has been implemented through a reform that imposes more stringent budget rules to local governments and a considerable reduction in grants-in-aid from the central government. This paper investigates empirically whether the response to this decrease in categorical lump-sum grants from the central to local governments results in an asymmetric response to intergovernmental grants. Hard budget and soft budget constraint hypotheses are estimated by using a sample of cross-sectional and time observations covering the 20 Italian regions over the period 1989–1993. The main finding is the existence of a standard and a super flypaper effect in both models. The introduction of the soft-budget constraint hypothesis results in a stronger effect of grants and a lower response of own resources which shows that local governments prefer to incur some deficit instead of reducing health care expenditure.     

Analyzing the effect of derivatives on the financial soundness of commercial banks in Italy: An approach based on the CAMELS framework

Italian economy is among the biggest economies in the Europe which suffered from the repercussions of the global financial crisis during this last decade. The weakness of Italian banking system coincides with the common debate about the implication of derivatives in the distress of banks’ soundness. Thus, the aim of our research is to examine the effect of derivative instruments on the banks’ soundness in Italy. To reach our goal, the CAMELS approach is employed to define the soundness of Italian commercial banks. To overcome the endogeneity issue of variables, an appropriate econometric procedure, namely the dynamic Generalized Method of Moments (GMM system) is applied using data from 22 commercial banks in Italy over the period 2005–2015. Explanatory variables are defined by derivative instruments (forwards, swaps, options, and futures), bank‐specific variable (bank's size as non‐CAMELS variable), industry‐specific variables (CR3, CR5, and HHI as indicators of bank's sector and market concentrations), and country‐specific variables (GDP and inflation). The main results reveal that the majority of the CAMELS indicators are favorably affected by derivative instruments especially forwards and options. The most important conclusion is that using derivative instruments does not threaten the financial soundness of commercial banks in Italy. As major implication decision‐makers and experts—after the global financial crisis—should not consider derivatives in part as responsible of the fragility of the Italian banking system.     

Land system change in Italy from 1884 to 2007: Analysing the North–South divergence on the basis of an integrated indicator framework

Over the past centuries, land systems in Italy experienced fundamental shifts, owing to the availability of new energy forms, population surges, and technological progress. The 20th century was characterized by massive productivity increases, accompanied by gradual land abandonment and the return of forest land. We here analyze 120 years of land system change in Italy, applying the human appropriation of net primary production (HANPP) framework, a metric for socio-economic pressures on terrestrial ecosystems. HANPP allows integrating ecological with societal perspectives, by systematically quantifying (a) biomass harvest and (b) the difference between potential productivity of ecosystems and current productivity induced by land use processes, such as land conversion, or land degradation. Besides assessing national trends we calculated HANPP separately for the Italian North and South between 1934 and 2007, in order to scrutinize if high regional discrepancies in terms of natural and socio-economic preconditions translate into diverging land system trajectories. Our results show that national HANPP has been declining from 78% of natural productivity before WWII to 56% in 2007, indicating a declining land -use induced pressure on biomass flows over time. Simultaneously, biomass harvest increased by around 26% due to agricultural intensification, despite shrinking croplands. Although we found a significant difference between the Northern and Southern region in the absolute levels of several land use indicators related to biomass appropriation, the overarching trends of land system change were remarkably similar in both regions. This suggests that underlying drivers of land system change, such as policies aimed at land-use intensification and structural change were equally dominating land system trajectories in the North and South of Italy, not withstanding their socio-ecological divergences.     

Airport ownership and financial performance: Evidence from Italy

In the past few decades many countries have increased the presence of various forms of private sector involvement in airport ownership and management. This paper focuses on the financial performance of Italian airport companies. We present empirical evidence separately for two groups where public or private management majority prevails. The main findings indicate that companies with a private majority outperform the others in terms of financial indicators that are related to operating income.     

Policy tolerance of economic crime? An empirical analysis of the effect of counterfeiting on Italian trade

Some governments seem ambivalent towards economic crime because, on the one hand, there are adverse effects on competition and legal businesses; on the other hand, there are benefits through (shadow) employment and income in less-developed areas, as well as benefits through relations of political clientage. We focus on counterfeiting and its economic effects on trade in Italy during the economic crisis. Using a newly built regional dataset and a dynamic panel model, we find evidence of the dual impact of counterfeiting. The production (and exchange) of fake goods depresses the legal market that relies on intellectual property rights but supports shadow-economic activities for the benefit of illegal workers, criminal organisations, and political clientele. We show that the negative effects outweigh the positive effects.     

The food neophobia scale and young adults’ intention to eat insect products

In the coming years, the new EU Regulation on Novel Food is likely to facilitate the development of a niche market for insects and insect‐based ingredients in many European countries. In this research, the aim is to explore the relationship between willingness to try (WTT) and behavior of eating insects, where the independent variables are food neophobia, sensory property expectations, and previous consumption. In total, 88 Italian participants took part in the study. The food neophobia scale (FNS) was constructed using 9 of the 10 items from the original FNS, and a Structural Equation Modeling approach was used to test the research hypotheses. The results show that males are more open to trying insects than females, and food neophobia is negatively correlated with the willingness to eat insects. Findings also indicate that the first exposure to insects positively increases consumers’ sensory property expectations. Intention to try is a strong predictor of the behavior of eating insects. People who scored lower on the FNS were more likely to try (intention) and consequently eat insects (behavior). These findings enhance knowledge about factors which could lead to lower levels of negative prejudice and greater willingness to taste edible insects among Western consumers. Finally, some marketing implications are discussed, like the need of information campaigns to emphasize positive sensory attributes of edible insects to increase the WTT this unfamiliar food.     

Separate waste collection in mountain municipalities. A case study in Campania

This paper aims to analyse the impact of land characteristics (i.e. altimetry and housing dispersion) on separate waste collection, with a focus on mountain municipalities. The high spatial heterogeneity of the driving factors of separate waste collection allows traditional techniques, such as OLS, to offer only a partial depiction of the situation, missing important information. In this view, we perform the Geographically Weighted Regression (GWR), which allows to control for the local determinants of waste management. Our data cover 550 municipalities of Campania, in Southern Italy. We control for a set of morphological and socio-economic variables, drawn from official records for 2012. Our results show that the relationships between land characteristics and separate waste collection are not constant over space. Moreover, they suggest that in the presence of non-modifiable factors (such as land characteristics) local governments should act on citizen motivations, promoting awareness on environmental issues, and should implement time-saving collection methods.