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Cost-effectiveness analysis of the use of letermovir for the prophylaxis of cytomegalovirus in adult cytomegalovirus seropositive recipients undergoing allogenic hematopoietic stem cell transplantation in Italy
No full textBackground: The aim of the analysis is to assess the efficiency of the allocation of economic resources related to the use of letermovir cytomegalovirus (CMV) prophylaxis in adult seropositive recipients (R+) patients receiving an allogenic hematopoietic stem cell transplantation (HSCT), compared with a no-prophylaxis strategy, assuming preemptive antiviral administration in both groups from the perspective of the Italian National Health Service (NHS), through a cost-effectiveness analysis. Methods: The model used is based on a decision tree which simulates on a lifetime horizon the progression of CMV infection, considering two alternatives: the use of letermovir CMV prophylaxis, followed by preemptive therapy in case of clinically significant CMV infection, or the avoided use of letermovir CMV prophylaxis, considering direct medical costs (referred to 2018) and quality-adjusted life years (QALYs), both discounted considering a 3% annual rate. Two scenarios were considered, representing the differences related to regional contexts and clinical practice of different typologies of hospitals (public or private accredited with Regional Health Services). Results: The use of letermovir prophylaxis compared with no prophylaxis strategy would lead to an increase of QALYs and direct medical costs in the two scenarios considered, with a mean increase of 0.45 QALYs, and an increase of direct medical costs of 10,222.4 € and of 10,809.9 € in the two scenarios. The incremental cost-effectiveness ratios are equal to 22,564 €/QALY and 23,861 €/QALY. The probabilistic sensitivity analysis conducted showed a percentage of results below the threshold of 40,000 €/QALY of 67.4% and 71.3%; and below a threshold of 25,000 €/QALY equal to 50.4% and to 53.0%. Conclusions: The use of letermovir CMV prophylaxis in adult R+ patients receiving allogenic HSCT, compared with a no-prophylaxis strategy, would be cost-effective for the Italian NHS considering the incremental cost-effectiveness thresholds of 40,000 €/QALY and of 25,000 €/QALY
The interaction of individual values and sticky formal institutions in economic development
No full textThis paper intends to take a step towards improving our understanding of how culture affects economic development. Relying on the theory of institutional stickiness (Boettke et al. 2008), the main hypothesis is that the "deep" cultural layer (proxied by individual values) interacts with the stickiest formal institutions in development, which leads to a very special "stuck-together" phenomenon. The aim of the paper is to investigate this specific effect empirically, and show the genuinely unique role of individual values in development. The cross-country empirical analyses provide details as regards the "stuck-togetherness" of values and institutions. Besides establishing that both values and sticky formal institutions are strong determinants of long-run income, I find that the "stuck-togetherness" of values and institutions acts as a separate factor in development, and, in addition, amplifies the impact of values on development in the good-institution countries. Another result is that better formal institutions increase the marginal income-increasing effect of those individual values that are favorable to development. The results seem to be very robust
Value creation in circular business models: the case of a US small medium enterprise in the building sector
No full textA circular business model represents a holistic system of co-evolving managerial practices for collective value creation, delivery and capture, which provide solutions for sustainable development. Previous research on circular business models aimed to understand value creation mostly in terms of a single managerial practice or in a relatively isolated manner. In particular, little is known regarding the system of managerial practices that creates value. Accordingly, this study proposes a theoretical framework characterized by a set of managerial practices in connection with relevant internal and external contextual factors for creating value within a circular business model. The framework was used in a specific case of a small medium-sized enterprise (SME) operating in building sector, which can be considered a great example of circular economy put into practice. Therefore, the explorative nature of the case allows for deep probing that helps consolidating the framework. Among the main results, essential outcomes included configuring and adapting the company's business model to particular internal and external contextual factors; valorization of local waste by harmonizing managerial practices, and socio-cultural and socio-economic settings, as well as sustainable behaviours among the actors of supply chain. This study contributes to the field of circular business models research by adopting a broader, interdisciplinary approach toward the concept of value creation. Further, it provides managers with a roadmap for creating value by enhancing the degree of circularity within a given context
A method for pricing the credit valuation adjustment of unlisted companies
No full textEstimating the credit valuation adjustment (CVA) for unlisted companies is a challenging issue because it is not possible to estimate the risk neutral default probability from either the credit default swap (CDS) par spread or equity stock. This paper proposes a calibration method that easily estimates the market risk premium, which is added to the internal rating model of unlisted companies to obtain a risk neutral default probability. The method is applied to price the CVA of a portfolio of swaps for unlisted counterparties using the advanced method approach, and the results are benchmarked using the Bank for International Settlements (BIS) approach for illiquid counterparties. Last, the robustness tests confirm the reliability of the calibration method, both for its use in risk management and accounting
Università Cattaneo research reports
No full textIl presente lavoro analizza l'esperienza di quattro giovani imprenditori, che alla guida della propria impresa di famiglia, hanno contribuito a determinare l'approccio delle medesime all'innovazione, in particolare quella collaborativa (Open Innovation: OI). Quattro sono le aree concettuali investigate (governance, contesto di business e risorse; fattori familiari - obiettivi non economici e/o atteggiamenti socio-emozionali; determinanti dell'innovazione; dimensioni dell'innovazione) al fine di esaminare le relazioni fra di esse e di spiegare come il giovane imprenditore abbia contribuito alle scelte di innovazione della propria azienda. I risultati dello studio evidenziano che i quattro giovani imprenditori sono animati da propri obiettivi non economici e/o atteggiamenti socio-emozionaliche li differenziano da quelli dei propri predecessori, e che tali obiettivi e/o atteggiamenti consentono loro di attivare una serie di leve manageriali in grado di stimolare l'OI e l'innovazione in senso lato