1,207 research outputs found
The clinical effectiveness and cost-effectiveness of topotecan for small cell lung cancer: a systematic review and economic evaluation
No full textObjectives: To assess the clinical effectiveness and cost-effectiveness of topotecan as second-line treatment for small cell lung cancer (SCLC).Data sources: Bibliographic databases were searched from 1990 to February 2009, including the Cochrane library, MEDLINE (Ovid), EMBASE (Ovid), PREMEDLINE In-Process & Other Non-Indexed Citations. Bibliographies of related papers were assessed and experts were contacted to identify additional references and the manufacturer’s submission to NICE was also searched.Review methods: Two reviewers independently screened titles and abstracts for eligibility. Inclusion criteria were applied to the full text of retrieved papers using a standard form. For the clinical effectiveness review, the studies were randomised controlled trials (RCTs), which included adult participants with relapsed SCLC who responded to first-line treatment and for whom re-treatment with first-line therapy was inappropriate. The treatment was topotecan (oral or intravenous, i.v.) compared with one another, best supportive care (BSC) or other chemotherapy regimens. Outcomes included measures of response or disease progression and measures of survival. For the cost-effectiveness review studies were eligible for inclusion if they reported cost-effectiveness, cost–utility, cost–benefit or cost–consequence analyses. Data extraction and quality assessment of included studies was undertaken by one reviewer and checked by a second. Studies were synthesised through a narrative review with full tabulation of results. An independent economic model estimated the cost-effectiveness of topotecan (oral or i.v.) compared with BSC. The model used survival analysis methods to derive estimates of mean survival for patients treated with topotecan or receiving BSC alone. These were combined with quality of life (QoL) weights to derive estimates of mean quality-adjusted life expectancy for patients receiving BSC alone or topotecan plus BSC. Categories of costs included in the model included drug use, chemotherapy administration and on-treatment monitoring, management of adverse events, monitoring for disease progression and palliative care.Results: A total of 434 references were identified of which five were included in the clinical effectiveness review. In these trials topotecan was compared with BSC, CAV [cyclophosphamide, Adriamycin (doxorubicin) and vincristine] or amrubicin, or oral topotecan was compared with i.v. topotecan. No economic evaluations were identified. There were no statistically significant differences between groups when i.v. topotecan was compared with either CAV or oral topotecan for overall response rate (ORR). Response rate was significantly better in participants receiving i.v. amrubicin than in those receiving a low dose of i.v. topotecan (38% versus 13%, respectively, p = 0.039). There was a statistically significant benefit in favour of oral topotecan compared with BSC (HR 0.61, 95% CI 0.43 to 0.87, p = 0.01). Drug acquisition costs for four cycles of treatment were estimated at £2550 for oral topotecan and £5979 for i.v. topotecan. Non-drug treatment costs accounted for an additional £1097 for oral topotecan and £4289 for i.v. topotecan. Total costs for the modelled time horizon of 5 years were £4854 for BSC, £11,048 for oral topotecan and between £16,914 and £17,369 for i.v. topotecan (depending on assumptions regarding time progression). Life expectancy was 0.4735, 0.7984 and 0.7784 years for BSC, oral topotecan and i.v. topotecan respectively. Total quality-adjusted life-years (QALYs) were 0.2247 and 0.4077, for BSC and oral topotecan respectively, resulting in an incremental cost-effectiveness ratio (ICER) of £33,851 per QALY gained. Total QALYs for i.v. topotecan were between 0.3875 and 0.4157 (depending on assumptions regarding time progression) resulting in an ICER between £74,074 and £65,507 per QALY gained.Conclusions: Topotecan appeared to be better than BSC alone in terms of improved survival, and was as effective as CAV and less favourable than i.v. amrubicin in terms of response. Oral topotecan and i.v. topotecan were similar in efficacy. Topotecan offers additional benefit over BSC, but at increased cost. ICERs for i.v. topotecan, compared with BSC, were high and suggest that it is unlikely to be a cost-effective option. The ICER for oral topotecan is at the upper extreme of the range conventionally regarded as cost-effective from an NHS decision-making perspective. Further research into the QoL of patients with relapsed SCLC could identify the impacts of disease progression and treatment response.<br/
Experiencing the armed struggle : the Soweto generation and after
No full textIncludes bibliographical references (p. 354-369).This study explores the experiences of the rank-and-file soldiers of Umkhonto we Sizwe and the Azanian People's Liberation Anny. Extensive interviews by the author and other researchers reveal the voices of the soldiers themselves. The African National Congress and Pan African Congress archives at the University of the Western Cape and the University of Fort Hare supplement and verify these oral testimonies, as do some published sources. Most previously published materials about the armed struggle against apartheid have already focused on diplomacy, strategy and tactics, operations, leadership, and human rights abuses to the neglect of the soldiers' actual experiences. This study complements these with significant new oral history materials from the Soweto generation of soldiers and their successors. When dealing with MK, many authors have documented issues of the camp structure in Angola, and operations inside South Africa, so much of this detail is only addressed briefly, leaving space to explore the soldiers' experiences. In the case of APLA, very little has been written on its history, and more detail is provided on these subjects. This study therefore deals with the soldiers' politicisation and motivation for joining the armed struggle, their experiences in leaving South Africa and training in exile, the crises in exile which limited their effectiveness for a time, their return to fight in South Africa, and their difficulties in the "new" South Africa. These materials reveal that vast problems remain facing these veterans of the struggle against apartheid, and that they have the potential, if properly supported and employed, to contribute substantially to the development of present day South Africa. Conversely, if their neglect continues, they also have the potential to bring vast harm to the country. Further use of the investigative tools of oral history, especially if extended to the former soldiers' vernacular languages, is necessary to augment the history of South Africa, and these soldiers' contributions
Institutions and trade-related inequality
Get PDF© 2020 The Author. International Journal of Finance & Economics published by John Wiley & Sons Ltd. Trade liberalization is famously known for both creating winners and losers via processes of dislocation, sectoral reallocation, and specialization. This paper studies the conditions under which excess “losers” are generated during the process of liberalization with a focus on the role of institutions in economic transition. I contend that poor institutions, in particular property rights and democracy, can create unnecessary hardship in the transition to greater openness, generating a much higher burden on compensatory policies and making it more difficult to sustain open trade policies. Using a new dataset of trade openness, economic inequality, and institutions, and using 3SLS estimation to account for endogeneity, the analysis finds that this is indeed the case: high property rights and more democracy appear to help to mitigate trade-related inequality. Moreover, poor institutions create a downward spiral, with greater inequality leading to lower trade openness. These results imply that basic institutions can help to minimize losses sparked by globalization, while other well-meaning policies can actually increase disruptions
The Coevolution of Finance and Property Rights: Evidence from Transition Economies
Get PDFThe transition from communism to capitalism was necessarily accompanied by a sudden and abrupt increase in the financialization of society. This increase occurred in an environment that, even now, still has little experience with or expertise in financialization. Given that financialization occurred simultaneously with the growth and evolution of other political and economic institutions, the question arises: What was the effect on these other nascent institutions like property rights? This article empirically analyzes the relationship between financialization and property rights in transition countries. Using a unique monthly database of twenty transition countries over a period from 1989 to 2012, this article finds that the influence of financialization depends on which definition of “financialization” is used. In particular, increases in basic financial intermediation improved property rights. However, higher-order “financialization,” proxied here by the size of capital markets and the wages in the financial sector, appeared to have a negative impact on the development of broad-based property rights in transition
What is the European Central Bank supposed to do?
Get PDFIn July 2021, the European Central Bank (ECB) published a new monetary policy strategy, the first time in 17 years that it had undertaken a review of its monetary policy. In the intervening time, the world – and the economic challenges facing the ECB – have changed immensely but partly as a result of the ECB’s own maneuvering. In particular, monetary policy has been relied upon for every single malaise facing the global economy, including and up to the coronavirus pandemic. This paper argues that a review of central banks as an institutional mechanism in general, and in particular the ECB, was overdue but should not have been limited to policies; instead, an opportunity was missed to have an institutional review to examine whether or not it has been performing as intended. In particular, the vast experiment of unconventional monetary policy/issuance should have been more scrutinized from an institutional level as it appears to have contributed to the current problems the European economy faces. Europe and the ECB would be well served by taking stock of its actions over the past two decades and especially during the era of unconventional monetary policy to find a sustainable route forward
Time to full publication of studies of anti-cancer medicines for breast cancer, and the potential for publication bias: a short systematic review
No full textObjectives: To identify the expected delay between publication of conference abstracts and full publication of results from trials of new anti-cancer agents for breast cancer and to identify whether there are any apparent biases in publication and reporting.Data sources: Major electronic databases were searched to identify randomised controlled trials (RCTs) of the selected interventions for the treatment of breast cancer.Review methods: A systematic review was conducted according to standard methods. Data were extracted from the included studies using a predesigned and piloted data extraction template.Results: Six anti-cancer treatments for breast cancer were included in the review: docetaxel, paclitaxel, trastuzumab, gemcitabine, lapatinib and bevacizumab. The literature searches generated 1556 references, from which 71 publications were retrieved and screened for inclusion. Screening identified 41 publications of 18 RCTs with at least one arm of treatment meeting the inclusion criteria for the review. Of the 18 included RCTs, only four publications (from three RCTs) reported the same outcomes in both an abstract and a full publication. Time between the abstract and full publication was 5 months in two cases, 7 months in one case and 19 months in one case (overall mean delay = 9 months). Eleven trials were identified that have not currently published in a full publication the data presented in an abstract or conference proceeding. The duration between publication of the abstracts and the end of August 2007 varied from 3 months to 38 months (mean delay 16.5 months). The longest delays in publication were for trials investigating gemcitabine (38 months) or bevacizumab (33 months). Observational analysis of the published and unpublished trials did not indicate any particular biases in terms of whether positive results were more likely to be fully published than non-significant ones.Conclusions: It was surprising that only three of the 18 relevant RCTs had one or more full papers that reported the same outcome measures (and stage of analysis) as an earlier conference abstract. However, a limitation of this review is the small number of studies included. With a larger sample size than that in the present report, investigation into the effect of publication delay on decision-making might be feasible. Future research should include extension of this work to other anticancer drugs and investigation into the reasons for lengthy delays to full publication noted for some trials
Book review: the clouded view from the Oval Office
No full textAuthor reviews: Christopher Andrew, "For the President's eyes only, secret intelligence and the American Presidency from Washington to Bush
Harmony and discord within the English ‘counter-culture’, 1965-1975, with particular reference to the ‘rock operas’ Hair, Godspell, Tommy and Jesus Christ Superstar
No full textPhDThis thesis considers the discrete, historically-specific theatrical and musical sub-genre of ‘Rock Opera’ as a lens through which to examine the cultural, political and social changes that are widely assumed to have characterised ‘The Sixties’ in Britain. The musical and dramatic texts, creation and production of Hair (1967), Tommy (1969), Godspell (1971), Jesus Christ Superstar (1970) and other neglected ‘Rock Operas’ of the period are analysed. Their great popularity with ‘mainstream’ audiences is considered and contrasted with the overwhelmingly negative and often internally contradictory reaction towards them from the English ‘counter-culture’. This examination offers new insights into both the ‘counter-culture’ and the ‘mainstream’ against which it claimed to define and differentiate itself.
The four ‘Rock Operas’, two of which are based upon Christian scriptures, are considered as narratives of spiritual quest. The relationship between the often controversial quests for re-defined forms of faith and the apparently precipitous ‘secularization’ and ‘de-Christianization’ of British society during the 1960s and 1970s is considered.
The thesis therefore analyses the ‘Rock Operas’ as significant, enlightening prisms through which to view many of the profound societal debates – over ‘faith’ and ‘belief’ in the widest senses, sexuality, the Vietnam war, generational conflict, drugs and ‘spiritual enlightenment’, and race – which were, to some considerable extent, elevated onto the national, political agenda by the activities of the broadly-defined ‘counter-culture’. It considers subsequent representations of the ‘counter-culture’ as the root of a contested but enduring popular legacy of ‘The Sixties' as a period of profound cultural change
The impact of institutional volatility on financial volatility in transition economies
Get PDFWhat have been the determinants of financial volatility in the transition countries of Central and Eastern Europe and the former Soviet Union? This paper posits that institutional changes, and in particular the volatility of crucial institutions such as property rights, have been the major causes of financial volatility in transition. Building a unique monthly database of 20 transition economies from 1991 to 2017, this paper applies the GARCH family of models to examine financial volatility as a function of institutional volatility. The results show that more advanced institutions help to dampen financial sector volatility, while institutional volatility feeds through directly to financial sector volatility in transition. Democratic changes in particular engender much higher levels of volatility, while property rights are sensitive to the metric used for their measurement
Bringing the benefits of David to Goliath: special economic zones and institutional improvement
Get PDFThe theory behind special economic zones (SEZs) focuses on their role in overcoming broader policy failings in a country. This paper hypothesizes that the ability of smaller countries to reform more quickly provides a theoretical ‘missing link’ as to how SEZs can assist reform, developing the idea of SEZs as a ‘small country in a large country’. Using a new database, the paper tests this proposition by examining if SEZs have actually been able to spur on institutional improvement in large countries. Results show that SEZs do influence the institutional development of a country, contingent upon prevailing institutional trends
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