In the US and UK, saving and borrowing routines have changed radically and become closely bound-up with the capital markets of global finance. As mutual funds have increased in popularity and pension ...provision has been transformed, many more individuals and households have come to invest in stocks and shares. As consumer borrowing has risen dramatically and mortgage finance has been extended to those deemed sub-prime, so the repayments of credit card holders and mortgagors have provided the basis for the issue and trading of bonds and other market instruments. The Everyday Life of Global Finance explores the unprecedented relationships that now bind society and the markets, challenging the dominant tendency to simply position recent developments in Wall Street and the City of London at the centre of contemporary finance. Grounded in literature from the sociology of finance and international political economy, drawing on the social theory of Callon, Foucault, and Latour, and informed by extensive empirical research, the book shows how global finance has become mundane and ordinary in Anglo-America. Finance is not 'out there somewhere', but is embedded in the calculative technologies and performances of reconfigured saving and borrowing networks, and is embodied through the assembly of everyday financial identities and self-disciplines. Society's new-found relationships with the financial markets are also shown, however, to be marked by stark inequalities, manifest contradictions, and political dissent. The Everyday Life of Global Finance is thus an ambitious and innovative contribution to our understanding of the contemporary financial world. Available in OSO: http://www.oxfordscholarship.com/oso/public/content/economicsfinance//toc.html
‘Crowdfunding’ is a method of raising money and finance to capitalize projects of various kinds. Drawing on the networking capabilities of the internet and software platforms, those seeking project ...funding appeal to potentially diverse audiences who are collectively referred to as ‘the crowd’. What practitioners, advocates and policymakers typically identify within crowdfunding is its ‘alternative’, ‘disruptive’ and ‘democratizing’ qualities; that is, it is held to be a novel, digitally rendered economic space which has the capacity to challenge established funding practices in banking, capital markets and venture capital networks, offering a more open and egalitarian source of capital for economic, social and cultural entrepreneurship. The paper develops the concept of ‘ecologies’, drawn from the geographies of money and finance literature, to advance a critical understanding of the crowdfunding economy that is sceptical of its apparent qualities. First, by encouraging the analysis of diverse and proliferative monetary and financial forms, the concept of ecologies enables an understanding that avoids the binary opposition of ‘capitalist/alternative’ economic forms and which differentiates between the variegated crowdfunding ecologies that have emerged to date. Second, by foregrounding the intermediation processes and credit–debt relations of monetary and financial ecologies, it is argued that crowdfunding may largely replicate rather than disrupt the extant institutional and debt dynamics of funding practices. Third, by emphasizing the socio-spatial effects of monetary and financial ecologies, attention is drawn to the need for further research into the unevenness that mitigates against crowdfunding being as open and egalitarian as its advocates claim.
One of the more unfortunate features of health technology assessment is the tenacity with which leaders in the field and organizations such as the International Society for Pharmacoeconomics and ...Outcomes Research (ISPOR) and the Institute for Clinical and Economic Review (ICER) cling to an evaluation framework that fails to meet the standards of normal science. Believers subscribe to a meme that is clearly non-science (metaphysics and pseudoscience) and one that should have been discarded over 30 years ago. Certainly, subscribing to an impossible belief is not unusual; indeed it may make the belief that much stronger. Yet the meme is non-sustainable; it is also pointless as the economic evaluation claims are non-evaluable. There is no acknowledgement of the standards of normal science or the limitations imposed by the axioms of fundamental measurement. The purpose of this commentary is to make the case that the recent release of the Consolidated Health Economic Evaluation Reporting Standards 2022 (CHEERS 22) checklist is misleading; CHEERS 22 fails to address the manifest deficiencies in the approach to economic evaluations endorsed by ISPOR and ICER. Instead, it continues to promote economic evaluations in healthcare that invent evidence and non-empirically evaluable value claims. Given the widespread publicity that has accompanied the release of CHEERS 22, the purpose of this commentary is to detail the deficiencies in CHEERS 22 and propose an alternative framework for economic evaluation in health care to meet the information needs of formulary committees. This means abandoning the standards for economic evaluations that have dominated health technology assessment for 30 years, notably the key role assigned to the mathematically impossible quality adjusted life year (QALY). The proposed new start recommends single attribute evaluable value claims that meet ratio or interval measurement standards and are supported by evaluation protocols.
The current standards for health technology cost-effectiveness assessment rest on the creation of lifetime assumption-driven modeled simulations for imaginary pricing and consequent patient access ...recommendations. A recent
BMJ paper reports a detailed assessment of 8,192 cost-effectiveness analyses, concluding that industry-sponsored modeled claims were more likely to publish incremental cost-effectiveness ratios (ICERs) below a USD 50,000 threshold than non-industry sponsored studies, supporting the claim that the product was cost-effective. This is unsurprising; indeed, the opposite can occur with a modeled claim deliberately resulting in ICER is excess of USD 50,000. This methodology is well entrenched with the recently published Consolidated Health Economic Evaluation Reporting Standards (CHEERS) 2022 guidance for creating imaginary cost-effectiveness modeled claims ensuring the opportunity for deliberately manipulated cost-effectiveness claims. This overlooks limitations imposed by fundamental measurement, rendering assumption-driven simulations redundant analytical exercises. Manipulation of ICERs and claims for cost-effectiveness are mathematically impossible; including cost-utility thresholds, because the preference or utilities supporting creation of quality-of-life years (QALYs) are ordinal scores. Nevertheless, with the promotion of CHEERS 2022, the belief in imaginary modeled value claims is both facilitated and reinforced. With CHEERS 2022, there is a concerted effort, largely in self-interest, to perpetuate the current belief system. This is a self-defeating strategy. Rather than admitting to the deficiencies of assumption-driven simulated imaginary claims, leaders are maintaining that health system decision makers can ignore standards of normal science and fundamental measurement in value claims for pharmaceutical products. This disregard of standards that are commonplace in the sciences and mainstream social sciences perpetuates the opportunity for self-serving modeled claims; where models are a marketing vehicle leading to sponsored systematic bias in formulary submissions. This supports the need for a NEW START paradigm for health technology assessment, focusing on evaluable single-attribute value claims, meeting the required standards for normal science and fundamental measurement.
This empirical qualitative study explores the role of gaming simulations in catalyzing changes to organization-wide management’s perspectives on a novel strategy for aircraft orders and retirements. ...A large US airline developed the new strategy to tackle the pervasive problem of profit cyclicality, driving poor average profit performance across the cycle. Based on the dynamic model used to develop the strategy with senior management, a gaming simulation workshop was designed and delivered in groups of 20 to over 200 organization-wide managers. They tested various strategies for aircraft orders and retirements, under scenarios for market demand and conduct for competitors and regulators.
A qualitative methodology was used to capture the workshop participants’ perspectives on the efficacy of various capacity strategies, before, during and after the workshop. The findings are that managers experiment risk-free with innovations in strategies for capacity orders and retirements and they do indeed discover for themselves that there are counterintuitive alternatives that can achieve large and stable profitable growth. These strategies depend on competitors (role-played by workshops participants in the simulation) cooperating to create a win-win equilibrium. Performance far exceeds the industry benchmark profit cycle.
The contribution is the empirical evidence of the effectiveness of gaming simulations to catalyze managers’ shared beliefs and buy-in to a new strategy or business model. There are implications for practitioners in airlines and other sectors on the use of a gaming simulation workshop toolset, to help create such buy-in for an emerging strategy or business model. Protocols for best practice gaming simulation workshop design are discussed.
Outcomes based payments contracting is in its infancy. The increased attention being given to rare disease place a premium on the ability to engage with payers to ensure that there is an analytical ...framework relevant to value claims contracting. Rare disease is not, of course, alone; many other chronic disease states may be suitable candidates and have been over the past 10 years or more. Rare disease, however stands apart: (i) the evidence base at product launch is limited; (ii) the therapy costs are often considered prohibitive; and (iii) the target patient population is small. At the same time, those seeking to implement an evidence-based engagement with health systems to support innovative rare disease interventions face a substantive technology assessment barrier. The focus in health technology assessment on assumption driven modeled cost-effectiveness simulations that support imaginary recommendations for cost-effective pricing and access is, however, an avoidable barrier. In the US, this barrier is the business model of the Institute for Clinical and Economic Review (ICER) and one endorsed by the International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Rare disease can be better served with other tools at our disposal with a proposed new start analytical framework in health technology assessment. The purpose of this brief note is to make the case that this proposed new start focused on single attribute value claims that meet the standards of normal science and fundamental evidence can not only dispense with the ICER imaginary modeling but, with a new start formulary submission package, integrate value claims with assessment protocols to set the stage for effective outcome-based contracting as the default standard for future payer negotiations.
Medicaid formulary committees and other gatekeepers face a difficult task. On the one hand they can utilize technical expertise in evaluating the real world evidence for clinical, quality of life and ...resource utilization claims for competing products while on the other hand they may be asked to assess claims built by simulation models for pricing and product access. A common option has been to take modeled claims from third parties such as the Institute for Clinical and Economic Review (ICER) at face value without challenging the model structure, its assumptions and its incremental cost-per-QALY claims set against competing products or the existing standard of care. Unfortunately, from the available evidence, it seems clear that many formulary assessment groups, last but not least those for whom the ICER modeling claims are targeted, have little if any appreciation of the limitations of ICER modeling. There are two substantive issues: (i) a failure to appreciate the limitations imposed by the standards of normal science for credible, empirically evaluable and replicable product claims and (ii) an understanding of limitations imposed by the axioms of fundamental measurement. In the latter case, a failure to recognize that the quality adjusted life year (QALY) is an impossible mathematical construct (hence the I-QALY). To these limitations should be added the potential for constructing competing imaginary claims. Surprisingly, ICER has provided the ideal opportunity to construct competing claims with the launch in late 2020 of the ICER Analytics cloud platform. Formulary committees and other health decision makers should be aware that claims based on the ICER Analytics platform together with competing lifetime modelled claims all fail the standards of normal science. Factoring these into formulary decisions is not only misguided but may have unintended consequences for pricing and access that may disadvantage significantly patients and caregivers. We have spent too much time debating the merits or otherwise of the I-QALY for targeted patient groups with the parties failing to recognize that the focus on simulated cost-per-I-QALY value assessments is a mathematical folly; I-QALY claims are a chimera. The I-QALY, at long last, should be abandoned together with modelled lifetime simulations. Medicaid formulary decision makes should rethink the required evidence base for formulary decisions and negotiations. Care should be taken to revisit previous negotiations where ICER recommendations have been utilized to support pricing and access.
It has been noted on numerous occasions that modeled claims for cost-effectiveness, if driven by assumption for the lifetime of a hypothetical patient population, can be easily 'gamed' to create a ...required claim. These marketing exercises to support product entry are all too common in the literature. The institute for Clinical and Economic Review (ICER) in its launch of the ICER Analytics platform has provided a framework to support precisely these activities. Following the mainstream methodology in health technology assessment, the ICER Analytics platform facilitates the creation of approximate information to support formulary decisions. This is an odd development because it undercuts ICERs belief that it is the key arbiter in health technology assessment in the US, setting the stage for pricing and access recommendations. With the release of the ICER Analytics platform, others can now customize the 'backbone' ICER model in a disease area (i.e., change assumptions) to develop alternative and competing value assessments and 'fair' price claims. The problem is, of course, that without a reference point, there is no basis for comparing modeled claims other than through challenging assumptions. Indeed, ICER has made this easy by reducing barriers to lifetime model building so that manufacturers and others can create competing (and confusing) claims within, literally, a few minutes. ICER will then become one of a multitude of competing voices for the attention of formulary committees and other health decision makers; letting a thousand imaginary models bloom where no model can be judged on the basis of credible, empirically evaluable and replicable product claims.
Understandably, after 30 years of ignoring the axioms of fundamental measurement, advocates of creating approximate information through the construction of lifetime cost-per-QALY worlds are somewhat ...unnerved by the realization that their methodology is incompatible with those axioms. This is made all the more unnerving when it is pointed out that this incompatibility was pointed out over 30 years ago, following the formalization of those axioms almost 80 years ago. Why this was overlooked is a mystery. The result was a commitment to the application of ordinal utility and other patient reported outcome measures to support claims for response to competing therapies; most egregiously, the advocacy of cost-per-QALY lifetime models and willingness to pay thresholds to support recommendations for pricing and access to pharmaceutical products and devices. Although this incompatibility has been pointed out in respect of simulation modeling, to groups such as the Institute for Clinical and Economic Review (ICER) they press on, producing evidence reports and recommendations for emerging products that fail the standards of normal science. While these are an analytical dead end, ICER has nowhere else to go. This is their business model; to admit otherwise would mean withdrawing their many evidence reports and admit they were wrong. ICER has rejected this; rather it has decided, together with its academic consultants, to challenge the axioms of fundamental measurement, to produce a parallel measurement universe that can sustain QALYs and the imaginary simulation lifetime models. The purpose here is to make clear that ICER is manifestly wrong and that there is no way it can maintain its credibility in pursuing this path. This is achieved by a deconstruction of the arguments put forward by ICER to defend its new vision of the axioms of fundamental measurement, a vision which provides a case study in the distinction between justified belief and opinion. Fortunately, we have the framework for a new paradigm in value assessment; a paradigm that recognizes the standards of normal science and rejects belief in an alternative reality consistent with fundamental measurement axioms.
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