The Origin and Evolution of Chinese Lineages

I aim to understand variation in an important and historically novel socio-political institution, the Chinese lineage. There is extensive geographic variation in the historical prominence and relevance of lineages. Using ethnographic and historical-economic evidence, I construct a theory explaining lineages as risk-pooling institutions, which provide lineage members with access to land. More so, variation in regional demand for risk-pooling and/or access to land likely stems from well-studied rice-wheat agroeconomicdifferences. I test this hypothesis by examining whether lineage activity is associated with landholding size, precipitation predictability, and historically documented precipitation disasters and find support for my hypothesis.

Tenancy Laws in Berlin

Berlin is facing large increases in rent levels over the last decades. To overcome pressure on the market, the Senate of the city has repeatedly introduced rent controls. While the German Constitutional Court has found the latest rent-controlling legislation, the Price Ceiling Act of 2020 to be violating German constitutional law and hence invalid and void, there is strong economic evidence for why rent controls do more harm than good and after all even lead to a decrease in housing provided. To provide for affordable housing, the City of Berlin needs to pursue other measures that stipulate the construction of new housing: the increase and acceleration of the granting of building permits, release of shallow land and actively engage in municipal construction.

Economic Evaluation of Long-Term Survivorship Care for Cancer Patients in OECD Countries: A Systematic Review for Decision-Makers

Long-term cancer survivorship care is a crucial component of an efficient healthcare system. For numerous reasons, there has been an increase in the number of cancer survivors; therefore, healthcare decision-makers are tasked with balancing a finite budget with a strong demand for services. Decision-makers require clear and pragmatic interpretation of results to inform resource allocation decisions. For these reasons, the impact and importance of economic evidence are increasing. The aim of the current study was to conduct a systematic review of economic evaluations of long-term cancer survivorship care in Organization for Economic Co-operation and Development (OECD) member countries and to assess the usefulness of economic evidence for decision-makers. A systematic review of electronic databases, including MEDLINE, PubMed, PsycINFO and others, was conducted. The reporting quality of the included studies was appraised using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. Each included study’s usefulness for decision-makers was assessed using an adapted version of a previously published approach. Overall, 3597 studies were screened, and of the 235 studies assessed for eligibility, 34 satisfied the pre-determined inclusion criteria. We found that the majority of the included studies had limited value for informing healthcare decision-making and conclude that this represents an ongoing issue in the field. We recommend that authors explicitly include a policy statement as part of their presentation of results.

Community interventions for people with complex emotional needs that meet the criteria for personality disorder diagnoses: systematic review of economic evaluations and expert commentary

Background Diagnoses of personality disorder are prevalent among people using community secondary mental health services. Identifying cost-effective community-based interventions is important when working with finite resources. Aims To assess the cost-effectiveness of primary or secondary care community-based interventions for people with complex emotional needs who meet criteria for a diagnosis of personality disorder to inform healthcare policy-making. Method Systematic review (PROSPERO: CRD42020134068) of databases. We included economic evaluations of interventions for adults with complex emotional needs associated with a diagnosis of personality disorder in community mental health settings published before 18 September 2019. Study quality was assessed using the CHEERS statement. Results Eighteen studies were included. The studies mainly evaluated psychotherapeutic interventions. Studies were also identified that evaluated altering the setting in which care was delivered and joint crisis plans. No strong economic evidence to support a single intervention or model of community-based care was identified. Conclusions Robust economic evidence to support a single intervention or model of community-based care for people with complex emotional needs is lacking. The strongest evidence was for dialectical behaviour therapy, with all three identified studies indicating that it is likely to be cost-effective in community settings compared with treatment as usual. More robust evidence is required on the cost-effectiveness of community-based interventions on which decision makers can confidently base guidelines or allocate resources. The evidence should be based on consistent measures of costs and outcomes with sufficient sample sizes to demonstrate impacts on these.

The Past, Present, and Future of Economic Evaluations of Precision Medicine at the Committee for Economic Analyses of the Canadian Cancer Trials Group

Precision medicine in oncology poses unique challenges to the generation of clinical and economic evidence used for cost-effectiveness analyses that can inform health technology assessment. The conduct of randomized controlled trials for biomarker-specific therapies targeted towards small populations has limitations in regard to feasibility, timeliness, and cost. These limitations result in associated challenges for groups involved in the generation of economic evidence to inform treatment-related decision making, including the Committee of Economic Analysis (CEA) at the Canadian Cancer Trials Group (CCTG). We provide a high-level description and vision about the new paradigm of clinical trial design, generation of economic evidence, and novel approaches to economic evaluations necessary in the space of precision medicine in oncology in Canada. The CEA’s previous approach to precision medicine, including master protocol designs and single-arm studies, is reviewed. Methods and approaches currently under consideration by the CEA and national collaborators, such as the role of real-world and clinical trial evidence in enabling life-cycle assessment of therapies, are explored. Finally, future initiatives being planned in the space of precision medicine at CCTG, such as the incorporation of correlative studies to identify and test high-performing biomarkers in trials, are discussed.

How are mathematical models and results from mathematical models of vaccine-preventable diseases used, or not, by global health organisations?

While epidemiological and economic evidence has the potential to provide answers to questions, guide complex programmes and inform resource allocation decisions, how this evidence is used by global health organisations who commission it and what organisational actions are generated from the evidence remains unclear. This study applies analytical tools from organisational science to understand how evidence produced by infectious disease epidemiologists and health economists is used by global health organisations. A conceptual framework that embraces evidence use typologies and relates findings to the organisational process of action generation informs and structures the research. Between March and September 2020, we conducted in-depth interviews with mathematical modellers (evidence producers) and employees at global health organisations, who are involved in decision-making processes (evidence consumers). We found that commissioned epidemiological and economic evidence is used to track progress and provides a measure of success, both in terms of health outcomes and the organisations’ mission. Global health organisations predominantly use this evidence to demonstrate accountability and solicit funding from external partners. We find common understanding and awareness across consumers and producers about the purposes and uses of these commissioned pieces of work and how they are distinct from more academic explorative research outputs. Conceptual evidence use best describes this process. Evidence is slowly integrated into organisational processes and is one of many influences on global health organisations’ actions. Relationships developed over time and trust guide the process, which may lead to quite a concentrated cluster of those producing and commissioning models. These findings raise several insights relevant to the literature of research utilisation in organisations and evidence-based management. The study extends our understanding of how evidence is used and which organisational actions are generated as a result of commissioning epidemiological and economic evidence.

Health economic evidence in clinical guidelines in South Africa: a mixed-methods study

Background Evidence-informed clinical practice guidelines (CPGs) are useful tools to inform transparent healthcare decision-making. Consideration of health economic evidence (HEE) during CPG development in a structured manner remains a challenge globally and locally. This study explored the views, current practice, training needs and challenges faced by CPG developers in the production and use of HEE for CPGs in South Africa. Methods This mixed-methods study comprised an online survey and a focus group discussion. The survey was piloted and subsequently sent to CPG role players - evidence reviewers, CPG panellists, academics involved with training in relevant disciplines like health economics and public health, implementers and funders. The focus group participants hold strategic roles in CPG development and health economic activities nationally. The survey evaluated mean values, measures of variability, and percentages for Likert scales, while narrative components were thematically analysed. Focus group data were manually coded, thematically analysed and verified. Results The survey (n = 55 respondents to 245 surveys distributed) and one focus group (n = 5 participants from 10 people invited) occurred between October 2018 and February 2019. We found the most consistent reason why HEE should inform CPG decisions was ‘making more efficient use of limited financial resources’. This was explained by numerous context and methodological barriers. Focus groups participants noted that consideration of complex HEE are not achievable without bolstering skills in applying evidence-based medicine principles. Further concerns include lack of clarity of standard methods; inequitable and opaque topic selection across private and public sectors; inadequate skills of CPG panel members to use HEE; and the ability of health economists to communicate results in accessible ways. Overall, in the absence of clarity about process and methods, politics and interests may drive CPG decisions about which interventions to implement. Conclusions HEE should ideally be considered in CPG decisions in South Africa. However, this will remain hampered until the CPG community agree on methods and processes for using HEE in CPGs. Focused investment by national government to address the challenges identified by the study is imperative for a better return on investment as National Health Insurance moves forward.