A review and validation of overall survival extrapolation in health technology assessments of cancer immunotherapy by the National Institute for Health and Care Excellence: how did the initial best estimate compare to trial data subsequently made available?

Background: Validation of overall survival (OS) extrapolations of immune-checkpoint inhibitors (ICIs) during the National Institute for Health and Care Excellence (NICE) Single Technology Assessment (STA) process is limited due to data still maturing at the time of submission. Inaccurate extrapolation may lead to inappropriate decision-making. The availability of more mature trial data facilitates a retrospective analysis of the plausibility and validity of initial extrapolations. This study compares these extrapolations to subsequently available longer-term data.

Methods: A systematic search of completed NICE appraisals of ICIs from March 2000 to December 2017 was performed. A targeted search was also undertaken to procure published OS data from the pivotal clinical trials for each identified STA made available post-submission to NICE. Initial Kaplan-Meier curves and associated extrapolations from NICE documentation were extracted to compare the accuracy of OS projections versus the most mature data.

Results: The review identified 11 STAs, of which 10 provided OS data upon submission to NICE. The extrapolations undertaken considered parametric or piecewise survival models. Additional data cut-offs provided a mean of 18 months of OS beyond the end of the original data. Initial extrapolations typically under-estimated OS from the most mature data cut-off by 0.4–2.7%, depending on the choice of assessment method and use of the manufacturer- or ERG-preferred extrapolation.

Conclusion: Long-term extrapolation of OS is required for NICE STAs based on initial immature OS data. The results of this study demonstrate that the initial OS extrapolations employed by manufacturers and ERGs generally predicted OS reasonably well when compared to more mature data (when available), although on average they appeared to underestimate OS. This review and validation shows that, while the choice of OS extrapolation is uncertain, the methods adopted are generally aligned with later-published follow-up data and appear appropriate for informing HTA decisions.     

Evaluating cost center productivity

The monthly and yearly productivity summaries were developed and applied to a computer spreadsheet to aid the nurse manager in better understanding and communicating budget issues for diverse ambulatory care departments. A computerized spreadsheet using a commercially available personal computer program, such as Lotus, Quattro Pro, or Excel, can be used to more quickly and accurately track and summarize monthly budget reports. The data can be entered into the spreadsheet either manually or imported by query from the financial mainframe system. Contact your agency's finance or information department for information on how to accomplish this. Periodically acuity and resources should be measured and compared with quality monitors to maintain standards. For the past 10 years, our facility has successfully used this tool to make more informed decisions by identifying trouble spots early, and taking corrective action to avoid crisis management.     

Information Unraveling Revisited: Disclosure of Horizontal Attributes

This paper analyzes in a spatial framework how much information a seller discloses about the variety he sells when he faces a buyer with a privately known taste for variety. I identify an equilibrium in which, for each possible variety, the seller's optimal strategy consists of either fully disclosing the variety or disclosing how far it is from the buyer's expected taste. The set of varieties the seller fully discloses monotonically expands as the buyer's taste for variety becomes stronger. I show that this is the unique undefeated equilibrium. From a policy perspective, mandating full disclosure is socially harmful.     

Spatial interaction modeling of interregional commodity flows

Drawing from both the spatial price equilibrium theoretical framework and the empirical literature on spatial interaction modeling, this paper expands models of interregional commodity flows (CFs) by incorporating new variables and using a flexible Box-Cox functional form. The 1993 US commodity flows survey provides the empirical basis for estimating state-to-state flow models for 16 commodity groups over the 48 continental US states. The optimized Box-Cox specification proves to be superior to the multiplicative one in all cases, while selected variables provide new insights into the determinants of state-to-state CFs.     

Are Hodrick-Prescott `forecasts' rational?

We evaluate the usefulness of the Hodrick-Prescott (HP) filter as a proxy for rational expectations, using long runs of annual US inflation data. Our conclusion is that while the HP series are not fully rational in the sense of Muth (1961), they do generally meet the criterion of `weak rationality' recently proposed by Grant and Thomas (1999). They are also rational proxy predictors of direction for, following Merton (1981), agents would not change their prior in the opposite direction to these `forecasts'. However, smoother HP `forecasts' are more prone to inefficiency and less useful predictors of direction. First Version Received: May 2000/Final Version Received: May 2001     

Sequential facility location with distance dependent demand

Systems providing identical service to many population centers frequently face the issue of where to locate the next retail outlet, branch, store, etc. In such systems the demand for the facilities' service depends mainly on the distance between facilities and customers. It is assumed that there are already m facilities located on a network to respond to the demand at the nodes. The paper addresses the problems of finding a location on the network for the (m +1 )st facility corresponding to a given total expected demand and of determining which demand points will be served by which facility. Also the range of the total expected demand values that can be realized along each link in the m +1 facility system is determined. Examples and a discussion of the results are provided.     

Operational competitiveness ratings of production units

The operational competitiveness of a production unit (PU) where resources are transformed into outputs of goods and services is a very important component of its overall competitiveness. A PU's operations are comprised of a number of purposeful activities that consume resources and generate rewards. The efficiency with which these activities are carried out determines the PU's operational competitiveness. A reliable rating system is prerequisite in order to control and improve operational competitiveness. In the present paper we adopt a multi-activity view of the concept of operational competitiveness and develop a procedure to calculate ratings to help gauge the relative operational competitiveness of a set of PUs. The procedure is based on a nonparametric model but its implementation involves simple ratio-type computations. The principal criteria for the procedure and the ratings resulting from its application are intuitive appeal, transparency, ease of computation, robustness and ability to reflect the prevailing managerial perspectives and competitive priorities. We demonstrate the application of the procedure to gauge the relative operational competitiveness of a major chartered bank's branch personnel.