The cost-effectiveness of the SPHERE intervention for the secondary prevention of coronary heart disease

Objectives: The Secondary Prevention of Heart disEase in geneRal practicE (SPHERE) trial has recently reported. This study examines the cost-effectiveness of the SPHERE intervention in both healthcare systems on the island of Ireland. Methods: Incremental cost-effectiveness analysis. A probabilistic model was developed to combine within-trial and beyond-trial impacts of treatment to estimate the lifetime costs and benefits of two secondary prevention strategies: Intervention - tailored practice and patient care plans; and Control - standardized usual care. Results: The intervention strategy resulted in mean cost savings per patient of 512.77 (95 percent confidence interval [CI], 1086.46-91.98) and an increase in mean quality-adjusted life-years (QALYs) per patient of 0.0051 (95 percent CI, 0.0101-0.0200), when compared with the control strategy. The probability of the intervention being cost-effective was 94 percent if decision makers are willing to pay €45,000 per additional QALY. Conclusions: Decision makers in both settings must determine whether the level of evidence presented is sufficient to justify the adoption of the SPHERE intervention in clinical practice. Copyright © Cambridge University Press 2010.

Government intervention in a dynamic economy

From the late 1970s onwards, the view that government intervention could provide a means of overcoming market failure in advanced was increasingly questioned. For some, intervention was to be discouraged because it interfered with individual liberty. For others, what was problematic was the welfare economist's assumption of an autonomous state acting in the public interest. Finally, there was the issue of the state's ability to achieve what it set out to do. Government failure it was argued was just as pervasive as market failure and no antidote to it. This paper critically evaluates such arguments in relation to competition, industrial change, innovation, and competitive advantage in production.

Home is Where the Human is?:Ethics, Intervention and Hospitality in Kosovo

The human is frequently made central to the way international ethics is thought and practiced. Yet, frequently, the human can be used to close down ethical options rather than open them up. This article examines the case of British foreign policy in Kosovo. It argues that the human in this context was placed at the centre of ethical action, but was discursively constructed as a silent, biopolitial mass which could only be saved close to its territorially qualified home. It could not be protected by being brought to the UK. To remain human, the subject of ethical concern, the Kosovan refugee, had to remain near Kosovo. This construction of the human-home relationship meant that military humanitarian intervention became the only ethical policy available; hospitality, a welcoming of the Kosovan refugee into the British home, was ruled out. This article questions such a construction of the human, listening to the voices of Kosovan refugees to open up the relationship between the human and its home. The complexity that results shows that a more nuanced view of the human would not allow itself to be co-opted so easily to a simplistic logic of intervention. Rather, it could enable the possibility of hospitality as another way of practicing international ethics.

Restraing Regulatory Capture? Anglo America, Crisis Politics and Trajectories of Change in Global Financial Governance

A growing number of respected commentators now argue that regulatory capture of public agencies and public policy by leading banks was one of the main causal factors behind the financial crisis of 2007–2009, resulting in a permissive regulatory environment. This regulatory environment placed a faith in banks own internal risk models, contributed to pro-cyclical behaviour and turned a blind eye to excessive risk taking. The article argues that a form of ‘multi-level regulatory capture’ characterized the global financial architecture prior to the crisis. Simultaneously, regulatory capture fed off, but also nourished the financial boom, in a fashion that mirrored the life cycle of the boom itself. Minimizing future financial booms and crises will require continuous, conscious and explicit efforts to restrain financial regulatory capture now and into the future. The article assesses the extent to which this has been achieved in current global financial governance reform efforts and highlights some of the persistent difficulties that will continue to hamper efforts to restrain regulatory capture. The evidence concerning the extent to which regulatory capture is being effectively restrained is somewhat mixed, and where it is happening it is largely unintentional and accidental. Recent reforms have overlooked the political causes of the crisis and have failed to focus explicitly or systematically on regulatory capture.