Réflexions sur les alternatives possibles dans la prise en charge du diabète : le rôle des associations de patients

[Table des matières] 1. Introduction: 1.1 Le diabète dans le monde selon l'OMS. 1.2 La prévention et les perplexités qu'elle soulève. 1.3 La prévention primaire. 1.4 La prévention secondaire. 1.5 Les problèmes liés au dépistage. 1.6 La prévention tertiaire. - 2. Le suivi du diabète aux Etats-Unis et en France (prévalence et coûts ; les réseaux diabète et l'ANDRED en France ; etc.). - 3. Le diabète en Suisse : 3.1 Prévalence et estimation des coûts. 3.2 Potentielles économies dues à une meilleure prise en charge du diabète. 3.3 Le managed care selon la troisième révision de la LAMal. - 4. L'association des patients diabétiques: 4.1 Le soutien social et psychologique. 4.2 Le support éducatif. 4.3 Aide à l'évaluation des thérapies et des besoins des patients. 4.4 Garant de la qualité des soins et des prestations. 4.5 Consultant éventuel pour la prévention primaire. 4.6. Mobilisation en cas de problèmes urgents et graves. - 5. Motiver les acteurs: 5.1 Les motivations des médecins. 5.2 Les motivations des assureurs. 5.3 Motiver les patients à la participation. 5.4 L'empowerment du patient : chance ou piège ? Conclusion . Annexe

Risk assessment and profit sharing in business networks

Nowadays network is the preferred governance form to conduct economic transactions. Network solution allows to reach flexibility maintaining cost and quality level. Since network concept refers to a great variety of organizational hybrids it is possible to choose the one that fits better market requirements. The new trends in interorganization relationships push towards network solutions: companies are interested in relationships with partners and customers to overcome resource dependence, to enter too risky market or simply differentiate their business portfolio. The proposed research focuses on the network concept aiming at highlighting threats and opportunities to investigate the double nature of the risk concept. Network structures offer flexibility and higher profit as a consequence and business risk sharing opportunity. These two aspects (profit and risk) are strictly related and have to be considered together to depict a complete scenario; this implies that risk assessment and management in network environment cannot neglect profit sharing or, in other words, that profit sharing mechanisms should use risk as driver. In this context our research proposes a methodology to measure risk taking into account network peculiarities; risk estimation is a basic step to evaluate the opportunity cost of capital needed to compute the network Net Present Value (NPV) that is assumed as base in the profit sharing process. The profit sharing process has been tackled using the Shapley value approach that is inspired to the fairness principle while the opportunity cost of capital is assessed using the Capital Asset Pricing Model (CAPM)

A real options based support system to open innovation

Pharmaceutical R&D process (PR&DP) has been deeply investigated by different streams of literature; the interest is due to the strategic implication of the related decisions undertaken. The PR&DP has been revolutionised by the biotech advent and as a consequence R&D managers cannot avoid to consider Open Innovation paradigm during this decision process. Starting from a Real Option optimization model available in literature, the paper aims at proposing a decision support system (DSS) able to suggest the candidate products to be included in the best R&D portfolio varying input parameters (resilient products), to provide a products Pareto analysis that aims at individuating the products for which it is worthwhile to acquire a deeper input parameters knowledge and to draw what if rules. The proposed DSS has been applied to a numerical example available in literature and research findings show interesting managerial and academic implications

A real options based model to select a balanced R&D portfolio

The R&D process in the pharmaceutical industry has a long and dynamic life then it is an ideal field of application for ROA. Actually, ROA implementation, as widely demonstrated in literature, is narrowed to very limited cases because its perceived complexity. This research wants to suggest a simplified method, respect the ones available in literature, that could foster the use of ROA: we built up an integer linear programming model, based on a model available in literature, useful for selecting a balanced R&D portfolio from a set of candidate drugs. The model has been tested through a case study

Open innovation: A real option to restore value to the biopharmaceutical R&D

The pharmaceutical landscape has changed, and new business models, based on alliances, are increasingly being adopted in this industry. Biotechnology advances have pushed this development, and pooling complementary resources coming from incumbents and newcomers is a key skill to succeed: these are the premises for a quick spread of the open innovation (OI) paradigm in this industry. R&D portfolio selection needs R&D project evaluation, and Real Options Analysis (ROA) is acknowledged as a powerful tool to evaluate uncertain projects that have an intrinsic flexibility. The present research aims to foster the use of ROA in the OI field in order to encourage firms to undertake this innovation model; to achieve this goal the authors propose a closed-form model that is easy to implement, to evaluate the OI initiative for selecting an optimal R&D portfolio. The study wants to support managers in optimal R&D portfolio construction in terms of choosing the most promising products, the means by which the related project has to be undertaken (in an open or closed manner; i.e. licensing-in or not) and the self-financing policy. The proposed model can be easily implemented into a spreadsheet, and the inputs needed to run it are usually requested to evaluate projects using the most used net-present-value-based methods. Moreover, some parameters of the model allow strategic aspects to be considered: for example the nature of the project (core/non-core), the impending project phase, and the risk-sharing opportunity. The results of the developed numerical example show that the selected portfolio is well balanced in terms of development stages, core/non-core therapeutic areas and, licensing-in (an inbound open innovation solution), is preferred in the case of products at their early stages of developmen

How risk influences the choice of governance mode in biopharmaceutical inter-firm relationships

This paper proposes a new theoretical framework for assessing the influence of risk in shaping the governance form in biopharmaceutical inter-firm relationships. In particular, we propose a multidimensional operationalization of relational and performance risk and, by following Transaction Cost Economics (TCE) and Real Options (RO) theory constructs, we hypothesize a relation between the aforementioned risk components and the choice of governance form. Specifically, following TCE reasoning, we hypothesize that a high level of relational risk leads towards more hierarchical governance forms, while, following RO theory, we hypothesize that a high level of performance risk leads toward market-oriented governance forms; finally, we hypothesize a moderating effect of each risk component on the other. We empirically test our framework through the analysis of 353 inter-firm relationships signed worldwide between pharmaceutical and biotech companies from 2007 to 2010. The results show substantive support for our theoretical framework. Furthermore, we find a significant moderating effect of the performance risk on the TCE relation between relational risk and governance forms

Drivers influencing the governance of inter-firm relationships in the biopharmaceutical industry: an empirical survey in the Italian context

This paper focuses on factors influencing the choice of the governance form in inter-firm relationships (IFRs) between pharmaceutical and biotechnology companies. By reviewing the relevant literature on transaction cost economics, property right theory, real option and resources-based view, we located some drivers that might influence such relationships and we formulated a set of hypotheses linking them to governance forms. Such a theoretical framework has been empirically tested through a survey conducted among the Italian companies associated to Farmindustria. Empirical results provide some interesting insights on how shaping bio-pharmaceutical deals; we found that the developmental stage of the product/technology object of the agreement, the existence of previous collaborations between firms and the number of products marketed by the biotech company are able to influence the selection of a specific governance for

Risky choices in strategic environments: An experimental investigation of a real options game

Managers frequently make decisions under conditions of fundamental uncertainty due the stochastic nature of the outcomes and competitive rivalry. In this study, we experimentally test a theoretical model under fundamental uncertainty and competitive rivalry by designing a sequential interaction game between two players. The first mover can decide either to choose a sure outcome that assigns a risky outcome to the second mover or to pass the decision to the second mover. If the second player gets the chance to decide, she can choose between a sure outcome, conditioned by the assignment of a risky payoff to the first mover, or the sharing of the risky outcome with the first mover. We then introduce the following experimental treatments: (i) relegating second-mover participants to a purely passive role and substituting them with a random device (absence of strategic uncertainty - that is, when the source of uncertainty is a human subject); (ii) providing information about the behaviour of second-mover counterparts; and (iii) completely removing the second-mover participant.We find that decision makers are sensitive to the presence or absence of strategic uncertainty; indeed, in the presence of strategic uncertainty, first movers more often diverge from the behaviour predicted by the model. Given our experimental results, the theoretical model needs to be revisited. The standard model of monetary payoff-maximizing agents should be substituted by one of decision makers who maximize a utility function which includes the psychological cost induced by strategic uncertainty. (C) 2019 Published by Elsevier B.V