RSS 1.0Doctoral Dissertations
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The market access of complementary diagnostics, precision medicine reimbursement policies and value assessmentPrecision medicine relies on two technologies jointly working together to deliver benefit to patients, a medicine on the one hand and a diagnostic on the other. The diagnostic's purpose is to identify the right patient population for the medicine, and could be considered complementary to the use of the medicine. In recent years the market access of these complementary diagnostics has been scrutinized as being inadequate to ensure time access for patients. This thesis has delved into this issue and, as indicated in Chapters 1 and 2, sought to gain insights in these market access hurdles and gain a better understanding of the value derived from complementary diagnostics for our healthcare system. Chapter 3 delves into the reimbursement policies of complementary diagnostics (such as companion diagnostics). It identifies the reasons why the reimbursement issues of complementary diagnostics, and specifically companion diagnostics have emerged across European countries. In this study several issues with the standard in vitro diagnostic reimbursement pathways were identified across eight European countries, that consequently have risen to prominence when precision medicine was gradually introduced into healthcare systems. Several alternative reimbursement approaches were identified, specifically for companion diagnostics in Germany and Belgium and more broadly for complementary diagnostics in France. Chapter 4 examines the Belgian healthcare payer's health technology assessment of precision medicines with companion diagnostics. This research formulated several recommendations that could enhance the assessment practice under the novel reimbursement pathway for precision medicines with companion diagnostics in Belgium, as identified and discussed in chapter 3. Specifically, the introduction of the linked-evidence approach was recommended to be introduced in the assessment practice as many companion diagnostics lack the necessary direct evidence to establish their clinical utility. In Chapter 5, a study on the interaction between the biomarker that is identified by the diagnostic test, and the precision medicine is discussed. This interaction can also be referred to as the 'precision mechanism'. In this chapter we introduce the use of a novel performance parameter that examines directly what is at the heart of precision medicine; The ability of the diagnostic test to identify patients who are more likely to respond to treatment. These novel parameters convey the probability that a patient belonging to a specific subgroup will benefit from precision therapy or not. We applied these novel parameters to European medicine agency's approved precision medicines. The result of this analysis shows that not every companion diagnostics, or therefore precision mechanism, provides the same clinical utility, and that this differentiation could inform reimbursement decision making. Chapter 6 covers a systematic review on the use and adoption of assessment frameworks for complementary diagnostics such as omics technologies, by health technology assessment agencies. Many of these frameworks have been published, however none have seen their wide scale adoption by health technology assessment agencies. When looking at the health technology assessment reports on these technologies, the most recurrent elements under assessment were the clinical utility and the cost-effectiveness of these types of tests. Concepts such as ethical, social, and organisational aspect were often not considered. Specifically for organisational aspects, this could be of concern, as the specific context in which a test is implemented determines its clinical utility and therefore its cost-effectiveness. In Chapter 7 this issue is further illustrated. The working hypothesis of the study is that specific contextual factors influencing the clinical utility of a test (e.g., level of training by the treating physician, local clinical guidelines, experience level, etc) will therefore influence the cost-effectiveness, and hence the value perception of the test, which is expressed through the value-based price at a certain willingness to pay threshold. The study collected a range of published clinical utility scenarios across countries and healthcare systems. These scenarios were consequently inputted into a cost-effectiveness model with all other variables kept the same. The results showed that there is a range of outcomes where either the test can be seen as extremely valuable to the current clinical practice and others where the test adds not much additional benefit tot the current practice. This finding has its implications if one is to consider value-based pricing mechanisms as a pricing methodology for complementary diagnostics. In summary, this work took a closer look at the policies forming the market access of complementary diagnostics together with a specific focus on their clinical utility, how it is established, how it can be interpretated through probabilistic performance parameters, how its interpretation has implications for reimbursement policies and finally how contextual factors determining the clinical utility influence the value perception of these tests.
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Strategic decision making in entrepreneurial firms: A coalitional viewWhen entrepreneurs are asked about their ventures’ estimated chances of growth and survival, they typically tend to be much more optimistic than what statistics would suggest. Both theory and empirical evidence support this view of entrepreneurs being unduly positive about their future venture prospects. Entrepreneurs create forecasts for making a wide variety of decisions such as sales and financing decisions. Errors or positive biases in these forecasts have been shown to substantially decrease venture performance. Far less attention, however, has been spent on how such errors affect important external stakeholders. In this project we focus on one particularly relevant stakeholder for entrepreneurial ventures, being their venture capital (VC) investors. VCs are one of the earliest resource providers to entrepreneurial ventures. Moreover, entrepreneurs’ forecasts about the future venture performance are what VCs rely on to inform their decisionmaking, both prior to and after the investment has been made. Given the importance of forecasts and the accuracy therein to VCs, this project will examine (1) when entrepreneurs provide more positively biased forecasts to their VCs and (2) how VCs react to positive bias in VC-backed ventures.
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Linguistic cues in online product reviewsOnline product reviews ("reviews" hereafter) are prevalent and valuable. Because of that, a large stream of research in marketing investigated reviews under the following three main topics: 1) the role of review writers, 2) the role of review readers, and 3) the role of linguistic cues in reviews. This dissertation further builds on this stream and proposes three new angles that were under-researched. Specifically, we compose three essays that focus on 1) the intents of review writers to write a review based on linguistic cues and their impact on perceived review helpfulness, 2) the effect of humanlike linguistic cues on perceived review helpfulness, and 3) the usage of emotional intent based on linguistic cues in fake reviews and its impact on review trustworthiness. All three essays are structured under the same pattern to use linguistic cues as a tool to provide a unique solution for the related issues in reviews from both writers' and readers' perspectives.
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A constitutive view on entrepreneurship through acquisition : Towards a conceptual frameworkThe purpose of the thesis is to analyze the phenomenon of “Entrepreneurship through Acquisition” or ETA. An ETA transaction as opposed to a buyout is defined here as a smaller and more entrepreneurial version of the classical leveraged management buy-in. Previous research on entrepreneurship and transitions into entrepreneurship, have always been predominantly focused on start-up entrepreneurship. ETA is a relatively widespread phenomenon and an alternative way to become an entrepreneur. The main focus here lays onthe study of the middle-aged senior (nascent) ETA entrepreneur. Besides making a typology of the nascent and actual ETA entrepreneur, the influence of different forms of entrepreneurial capital and the likelihood of ETA entrepreneurial entry has been analyzed in the first part of the thesis. While work and/or managerial experience, prior start-up or shareholdings and parental background do not have a significant impact on the likelihood of becoming an ETA entrepreneur, self employment, the higher the amount an ETA entrepreneur is prepared to invest and a certain age do increase the odds of acquiring a company. A second part of the thesis analyzes the investment criteria of an ETA manager, while comparing them between nascent and actual ETA managers and comparing them with the IC of other types o similar investors like private equity (LBO and MBI), venture capital, business angels and search funds. The latter and the MBI investors being the most similar. “Potential market growth”, “professionalization and improvement potential”, as well as “stable demand and recurring customers” were found to be the three most important investment criteria, showing little differences, except for “location” and “technology”, between the nascent and actual ETA entrepreneur. Three criteria, i.e. “potential market growth”, “technology” and “sales turnover” have the strongest significant influence on whether a company finally gets acquired or not. A third part of the thesis measures the social identities of the (nascent) ETA entrepreneurs and their impact on the nascent-active gap. Using the framework of Fauchart & Gruberfor founder identities measured by the scale developed by Sieger et al., the Darwinian founder social identity is the predominant social identity of the (nascent) ETA entrepreneur. On the other hand, no significant relationships between one of the social identities and the likelihood to actually become an active ETA entrepreneur in a given time period compared to when they do not have this identity, were found.
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Value and Marketability - Determinants of the discount for lack of marketabilityThe valuation of private companies is a matter of interest for many stakeholders, including valuation professionals, auditors, courts, and tax authorities. The matter is deceptively complex, notably because there is no consensus on the nature, size, and determinants of the so-called discount for lack of marketability (DLOM). The DLOM can be defined as an amount or percentage deducted from the value of an ownership interest to reflect the relative absence of marketability. Indeed, most valuation methods lead to value indications for a marketable interest, and it is generally accepted that investors attach a lower price to assets that are not readily marketable. The DLOM is oftentimes oversimplified as the difference in value between an illiquid (unlisted) stock and an all-else-equal liquid (listed) security. This value gap is important but ill understood. Leading scholars have noted time and time again that fair market value calculations often boil down to taking a marketable value estimate and reducing that amount by a contrived percentage. In practice, DLOMs of 20% to 40% are routinely used for valuing private businesses. The extant literature has proposed various DLOM estimation methods that fall into two broad categories: theoretical and empirical models. All of these models have been challenged, either because they require the input of information that cannot be objectively determined for private companies (theoretical models), or because estimates based on the comparisons between liquid and illiquid valuation subjects are by nature always imperfect and thus prone to discussion (empirical models). Nevertheless, and in the absence of better information, the empirical models, especially, have received lots of attention and the averages presented in these studies are often used in practice without much formal reasoning or economic justification. In order to shed more light on the determinants of the DLOM we have turned to an alternative source of information that can bring additional insights. Specifically, we have turned to court decisions that decide on private company valuations, including the DLOM to be applied. The court typically justifies its decision by referring to how the specific company is situated, and the rights and obligations attached to the valuation subject. This contextual information provides more background than the pure financial information that can be found in traditional data sources. This method which combines elements of qualitative and quantitative analysis has allowed us to demonstrate that the company’s ownership structure, its operations, the transfer restrictions on shares, the exit possibilities for shareholders, and the level of control attached to the valuation subject have a significant impact on the DLOM.
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Essays in financial innovation and sustainabilityThe scope of this dissertation is to observe three of the most prominent trends of this era and to present innovations that could inspire both academics and businesses. There is an urgent need to improve the traditional ways in which the markets operate to achieve financial growth while respecting the environment and the society. The third and fourth manuscript tackle directly the topic of sustainable development through the lenses of SMEs. The first manuscript offers evidence related to the development of FinTech entrepreneurship in a market. Through FinTech and sustainability might appear unrelated at first, their simultaneous development could support achievement of a sustainable economy. FinTech could foster the availability of green finance, which is necessary to the capital-intensive sustainability transformation (Vergara and Agudo, 2021). FinTech supports the sustainable development not only through green finance but also by providing financial resources to underrepresented groups, hence promoting financial inclusion (Arnert et al., 2020). Both FinTech and sustainability are relatively recent trends, hence this dissertation, which focuses on financial innovation and sustainability, oughts to provide evidence for both considering their increasing dependency and relevance.
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Essays on the future of employee mobilityIn this dissertation, we empirically examine a new model of employee mobility in large, hierarchical organizations. Our focus is on three guiding questions: (1) What processes are replacing conventional mobilization and development approaches? And what technologies are expected to play a key role therein?; (2) What technology design are organizations applying to revise their approaches to employee mobility and development?; (3) How do employees experience individual work and development in these new marketplaces of work? We find that traditional mobility models are being replaced by more nimble and market-like forms of mobility that provide employees unprecedented opportunities to self-direct their careers within their broader organization. We emphasize both the theoretical and practical implications of our findings and identify several areas of future inquiry.
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A social-psychological perspective on angel investment decision-makingAcademics and practitioners have all often claimed that acquiring resources is a challenging task that entrepreneurs need to overcome to develop their ventures (e.g., Stinchcombe, 1965). This challenge is particularly acute for young, high-growth potential ventures because they often involve unproven technologies or business models (e.g., Berger & Udell, 1998). Angel investors are a primary source of early-stage (i.e., seed and startup) risk capital available to such entrepreneurs, and tend to come in after entrepreneurs have depleted their personal savings and money from family and friends (e.g., Drover et al., 2017). Many highly successful companies such as Zoom, Airbnb, Google, Starbucks, The Body Shop, Innocent Smoothies, and Showpad have all been backed by angels. The pitch represents a critical first step towards raising interest among angel investors and securing much-needed funding (e.g., Chen et al., 2009; Kanze, Huang, Conley, & Higgins, 2018; Maxwell, Jeffrey, & Lévesque, 2011). The pitch is a decisive moment in entrepreneurs' quest for money as investors reject 70 to 90 percent of pitches (e.g., Chen et al., 2009; Huang & Pearce, 2015; Maxwell et al., 2011). This dissertation contributes to the growing stream of research that examines angels' investment decision-making. By drawing on theories from social psychology literature, this dissertation seeks to offer a more relational perspective to explore how angels judge entrepreneurs during their pitch and how angel and entrepreneur interact with each other during their first face-to-face meeting. The first paper of this dissertation focuses on the impact of angel's judgment about the entrepreneur on their decision to invest at the end of the pitching phase (i.e., after Q&A session), the second paper focuses on explaining why angels lose interest to invest within the pitching phase (from after the presentation to after the Q&A session) and the third paper focuses on the social interaction between entrepreneur and angel during the Q&A session. More specifically, building on social judgment research and resource allocation theory, the first study explores entrepreneur's warmth and competence as two critical dimensions along which angels perceive and judge entrepreneurs when making investment decisions and how angels' mental resources explain the interplay between perceived warmth, perceived competence and pitch sequence. The second study builds on the Elaboration Likelihood Model as dual-process theory to examine the impact of angel's experience and entrepreneur's verbal and nonverbal behavior on angel's likelihood to lose interest to invest from the presentation to after the Q&A session. In the third study examines the impact of angel's power words when asking questions on entrepreneur's answers.
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Distressed M&A and the role of m&a in corporate restructuringThe global financial and economic crisis have led to a moderation in global M&A activity. The large M&A deals have disappeared and deal volume has fallen. Nonetheless, M&A remains a core part of business growth. Firms continue to look for acquisitions that allow them to capture a new customer base, technologies and products, access new markets and increase market share. While some years ago the M&A market was characterized by growing firms with a healthy track record, transactions involving distressed firms are increasing. Many investors, managers, advisors and academics are familiar with traditional mergers and acquisitions but little is known about distress-related M&A. However the surge in restructurings and failures has marked the M&A landscape and triggered a growing interest in these type of transactions. The practitioner-oriented and academic literature provide us with some insights but the risks and benefits of such transactions remain largely ambiguous. The goal of this dissertation is to increase our understanding of transactions involving troubled firms.
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Advanced analytics in pharmaceutical innovation: The use of real-world evidence in oncologyThe smart use of real-world evidence (RWE) is known to enable more flexible forms of access to novel medicines. This flexibility may be especially promising for targeted cancer medicines, which often do not align with the traditional approach to medicinal development, and for which therapeutic innovation (i.e. favourable and clinically significant benefits at an affordable price) in routine clinical practice is becoming ever more difficult to achieve due to its highly complex nature. Amongst others, RWE should include information on the performance of those medicines for every individual patient. However, the current estimation of this patientlevel performance using conventional methods from pharmaceutical and medical sciences is challenging. This is because these methods are unable to derive causal conclusions on medicinal performance from the complex real-world environment, as opposed to controlled and randomised clinical trial settings. Simultaneously, the increasing emergence of novel medicines, and their promising combined effects are now creating a new combinatorial complexity level on the captured data. At the same time, new and advanced analytical methods within the field of data science are continuously being developed and have recently been applied to pharmaceutical and medical research, including the domain of pharmacoepidemiology. These powerful methods include techniques such as machine learning and Bayesian approaches, both being recognised as having a transformative potential in clinical research and practice. Specifically, they may be used to gain new insights into the patient-level performance of novel medicines in the messy real world, thereby providing a better understanding of RWE. In doing so, studies may generate new hypotheses through the exploration of data sets, or test existing hypotheses prespecified during prior clinical research. In this dissertation, I present the specific methods of advanced analytics to unravel the complexity of RWE , therefore, increasing our understanding of the individual performance of cancer treatments. These methods are investigated for their use in both hypothesis generation (part 1) and hypothesis testing (part 2) studies. A general ntroduction into the field is provided in Chapter 1, followed by the research objectives. In Chapter 2, I validate the use of an advanced modelling technique, i.e. machine learning, as a personal performance prediction model for glioblastoma. Optimisations of this model to be used on novel medicines in more complex situations are proposed in Chapter 3. In Chapter 4, the importance of multi-product RWE assessments is explored, for which hypotheses. Lastly, for these investigated analytics to become useful in healthcare, the need for an insight-providing federated network is introduced in Chapter 6. Chapter 7, the last chapter of this dissertation, presents a general conclusion with discussion of the research contributions.