Purpose – The purpose of this paper is to investigate whether the implementation of a defined competitive strategy – differentiation or cost leadership – brings about different value creation levels, where “value” is defined in a twofold perspective as “shareholder value” vs “stakeholder value” and “social capital”. Design/methodology/approach – A sample of 169 European companies is investigated. Simple linear regressions and t-tests for the equality of means are conducted. Findings – While no significant differences are found in the creation of value for the shareholders, firms following differentiation strategies generate considerably higher value for all the stakeholder groups than companies pursing cost leadership strategies. Results also show that size and reputational considerations play a significant role in explaining the different stakeholder value performances. Research limitations/implications – Some data such as off-balance sheet items could have influenced the calculation of the discriminant values for strategy classification. Practical implications – Although the two groups manage to achieve comparable levels of profitability, the differentiators, presumably because of their structural outward-facing orientation, seem to be better positioned to meet the challenges of the next wave of growth, which resides in the substantial interconnection between economic and societal value. Companies need a better understanding of how the stakeholder value theory and social capital can influence value creation and long-term success. Originality/value – In light of the importance of competitive strategy as a value-creation tool, the paper sheds new light on the relationship between competitive strategies and value creation.

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Screening outcomes, utilities, and cost inputs were obtained through systematic literature reviews. Primary model outcomes included total healthcare costs and quality-adjusted life years (QALYs) gained with a 3% yearly discount. One-way and two-way sensitivity analyses were conducted to evaluate model uncertainty. An additional analysis of chronic high-dose aminoglycoside users was performed to account for differences in patient populations. Results: In a hypothetical cohort of one hundred patients over three years, routine screening using a tablet audiometer increased promptly detected hearing loss by eight patients. There was an incremental gain of 3.2 QALYs at an increased cost of $328,901 when compared to current screening practices. This resulted in an incremental cost-effectiveness ratio (ICER) of $103,297 per QALY. When model inputs were varied in one-way sensitivity analyses, the ICER ranged between $64,078 and $257,098 per QALY. When only considering chronic users, the ICER increased to $115,266 per QALY. Conclusions: There is currently no standardized protocol for assessing ototoxicity in CF centers. Utilizing a tablet audiometer for routine hearing screening appears to be a cost-effective option at a $150,000 per QALY threshold when only considering the immediate utility gained. This analysis did not examine the long-term benefit of early detection in speech and language development for pediatric patients.