Modeling Multiple-Objective Recreation Trips with Choices Over Trip Duration and Alternative Sites

Traditionally, recreation demand studies have focused on single-day, single-activity trips, despite anecdotal and empirical evidence that many recreational trips involve overnight stays and multiple purposes. This paper develops a random utility model that explores how visitors choose alternative sites and trip durations for multiple-objective trips. We focus on a recreational activity, beach visits, that appear to have significant proportions of the population taking single and multiple-day trips, and many of the multiple day trips involve multiple objectives. Multiple-duration and multiple-objective issues are incorporated in pricing trip costs. The results of the research suggest that the accepted method for incorporating travel costs into random utility models can lead to biased estimates of the structural utility parameters and, consequently, biased measures of welfare in a multiple-objective trip setting for single- and multiple-day users.     

The impact of license regulation on the number of recreation trips: is it worth considering?

A two-stage nonlinear least-squares model (2NLS) with an endogenous treatment effect on recreation trips describes the behavior of recreationists with and without a fishing/hunting license. The proposed 2NLS is applied to the derivation of the policy-relevant average gains in the presence of an endogeneity bias to a license fee implementation program regulated by states. Recreationists who purchased a license are likely to recreate more than are the nonlicensed holders because the regulation may reduce congestions at sites where licensee visit often. The license regulation has a greater impact on the use of natural resources after controlling observed and unobserved confounders which might be correlated with the probability of being a license holder and with the final outcome, the number of recreation trips. We confirm that the individual without a permit regards the recreation trip as less valuable than does the individual having a license permit. We also found that the likelihood of purchasing a license among young adult recreationists is not at the level the states may desire. In addition, the number of trips demanded is more responsive to the nontransportation-related implicit travel cost than to the transportation-related implicit travel cost, although travel implicit costs are price inelastic.      

Pricing of Transport Networks,Redistribution, and Optimal Taxation

The author studies optimal pricing of roads and public transport in the presence of nonlinear income taxation. Individuals are heterogeneous in unobservable earning ability. Optimal transport tariffs depend on time costs of travel and work schedule adjustments (days and hours worked per day) as a response to commuting costs. The author finds that discounts for low‐income individuals are optimal only if the time cost of a trip is small enough. Lower travel time costs facilitate screening; therefore, redistribution provides an additional motive for congestion pricing. Finally, the study investigates the desirability of means‐testing of transport tariffs.     

Public acceptance of and heterogeneity in behavioral beach trip responses to offshore wind farm development in Catalonia (Spain)

A combined travel cost – contingent behaviour survey of residents and tourists in Catalonia is conducted on-site to examine the effects on beach recreational demand of developing an offshore wind farm (OWF) project. The survey considers four potential OWF scenarios with different degrees of visual impact. We allow for heterogeneity in trip preferences among individuals and control for on-site sampling through the use of a random parameters negative binomial (RPNB) model and a Multivariate Poisson log-normal (MPLN) model, respectively. The welfare measures derived from the RPNB model relate to the current beach users only, whereas those from the MPLN model refer to the general population of residents and tourists in Catalonia. The results show the importance of the specific place of location of the OWF project and how the installation of wind turbines would significantly decrease the demand for trips, depending on their degree of visual impacts, leading to a substantial welfare loss. However, the results also show that the project mainly would cause a displacement of trips to other beaches within Catalonia rather than outside Catalonia and that the welfare per trip measures generated by the RPNB and MPLN models substantially differ. Policy implications of these findings are discussed.     

Exploring the shelf-life of travel cost methods of valuing recreation for benefits transfer

This study tests the stability of willingness to pay (WTP) for recreational fishing over two decades based on three rounds of a representative angler survey conducted in New York State in 1988, 1996, and 2007. We employ the travel cost method (TCM) by using the repeated conditional logit and mixed logit models to estimate demand for daily fishing trips. Our estimates suggest that anglers’ WTP for fishing in 1988 and 1996 were similar, with values per trip at $35.2 and $36.4, respectively. However, there was a noticeable decrease in WTP, to $30.6, in 2007. This decrease is consistent with two salient features of the 2007 survey: (1) long-distance trips, such as those to the Great Lakes were less frequent, and (2) anglers were, on average, older than in previous surveys.     

Cost-effectiveness of rivaroxaban versus warfarin for stroke prevention in non-valvular atrial fibrillation in the Japanese healthcare setting

Abstract

Aims: This article aimed to examine the cost-effectiveness of rivaroxaban in comparison to warfarin for stroke prevention in Japanese patients with non-valvular atrial fibrillation (NVAF), from a public healthcare payer’s perspective.

Materials and methods: Baseline event risks were obtained from the J-ROCKET AF trial and the treatment effect data were taken from a network meta-analysis. The other model inputs were extracted from the literature and official Japanese sources. The outcomes included the number of ischaemic strokes, myocardial infarctions, systemic embolisms and bleedings avoided, life-years, quality-adjusted life-years (QALYs), incremental costs and incremental cost-effectiveness ratio (ICER). The scenario analysis considered treatment effect data from the same network meta-analysis.

Results: In comparison with warfarin, rivaroxaban was estimated to avoid 0.284 ischaemic strokes per patient, to increase the number of QALYs by 0.535 per patient and to decrease the total costs by ¥118,892 (€1,011.11) per patient (1 JPY = 0.00850638 EUR; XE.com, 7 October 2019). Consequently, rivaroxaban treatment was found to be dominant compared to warfarin. In the scenario analysis, the ICER of rivaroxaban versus warfarin was ¥2,873,499 (€24,446.42) per QALY.

Limitations: The various sources of data used resulted in the heterogeneity of the cost-effectiveness analysis results. Although, rivaroxaban was cost-effective in the majority of cases.

Conclusion: Rivaroxaban is cost-effective against warfarin for stroke prevention in Japanese patients with NVAF, giving the payer WTP of 5,000,000 JPY.     

The cost-effectiveness and monetary benefits of dabigatran in the prevention of arterial thromboembolism for patients with non-valvular atrial fibrillation in the Netherlands

Background: Atrial fibrillation (AF) causes a significant health and economic burden to the Dutch society. Dabigatran was proven to have at least similar efficacy and a similar or better safety profile when compared to vitamin K antagonists (VKAs) in preventing arterial thromboembolism in patients with AF.

Objective: To evaluate the cost-effectiveness and monetary benefit of dabigatran vs VKAs in Dutch patients with non-valvular AF. Value-based pricing considerations and corresponding negotiations on dabigatran will be explicitly considered.

Methods: The base case economic analysis was conducted from the societal perspective. Health effects and costs were analysed using a Markov model. The main model inputs were derived from the RE-LY trial and Dutch observational data. Univariate, probabilistic sensitivity, and various scenario analyses were performed.

Results: Dabigatran was cost saving compared to VKAs. A total of 4,552 QALYs were gained, and €13,892,288 was saved in a cohort of 10,000?AF patients. The economic value of dabigatran was strongly related to the costs of VKA control that are averted. Notably, dabigatran was cost saving compared to VKAs if annual costs of VKA control exceeded €159 per person, or dabigatran costs were below €2.81 per day.

Conclusion: Dabigatran was cost saving compared to VKAs for the prevention of atrial thromboembolism in patients with non-valvular AF in the Netherlands. This result appeared robust in the sensitivity analysis. Furthermore, volume based reduction of the price in the Netherlands will further increase the monetary benefits of dabigatran.     

电子客票透明化对航空客运需求影响及对策研究

电子客票的产生增加了市场信息透明度。首先介绍电子客票的发展历程及其透明化特点,然后分析了价格透明和产品透明对航空客运需求的影响效果,发现价格透明对航空客运需求有抑制作用,而产品透明则有促进作用。最后给出运用收益管理技术的应用设想,以化解价格透明的负面影响。     

A cost-effectiveness modeling evaluation comparing a biosimilar follitropin alfa preparation with its reference product for live birth outcome in Germany,Italy and Spain

Abstract

Background/objective: Although biosimilar drugs may be cheaper to purchase than reference biological products, they may not be the most cost-effective treatment to achieve a desired outcome. The analysis reported here compared the overall costs to achieve live birth using the reference follitropin alfa (GONAL-f) or a biosimilar (Ovaleap) in Spain, Italy and Germany.

Methods: Patient and treatment data was obtained from published sources; assisted-reproductive technology, gonadotropin, follow-up and adverse-event-related costs were calculated from tariffs and reimbursement frameworks for each country. Incremental cost-effectiveness ratios (ICERs) were calculated from the difference in costs between reference and biosimilar in each country, divided by the difference in live-birth rates. Mean cost per live birth was calculated as total costs divided by the live-birth rate.

Results: The published live birth rates were 32.2% (reference) and 26.8% (biosimilar). Drug costs per patient were higher for the reference recombinant human follicle-stimulating hormone in all three countries, with larger cost differences in Germany (€157.38) and Italy (€141.50) than in Spain (€22.41). The ICER for the reference product compared with the biosimilar was €2917.47 in Germany, €415.43 in Spain and €2623.09 in Italy. However, the overall cost per live birth was higher for the biosimilar in all three countries (Germany €8135.04 vs. €9185.34; Italy €8545.22 vs. €9733.37; Spain €14,859.53 vs. €17,767.19). Uncertainty in efficacy, mean gonadotropin dose and costs did not have a strong effect on the ICERs.

Conclusions: When considering live birth outcomes, treatment with the reference follitropin alfa was more cost effective than treatment with the biosimilar follitropin alfa.     

Fingolimod reduces direct medical costs compared to natalizumab in patients with relapsing–remitting multiple sclerosis in The Netherlands

Abstract

Objective:

To assess the costs of oral treatment with Gilenya® (fingolimod) compared to intravenous infusion of Tysabri® (natalizumab) in patients with relapsing–remitting multiple sclerosis (RRMS) in The Netherlands.

Methods:

A cost-minimization analysis was used to compare both treatments. The following cost categories were distinguished: drug acquisition costs, administration costs, and monitoring costs. Costs were discounted at 4%, and incremental model results were presented over a 1, 2, 5, and 10 year time horizon. The robustness of the results was determined by means of a number of deterministic univariate sensitivity analyses. Additionally, a break-even analysis was carried out to determine at which natalizumab infusion costs a cost-neutral outcome would be obtained.

Results:

Comparing fingolimod to natalizumab, the model predicted discounted incremental costs of ?€2966 (95% CI: ?€4209; ?€1801), ?€6240 (95% CI: ?€8800; ?€3879), ?€15,328 (95% CI: ?€21,539; ?€9692), and ?€28,287 (95% CI: ?€39,661; ?€17,955) over a 1, 2, 5, and 10-year time horizon, respectively. These predictions were most sensitive to changes in the costs of natalizumab infusion. Changing these costs of €255 within a range from €165–364 per infusion resulted in cost savings varying from €4031 to €8923 after 2 years. The additional break-even analysis showed that infusion costs—including aseptic preparation of the natalizumab solution—needed to be as low as the respective costs of €94 and €80 to obtain a cost neutral result after 2 and 10 years.

Limitations:

Neither treatment discontinuation and subsequent re-initiation nor patient compliance were taken into account. As a consequence of the applied cost-minimization technique, only direct medical costs were included.

Conclusion:

The present analysis showed that treatment with fingolimod resulted in considerable cost savings compared to natalizumab: starting at €2966 in the first year, increasing to a total of €28,287 after 10 years per RRMS patient in the Netherlands.     

A panel data analysis of the effect of corruption on tourism

This study empirically tests the hypothesis that corruption has a negative effect on tourism. Having to pay bribes while on holiday or a business trip increases the costs of travelling to a country where corruption is prevalent. Tourists are thus more likely to travel to countries where these additional costs do not need to be incurred. This hypothesis is tested using a panel data set of over 100 countries and 16 years. The results indicate that a 1-point increase in the Corruption Perception Index (implying a decrease in corruption) results in a 2% to 7% increase in tourist inflows. In addition, tourist inflows rise with GDP per capita, openness and growth and are higher in countries with a temperate climate.     

Budget impact analysis of orphan drugs in Belgium: estimates from 2008 to 2013

Objective: This article aims to calculate the impact of orphan drugs on the Belgian drug budget in 2008 and to forecast its impact over the following 5 years.

Method: The 2008 budget impact was calculated by triangulating information derived from multiple Belgian data sources. The 2008–2013 budget impact analysis was based on three scenarios reflecting different levels of growth in the number of registered orphan drugs in the European Union, the number of drugs reimbursed in Belgium, and the average annual cost per patient per drug in Belgium.

Results: The orphan drug budget impact amounted to €66.2 million (or 5% of the Belgian hospital drug budget) in 2008. The impact would increase to €130–204 million in 2013, depending on the scenario.

Conclusions: This static analysis measured orphan drug costs only, assuming that other components of health expenditure do not change over time. The analysis showed that the budget impact of orphan drugs in Belgium is substantial and rising, thereby putting pressure on total drug expenditure. Policy options to address the rising budget impact include pricing linked to return on investment, risk-sharing arrangements and re-appraisal of orphan drug status if additional indications are approved.     

Valuing cultural world heritage sites: an application of the travel cost method to Mont-Saint-Michel

This article, using the zonal version of the travel cost method (ZTCM), provides the first economic valuation of recreational trips to Mont-Saint-Michel (MSM). The MSM was designated as United Nations Educational, Scientific and Cultural Organization World Heritage Site in 1979, and is the most visited coastal site in France. The potential effects on consumer surplus (CS) estimates of some aspects of the ZTCM are considered, namely the treatment of the multiple purpose/destination (MP/D) trips, the inclusion of the opportunity cost of time (OCT) in the recreation demand model and the heterogeneity in the preferences. The heterogeneity in the preferences is examined through a random parameters Poisson model (RPPM). The RPPM generalizes the standard Poisson model (SPM) by allowing coefficients of explanatory variables to vary randomly across geographical units rather than being fixed. Our results show that (1) substantial CS values are associated with the MSM; (2) excluding/ignoring MP/D trips result in biased CS estimates; (3) omitting OCT does not substantially bias CS estimates; (4) the RPPM provides richer information about the impact of explanatory variables on the demand for trips than the SPM, but (5) leads to statistically similar CS estimates than the SPM.     

A comparison of the estimated costs of erlotinib,docetaxel and pemetrexed for the second-line treatment of non-small cell lung cancer from the German healthcare perspective

Summary

The estimated costs of second-line therapy with erlotinib versus docetaxel or pemetrexed were analysed in patients with advanced non-small cell lung cancer (NSCLC) assuming the survival benefits delivered by these three drugs are comparable. Direct total costs to the German statutory health insurance system per patient per quarter were compared, including the impact of grade 3/4 side effects. Resource utilisation data came from clinical studies and/or were supplemented on the basis of guidelines/prescribing information. Basic costs per patient per quarter were: erlotinib €8,172; docetaxel €8,055; and pemetrexed €15,870. Including the cost of managing side effects, the total cost per patient per quarter with erlotinib was €8,376 compared with €9,976 for docetaxel and €16,596 for pemetrexed. The main influence on the cost analysis was the management of haematological side effects associated with docetaxel and to a lesser extent pemetrexed. Sensitivity analyses confirmed the robustness of the results. Based on its favourable side-effect profile, erlotinib offers health economic advantages over docetaxel and pemetrexed in relapsed advanced NSCLC in Germany.     

Evaluating drug cost per responder and number needed to treat associated with lixisenatide on top of glargine when compared to rapid-acting insulin intensification regimens on top of glargine,in patients with type 2 diabetes in the UK,Italy, and Spain

Objectives: This study investigated the cost per responder and number needed to treat (NNT) in type 2 diabetes mellitus (T2DM) patients for lixisenatide compared to insulin intensification regimens using composite endpoints in the UK, Italy, and Spain.

Methods: Efficacy and safety outcomes were obtained from GetGoal Duo-2, a 26-week phase 3 trial comparing lixisenatide vs insulin glulisine (IG) once daily (QD) and three times daily (TID). Response at week 26 was extrapolated to 52 weeks, assuming a maintained treatment effect, based on long-term evidence in other T2DM populations. Responders were defined using composite end-points, based on an HbA1c threshold and/or no weight gain and/or no hypoglycemia. The HbA1c threshold was varied in sensitivity analyses. Annual treatment costs were estimated in euros (1 GBP?=?1.26 EUR), including drug acquisition and resource use costs. Cost per responder was computed by dividing annual treatment costs per patient by the proportion of responders.

Results: Lixisenatide was associated with the lowest cost per responder for all composite end-points that included a weight-related component. For the main composite end-point of HbA1c ≤7.5% AND no weight gain AND no symptomatic hypoglycemia, cost per responder results were: UK: 6,867€, 8,746€, and 12,410€; Italy: 7,057€, 9,160€, and 12,844€; Spain: 8,370€, 11,365€, and 17,038€, for lixisenatide, IG QD, and TID, respectively. The NNT analysis showed that, for every 6.85 and 5.86 patients treated with lixisenatide, there was approximately one additional responder compared to IG QD and TID, respectively.

Limitations: A limitation of the clinical inputs is the lack of 52-week trial data from GetGoal Duo-2, which led to the assumption of a maintained treatment effect from week 26 to 52.

Conclusions: This analysis suggests lixisenatide is an efficient economic resource allocation in the UK, Italy, and Spain.     

WELFARE EFFECTS OF DISTORTIONARY FRINGE BENEFITS TAXATION: THE CASE OF EMPLOYER‐PROVIDED CARS*

In Europe, many employees receive company cars as fringe benefits induced by taxation. We analyze the welfare effects of company car taxation for the Netherlands by estimating to what extent car expenditure and private car travel change when employees receive a company car. Tax treatment of company cars generates an annual welfare loss, ranging from €600 to €780 per company car, mainly due to a shift toward more expensive cars (from €420 to €600), but also due to increased private travel (€180). For the whole of Europe, the annual welfare loss is about €12 billion.     

Endogenously chosen travel costs and the travel cost model: an application to mountain biking at Moab,Utah

The travel cost model is frequently used to estimate net willingness to pay for recreation at remote sites by using the visitor's travel costs as a proxy for the price of recreation. However, some concern has been raised over the validity of using the visitor's stated travel costs as a proxy for price. This paper addresses some of these concerns, by examining the possible over-estimation of consumer surplus due to endogenously chosen travel costs. This paper extends past theoretical work for the linear model by developing a correction for endogenously chosen travel costs in more commonly used nonlinear models such as the Poisson or count data model. Also provided is the first empirical test of the presence of endogeneity and an estimate of the magnitude of the error from ignoring endogeneity in travel costs. After applying this test and the correction to data that was gathered for mountain biking at Moab, Utah the estimate of consumer surplus falls from US $153 to US $135, which is a 12% reduction.     

Migraine burden and costs in France: a nationwide claims database analysis of triptan users

Objectives: To estimate the burden of migraine in the population of French patients identified as specific migraine acute treatment users compared to a control group.

Methods: A cross-sectional retrospective analysis was performed on the Echantillon Généraliste des Bénéficiaires claims database, a 1/97 random sample of the French public insurance database. A representative sample of all adults with at least one delivery of triptans, ergot derivatives or acetylsalicylic acid/metoclopramide (all drugs with a specific label in migraine acute treatment – SMAT) in 2014 was selected with a control group matched on age, gender and geographic region. Among triptan users, a sub-group of over-users was defined according to their level of triptan uptake expressed in defined daily doses (DDD – a standard daily dose of treatment of acute migraine) per month over 3?months and more, was also compared with controls. The cost analysis was performed in a societal perspective for direct costs. Sick leave indirect costs were estimated using the human capital approach.

Results: In total 8639 SMAT users (mean age: 44.6?years; 78.7% women) were selected representing a crude prevalence rate of 1.7%. The annual per capita total healthcare expenditures were higher by €280 in this group compared to controls (€2463 vs. €2183). Triptans contributed 47.8% to this extra cost. They used significantly (p?Conclusions: Due to its high prevalence, migraine costs generate a significant societal burden. The group of over-users concentrates high per capita direct and indirect costs.     

Less frequent dosing of erythropoiesis stimulating agents in patients undergoing dialysis: a European multicentre cost study

Abstract

Objective: To calculate the variable costs involved with the process of delivering erythropoiesis stimulating agents (ESA) in European dialysis practices.

Methods: A conceptual model was developed to classify the processes and sub-processes followed in the pharmacy (ordering from supplier, receiving/storing/delivering ESA to the dialysis unit), dialysis unit (dose determination, ordering, receipt, registration, storage, administration, registration) and waste disposal unit. Time and material costs were recorded. Labour costs were derived from actual local wages while material costs came from the facilities’ accounting records. Activities associated with ESA administration were listed and each activity evaluated to determine if dosing frequency affected the amount of resources required.

Results: A total of 21 centres in 8 European countries supplied data for 142 patients (mean) per hospital (range 42–648). Patients received various ESA regimens (thrice-weekly, twice-weekly, once-weekly, once every 2 weeks and once-monthly). Administering ESA every 2 weeks, the mean costs per patient per year for each process and the estimates of the percentage reduction in costs obtainable, respectively, were: pharmacy labour (€10.1, 39%); dialysis unit labour (€66.0, 65%); dialysis unit materials (€4.11, 61%) and waste unit materials (€0.43, 49%).

Limitation: Impact on financial costs was not measured.

Conclusion: ESA administration has quantifiable labour and material costs which are affected by dosing frequency.     

How complicated skin and soft tissue infections are treated in Italy: economic evaluation of inpatient intravenous antibiotic treatment in seven hospitals

Abstract

Objectives: Complicated skin and soft tissue infections (cSSTIs) are a common cause of morbidity at hospital level. This study aimed to evaluate the costs and outcomes of inpatient intravenous antibiotic therapy for the treatment of cSSTI in seven Italian hospitals.

Methods: A total of 307 patients were enrolled in a retrospective, multicentre, incidence-based, observational study. The target population consisted of hospitalised patients eligible to receive intravenous antibiotic therapy for cSSTI. Direct hospital costs were measured through a microcosting approach.

Results: Failure of initial antibiotic therapy occurred in 23% of patients. Average antibiotic treatment lasted 12.2 days; the average full cost of admission totalled €5,530. If the initial antibiotic regimen fails to eradicate the infectious organism, the length of stay extends for 7 days and costs increase by €2,850 per patient. Nevertheless, when taking into account the lower intensity of care during the last days of treatment, savings reduce costs to €671 per patient. These could be increased by €74 for each hospital day avoided because of faster antibiotic action.

Conclusions: Efforts should be made to minimise the risk of selecting wrong antibiotics and to identify the quickest antibiotic in eradicating the infection.