效率提高会吞噬就业吗？旅游产业升级的就业效应研究

文章构建了旅游产业升级的就业效应测算模型,将旅游产业升级的就业效应分解为就业创造和就业破坏两个方面,并从总量、结构以及行业异质性三个角度对2000-2014年中国旅游产业升级的就业创造和破坏机制进行了研究。结果表明：(1)中国旅游产业升级总体上具有积极的就业增长效应,但由于旅游产业功能升级不足,旅游产业升级的就业创造效应主要来源于规模扩张和结构变动。(2)各行业就业增长与其效率滞后性基本呈现为正相关的关系,说明在旅游业内部存在鲍莫尔成本病问题。(3)住宿业就业创造与旅游总产出增长之间出现了此消彼长的两难困境。未来中国旅游产业升级应注重与文化产业融合,推进旅游向审美化、品质化、体验化方向发展。     

Farmers’ Willingness to Pay for a Tuberculosis Cattle Vaccine

We use contingent valuation (CV) and choice experiment (CE) methods to assess cattle farmers’ attitudes to and willingness to pay (WTP) for a bovine tuberculosis (bTB) cattle vaccine, to help inform vaccine development and policy. A survey questionnaire was administered by means of telephone interviews to a stratified sample of 300 cattle farmers in annually bTB‐tested areas in England and Wales. Farmers felt that bTB was a major risk for the cattle industry and that there was a high risk of their cattle getting the disease. The CE estimate produced a mean WTP of £35 per animal per single dose for a vaccine that is 90% effective at reducing the risk of a bTB breakdown and an estimated £55 for such a vaccine backed by 100% insurance of loss if a breakdown should occur. The CV estimate produced a mean WTP of nearly £17 per dose/per animal/per year for a vaccine (including 100% insurance) which, given the average lifespan of cattle, is comparable to the CE estimate. These WTP estimates are substantially higher than the expected cost of a vaccine which suggests that farmers in high risk bTB ‘hotspot’ areas perceive a substantial net benefit from buying the vaccine.     

Administrative cooperation and disease control in cross-border pork production

In recent years, the continuous structural change in the value chain of modern food production has been characterised by an increasing international division of labour among manufacturing companies. A regional specialisation of primary agricultural production is especially apparent in meat production. Thus, the German–Dutch border area has developed into a region of unprecedented intensive pork production. While The Netherlands specialises in piglet production, the production of fattened pigs continues to grow in northwest Germany. As a result of this increasing transnational value chain development, German imports of Dutch piglets have risen continuously since 2000. However, this structural interweaving of pork production between The Netherlands and Germany has resulted in many new challenges for the cooperation between the various participants and in particular for the administrative authorities in the field of food and feed safety as well as efficient animal disease control. The motivation for this exploratory study stems from the lack of scientific work on this topic to date. The aim of this research is to illustrate the relevance of functioning cross-border cooperation in the food sector, using commodity flow structures and disease spread analysis. Results indicate that cross-border cooperation between authorities during a CSF epidemic can reduce the risk of recurrence and the duration by 50%.     

Costs of providing infusion therapy for patients with inflammatory bowel disease in a hospital-based infusion center setting

Aims: Inflammatory bowel disease (IBD) (e.g. ulcerative colitis [UC] and Crohn’s disease [CD]) severely impacts patient quality-of-life. Moderate-to-severe disease is often treated with biologics requiring infusion therapy, adding incremental costs beyond drug costs. This study evaluates US hospital-based infusion services costs for treatment of UC or CD patients receiving infliximab or vedolizumab therapy.

Materials and methods: A model was developed, estimating annual costs of providing monitored infusions using an activity-based costing framework approach. Multiple sources (published literature, treatment product inserts) informed base-case model input estimates.

Results: The total modeled per patient infusion therapy costs in Year 1 with infliximab and vedolizumab was $38,782 and $41,320, respectively, and Year 2+, $49,897 and $36,197, respectively. Drug acquisition cost was the largest total costs driver (90–93%), followed by costs associated with hospital-based infusion provision: labor (53–56%, non-drug costs), allocated overhead (23%, non-drug costs), non-labor (23%, non-drug costs), and laboratory (7–10%, non-drug costs).

Limitations: Limitations included reliance on published estimates, base-case cost estimates infusion drug, and supplies, not accounting for volume pricing, assumption of a small hospital infusion center, and that, given the model adopts the hospital perspective, costs to the patient were not included in infusion administration cost base-case estimates.

Conclusions: This model is an early step towards a framework to fully analyze infusion therapies’ associated costs. Given the lack of published data, it would be beneficial for hospital administrators to assess total costs and trade-offs with alternative means of providing biologic therapies. This analysis highlights the value to hospital administrators of assessing cost associated with infusion patient mix to make more informed resource allocation decisions. As the landscape for reimbursement changes, tools for evaluating the costs of infusion therapy may help hospital administrators make informed choices and weigh trade-offs associated with providing infusion services for IBD patients.     

血栓通治疗冠心病有效性和安全性的Meta分析

目的综合评价血栓通治疗冠心病的有效性和安全性,为临床治疗决策提供科学依据。方法利用计算机检索文献,并进行筛选,在对纳入文献进行方法学质量评价后,应用RevMan5.0软件,采用固定效应模型或随机效应模型对纳入文献进行Meta分析。结果本研究共纳入31篇文献,质量评级均为C级。在心电图总有效方面,血栓通单用VS复方丹参单用、血栓通联用其它药物VS复方丹参联用其它药物、血栓通联用硝酸甘油VS硝酸甘油、血栓通联用其它药物VS其它药物比较,RR及95%CI分别为1.45（1.29～1.62）、1.19（1.01～1.41）、1.22（1.10～1.34）、1.28（1.19～1.38）,差异具有统计学意义。在心绞痛总有效方面,血栓通联用其它药物VS其它药物、血栓通联用硝酸甘油VS硝酸甘油比较,RR及95%CI分别为1.28（1.19～1.38）、1.30（1.15～1.48）,差异具有统计学意义。敏感性分析验证了结果的稳定性。结论血栓通不论是单用还是与其它药物联合应用,在心绞痛和心电图总有效方面均较其它药物优秀。     

Caregiver priorities for endpoints to evaluate treatments for Prader-Willi syndrome: a best–worst scaling

Abstract

Objectives: Prader-Willi syndrome (PWS) is a rare genetic disorder associated with varying degrees of hyperphagia, obesity, intellectual disability, and anxiety across the affected individuals’ lifetimes. This study quantified caregiver priorities for potential treatment endpoints to identify unmet needs in PWS.

Methods: The authors partnered with the International Consortium to Advance Clinical Trials for PWS (PWS-CTC) and a diverse stakeholder advisory board to develop a best–worst scaling instrument. Seven relevant endpoints were assessed using a balanced incomplete block design. Caregivers were asked to determine the most and least important of a sub-set of four endpoints in each task. Caregivers were recruited nationally though patient registries, email lists, and social media. Best–worst score was calculated to determine caregiver priorities; ranging from 0 (least important) to 10 (most important). A novel kernel-smoothing approach was used to analyze caregiver endpoint priority variations with relation to age of the PWS individual.

Results: In total, 457 caregivers participated in the study. Respondents were mostly parents (97%), females (83%), and Caucasian (87%) who cared for a PWS individual ranging from 4–54 years. Caregivers value treatments addressing hyperphagia (score?=?7.08, SE?=?0.17) and anxiety (score?=?6.35, SE?=?0.16) as most important. Key variations in priorities were observed across age, including treatments targeting anxiety, temper outbursts, and intellectual functions.

Conclusions: This study demonstrates that caregivers prioritize hyperphagia and, using a novel method, demonstrates that this is independent of the age of the person with PWS. This is even the case for parents of young children who have yet to experience hyperphagia, indicating that these results are not subject to a hypothetical bias.     

Cost utility of allogeneic stem cell transplantation with matched unrelated donor versus treatment with imatinib for adult patients with newly diagnosed chronic myeloid leukaemia

Objective: To estimate, from the perspective of the German statutory health insurance, the cost utility of allogeneic stem cell transplantation with matched unrelated donor (MUD-SCT) in newly diagnosed, chronic-phase chronic myeloid leukaemia (CML) patients aged 40 years or younger, relative to the treatment with imatinib.

Methods: The incremental cost-effectiveness ratio (ICER) of the additional cost of imatinib versus MUD-SCT per quality-adjusted life year (QALY) gained was chosen as a target assessment. ICER was quantified using a Markov cohort modelling approach. The evaluation encompassed 5 years of treatment with either approach, and only direct medical costs (in €, year 2005) were considered.

Results: There were incremental costs of €77,410 for imatinib therapy per QALY gained versus MUD-SCT. No strategy was clearly dominant; on average, during 5 years, cost savings of €63,433 were obtained and 0.82 QALY lost by SCT compared to treatment with imatinib. QALYs gained in CML patients with either treatment resulted in considerable cost to the third-party payer in Germany. The results were particularly sensitive to the price of imatinib.

Conclusions: The analysis finds that imatinib is more costly but more effective (as measured in QALYs) over a 5-year time horizon. The resulting ICER of €77,410 per QALY is higher than commonly cited thresholds. The cost utility of MUD-SCT to treat CML in patients with a European Group for Blood and Marrow Transplantation score ≤ to 2 compares with that of the imatinib strategy.     

浅析公路路基病害及对策

随着我国经济社会的不断发展,人民生活水平的不断提高,对公路的需求越来越多。公路路基的病害是多种多样的,其直接影响着公路能否正常使用,如何有效解决公路路基的病害也就成为了人们关注的焦点,下面就公路路基病害的成因,预防措施及解决的方法进行探讨。     

Chronic Diseases, Labor Supply and Medical Expenditure at Older Age: Evidence from China

China has undergone a rapid epidemiological transition from infectious diseases to chronic diseases. Using data from the China Health and Retirement Longitudinal Study (CHARLS), this paper documents the profile of chronic diseases among older Chinese people, estimates the impact of the onset of chronic diseases on the labor supply, and examines the correlation between the prevalence of chronic diseases, a household’s medical expenditure and the role of health insurance in reducing medical costs. Empirical results show that the prevalence of chronic diseases is extremely high among older Chinese people and increases sharply with age. We find significant negative effects from the onset of chronic diseases on an individual’s livelihood at work. The estimation results by age and education suggest that the labor supply of the older and more highly educated people is more sensitive to the onset of chronic diseases. We also show that there can be a substantial indirect loss of individual and household income due to the onset of chronic diseases by limiting the labor supply. We find that the prevalence of chronic diseases is significantly associated with higher out-of-pocket medical expenditure. The reduced-form estimation results suggest that people with insurance have lower medical expenditure caused by minor chronic diseases, but this is only the case for women and urban residents. However, health insurance contributes little in reducing medical expenditure caused by major chronic diseases.     

论分税制下财政转移支付与地方财政努力差异——基于功能与地区多重分类考察的另类荷兰病分析

文章主要研究分税制下政府间转移支付与地区财政努力差异的关系.通过理论模型推导和对转移支付的实证检验发现:中国现行转移支付制度在总体上抑制了地方政府的财政努力.就区域效果而言,转移支付在促进东部发达省份财政努力的同时,抑制了中、西部落后地区的财政努力;就转移支付的功能类型而言,以税收返还为主的条件性转移支付会激励地方政府努力征税,而非条件性转移支付,包括财力性和专项转移支付将不同程度地抑制地方财政努力.这就产生了挤出效应与另类"荷兰病"的问题.