Burden of illness for super-refractory status epilepticus patients

Objective: To provide an estimate of the annual number of super-refractory status epilepticus (SRSE) cases in the US and to evaluate utilization of hospital resources by these patients.

Methods: The Premier Hospital Database was utilized to estimate the number of SRSE cases based on hospital discharges during 2012. Discharges were classified as SRSE cases based on an algorithm using seizure-related International Classification of Diseases-9 (ICD-9) codes, Intensive Care Unit (ICU) length of stay (LOS), and treatment protocols (e.g. benzodiazepines, anti-epileptic drugs (AEDs), and ventilator use). Secondary analyses were conducted using more restrictive algorithms for SRSE.

Results: A total of 6,325 hospital discharges were classified as SRSE cases from a total of 5,300,000 hospital discharges. Applying a weighting based on hospital characteristics and 2012?US demographics, this projected to an estimated 41,156 cases of SRSE in the US during 2012, an estimated incidence rate of ～13/100,000 annually for SRSE in the US. Secondary analyses using stricter SRSE algorithms resulted in estimated incidence rates of ～11/100,000 and 8/100,000 annually. The mean LOS for SRSE hospitalizations was 16.5 days (median =11; interquartile range [IQR]?=?6–20), and the mean ICU LOS was 9.3 days (median =6; IQR =3–12). The mean cost of an SRSE hospitalization was $51,247 (median = $33,294; 95% CI = $49,634–$52,861).

Limitations: The analysis uses ICD-9 diagnostic codes and claims information, and there are inherent limitations in any methodology based on treatment protocol, which created challenges in distinguishing with complete accuracy between SRSE, RSE, and SE on the basis of care patterns in the database.

Conclusion: SRSE is associated with high mortality and morbidity, which place a high burden on healthcare resources. Projections based upon the findings of this study suggest an estimated 25,821–41,959 cases of SRSE may occur in the US each year, but more in-depth studies are required.     

Cost-effectiveness of 3-month paliperidone treatment for chronic schizophrenia in Spain

Background: A 3-month long treatment of paliperidone palmitate (PP3M) has been introduced as an option for treating schizophrenia. Its cost-effectiveness in Spain has not been established.

Aims: To compare the costs and effects of PP3M compared with once-monthly paliperidone (PP1M) from the payer perspective in Spain.

Methods: This study used the recently published trial by Savitz et al. as a core model over 1 year. Additional data were derived from the literature. Costs in 2016 Euros were obtained from official lists and utilities from Osborne et al. The authors conducted both cost-utility and cost-effectiveness analyses. For the former, the incremental cost per quality-adjusted life-year (QALY) gained was calculated. For the latter, the outcomes were relapses and hospitalizations avoided. To assure the robustness of the analyses, a series of 1-way and probability sensitivity analyses were conducted.

Results: The expected cost was lower with PP3M (4,780€) compared with PP1M (5,244€). PP3M had the fewest relapses (0.080 vs 0.161), hospitalizations (0.034 v.s 0.065), and emergency room visits (0.045 v.s 0.096) and the most QALYs (0.677 v.s 0.625). In both cost-effectiveness and cost-utility analyses, PP3M dominated PP1M. Sensitivity analyses confirmed base case findings. For the primary analysis (cost-utility), PP3M dominated PP1M in 46.9% of 10,000 simulations and was cost-effective at a threshold of 30,000€/QALY gained.

Conclusions: PP3M dominated PP1M in all analyses and was, therefore, cost-effective for treating chronic relapsing schizophrenia in Spain. For patients who require long-acting therapy, PP3M appears to be a good alternative anti-psychotic treatment.     

The impact of stress on tournament entry

Individual willingness to enter competitive environments predicts career choices and labor market outcomes. Meanwhile, many people experience competitive contexts as stressful. We use two laboratory experiments to investigate whether factors related to stress can help explain individual differences in tournament entry. Experiment 1 studies whether stress responses (measured as salivary cortisol) to taking part in a mandatory tournament predict individual willingness to participate in a voluntary tournament. We find that competing increases stress levels. This cortisol response does not predict tournament entry for men but is positively and significantly correlated with choosing to enter the tournament for women. In Experiment 2, we exogenously induce physiological stress using the cold-pressor task. We find a positive causal effect of stress on tournament entry for women but no effect for men. Finally, we show that although the effect of stress on tournament entry differs between the genders, stress reactions cannot explain the well-documented gender difference in willingness to compete.     

Defending free trade after physiocracy: On Dugald Stewart's architectonic of passions,reason and Providence

Abstract

Dugald Stewart (1753–1828) defended free trade in light of a providential account of Nature, according to which there would be an “identity of interests” (Halévy 1901–1904). He thereby tried to rid economic thought of references to conflicts and thus pursued the physiocrats’ programme rather than Adam Smith's. In fact, Stewart claimed that (i) self-love depends on an accommodation to Providence, by which individuals restrain their passions; (ii) self-love fosters actions that lead to a direct increase of public happiness; (iii) the perfectibility of mind allows to dismiss “legal despotism”, which can be replaced by religious education.     

Disaggregated data and trade policy analysis: The value of linking partial and general equilibrium models

Computable General Equilibrium (CGE) models are now routinely utilized for the evaluation of trade policy reforms, yet they are typically quite highly aggregated, which limits their usefulness to trade negotiators who are often interested in impacts at the tariff line. On the other hand, Partial Equilibrium (PE) models, which are typically used for analysis at disaggregate levels, deprive the researcher of the benefits of an economy-wide analysis, which is required to examine the overall impact of broad-based trade policy reforms. Therefore, a PE–GE, nested modeling framework has the prospect of offering an ideal tool for trade policy analysis. In this paper, we develop a PE model that captures international trade, domestic consumption and output, using Constant Elasticity of Transformation (CET) and Constant Elasticity of Substitution (CES) structures, market clearing conditions and price linkages, nested within the standard GTAP model. In particular, we extend the welfare decomposition of Huff and Hertel (2001) to this PE–GE model in order to contrast the sources of welfare gain in PE and GE analyses. To illustrate the usefulness of this model, we examine the contentious issue of tariff liberalization in the Indian auto sector, using PE, GE and PE–GE models. Both the PE and PE–GE models show that the imports of motorcycles and automobiles change drastically with both unilateral and bilateral tariff liberalization by India, but the PE model does a poor job predicting the overall size and price level in the industry, post-liberalization. On the other hand, the GE model overestimates substitution between regional suppliers due to “false competition” and underestimates the welfare gain, due to the problem of tariff averaging in the aggregated model. These findings are shown to be robust to wide variation in model parameters. We conclude that the linked model is superior to both the GE and PE counterparts.     

Municipalities and regions in locational competition — New economic considerations

Locational competition has intensified in recent years in the wake of globalisation as well as the general development towards a knowledge- and service-based economy. In this context, newer economic analyses point to a shifting of the locational factors considered relevant for success in local and regional competition. With respect to these fundamental changes, it is becoming increasingly relevant to ask how local and regional development processes must be constructed in order for municipalities and regions in modern industrial countries to maintain the positions they have already achieved.     

An Attempt to Determine the CSR Potential of the International Clothing Business

Most empirical studies of corporate social responsibility (CSR) focus on variables at the company level. In this article, I focus on the sector level: I consider features of the international clothing business and of the global economy in general, that may influence the CSR potential. There is high ‘CSR potential’ when sector-specific features indicate that the risk of violating CSR standards is high. Thus, ‘high CSR potential’ indicates that there is a potential for positive influence through CSR-related actions. Based on several empirical studies of the clothing business, I identify six features that indicate a high CSR potential. These features are shown to be consistent with more general features of the global economy. This holds whether we emphasize asymmetric relations and unequal distribution, the product cycle, or transnationalization. Thus, the CSR potential of the international clothing business seems not only to be a product of sector-specific properties, but also of more systemic and general features of the global economy. This suggests that the CSR performance of individual companies may enhance their social and environmental impact, but will probably have little effect on the features that determine the CSR potential. In order to affect these features I argue, we rely on other institutions to act – mainly governments. Finally, I conclude that this study shows that it is useful to identify the CSR potential of a business sector. We get a picture of which part of the international CSR standards companies run the greatest risk of violating and of which structural issues intergovernmental actions should address to reduce the potential for violating CSR standards.     

An empirical test of purchasing power parity in selected developing countries: a panel data approach

Abstract

This paper examines the empirical validity of Purchasing Power Parity (PPP) for certain large developing economies by using a panel unit root methodology. The test results show that a long run real exchange rate depreciation trend exists in certain developing countries. Without considering this depreciation trend, it is hard to verify the stationarity and to explain the existence of the extremely long half-lives of the real exchange rates. When a linear time trend is included in the tests, the results tend to support the stationarity of the underlying real exchange rate processes, and the half-lives are significantly shorter and their range can be explained by transitory disturbances.     

Supply Elasticity and the Housing Cycle of the 2000s

There is no evidence that differences in supply elasticity caused cross‐sectional variation among U.S. housing markets in the severity of the 2000s housing cycle. This is true in three sets of empirical specifications: a first that assumes identical demand changes in the 2000s across markets, a second that proxies for supply elasticity and demand changes in the 2000s with estimates based on price and quantity changes in the 1980s and a third that uses physical and regulatory constraints to proxy for supply elasticity and uses state fixed effects to capture variation in demand conditions.