A cost-effectiveness analysis of revaccination and catch-up strategies with the 23-valent pneumococcal polysaccharide vaccine (PPV23) in older adults in Japan

Objective: In Japan, the National Immunization Program (NIP) includes PPV23 as the primary vaccination for adults and catch-up cohorts. The Japanese Association for Infectious Diseases recommends revaccination for older adults who received primary vaccination ≥5 years earlier. The cost-effectiveness of adding revaccination and/or continuing catch-up vaccination in the NIP was evaluated from the public payer perspective in Japan.

Methods: The Markov model included five health states: no pneumococcal disease, invasive pneumococcal diseases (IPD), non-bacteremic pneumococcal pneumonia (NBPP), post-meningitis sequelae, and death. Cohorts of adults aged 65–95 were followed until age 100 or death: 2014 cohort (aged 65–95, vaccinated: 2014); 2019 cohort (aged 65: 2019); and 2019 catch-up cohort (aged 70–100: 2019, unvaccinated: 2014). Strategies included: (1) vaccinate 2014 and 2019 cohorts; (2) vaccinate 2014 and 2019 cohorts and revaccinate both; (3) strategy 1 and vaccinate 2019 catch-up cohort; (4) strategy 2 and vaccinate 2019 catch-up cohort; and (5) strategy 4 and revaccinate 2019 catch-up cohort. Parameters were retrieved from global and Japanese sources, costs and QALYs discounted at 2%, and incremental cost-effectiveness ratios (ICERs) estimated.

Results: Strategy 1 had the highest number of IPD and NBPP cases, and strategy 5 the lowest. Strategies 3–5 dominated strategy 1 and strategy 2 was cost-effective compared to strategy 1 (ICER: ¥1,622,153 per QALY gained). At a willingness-to-pay threshold of ¥5 million per QALY gained, strategy 2 was cost-effective and strategies 3–5 were cost-saving compared to strategy 1.

Conclusions: Strategies including revaccination, catch-up, or both were cost-effective or cost-saving in comparison to no revaccination and no catch-up. Results can inform future vaccine policies and programs in Japan.     

Real Exchange Rate Misalignments in the Euro Area

Open Economies Review - Building upon a Behavioural Equilibrium Exchange Rate model, estimated at a quarterly frequency since 1999 on a broad sample of 57 countries, this paper assesses both the...     

The Impact of Institutional Differences on Derivatives Usage: a Comparative Study of US and Dutch Firms

This paper examines the influence of institutional differences on corporate risk management practices in the USA and the Netherlands. We compare results to surveys in each country using a strategy that corrects for differences over industry and size classes across the Dutch and US samples. We document several differences in the firms’ uses and attitudes towards derivatives and attempt to attribute them to the differences in the institutional environments between the USA and the Netherlands. We find that institutional differences appear to have an important impact on risk management practices and derivatives use across US and Dutch firms.     

Optimales Vertragsdesign bei moralischem Risiko in der Rückversicherung

This paper addresses the optimal design of risk sharing arrangements in reinsurance contracts with asymmetric information concerning the primary insurer’s behavior. The latter usually has significant unobservable discretions, for instance with respect to risk selection, implying a moral hazard problem. We show that the existence of moral hazard strongly affects the characteristics of the reinsurance indemnification rule, i. e. the connection between the level of losses and the indemnity, which is specified in the contract. For this analysis, a standard model framework from the theory of optimal reinsurance with perfect information is modified by the assumption that the primary insurer has unobservable control of the probability distribution of the extent of losses. In particular, the solution indicates that for this situation, a Pareto-optimal indemnity rule is less steep, and therefore the primary insurer’s share in a marginal increase of the loss is greater, compared to the case of complete information. A deductible, however, turns out not to be a suitable approach in this context.     

Uncertainty in the Austrian Theory of Capital

This paper is based on the traditional Austrian Theory of Capital which deals with expected values of future returns of investments over various periods of time. The longer the time period that elapses between the beginning of a production process and its end, the higher the (expected) productivity must be due to positive time preferences of individuals. This paper focuses on the uncertainty of future returns and on uncertainty preferences, instead. Based on the Hayekian idea of the dispersion of knowledge in society, it will be shown that there is a systematic relationship between the structure of capital and uncertainty. This result will be derived for a production process characterized by complete vertical integration and one which is not completely vertically integrated. The distinction between these two settings is crucial, if one accepts the distinction between an individual and a social period of production and the planning horizon which are introduced in this paper.     

An Experimental Bribery Game

Essential characteristics of corruption are (1) reciprocityrelationships between bribers and public officials, (2) negativewelfare effects, and (3) high penalties when discovered. Weseparate the influences of these factors in an experiment. Ina two-player game, reciprocation is economically inefficientthrough negative externalities. A control treatment withoutexternalities is also conducted. In a third, so-called suddendeath treatment, corrupt pairs face a low probability of exclusionfrom the experiment without payment. The results show that reciprocitycan establish bribery relationships, where negative externalitieshave no apparent effect. The penalty threat significantly reducescorruption, although discovery probabilities are typically underestimated.     

How Leviathan Taxes

The Leviathan hypothesis remains a cornerstone of constitutional tax theory. Following Brennan and Buchanan's (1980) seminal contribution, the power to tax is often likened to a monopoly, and its use by a revenue-maximising government is said to obey the rules of optimal taxation theory. We revisit, and refine, this position, explaining its underpinnings and discussing the Leviathan solution in several well-known optimal taxation models. It turns out that the power to tax is not a perfect analogue of ordinary monopoly power and that the similarity between Leviathan and optimal taxation solutions hinges on the irrelevance of distributional weights.