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.     

Modeling Methods for Discrete Choice Analysis

This paper introduces new forms, sampling and estimation approaches fordiscrete choice models. The new models include behavioral specifications oflatent class choice models, multinomial probit, hybrid logit, andnon-parametric methods. Recent contributions also include new specializedchoice based sample designs that permit greater efficiency in datacollection. Finally, the paper describes recent developments in the use ofsimulation methods for model estimation. These developments are designed toallow the applications of discrete choice models to a wider variety ofdiscrete choice problems.     

Strategic Debt in Vertical Relations: Evidence from Franchising

In this paper, we examine the strategic use of debt in franchise organizations. We focus on both the franchisee's and the franchisor's capital structures. The primary goal of this study is to examine whether franchisors impose limits on franchisees’ debt levels to be able to increase their own leverage. We find that the franchisor's leverage is significantly related to the maximum leverage allowed for the franchisee. As the franchisor sets an upper limit on the franchisee's debt ratio, the franchisor can raise more debt and therefore seizes tax benefits, since interest payments are tax deductible. We find that this effect is stronger in chains with larger fractions of franchised outlets.     

Regional patterns of employment changes of less-educated men in Japan: 1990–2007

We investigate regional patterns in employment of less-educated men in Japan from 1990 to 2007. The employment–population ratio of junior high school graduate men (9 years of compulsory schooling) decreased from 1990 to 2007. Wage growth across regions had a unique pattern during this period: it was high in the low-wage regions in the 1990s but high in the high-wage regions in the 2000s. We use these regional variations in wage growth to identify the labor supply elasticity of less-educated men. The estimated elasticity of the employment-to-population ratio of junior high school graduate men is around 0.15.     

Journal Articles of Interest from Other Disciplines

The authors describe the present state of economic education in Japan. There is a larger number of undergraduate students who major in economics, but their purpose of studying economics and their economic literacy differ. Precollege economic education is regulated by the course of study and limited by the poor ability of teachers to teach the economics content.     

A Comparison of Wage Structures in the United States and Japan: Results from Cell Mean Regressions

This paper discusses three issues in estimating wage regressions by using the aggregated data from the Japanese Basic Survey of Wage Structure (BSWS). The issues include: (1) the order of taking averages and logs, (2) the usage of differently aggregated tables in the BSWS, (3) the treatment of the bonus variable for workers who have just joined a firm. To address them, I present regression results from the US Current Population Survey (CPS). I find that using differently aggregated tables sometimes affects the estimates significantly. I also present the results from wage regressions from the differently aggregated BSWS data.
JEL Classification Number: J30.     

How does earnings management influence investor’s perceptions of firm value? Survey evidence from financial analysts

Survey evidence shows CFOs to believe that earnings management can enhance investor valuation of their firms. This evidence raises the question of correspondence between the beliefs of CFOs and investors. Surveying financial analysts to gain insight into how earnings management influences investor perception of firm value, we find analysts’ and CFOs’ beliefs to be generally consistent. We find that analysts perceive meeting earnings benchmarks and smoothing earnings to enhance investor perception of firm value and all earnings management actions to reach a benchmark, save share repurchases, to be value destroying. CFOs, however, are reluctant to repurchase shares, preferring to use techniques viewed by analysts as value destroying (e.g., reductions in discretionary spending). Analysts’ inability to unravel such techniques perhaps explains CFOs’ preferences.     

Capital structure around the world: The roles of firm- and country-specific determinants

We analyze the importance of firm-specific and country-specific factors in the leverage choice of firms from 42 countries around the world. Our analysis yields two new results. First, we find that firm-specific determinants of leverage differ across countries, while prior studies implicitly assume equal impact of these determinants. Second, although we concur with the conventional direct impact of country-specific factors on the capital structure of firms, we show that there is an indirect impact because country-specific factors also influence the roles of firm-specific determinants of leverage.     

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.