A review of biopsychosocial strategies to prevent and overcome early-recognized poor adherence in growth hormone therapy of children

Abstract

Background:

Adherence to growth hormone (GH) therapy among children is variable and remains a problem, possibly affecting growth outcomes and future health, and having economic consequences.

Objective:

To provide a review of the issues related to poor adherence to GH therapy in children and describe integrative strategies that may improve adherence.

Results:

Poor adherence may be caused by various factors, affecting both the children and their families. The key reasons for adherence difficulties are psychological/emotional problems, social/everyday problems and technical handling issues of the drug delivery device. Correspondingly a broad range of strategies to address adherence to GH therapy often revolve around counseling and education, not just for the patient but also for the family giving care.

Limitations:

This review is intended as a general survey of strategies which could help, in clinical practice, to overcome poor adherence to growth hormone therapy in children; it summarizes the representative literature but it does not aim to be a rigorous database literature search in every aspect.

Conclusions:

If poor adherence is recognized early on during treatment, appropriate steps may be taken to identify barriers that are amenable to change for encouraging the child to adhere to the treatment regimen. A preventative approach may also be considered; for example, doctors could address adherence issues early and train families of children treated with GH to recognize the resources as well as the barriers to adherence. The broad range of different causes for poor adherence demands a great variety of interventions, making it important to individualize optimal treatment behavior. Additionally, economic studies are required to quantify the cost of poor adherence to GH therapy and to show the financial benefits of good adherence.     

A systematic review of pharmacoeconomic guidelines

Objective: To review, summarize, and analyze both similarities and differences of pharmacoeconomic (PE) guidelines, to enable researchers to access their characteristics and the current state of PE guidelines; furthermore, to learn which methodological issues still remain contested and to promote the methodological development of PE guidelines.

Materials and methods: The authors performed a search for PE guidelines using PubMed, the Cochrane library database, and the websites of the International Society for Pharmacoeconomics and Outcomes Research. Information of each guideline was extracted using a pre-designed extraction template, which included 22 aspects; the guidelines were summarized in the forms of charts, and their characteristics have been described.

Results: A total of 40 PE guidelines were studied. The most common methodological issues include the types of analysis, sources for effectiveness, use of quality-adjusted life-years (QALYs) to measure outcomes, and use of incremental cost effectiveness ratios to present results. The majority of the guidelines preferred a cost utility analysis with outcomes expressed in terms of QALYs. Most of the guidelines preferred meta-analysis or meta-analysis of the randomized controlled trials, and required a systematic review of all evidence. Issues that varied most in the guidelines were the choice of the comparator, recommended costs to be included, methods related to indirect cost calculations, methods of sensitivity analysis, and discounting rate.

Conclusion: A comparison of these guidelines revealed that a number of differences exist among them in several key aspects, and some critical methodological issues still exist, for which no best solution is available. Furthermore, efforts need to be made to develop harmonious methods for the PE, and to improve the transferability of the outcomes of PE evaluations.     

A new model to evaluate the long-term cost effectiveness of orphan and highly specialised drugs following listing on the Australian Pharmaceutical Benefits Scheme: the Bosentan Patient Registry

Abstract

Background: Pharmaceutical subsidy schemes are under increasing pressure to evaluate the cost effectiveness of new highly specialised and orphan drugs for universal subsidy. In the absence of longer-term outcome data, drug sponsors often present modelled data, which can carry a significant level of uncertainty over longer-term projections. Risk-sharing schemes between drug sponsor and government may provide an acceptable method of balancing the uncertainty of longer-term cost effectiveness with the public demand for equitable and timely access to new drugs.

Methods: The Bosentan Patient Registry (BPR) is an example of a unique risk-sharing model utilised in Australia aiming to provide clinical evidence to support the modelled predictions, with the registry survival outcomes linked to future price. Concomitant medication, health and vital status data was collected from clinicians, government health departments and death registries.

Results: The BPR has identified a number of issues surrounding registry governance, ethics and patient privacy, and the collection of timely and accurate data, which need to be addressed for the development of a generic registry model for systematic evaluation.

Conclusion: The success of a generic drug registry model based on the BPR will be enhanced by addressing a number of operational issues identified during the implementation of this project.

Material in this paper was presented in an oral presentation to the National Medicines Symposium: Quality Use of Medicines, 7–9 June 2006, Canberra, Australia.     

Comparative analyses of published cost effectiveness models highlight critical considerations which are useful to inform development of new models

Abstract

Background: Comparative analyses of published cost effectiveness models provide useful insights into critical issues to inform the development of new cost effectiveness models in the same disease area.

Objective: The purpose of this study was to describe a comparative analysis of cost-effectiveness models and highlight the importance of such work in informing development of new models. This research uses genotypic antiretroviral resistance testing after first line treatment failure for Human Immunodeficiency Virus (HIV) as an example.

Method: A literature search was performed, and published cost effectiveness models were selected according to predetermined eligibility criteria. A comprehensive comparative analysis was undertaken for all aspects of the models.

Results: Five published models were compared, and several critical issues were identified for consideration when developing a new model. These include the comparator, time horizon and scope of the model. In addition, the composite effect of drug resistance prevalence, antiretroviral therapy efficacy, test performance and the proportion of patients switching to second-line ART potentially have a measurable effect on model results. When considering CD4 count and viral load, dichotomizing patients according to higher cost and lower quality of life (AIDS) versus lower cost and higher quality of life (non-AIDS) status will potentially capture differences between resistance testing and other strategies, which could be confirmed by cross-validation/convergent validation. A quality adjusted life year is an essential outcome which should be explicitly explored in probabilistic sensitivity analysis, where possible.

Conclusions: Using an example of GART for HIV, this study demonstrates comparative analysis of previously published cost effectiveness models yields critical information which can be used to inform the structure and specifications of new models.     

Essential medicine policy in China: pros and cons

Abstract

Objective:

To analyze the achievements, issues and policy recommendations for implementing essential medicine system in China after a 3-year effort.     

Confidence in Keynes and Hayek: Reply to Burczak

We agree with Burczak's identification of the crucial issues. We disagree with his interpretation of them. We expand our defense of the claim that Keynes was a rationalist. We introduce the "horizon principle" to critize Keynes' dichotomy between short-term and long-term expectations. We question the statistical simile guiding some Post Keynesian dsiscussions of uncertainty. We point to the role of evolution in shaping conventions that fit the economic environment in a world with novel events. We think the evidence favors our view over Burczak's. Finally, we put in a plea for framing the issues in a way that facilitates empirical testing.     

A comparison of work absence periods and the associated costs for two different modes of exercise therapies for patients with longstanding subacromial pain

Abstract

Background: There are no studies on economic issues concerning rehabilitation exercises for shoulder pain.

Objective: The aim of the study was to investigate sick leave and the associated costs after a medical exercise therapy programme in patients with longstanding subacromial pain/impingement.

Methods: A randomised controlled trial in which 61 patients were randomly assigned either to a high-dosage medical exercise therapy group (HD) (n=31) or to a low dosage exercise therapy group (LD) (n=30). Both groups were given three treatments a week over 3 months. The differences between the groups were number of repetitions, number of sets and time performing global aerobic exercises.

Results: The outcome for the HD group was significantly (p<0.05) better compared to the LD group. The reduction in costs for sick leave for the HD group was 59.1%, whereas for the LD group, the reduction was only 42.3%, which is a significant difference.

Conclusion: In patients with longstanding subacromial pain, HD medical exercise therapy might be an efficient treatment approach.     

The status of modeled claims

Abstract

The only acceptable modeled claims for costs and outcomes are those that are testable and can be validated in a timeframe that is acceptable to a formulary committee. This issue provides four papers which explore the methodological issues in validation, the UK experience with NICE, the questions a formulary committee should ask of modeled claims, and the role of Big Data in validating modeled claims.     

Creative vs. Mechanical Evolutionism: A Commentary on Petr

Abstract:

The paper deals with the lack of attention that many socially minded economists pay to social issues, with social costs being a special case. It argues that while these economists acknowledge that social costs exist, and are rooted in the way the economy functions, they do not frame their economic inquiries accordingly. This is because they believe that scientific dialogue is possible only by accepting a commonly shared ground for scientific inquiry that focuses on restricted, but generally accepted goals. This behavior obscures a major implication of systemic openness: The choice of goals and the way scientific inquiry is carried out do not depend on once-and-for-all criteria, but require the explicit formulation of a range of value judgments. The conclusion of the paper is that it is possible to deal with social issues while pursuing scientific dialogue, but this requires framing the dialogue in a twofold manner: identifying the shared grounds of inquiry and identifying the specific issues to be investigated     

Economic burden of healthcare-associated infection in US acute care hospitals: societal perspective

Abstract

Background:

Assessing the costs of healthcare-associated infection (HAI) is challenging. Methodological issues abound. Previous estimates have been derived in diverse ways from varied perspectives in different settings with dissimilar data. Results can be confusing. Full societal costs, which are more inclusive than commonly reported direct hospital costs, have never been fully measured or reported.

Objective:

To update, combine, and expand previous cost estimates to determine the annual societal burden of illness (direct medical, non-medical, and indirect costs) arising from HAIs in US acute-care hospitals.

Methods:

The research approach encompassed literature and internet searches; reference identification, selection, and review; then data abstraction, compilation, and analyses to estimate full societal costs. Previously published systemic reviews, surveillance reports, and individual clinical studies, along with newly computed component costs, all contributed to final estimates.

Results:

HAIs in US acute-care hospitals lead to direct and indirect costs totaling $96–$147 billion annually. These results are subject to the same limitations as previous studies from which contributing data were derived.

Conclusion:

The enormous clinical and economic burden of infection places HAIs high on the list of devastating and costly illnesses, such as cancer, heart attack, stroke, and diabetes, thereby mandating further research and greater efforts to contain a pressing healthcare problem.     

INTELLECTUAL PROPERTY RIGHTS IN A KNOWLEDGE-BASED ECONOMY: A NEW FRAME-OF-ANALYSIS

The debate on software intellectual property rights (IPRs) has not only highlighted fundamental issues regarding the scheme of protection that software enjoys, it has also pointed out major gaps in the representation of computer programs as economic goods. In this respect, various interpretations of software propose a limited outlook by referring only to particular aspects of computer programs.

The paper discusses the economic nature of software and computational processes and how they should be properly represented as commodities by focusing on software IPR legislation in the US. It elaborates the similarities and differences between software applications and machines on the basis of historical evidence from the evolution of information technologies and computer science. Further, we discuss whether computer programs should enjoy IPR protection (like their physical equivalents) and which legal regime would induce the maximal degree of societal benefits, while satisfying private and public interests.

The paper also elaborates the essential issues of the distinction between ideas and expressions and the ways they are treated as intellectual property. It highlights major aspects in the debate over protection of software applications by both patents and copyrights and analyses the economic impact of the joint regime.

By highlighting the dissimilarities in the economic nature and market behaviour of ideas and expressions we point out the difficulties in drawing parallels between software and physical equivalents. Finally, we provide alternative ways to establish coherent juridical basis and legal policy of software IPRs that aim at stimulating innovation and developing the technological landscape in information technologies.     

Jules Dupuit,Société d'économie politique de Paris and the issue of population in France (1850 – 66) ∗

Abstract

The tradition that views Dupuit only as a brilliant engineer-economist who trained at the École nationale des Ponts et Chaussées remained strong in the fifty years that followed World War II. Within this tradition, research on Dupuit mostly was focused on his publications on surplus theory, road tolls and discriminating monopoly. His participation in the debates about other issues taking place within the various learned societies to which he belonged (Société d'économie politique de Paris, Société d'économie sociale, Société de statistique de Paris) long remained unexplored. But recent research has begun filling the gap. This paper follows on these latter research efforts. It aims at uncovering a largely unknown facet of Dupuit, endeavouring to fully elicit his role in the various controversies that took place in France between 1850 and 1866 on the issues of population and the Malthusian principle of population.     

Post‐cold war self‐determination: Ireland and east Timor

The national conflicts centred on Northern Ireland and East Timor bear little resemblance. Yet the two main political groupings aspiring to national liberation, Sinn Féin in Ireland and the National Council of Timorese Resistance (CNRT) have developed remarkably similar peace proposals. These define the process of reconstruction, protection of human rights and self‐government as separable from issues of state sovereignty, at least in the medium term. Both have promoted the creation of transitional structures to address these issues, delaying self‐determination in order to promote conflict resolution and political reconciliation. The two peace initiatives have been relatively successful in seizing the moral high ground, and have forced the respective state authorities to participate in a process of peace‐making that has substantially recast the exercise of political authority.     

The Right to Organize in the Philippine Business Process Outsourcing Industry

Abstract

There has been some concern over the past few years that nations with emerging economies are sacrificing human dignity over economic progress. An emerging market such as the Philippines has to deal with a host of economic, social, and political issues as its economy develops. One of the issues that concern those who are involved in human rights advocacy is labor rights. The purpose of this paper is to investigate the labor rights issues surrounding the Philippine business process outsourcing (BPO) industry, specifically the right to organize. It also aims to investigate how the changing structure of the Philippine economy has affected the labor rights of its people. This paper will use the BPO industry in the Philippines as a case study. This paper will also try to compare the Philippine experience with those of other countries in order to put its findings in context. Finally, the paper shall examine the effects of globalization on workers’ ability to organize and advocate for their rights.     

The use of Zostavax in Spain: the economic case for vaccination of individuals aged 50 years and older

Background Population aging brings up a number of health issues, one of which is an increased incidence of herpes zoster (HZ) and its complication, post-herpetic neuralgia (PHN). Zostavax vaccine has recently become available to prevent HZ and PHN. This study evaluates the cost-effectiveness of vaccination against HZ in Spain considering a vaccination of the population aged 50 years and older and comparing this to the current situation where no vaccination is being administered.

Methods An existing, validated, and published economic model was adapted to Spain using relevant local input parameters and costs from 2013.

Results Vaccinating 30% of the Spanish population aged 50 years and older resulted in €16,577/QALY gained, €2025/HZ case avoided, and €5594/PHN case avoided under the third-party payer perspective. From a societal perspective, the ICERs increased by 6%, due to the higher price of the vaccine. The number needed to vaccinate to prevent one case was 20 for HZ, and 63 for PHN3. Sensitivity analyses showed that the model was most sensitive to the HZ and PHN epidemiological data, the health state utilities values, and vaccine price used.

Conclusion Considering an acceptable range of cost-effectiveness of €30,000–€50,000 per QALY gained, vaccination of the 50+ population in Spain against HZ with a new vaccine, Zostavax, is cost-effective and makes good use of the valuable healthcare budget.     

Bilateral monopoly: a contribution by Francesco Ferrara

Abstract

In this paper, we propose an interpretation of the application of ‘cost of reproduction’ of Francesco Ferrara to the exchange between two agents to highlight its relevance for the theory of bilateral monopoly. In the Teoria delle Mercedi, Ferrara gives a numerical example to explain price determination in the exchange between one buyer and one seller. Here, this example is translated into a mathematical model that reproduces the fundamental issues of the neoclassical debate on the indeterminacy of price in the Cournot model, and anticipates the solutions proposed by Edgeworth at the end of this debate.     

Social Security Reform and Corporate Governance

Abstract

This paper considers implementation issues arising from potential reforms to the United States Social Security system. Many reform proposals involve individually invested accounts, but the corporate governance implications of such accounts have not been fully explored. Existing reform plans will result in a large fraction of votes being concentrated at one private fund manager. The implications for corporate governance and debt management under alternative fund management strategies are evaluated. The use of futures to construct synthetic investments could alleviate corporate governance and debt management problems.     

Psychology,social evolution and liberalism: a Hayekian trinity

Abstract

The work of Friedrich Hayek describes an extensive political economy, with explicit consideration of the psychological limits to human understanding, the market as a mechanism of information gathering and social coordination, and the relationship between market processes and the free society, where moral and political issues are relevant within a framework of continuous adaptation. Although the survival characteristics of social institutions largely defy rational enquiry, political liberalism secures the diversity that is necessary for evolutionary social adaptation.     

Transition towards a decentralised energy system: analysing prospects for innovation facilitation and regime destabilisation in Finland

ABSTRACT

The Finnish energy system is rather centralised and its governing regime is characterised as exclusive. Recently, pressure to move towards decentralised, small-scale energy production has increased. This article utilises a combination of ideas from technological innovation systems and regime destabilisation and analyses the prospects for the transition towards a decentralised energy system in Finland's socio-economic context. We argue that the transition towards a decentralised energy system requires both innovation facilitation and proactive destabilisation of the existing regime, and therefore these issues must also be included in energy transition analyses.     

Innovation in knowledge-based professional service firms. An integrated conceptual model*

ABSTRACT

The current paper offers a new conceptual model to understanding innovation processes in professional service firms, to make hidden relationships more explicit and to find out what are the issues still unexplored. The paper employs a systematic literature review, and draws upon original categorizations of extant literature, to identify main processes for each category of PSFs. It unveils connections among a wide range of factors setting a conceptual model for innovation pathways and highlighting neglected questions relevant from both the theoretical and the practical perspectives.