A cost–benefit analysis of hearing aids,including the benefits of reducing the symptoms of dementia

We carried out a CBA of hearing aids (HAs) in which we estimated the direct utility benefits, and included the indirect utility benefits working through a reduction in dementia symptoms. The benefits methodology involved using QALYs as the outcome measure and then applying the price of a QALY to convert the outcome measure into monetary terms. The price of a QALY was derived from an age-specific VSL estimate. The effects of HAs on utility were estimated from a fixed effects regression on a large national panel data set provided by NACC where we used a negative proxy for the QoL. We also used a fixed effects regression for the estimate of the indirect benefits involving HAs reducing dementia symptoms. We found that the total benefits, mainly coming from the direct benefits, were extremely large relative to the costs, with benefit–cost ratios over 30.     

Spell durations and the impact of censoring

A grouped hazard approach for analysing multiple-spell durations subject to censoring is applied to spells of absence from the workplace. We follow Barmby, Orme and Treble's (1991) procedure for dealing with unobserved heterogeneity, but argue that their treatment of the observed discrete data, and the inherent censoring, is inappropriate and could lead to significant overestimation of duration dependence. First version received: September 1996/Final version received: June 2000     

Impulse response analysis in a misspecified DSGE model: a comparison of full and limited information techniques

In this article, we examine the effect of estimation biases – introduced by model misspecification – on the impulse responses analysis for dynamic stochastic general equilibrium (DSGE) models. Thereby, we use full and limited information estimators to estimate a misspecified DSGE model and calculate impulse response functions (IRFs) based on the estimated structural parameters. It turns out that IRFs based on full information techniques can be unreliable under misspecification.     

扭曲与矫正之成本权衡--汇率机制改革后人民币升值压力累积与释放效应分析

目前人民币仍面临由自身价值提高、篮子货币贬值和市场升值预期复合而成的多重升值压力.面对压力,有名义升值、实际升值和压力累积等三种政策方案可供选择.从成本收益量化比较来看,名义升值净成本最低.因此,应在不超过升值压力幅度的范围内允许人民币名义汇率继续缓升,以消除货币低估,实现内外均衡.     

The effects of wind generation capacity on electricity prices and generation costs: a Monte Carlo analysis

We use Monte Carlo analysis to examine the potential of increased renewable generation to provide a hedge against variability in energy prices and costs. Fuel costs, electricity demand and wind generation are allowed to vary and a unit commitment and economic dispatch algorithm is employed to produce cost-minimizing generation schedules under different levels of installed wind capacity. Increased wind capacity reduces the mean and the variance of production costs but only the variance of electricity prices. Wind generators see their market revenues increase while consumer payments and fossil generator profits do not considerably vary as wind capacity increases. Risk aversion is captured by considering the conditional value-at-risk for both consumers and producers. The optimal level of wind generation increases as risk aversion increases due to the potential of wind to act as a hedge against very high electricity prices in high fuel price scenarios.     

Student-t distribution based VAR-MGARCH: an application of the DCC model on international portfolio risk management

Significant second-moment transmission effects and obvious time-varying patterns of correlation coefficients among major equity and currency markets in the US, Japan and the UK are found to exist. Such observations inspire the time-varying setting of dynamic conditional correlation coefficients in MGARCH models. On the other hand, the multivariate Student-t distribution is suitable for analysing the visible leptokurtosis that is common in financial markets. Both are important for international portfolio risk management. Thus, a comparison on the hedging efficiency of hypothetical portfolios consisting of stock and currency future positions is conducted in order to justify the multivariate Student-t distribution based on the DCC-MGARCH model.     

A cost-utility analysis of adjunctive treatment with newer antiepileptic drugs in the UK

Summary

A recent review found that economic assessment of epilepsy treatment relies largely on hypothetical modelling of outcomes and combining these with resource and cost data from different sources. Prospective evaluations combining cost studies with outcome assessments are lacking. However, such a prospective observational study has been carried out previously, but only partially reported. We present a comprehensive cost-utility analysis of adjunctive newer antiepileptic drugs (AEDs) based on observational data from that study, and assess the uncertainty of the results using bootstrapping.

A total of 125 patients with intractable epilepsy were recruited. Each patient was about to start treatment with a new adjunctive AED [clobazam, (non-proprietary) gabapentin (Neurontin®, Parke-Davis, UK), lamotrigine (Lamictal®, GlaxoSmithKline, UK), topiramate (Topamax®, Janssen-Cilag, UK), or vigabatrin (Sabril®, Aventis Pharma, UK)]. Patients completed semi-structured interviews on resource use, side effects, and the EuroQol EQ-5D. Patients were followed up for 6 months. Patient-specific cost and utility data were analysed separately for each AED on an intent-to-treat basis. Uncertainty in the estimated incremental cost-utility ratios was quantified using the non-parametric bootstrap method, and cost-effectiveness acceptability curves were calculated.

At 6 months, 78 patients were still on their prescribed drug. Only topiramate and vigabatrin patients showed an increase in EQ-5D scores, and therefore dominated

other AEDs. Topiramate had an incremental cost-effectiveness ratio of £7,869/QALY compared with vigabatrin, and had more than a 50% chance of being optimal if the ceiling ratio was above £10,000/QALY.

Observational studies provide a valuable source of information for the economic evaluation of AEDs. In this study non-parametric bootstrapping was used to confirm the cost-effectiveness of adjunctive topiramate for patients with refractory epilepsy.     

A prospective analysis of labour market status and self-rated health in the UK and Russia

Comparing prospective data from the UK and Russia, this paper analyzes whether the association of labour market status, and particularly unemployment, with subsequent health varies by the level of state protection provided to the unemployed. While the UK's unemployment welfare regime is classified as providing minimal protection, the Russian regime is sub-protective. Employing Cox duration analysis upon data from the Russian Longitudinal Monitoring Survey and the British Household Panel Survey for the period 2000–2007, this study finds that labour market status and economic circumstances independently predicted individual-level declines in self-rated health and, contrary to expectations, the associations of unemployment with health decline were similarly sized in the two countries.     

Knowledge flows and the geography of networks: A strategic model of small world formation

This paper aims to demonstrate that the strategic approach to link formation can generate networks that share some of the main structural properties of most real social networks. For this purpose, we introduce a spatialized variation of the Connections model [Jackson, M.O., Wolinsky, A., 1996. A strategic model of social and economic networks. Journal of Economic Theory 71, 44–74] to describe the strategic formation of links by agents who balance the benefits of forming links resulting from imperfect knowledge flows against their costs, which increase with geographic distance. We show, for intermediate levels of knowledge transferability, clustering occurs in geographical space and a few agents sustain distant connections. Such networks exhibit the small world property (high clustering and short average relational distances). When the costs of link formation are normally distributed across agents, asymmetric degree distributions are also obtained.     

A cost-benefit analysis of restoring the Em River in Sweden: valuation of angling site characteristics and visitation frequency

This article uses Cost-Benefit Analysis (CBA) to evaluate restoration scenarios aimed at improving angling on the Em River in Sweden. We find that none of the proposed projects are socially profitable when considering only values associated with angling. We rely on a Choice Experiment (CE) to derive utilities and estimate the monetary value of angling site characteristics and then also use the utilities derived in a visitation frequency using a two-stage budgeting approach. The visitation frequency is then used to extract values for fishing license sales and business-related income. The case study illustrates how CBA can provide useful insights into the potential economic returns of environmental restoration projects. Our case study also indicates that the results in terms of Willingness-To-Pay (WTP) and visitation frequency are general findings – i.e. they appear similar across angling sites – which is particularly useful from a policy point of view because it supports the use of benefit transfer for more cost-effective river management.     

Evaluating drug cost per responder and number needed to treat associated with lixisenatide on top of glargine when compared to rapid-acting insulin intensification regimens on top of glargine,in patients with type 2 diabetes in the UK,Italy, and Spain

Objectives: This study investigated the cost per responder and number needed to treat (NNT) in type 2 diabetes mellitus (T2DM) patients for lixisenatide compared to insulin intensification regimens using composite endpoints in the UK, Italy, and Spain.

Methods: Efficacy and safety outcomes were obtained from GetGoal Duo-2, a 26-week phase 3 trial comparing lixisenatide vs insulin glulisine (IG) once daily (QD) and three times daily (TID). Response at week 26 was extrapolated to 52 weeks, assuming a maintained treatment effect, based on long-term evidence in other T2DM populations. Responders were defined using composite end-points, based on an HbA1c threshold and/or no weight gain and/or no hypoglycemia. The HbA1c threshold was varied in sensitivity analyses. Annual treatment costs were estimated in euros (1 GBP?=?1.26 EUR), including drug acquisition and resource use costs. Cost per responder was computed by dividing annual treatment costs per patient by the proportion of responders.

Results: Lixisenatide was associated with the lowest cost per responder for all composite end-points that included a weight-related component. For the main composite end-point of HbA1c ≤7.5% AND no weight gain AND no symptomatic hypoglycemia, cost per responder results were: UK: 6,867€, 8,746€, and 12,410€; Italy: 7,057€, 9,160€, and 12,844€; Spain: 8,370€, 11,365€, and 17,038€, for lixisenatide, IG QD, and TID, respectively. The NNT analysis showed that, for every 6.85 and 5.86 patients treated with lixisenatide, there was approximately one additional responder compared to IG QD and TID, respectively.

Limitations: A limitation of the clinical inputs is the lack of 52-week trial data from GetGoal Duo-2, which led to the assumption of a maintained treatment effect from week 26 to 52.

Conclusions: This analysis suggests lixisenatide is an efficient economic resource allocation in the UK, Italy, and Spain.     

关于统计分析教学方法的改革和探索

本文从有关统计分析教学现状出发,论述了开设统计分析方法及其应用软件课程教学的必要性,并介绍了笔者自2003年以来给本校研究生开设统计分析课程和在本系开设数学实验课程的情况、收获和体会。     

A cost analysis of the management of attention-deficit/hyperactivity disorder (ADHD) in children in the UK

SUMMARY

A decision analysis was performed to model the effects and health economic differences of current UK management approaches to attention-deficit/hyperactivity disorder (ADHD) in children aged between 6 and 16 years. The approaches modelled were: medication using a standard immediate-release methylphenidate (MPH-IR) (once, twice or three times daily); medication using CONCERTA®XL (OROS®* methylphenidate; MPH), a long-acting once-daily formulation of methylphenidate; or behavioural therapy (BEH). Starting treatment with BEH alone resulted in the highest annual cost (UK£2,147), while the costs of starting treatment with MPH-IR alone (£1,332), or OROS®* MPH alone (£1,362) were comparable. Treatment switches to behavioural treatment or combined treatment (medication and behavioural) due to treatment failure occurred in 11.8% of OROS®* MPH and 24.2% of MPH-IR patients. Probabilistic sensitivity analyses showed that the results were sensitive towards treatment success and the proportion of patients with comorbidities, although conclusions were not altered. UK treatment costs over 1 year appear comparable regardless of whether patients were treated first with OROS®* MPH or MPH-IR. Treating patients first with BEH and then adding stimulant medication if needed resulted in higher overall annual treatment costs.

CONCERTA® XL and OROS® are trademarks of ALZA Corporation, USA.     

A regional analysis of flows into and out of the UK national minimum wage

This article utilizes the panel element of the UK Labour Force Survey (LFS) to identify for individual regions total inflows and outflows and hazards for those individuals paid at or below the National Minimum Wage (NMW). In particular, it examines the extent and direction of the correlation between low-pay inflows and outflows and the economic cycle. Further, it examines the impact of regional variations in the bite of the NMW on regional flows into and out of the NMW.     

Dynamics of the UK natural gas industry: System dynamics modelling and long-term energy policy analysis

We present a dynamic model of the indigenous natural gas industry in the UK. The model has been built using a system dynamics approach. Using the model several scenarios have been analyzed. We found that management of the supply-side policy alone cannot substantially postpone the discovery, production and consumption peak. We also found that the dynamics of the main variables, namely, exploration, production and consumption, are sensitive to initial demand conditions. Postponing the onset of gas price increases can therefore be achieved more effectively through efforts to reduce demand growth. One might expect that a low taxation policy would encourage more exploration and production of gas and thereby stimulate higher consumption rates. Instead, there was no overall net effect on production and consumption in the long term. The depletion effect on cost of exploration acts as counterbalance to low taxation policy. Depletion effect causes cost and thus price to rise further which depress consumption rate. The advances in exploration and production technology can delay the peak of exploration, production and consumption. Technological improvements mean lower cost of exploration and production which pressure down the long-term pattern of price dynamics.     

A multi-level analysis of sustainable mobility transitions: Niche development in the UK and Sweden

A wide range of intractable problems such as polluting emissions, noise, accidents, resource depletion, and inaccessibility of amenities are associated with the current transport regime. Given the slow movement towards a more sustainable mobility system, more radical, systemic innovation - a ‘transition’ - is required. Broadly speaking, this may be achieved via three routes: technological change, modal shift, and reduced travel demand. Drawing on concepts from the transitions literature (e.g., [Geels, F.W.: Technological Transitions and System Innovations: A Co-evolutionary and Socio-Technical Analysis, Edward Elgar, Cheltenham, 2005.]), we conceptualise each of these routes as a bundle of niche activities within an Area of Innovation, deviating to differing degrees from the current mobility ‘regime’. We present empirical evidence and indications of ongoing development of niches in these three areas within the UK and Sweden, and explore processes of co-evolution, divergence and tension within and between niches. Findings indicate recent market penetration of novel transport technologies, more advanced than modal shift or demand management activities; however, different transport technologies are more successful in each country. We also identify examples of a close relationship between development of radical vehicle/fuel technologies and provision of mobility services; and information technology as a driver in all three areas of innovation. We conclude that future innovation in transport depends on diversity, hybridisation, and co-evolution of niches. Finally, policy implications are discussed.     

A UK analysis of the cost of switching renal transplant patients from an immediate-release to a prolonged-release formulation of tacrolimus based on differences in trough concentration variability

Background and aims:

Randomized controlled trials have shown that a once-daily prolonged-release (PR) tacrolimus formulation (PR tacrolimus; Advagraf), is non-inferior to a twice-daily immediate-release (IR) tacrolimus formulation (IR tacrolimus; Prograf) in terms of biopsy-proven acute rejection, graft failure and mortality in renal transplant recipients. However, relative to IR tacrolimus, PR tacrolimus exhibits reduced tacrolimus trough concentration variability, which has been associated with reduced graft failure. Based on these data, the present study evaluated the cost of switching UK renal transplant patients from IR tacrolimus to PR tacrolimus.

Methods:

UK-specific data on acute rejection, graft failure, and mortality were used to construct a budget impact model to assess the costs of switching from IR tacrolimus to PR tacrolimus on a 1:1?mg:mg basis. The model assumed that 3.1% of patients on PR tacrolimus had high tacrolimus trough concentration variability compared with 17.4% on IR tacrolimus, based on a study comparing PR tacrolimus and IR tacrolimus pharmacokinetics. A relative graft failure risk of 2.38 was applied to high variability patients based on data from a tacrolimus variability study in which 10/148 patients with low variability experienced graft failure, compared with 24/149 in the high variability group. Cost data were taken from the British National Formulary and 2012–2013 NHS tariff information.

Results:

The mean per-patient cost (including tacrolimus, concomitant immunosuppressive medications, dialysis after graft failure, and treatment for acute rejection) was GBP 26,941 (standard deviation [SD]?=?GBP 2765) with PR tacrolimus vs GBP 30,356 (SD?=?GBP 3085) for IR tacrolimus over a 5-year period, corresponding to a saving of GBP 3415 (SD?=?GBP 516) per patient or GBP 341,500 in a hypothetical 100-patient transplant center. Cost savings were driven primarily by lower dialysis costs resulting from the lower proportion of PR tacrolimus patients with high tacrolimus trough concentration variability (leading to lower graft failure risk).

Limitations:

The main limitation of the study was the use of heterogeneous data sources to capture the effect of within-patient variability on graft failure. The most important difference between the studies was the definition of the threshold between low and high within-patient variability. This was explored in sensitivity analyses in which the inter-arm difference in the inter-arm proportions of patients with high and low variability was abolished.

Conclusions:

Converting UK renal transplant recipients from IR tacrolimus to PR tacrolimus was associated with lower pharmacy and dialysis costs.     

A cost analysis of SIR-Spheres yttrium-90 resin microspheres versus tyrosine kinase inhibitors in the treatment of unresectable hepatocellular carcinoma in France,Italy, Spain and the UK

Abstract

Background and aims: A wide range of treatment options are available for hepatocellular carcinoma (HCC), including systemic treatment with tyrosine kinase inhibitors (TKIs) such as sorafenib and lenvatinib, immunotherapies, locoregional therapies such as selective internal radiation therapy (SIRT) and treatments with curative intent such as resection, radiofrequency ablation and liver transplantation. Given the substantial economic burden associated with HCC treatment, the aim of the present analysis was to establish the cost of using SIRT with SIR-Spheres yttrium-90 (Y-90) resin microspheres versus TKIs from healthcare payer perspectives in France, Italy, Spain and the United Kingdom (UK).

Methods: A cost model was developed to capture the costs of initial systemic treatment with sorafenib (95%) or lenvatinib (5%) versus SIRT in patients with HCC in Barcelona Clinic Liver Cancer (BCLC) stages B and C. A nested Markov model was utilized to model transitions between progression-free survival (PFS), progression and death, in addition to transitions between subsequent treatment lines. Cost and resource use data were identified from published sources in each of the four countries.

Results: Relative to TKIs, SIRT with SIR-Spheres Y-90 resin microspheres were found to be cost saving in all four country settings, with the additional costs of the microspheres and the SIRT procedure being more than offset by reductions in drug and drug administration costs, and treatment of adverse events. Across the four country settings, total cost savings with SIR-Spheres Y-90 resin microspheres fell within the range 5.4–24.9% and SIRT resulted in more patients ultimately receiving treatments with curative intent (4.6 vs. 1.4% of eligible patients).

Conclusion: SIR-Spheres Y-90 resin microspheres resulted in cost savings relative to TKIs in the treatment of unresectable HCC in all four country settings, while increasing the proportion of patients who become eligible for treatments with curative intent.     

A cost-utility analysis of prolonged-release tacrolimus relative to immediate-release tacrolimus and ciclosporin in liver transplant recipients in the UK

Background: Calcineurin inhibitors (CNIs) represent the cornerstone of immunosuppressive therapy after liver transplantation. A recent network meta-analysis (NMA) evaluated the relative efficacy of CNIs ciclosporin, prolonged-release (PR) tacrolimus, and immediate-release (IR) tacrolimus in adult liver transplant recipients based on randomized and large observational trials published since 2000. Based on the NMA findings, the present study evaluated the cost-utility of PR tacrolimus relative to ciclosporin or IR tacrolimus in liver transplant recipients in the UK.

Methods: A Markov model was developed to evaluate the cost-utility of immunosuppressive regimens in liver transplant recipients, capturing costs associated with immunosuppression, retransplantation, acute rejection (AR), and cytomegalovirus infection. Mortality, graft loss, and AR odds ratios were derived from the NMA. Costs were taken from the British National Formulary and the NHS National Tariff and expressed in 2016 pounds sterling. Future costs and effects were discounted at 3.5% annually.

Results: Over 25 years, PR tacrolimus resulted in increased life expectancy and quality-adjusted life expectancy (QALE) relative to IR tacrolimus and ciclosporin. Relative to ciclosporin, QALE increased by 1.17 quality-adjusted life years (QALYs) with PR tacrolimus while costs increased by GBP £4645, yielding an incremental cost-effectiveness ratio (ICER) of £3962 per QALY gained. Relative to IR tacrolimus, QALE increased by 0.78 QALYs and costs by £1474, resulting in an ICER of £1889 per QALY gained. Sensitivity analysis showed the analysis to be most sensitive to dosing assumptions.

Conclusions: Based on a UK-specific analysis of the projected cost-utility of PR tacrolimus relative to IR tacrolimus and ciclosporin, PR tacrolimus was cost-effective, improving life expectancy and QALE relative to both IR tacrolimus and ciclosporin, yielding ICERs below £20 000 per QALY gained. The main limitations of the study were data source heterogeneity and omitting the economic and clinical effects of treating aspects of recurrent liver disease.     

Personal attitudes in the assessment of the future of science and technology: A factor analysis approach

In 1996, the second German Delphi study (“Delphi '98”) was started. The Delphi '98 is a two-round Delphi expert survey being conducted by the Fraunhofer Institute for Systems and Innovation Research (ISI) on behalf of the German Federal Ministry of Education, Research, Science, and Technology (BMBF). The study was published in February 1998, and is now getting into its implementation phase. Its inherent focus is on the development of science and technology in 12 thematic fields in the next 30 years. To arrive at a better understanding of the influence of personal attitudes towards general developments in natural environment and society, the respondents were asked in the first round of the Delphi survey for their personal opinion towards several megatrends concerning the natural environment, economic, sociological, and political developments. Over 2,300 answers led to a very solid database, which gives insights into the general attitudes of the German R&D experts. On some topics, there is a high consensus, whereas in others, opposite opinions coexist. These results may serve as the database for a factor analysis leading to the identification of five different expert types. This paper examines the crucial question of whether different patterns in assessing the future development in science and technology by expert types can be observed. In general, it turned out that differences in personal attitudes towards megatrends do not influence the estimation of developments in science and technology. However, differences exist in specific topics and the distribution of the five experts types among the respondents differs significantly in the 12 fields.