International law as a moral theory of state territory?

Current states face challenges from other states and secessionist movements, and no moral theory exists to evaluate these conflicting claims. One step towards a theory is to evaluate international law on territory, specifically as articulated through decolonisation. I argue that international law does not provide a plausible moral theory of territory because the principles of territorial integrity and uti possidetis cannot coherently coexist with the principle of self‐determination. I suggest that philosophers must choose between viewing territory as an expression of national self or as a property right, or else develop a third view from sources beyond current international law.     

Adam Smith and Alexis de Tocqueville on the division of labour*

Abstract

Adam Smith and Alexis de Tocqueville dealt with the division of labour as a characteristic feature of commercial society. There are connections and similarities between the two-sided understanding they both had of the division of labour. One of these coincidences is their assessment of the effects it has, jointly with the extension of the market, that points to the vulnerability of the labouring poor. Exploring this coincidence brings light to their understanding of the social consequences of the market and the possible solutions they propose.     

Smith and Rousseau on envy in commercial societies

Abstract

Several works emphasise the similarities between Rousseau and Smith's analysis of self-interest. We will show, along the lines of Le Jalle, that these similarities end on a divergent appreciation of the importance of envy in commercial societies for, contrary to Rousseau, Smith did not consider envy to be a major threat in commercial societies. Part 1 presents their quite similar definitions of envy based on three characteristics: envy comes from a disadvantageous comparison with others; it is painful and malevolent. Part 2, then, studies their moral psychology, or the way they understand the relationship between sympathy and pity on the one hand, and comparison and envy on the other. Here, we identify significant differences between our two philosophers which might explain why they have opposing views on the predominance of envy in commercial societies and on the issue of inequalities of wealth as we show in Part 3. Rousseau thinks that envy increases with wealth and inequality and thus pervades commercial societies, while Smith sees envy as the exception rather than the rule, and, moreover, does not provide a historical genesis for envy. For Smith, it is emulation rather than envy which is the driving force of the progress of society.     

Wealth and sensibility. The historical outcome of better living conditions for all according to Adam Smith

In this paper, I argue that Smith's commercial society is characterised more by restraint of self-command than by restraint of emotions through self-command, as usually stated. According to Smith, the appropriate degree of self-command varies with historical circumstances: better living conditions for all favour relaxation of self-command and lead people to express their sentiments more freely. I thus highlight a crucial link in Smith's thought between variations in general economic conditions and variations in moral judgement on the expression of emotions, or, in other words, between The Theory of Moral Sentiments and the Wealth of Nations.     

Modelling the lifetime economic consequences of glaucoma in France

Abstract

Objective: To estimate the lifetime economic consequences of glaucoma in France.

Methods: A Markov model estimated the average discounted outcome and cost of glaucoma treatment over a patient's lifetime. Clinical states were defined as first- to fourth-line drugs, no treatment, laser therapy, surgery, blindness and death. After each failure (always after the fourth-line drug) patients could receive either laser treatment or surgery followed by no treatment, or a new treatment. A societal perspective was adopted. Sensitivity analyses were performed.

Results: Discounted medical costs were €7,322 for ocular hypertension treatment (OHT) and €8,488 for a glaucoma patient. Social costs of OHT and glaucoma patients exceeded medical costs. First-line use of the most effective drug would reduce medical and social costs. Societal willingness to pay for the vision benefit would equal the medical costs. Treatment initiated with the most effective drug is a cost saving strategy.

Conclusions: Public health decisions in glaucoma treatment should take a broad economic view embracing the lifetime duration of the disease. There is still a place both within and outside the healthcare system for therapeutic innovations with important economic consequences that bring high added value to patients.     

From the laws of human nature to capital accumulation: James Mill's analysis of the states of society in the Elements of Political Economy

Abstract

James Mill's Elements of Political Economy is usually treated as a textbook of Ricardian political economy. Although this might be justified, there is a passage in this Ricardian textbook that is not Ricardian. The passage deals with Mill's analysis of the states of society, in which he underlines the laws of human nature conducive to capital accumulation. This paper investigates such states.     

Hypoglycemia: An overview of fear of hypoglycemia,quality-of-life,and impact on costs

Abstract

Background:

The clinical goal in the treatment of diabetes is to achieve good glycemic control. Tight glycemic control achieved with intensive glucose lowering treatment reduces the risk of long-term micro- and macro-vascular complications of diabetes, resulting in an improvement in quality-of-life for the patient and decreased healthcare costs. The positive impact of good glycemic control is, however, counterbalanced by the negative impact of an increased incidence of hypoglycemia.

Methods:

A search of PubMed was conducted to identify published literature on the impact of hypoglycemia, both on patient quality-of-life and associated costs to the healthcare system and society.

Results:

In people with type 1 or type 2 diabetes, hypoglycemia is associated with a reduction in quality-of-life, increased fear and anxiety, reduced productivity, and increased healthcare costs. Fear of hypoglycemia may promote compensatory behaviors in order to avoid hypoglycemia, such as decreased insulin doses, resulting in poor glycemic control and an increased risk of serious health consequences. Every non-severe event may be associated with a utility loss in the range of 0.0033–0.0052 over 1 year, further contributing to the negative impact.

Limitations:

This review is intended to provide an overview of hypoglycemia in diabetes and its impact on patients and society, and consequently it is not a comprehensive evaluation of all studies reporting hypoglycemic episodes.

Conclusion:

To provide the best possible care for patients and a cost-effective treatment strategy for healthcare decision-makers, a treatment that provides good glycemic control with a limited risk of hypoglycemia would be a welcome addition to diabetes management options.     

A study of regional variation in the inpatient cost of lower extremity amputation among patients with diabetes in the United States

Abstract

Objective:

Understanding of the effects of providers’ cost on regional variation in healthcare spending is still very limited. The objective of this study is to assess cross-state and cross-region variations in inpatient cost of lower extremity amputation among diabetic patients (DLEA) in relation to patient, hospital, and state factors.

Methods:

Patient and hospital level data were obtained from the 2007 US Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project (HCUP). State level data were obtained from the US Census Bureau and the Kaiser Family Foundation websites. Regression models were implemented to analyze the association between in-patient cost and variables at patient, hospital, and state levels.

Results:

This study analyzed data on 9066 DLEA hospitalizations from 39 states. The mean cost per in-patient stay was $17,103. Four out of the five most costly states were located on the East and West coasts (NY and NJ, CA and OR). Age, race, length of stay, level of amputation, in-patient mortality, primary payer, co-morbidities, and type of hospital were significantly correlated with in-patient costs and explained 55.3% of the cost variance. Based on the means of costs unexplained by those factors, the three West coast states had the highest costs, followed by five Midwestern states, and four Southern states, and Kansas were the least costly.

Conclusions:

Over 40% of the variations in DLEA hospital costs could not be explained by major patient-, hospital-, and state-level variables. Further research is needed to examine whether similar patterns exist for other costly surgical procedures among diabetic patients.     

Burden of rotavirus gastroenteritis and potential benefits of a pentavalent rotavirus vaccination in Belgium

Abstract

Objective and Methods: A decision analytic model was built to assess the paediatric rotavirus gastroenteritis (RVGE) burden and potential benefits associated with the introduction of RotaTeq^®? (pentavalent rotavirus vaccine) in Belgium.

Results: In the absence of a rotavirus (RV) immunisation programme, paediatric RVGE was estimated to account for about 5,860 hospitalisations, 1,720 cases of nosocomial infections, 9,410 cases treated by general practitioners/paediatricians (GP/P) and 10,790 cases not seeking medical care for a birth cohort followed up to 5 years of age. Paediatric RVGE was estimated to cost about €9.0 million from the Belgian healthcare provider perspective and €15.3 million to society. Given a 90% RV vaccination coverage rate, the pentavalent RV vaccine would have a high impact on RV burden by preventing more than 4,850 hospitalisations, 995 cases of nosocomial infections, 7,145 cases treated by GP/P and 8,190 cases not seeking medical care, and reduce RVGE costs by €7.1 million from the Belgian healthcare provider perspective and €12.0 million to society.     

Religion and the sociological critique of political economy: Altruism and gift

Abstract

This article shows that there is a strong connection between the religious component of French sociology and the critique of political economy. In the first section, I consider how selfish behaviour, or egoism, became treated as a major threat endangering the creation of industrial society by those concerned about the diffusion of political economy. I then summarise the methodological critique set forth in the Cours, before connecting this critique to the economic content of the Système and the concept of altruism. In the following section, Spencer's view of altruism is contrasted to that held by Comte, and then I consider the reaction of French political economists, defending the moral value bought about by their science. In the final section, I explain how the Comtean approach was re-enacted by Durkheim and then by Mauss, at the head of the “sociology of religion” section of L'Année sociologique, the Durkheimian journal, to give birth to the theory of gift-giving behaviour that Mauss used to critique political economy in the 1920s.     

Economic evaluation of a 100% whey-based partially hydrolyzed infant formula in the prevention of atopic dermatitis among Danish children

Abstract

Objective:

A pharmacoeconomic analysis was undertaken to determine costs, consequences, and cost-effectiveness of a brand of partially hydrolyzed 100%-whey formula manufactured by Nestlé (PHF-W), in the prevention of atopic dermatitis (AD) in ‘at risk’ Danish children compared to extensively hydrolyzed formula (EHF-Whey or Casein).

Methods:

Given the non-significant differences between PHF-W and EHF, the base case analytic approach amounted to a cost-minimization analysis (CMA) reporting the difference in formula acquisition costs over the period of formula consumption for the population of interest. However, sensitivity analyses (SAs) were undertaken to explore applying the nominal efficacy of PHF-W and EHF, thus leading to a cost-effectiveness analysis (CEA). Hence, an economic model based on a 12-month time horizon was developed synthesizing treatment pathways, resource utilization, and costs associated with the treatment of AD in the population of interest. The final economic outcome of the SAs was the incremental cost per avoided case (ICER) defined as the expected cost per avoided case of AD for PHF-W vs EHF, determined from three perspectives: the Ministry of Health (MOH), the family of the subject, and society (SOC).

Results:

In the base case CMA, savings of DKK 9?M, DKK 20?M, and DKK 29?M were generated for PHF-W vs EHF from the MOH, family, and SOC perspectives. In the sensitivity CEA, PHF-W was dominant over EHF-Whey from all perspectives, while EHF-Casein displayed against PHF-W unattractive ICERs of DKK 315,930, DKK 408,407, and DKK 724,337 from the MOH, family, and SOC perspectives. Probabilistic SAs indicated that PHF-W was 86% likely to be dominant over EHF-Whey, whereas EHF-Casein had no likelihood of dominating PHF-W.

Conclusion:

Under a range of assumptions, this analysis demonstrated the attractiveness of PHF-W vs both types of EHF in the prevention of AD among ‘at risk’ Danish infants who are not or cannot be exclusively breastfed.     

Trade and the Recognition of Commercial Lingua Francas: Russian Language Laws in Post‐Soviet Countries

Trade has the potential to influence a wide range of political and social outcomes. Using the post‐Soviet context, we examine how language policies – vital components for how minorities are treated with far‐reaching economic consequences – are influenced by trade. We argue that while ethnic politics and colonial legacies are both important in shaping language laws, it is important to recognize that the Russian language remains a significant commercial lingua franca in the region. When economic exchanges between Russia and other post‐Soviet republics are frequent, governments are more likely to adopt pro‐Russian language laws as a practicality and to maintain favor with the Russian government and Russian‐speaking businesses. Using an original dataset covering all Russian language‐related laws in the former Soviet states from 1992 to 2009, we find a significant and positive relationship between trade and pro‐Russian language laws. These results are robust even when we (1) instrument for Russian import levels and (2) consider the Baltic effect, spillovers from cultural affinity, and the uniqueness of fuel exports.     

Cost-effectiveness of denosumab vs zoledronic acid for prevention of skeletal-related events in patients with solid tumors and bone metastases in the United States

Abstract

Objective:

With increasing healthcare resource constraints, it has become important to understand the incremental cost-effectiveness of new medicines. Subcutaneous denosumab is superior to intravenous zoledronic acid (ZA) for the prevention of skeletal-related events (SREs) in patients with advanced solid tumors and bone metastases. This study sought to determine the lifetime cost-effectiveness of denosumab vs ZA in this setting, from a US managed-care perspective.

Methods:

A lifetime Markov model was developed, with relative rate reductions in SREs for denosumab vs ZA derived from three pivotal Phase 3 trials involving patients with castration-resistant prostate cancer (CRPC), breast cancer, and non-small-cell lung cancer (NSCLC), and bone metastases. The real-world SRE rates in ZA-treated patients were derived from a large commercial database. SRE and treatment administration quality-adjusted life year (QALY) decrements were estimated with time-trade-off studies. SRE costs were estimated from a nationally representative commercial claims database. Drug, drug administration, and renal monitoring costs were included. Costs and QALYs were discounted at 3% annually. One-way and probabilistic sensitivity analyses were conducted.

Results:

Across tumor types, denosumab was associated with a reduced number of SREs, increased QALYs, and increased lifetime total costs vs ZA. The costs per QALY gained for denosumab vs ZA in CRPC, breast cancer, and NSCLC were $49,405, $78,915, and $67,931, respectively, commonly considered good value in the US. Costs per SRE avoided were $8567, $13,557, and $10,513, respectively. Results were sensitive to drug costs and SRE rates.

Limitations:

Differences in pain severity and analgesic use favoring denosumab over ZA were not captured. Mortality was extrapolated from fitted generalized gamma function beyond the trial duration.

Conclusion:

Denosumab is a cost-effective treatment option for the prevention of SREs in patients with advanced solid tumors and bone metastases compared to ZA. The overall value of denosumab is based on superior efficacy, favorable safety, and more efficient administration.     

Cost drivers for breast,lung, and colorectal cancer care in a commercially insured population over a 6-month episode: an economic analysis from a health plan perspective

Aims: In the absence of clinical data, accurate identification of cost drivers is needed for economic comparison in an alternate payment model. From a health plan perspective using claims data in a commercial population, the objective was to identify and quantify the effects of cost drivers in economic models of breast, lung, and colorectal cancer costs over a 6-month episode following initial chemotherapy.

Research design and methods: This study analyzed claims data from 9,748 Cigna beneficiaries with diagnosis of breast, lung, and colorectal cancer following initial chemotherapy from January 1, 2014 to December 31, 2015. We used multivariable regression models to quantify the impact of key factors on cost during the initial 6-month cancer care episode.

Results: Metastasis, facility provider affiliation, episode risk group (ERG) risk score, and radiation were cost drivers for all three types of cancer (breast, lung, and colorectal). In addition, younger age (p?p?p?p?p?Conclusions: Value-based reimbursement models in oncology should appropriately account for key cost drivers. Although claims-based methodologies may be further augmented with clinical data, this study recommends adjusting for the factors identified in these models to predict costs in breast, lung, and colorectal cancers.     

Economic evaluation of a 100% whey-based partially hydrolyzed infant formula in the prevention of atopic dermatitis among Swiss children

Abstract

Objective:

A pharmacoeconomic analysis was undertaken to determine costs, consequences, and cost-effectiveness of a partially hydrolyzed 100% whey-based infant formula, NAN-HA®, manufactured by Nestlé S.A, Switzerland (PHF-W), branded under BEBA HA® in Switzerland, in the prevention of atopic dermatitis (AD) in ‘at risk’ Swiss children when compared to standard cow’s milk formula (SF).

Methods:

Based on a 12-month time horizon including 6 months of formula consumption, an economic model was developed synthesizing treatment pathways, resource utilization, and costs associated with the treatment of AD in healthy ‘at risk’ Swiss newborns who could not be exclusively breastfed. Model inputs were retrieved from the literature, official formularies, and expert opinion. The treatment pathways considered a medical treatment approach, supplemented in some instances by a change of formula. The final outcome was the expected cost per avoided case of AD, yielding an incremental cost effectiveness ratio (ICER) for PHF-W vs SF. Outcomes were presented from three perspectives: the Swiss public healthcare system (MOH), the subject’s family, and society (SOC). A secondary analysis compared PHF-W to whey-based extensively hydrolyzed formula (EHF) in prevention.

Results:

The model yielded 1653 avoided AD cases by selecting PHF-W over SF in a birth cohort of 22,933 ‘at risk’ infants. The base case analyses generated an expected ICER of CHF 982 from the MOH perspective as well as savings of CHF 2202 and CHF 1220 from the family and SOC perspectives, respectively. PHF-W yielded CHF 11.4M savings against EHF when the latter was assumed to be used in prevention. One-way and probabilistic sensitivity analyses confirmed the robustness of the model.

Conclusion:

Under a range of assumptions, this analysis has established the dominance from the family and societal perspectives and cost-effectiveness from the MOH perspective of PHF-W vs SF in the prevention of AD among ‘at risk’ Swiss infants.     

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.     

Retrospective evaluation of the clinical benefit of long-term continuous use of zoledronic acid in patients with lung cancer and bone metastases

Abstract

Background:

For patients with bone metastases, skeletal-related events including fracture are common, can cause considerable morbidity, and may reduce overall survival (OS). This retrospective analysis assessed the effect of Zometa (zoledronic acid, ZOL), an intravenous bisphosphonate (IV-BP), on fracture risk and OS in patients with bone metastases from lung cancer (LC). (Zometa is a registered trademark of Novartis Pharmaceuticals Corporation, USA.)

Methods:

A claims-based analysis using commercial and Medicare Advantage data from >45 US managed-care plans was used to evaluate the association between fracture risk and treatment persistency (31–90, 91–180, 181–365, and ≥366 days) and follow-up duration in LC patients diagnosed with bone metastases between 01/01/2001 and 12/31/2006 and treated with ZOL or without (no IV-BP). Persistency was defined as the absence of a >45-day gap between ZOL treatments. Analysis of variance tests were used to compare follow-up duration, a proxy for OS, between ZOL persistency groups. The effect of time to treatment with ZOL was also assessed.

Results:

In 9874 LC patients with bone metastases (n?=?1090 ZOL; n?=?8784 no IV-BP) the unadjusted relative fracture risk was reduced by 40% with ZOL vs no IV-BP; fracture risk decreased consistently with increasing duration of ZOL treatment. Even short-term (31–90 days) ZOL significantly reduced fracture risk (47%) vs no IV-BP (p?=?0.005) with adjustment for differences in demographic and clinical characteristics. Delaying ZOL until after bone metastases were diagnosed significantly increased fracture risk (p?=?0.0017). For a sub-set of patients included in a survival analysis (n?=?550 ZOL; n?=?4512 no IV-BP), mortality was significantly lower (mean, 38.6 vs 46.8 deaths/100 person-years; p?=?0.038) in those treated with ZOL vs no IV-BP.

Limitations:

Interpretation of this claims-based analysis must be tempered by the inherent limitations of observational data, such as limited clinical information and the ability to control for prognostic factors.

Conclusions:

This retrospective analysis demonstrates that LC patients with bone metastases receiving ZOL had significantly reduced risk of fracture (p?=?0.005) and death (p?<?0.038) vs patients receiving no IV-BP. Longer ZOL persistency consistently yielded better outcomes, with ≥12 months’ treatment producing the greatest benefit.