Adult mortality in Russia

This paper studies the determinants of Russian adult mortality controlling for both individual and household heterogeneity. We employ survival analysis and utilize 12 rounds of the Russian Longitudinal Monitoring Survey spanning a 14‐year period. Although confirming the crucial role of excessive alcohol consumption in shaping adult mortality risks in Russia, the results are original in several other respects. We find empirical support for the importance of relative status measured in non‐income terms in shaping mortality hazards. We find evidence of the influence of labour market behaviour, and sectoral and occupational mobility in particular, on longevity. The detrimental role of smoking to health is found to be comparable with the role of excess alcohol consumption, which is novel in the Russian context where the influence of smoking is typically downplayed in comparison with alcoholism. Finally, we find no micro evidence in support of the political economy view based on a positive correlation between low alcohol prices and high mortality rates found in regional‐level data.     

Sectoral differences in the use of information technology and matching efficiency in the US labour market

The present study examines how the heterogeneity of use of information technology in production affects the probability that an unemployed worker will be matched with a vacancy. Using US time series from 1967 to 2007, I construct measures of dispersion of the stocks of software and hardware per worker across 13 industries. The measures exhibit three waves whose timing roughly corresponds to the diffusion of mainframe computers in the 1960s and 1970s, personal computers in the 1980s and the Internet in the late 1990s. After controlling for other influences, I find that the probability of transitioning from unemployment to employment responds negatively to an increase in either measure. The results imply that by enhancing technical heterogeneity, the diffusion of a new technology may suppress the job finding rate.     

A Head-to-Head Comparison of Augmented Wealth in Germany and the United States*

We examine the composition of augmented household wealth (i.e., the sum of net worth and pension wealth) in the United States and Germany. Pension wealth makes up a considerable portion of household wealth, of about 48 percent in the United States and 61 percent in Germany. When pension wealth is included in household wealth, the Gini coefficient falls from 0.889 to 0.700 in the United States, and from 0.755 to 0.508 in Germany. If the wealth shares in Germany were the same as in the United States, this would lead to a 12.6 percent increase in the Gini coefficient in the augmented wealth distribution in Germany.     

A cost-benefit analysis of the random assignment UK Employment Retention and Advancement Demonstration

This article presents a cost-benefit analysis of Britain’s Employment Retention and Advancement (ERA) demonstration, which was evaluated through the first large-scale randomized control trial in the UK. ERA used a combination of job coaching and financial incentives in attempting to help long-term unemployed men and low-income lone parents sustain employment and progress in work once they were employed. Using both administrative and survey data, ERA’s effects on benefits and costs were estimated through impact analyses, which exploited the experimental design. The findings indicated that ERA was cost beneficial for long-term unemployed adult men, but not for lone parents. The key findings appear robust to sensitivity tests. Uncertainty, as implied by the SEs of the estimated impacts, was addressed through a Monte Carlo analysis, an approach seldom previously used in cost-benefit analyses of social programs.     

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.     

Temporary employment and segmentation in the Spanish labour market: An empirical analysis through the study of wage differentials

We aim to add empirical evidence to the already studied field of wage differentials between temporary and permanent workers in Spain. Our goal is to find out which determinants of wage differentials are relevant when explaining such differences. Furthermore, the endogeneity of such feature (the type of contract) is controlled for. The same exercise is done with two data sets: the ECHP and the Structure of Earnings Survey. Results show that wage differentials between temporary and permanent workers are explained by the differences in the distribution of personal and job characteristics in both groups, but not by differences in the rewards for those characteristics. These results remain mostly unchanged during the second part of the 1990s, using information from five waves of the ECHP, and are robust to different changes in the econometric specification.JEL Classification: J31, J41The authors would like to thank the participants in the 3rd Summer School of Labour Economics (organised by IZA in Amersee, Munich), in a seminar in the University of Alcalá and in another seminar in the European University Institute in Florence and especially Alison Booth, Luis Toharia, Juan F. Jimeno, Juan José Dolado and two anonymous referees for their helpful comments and suggestions. Florentino Felgueroso kindly helped us with the handling of data. The usual disclaimer applies. The ECHP is being used on behalf of the contract reference ECHP/15/00 between the University of Alcalá and EUROSTAT.     

Time-varying comovement and changes of comovement structure in the Chinese stock market: A causal network method

The driving force for the comovement in stock returns is a long-standing debate between classical asset pricing theory and behavioral finance theory. It has become critically important recently for understanding systemic risk and risk contagion in the market. In this study, we propose complex networks enabled new methods to measure the causal comovement of individual stocks and the comovement structure of the market, which facilitate the examination of all kinds of hypotheses of comovement theories in a unified framework. Using a sample of the Chinese stock market from Jan. 1, 2006 to Dec. 31, 2016, we find that the degree of comovement generally intensifies over time, with a drastic increase from 2011 to 2015, while the comovement structure of the market changes with different market situations. Most importantly, our study reveals the driving force of causal comovement among individual stocks; that is, sentiment-based factors related to the market index indeed induce excess causal comovement in returns beyond that can be justified by fundamental factors including beta coefficient, book-to-market ratio, liquidity, profitability and volatility. Our study also reveals the determinants of comovement structure, which are attributable to the change of investors' behaviors in different periods. It turns out that investors in the Chinese stock market care about risk-return relationship in normal periods, while they seem to care only about risk in crisis periods.     

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.     

Medical cost,incidence rate,and treatment status of gastroesophageal reflux disease in Japan: analysis of claims data

Objectives: Published reports have shown the prevalence and incidence of gastroesophageal reflux disease (GERD) is increasing in Japan. The objective of this study is to examine change in GERD incidence, and to understand current patient demographics, medical costs, treatment status, and the suitability of current treatment based on analysis of an insurance claims database.

Methods: An insurance claims database with data on ～1.9 million company employees from January 2005 to May 2015 was used. Prevalence, demographics, and medical costs were analyzed by cross-sectional analysis, and incidence and treatment status were analyzed by longitudinal analysis among newly-diagnosed GERD patients.

Results: GERD prevalence in 2014 was 3.3% among 20–59 year-olds, accounting for 40,134 people in the database, and GERD incidence increased from 0.63% in 2009 to 0.98% in 2014. In 2014, mean medical cost per patient per month for GERD patients aged 20–59 was JPY 31,900 (USD 266 as of January 2016), which was ～2.4-times the mean national healthcare cost. The most frequently prescribed drugs for newly-diagnosed GERD patients were proton pump inhibitors (PPIs). Although PPIs were prescribed more often in patients with more doctor visit months, over 20% of patients that made frequent doctor visits (19 or more visits during a 24 calendar months period) were prescribed PPIs during only 1 calendar month or not at all.

Limitations: The database included only reimbursable claims data and, therefore, did not cover over-the-counter drugs. The database also consisted of employee-based claims data, so included little data on people aged 60 years and older.

Conclusions: Given the increasing incidence of GERD in Japan there is a need for up-to-date information on GERD incidence. This study suggests that some GERD patients may not be receiving appropriate treatment according to Japanese guidelines, which is needed to improve symptom control.     

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 new test procedure for the choice of dependence structure in risk measurement: application to the US and UK stock market indices

The choice of an appropriate dependence structure in modelling multivariate risks is an important issue because different tail structure embedded in copula leads to a different capital requirement for the institution. We present how to select a well-specified dependence structure to given application data. Using a simple simulation technique, we develop a statistical test to assess the adequacy of a specific dependence structure. We examine the sensitivity of risk estimates to the choice of copulas using the S&P 500 and FTSE 100 stock indices.     

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 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-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.     

A review and validation of overall survival extrapolation in health technology assessments of cancer immunotherapy by the National Institute for Health and Care Excellence: how did the initial best estimate compare to trial data subsequently made available?

Background: Validation of overall survival (OS) extrapolations of immune-checkpoint inhibitors (ICIs) during the National Institute for Health and Care Excellence (NICE) Single Technology Assessment (STA) process is limited due to data still maturing at the time of submission. Inaccurate extrapolation may lead to inappropriate decision-making. The availability of more mature trial data facilitates a retrospective analysis of the plausibility and validity of initial extrapolations. This study compares these extrapolations to subsequently available longer-term data.

Methods: A systematic search of completed NICE appraisals of ICIs from March 2000 to December 2017 was performed. A targeted search was also undertaken to procure published OS data from the pivotal clinical trials for each identified STA made available post-submission to NICE. Initial Kaplan-Meier curves and associated extrapolations from NICE documentation were extracted to compare the accuracy of OS projections versus the most mature data.

Results: The review identified 11 STAs, of which 10 provided OS data upon submission to NICE. The extrapolations undertaken considered parametric or piecewise survival models. Additional data cut-offs provided a mean of 18 months of OS beyond the end of the original data. Initial extrapolations typically under-estimated OS from the most mature data cut-off by 0.4–2.7%, depending on the choice of assessment method and use of the manufacturer- or ERG-preferred extrapolation.

Conclusion: Long-term extrapolation of OS is required for NICE STAs based on initial immature OS data. The results of this study demonstrate that the initial OS extrapolations employed by manufacturers and ERGs generally predicted OS reasonably well when compared to more mature data (when available), although on average they appeared to underestimate OS. This review and validation shows that, while the choice of OS extrapolation is uncertain, the methods adopted are generally aligned with later-published follow-up data and appear appropriate for informing HTA decisions.     

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.     

A cost-effectiveness and budget impact analysis of apremilast in patients with psoriasis in the Italian setting

Abstract

Aims: The aim of this study was to conduct a cost-effectiveness analysis, as well as a budget impact analysis, on the use of apremilast for the treatment of adult patients with moderate-to-severe plaque psoriasis (defined as a psoriasis area severity index [PASI]?≥?10), who failed to respond to, had a contraindication to, or were intolerant to other systemic therapies, within the Italian National Health Service (NHS).

Materials and methods: A Markov state-transition cohort model adapted to the Italian context was used to compare the costs of the currently available treatments and of the patients’ quality of life with two alternative treatment sequences, with or without apremilast as pre-biologic therapy. Moreover, a budget impact model was developed based on the population of patients treated for psoriasis in Italy, who would be eligible for treatment with apremilast.

Results: Over 5?years, the cost-effectiveness analysis showed that the strategy of using apremilast before biologic therapy was dominant compared with the sequence of biologic treatments without apremilast. In addition, it is important to underline that the use of apremilast slightly increases the quality-adjusted life years gained over 5?years. Furthermore, within the budget impact analysis, the strategy including apremilast would lead to a saving of €16 million within 3?years. Savings would mainly be related to a reduction in pharmaceutical spending, hospital admissions and other drug administration-related costs.

Conclusion: These models proved to be robust to variation in parameters and it suggested that the use of apremilast would lead to savings to the Italian healthcare system with potential benefits in terms of patients’ quality of life.     

A scenario analysis of energy requirements and energy intensity for China's rapidly developing society in the year 2020

Both energy requirements and energy intensity are crucial to the development of a society. This article uses an input–output model to assess how social and economic changes will affect energy requirements and energy intensity for China's rapidly developing society. According to the proposed input–output model, six scenarios were sequentially developed by introducing major impact factors, such as technological advancement, population, income, and urbanization, in order to project China's energy requirements. Based on 1997 data, the impact of economic and social changes on China's energy requirements in 2010 and 2020 were quantitatively analyzed. The results show that technological advancement has the strongest impact on energy intensity. Based on these findings, some related conclusions and corresponding policy recommendations are proposed.