Modelling the cost-effectiveness of nevirapine triple combination therapy and dual combination therapy for the treatment of HIV disease in the United Kingdom

Summary

Recent advances in HIV antiretroviral therapy together with limited budgets have forced payers to look for evidence that new combinations provide good value for money. Using a public financing perspective, two Markov models are employed to evaluate the first-year outcomes and costs and the long-term cost-effectiveness of adding nevirapine (NVP) to dual combination therapy with zidovudine (ZDV) and didanosine (ddI) in the United Kingdom.

First-year medical care savings are estimated to be £2,122 (103.8% of NVP cost). In the longer term, NVP/ZDV/ddI therapy yields £6,186 per life year saved (costs discounted at 6%). The model is moderately sensitive only to duration of therapy effects and the therapy initiation time. These model estimates suggest that policy makers may expect to observe superior initial health outcomes and substantial medical cost savings during the first year of therapy, as well as acceptable long-term cost-effectiveness, when NVP/ZDV/ddI is used in place of dual therapy.     

The Nonparametric Approach to Applied Welfare Analysis

Changes in total surplus are traditional measures of economic welfare. We propose necessary and sufficient conditions for rationalizing individual and aggregate consumer demand data with individual quasilinear and homothetic utility functions. Under these conditions, consumer surplus is a valid measure of consumer welfare. For nonmarketed goods, we propose necessary and sufficient conditions on input market data for efficient production, i.e. production at minimum cost. Under these conditions we derive a cost function for the nonmarketed good, where producer surplus is the area above the marginal cost curve. We are greatful to helpful remarks and comments of the referees and the editor. The work is partially supported by the Spanish Ministry of Science and Technology, through Grant BEC2002-2130, the Generalitat de Catlaunya, through Grant 2005SGR-00454 and the Barcelona Economics Program (CREA).     

Using Contingent Ranking to Estimate the Loss of Amenity Value for Inland Waterways from Public Utility Service Structures

A contingent ranking exercise was used to estimate the amenity loss for recreational users associated with pylons, overhead cables and pipelines along canals. Over 80% of canal users were willing to pay higher utility bills to reduce the number of service structures found along canals. Aggregated across all canal users, mean annual willingness to pay for a 1% decrease in service structures was estimated to be nearly £750,000. The implications of these findings could be significant in any future negotiations between British Waterways and those companies responsible for siting pipelines and cables along canals.     

PFI—公用事业的建设和运营模式

PFI是发展公用事业的制度创新,在公用事业领域引入竞争机制,由企业提供公共产品和服务。PFI是一个系统工程,有赖于法律政策体系、公共支援、融资体系的支持。我国有必要在全面理解PFI的基础上,运用PFI发展公用事业。PFI有利于解决公用事业投资不足、公用事业单位改革、引导社会资本投资和地方政府的过度负债等问题。     

Costs and Structure of Technology in the Italian Water Industry

This paper analyses from an empirical point of view the technology underlying the Water industry. Firstly, we study the impact of environmental and quality factors on the production process. Secondly, different functional forms are analysed in order to represent the technology. Overall results show that the coefficient of hedonic variables are significant and that the best functional form is the transcendental logarithmic one. Finally, evidence on return to scale depends on the functional form adopted and on the inclusion ofhedonic variables.     

Economics,Ethics, and the Long Arc of Public Utilities: A Paper in Honor of Harry M. Trebing

Harry M. Trebing has made substantial contributions to the understanding of social control of economic enterprise, particularly in the regulation of public utilities. Imbued with institutional economic ways of knowing, he sustained the construct of progressive-era public interest regulation during a period of neoclassical economic assault on regulatory institutions.     

Price Squeezes in a Regulatory Environment

This paper analyzes the relevance and the scope of price squeeze tests in a regulatory environment. We distinguish between three types of ex ante regulation (full, partial or no regulation) to identify regulatory squeezes, predatory squeezes, and squeezes as foreclosure. We argue that policy makers should (i) use price squeeze tests as an ex post instrument, compatible with the ex ante regulatory environment, and (ii) focus on predatory price squeezes. We propose a predatory squeeze test that respects regulatory choices that have been made previously, in contrast with the earlier proposed tests. We extend our framework to ask at which aggregation level predatory price squeeze tests ought to be applied, a much-debated issue in telecommunications.JEL Classification: L40, L51, L97Jan Bouckaert acknowledges the financial support from the University of Antwerp (NOI2003). Frank Verboven acknowledges financial support from the Belgian Science Foundation-Flanders. We are grateful to two anonymous referees and the Editor for their helpful remarks. We also thank conference and seminar participants at CEFIR (Moscow), CPB (The Hague), the University of Antwerp, and Massimo Motta, Walter Nonneman, Wilfried Pauwels, and Tomasso Valletti for very useful comments.     

Are banks public utilities? Evidence from Europe

The regulatory response to the global financial crisis has been to instal a myriad of new rules in order to improve bank capital and liquidity, as well as to reduce systemic risks through structural reform. All these new rules place a straightjacket around banker’s activities and inhibit their operational freedom. This new environment has made European banks look less like private free-wheeling profit-maximising firms and more like public utilities. The utility services banks provide to society means that they should be overseen even more heavily. This includes greater regulatory oversight of bank pricing, profitability and service provision.     

Two-persons efficient risk-sharing and equilibria for concave law-invariant utilities

Efficient risk-sharing rules and equilibria between two agents with utilities in a class that contains the rank dependent expected utility (RDU) are fully characterized. Specific attention is given to the RDU. Call-spreads and contracts with mixed regimes are shown to be efficient. Closed-form solutions are obtained for several examples.      

The Coasean analysis of lighthouse financing: myths and realities

In ‘The Lighthouse in Economics’ (Coase, R. H. Journalof Law and Economics, vol. 17, no. 2, 357–76, 1974), Coasereached the conclusion that in England there existed a relativelyefficient privately financed lighthouse system, which wouldrefute economists' traditional statements concerning the productionof public goods. The purpose of this paper is to challenge hisconclusion. We first show that, from a methodological and theoreticalperspective, ‘The Lighthouse’ is consistent with‘The Problem of Social Cost’ (Coase, R. H. Journalof Law and Economics, vol. 3, 1–44, 1960). Then, applyingCoase's own method (historical case studies), we attempt tore-examine the respective roles and efficiencies of privateinitiative and government.     

Alternative Environmental Regulation Schemes for the Belgian Power Generation Sector

This paper discusses the effects of alternative waysof using external cost estimates to regulateinvestments and generation in the electricityproduction sector. Starting from the existing system,four alternatives are considered: emission taxes forthe utility and for independent producers, emissiontaxes limited to the electric utility, emissionpermits limited to the electric utility and finally asystem where only investments are regulated, anddispatch is not. Taking external damage estimates fromthe literature, these alternatives are compared usinga dynamic partial equilibrium model of the Belgianelectricity market for the period 1995–2034. Theefficiency and distribution effects of the alternativeenvironmental policy instruments are quantified.     

城市公用事业项目市场化运营中的风险管理

当前我国正在广泛采用市场化运营的方式推进对城市公用事业项目的建设。在公用事业项目市场化运营的热潮中,必须注意防范和规避各种风险。通过风险管理的手段加强公用事业项目的建设可以更好地保障公用事业项目市场化运营的成效。     

城市公用事业民营化中的腐败与削减

城市公用事业民营化虽然作为中国城市公用事业改革的趋势方向,同任何改革一样,也存在着负面效应,民营化中的腐败就是其主要负面效应之一.与民营化相关的腐败主要包括两个方面,即民营化中的国有资产流失与民营化后的寻租.本文分析了城市公用事业民营化中的腐败、形式、成因,并结合模型从预防角度上提出了治理对策.     

公用事业市场化产权模式构建——基于公共提供与生产理论视阈

公用事业市场化改革中的产权制度安排,一直是理论界关注的热点,同时也是公用事业市场化改革中分歧最大的问题。从国内外关于公用事业产权改革的现状及成败看,产权私有化任其发展会导致非常危险的结果。既要保证公用事业的公共利益,又要保证市场化改革的效率,这是公用事业产权改革的基本原则与目标。     

Mergers and acquisitions as a response to the deregulation of the electric power industry: value creation or value destruction?

Many electric utilities, as a response to the deregulation of the electric power industry, adopted a strategy of acquiring other electric or gas utilities. We examine whether these merger and acquisition strategies create value for the utility shareholders and whether the strategies result in superior post-merger operating and stock-price performance relative to utilities that did not grow through acquisitions. We find little evidence that the mergers and acquisitions created long-term value for a fully diversified investor. Furthermore, the stock price and operating performance of the acquirers under performed the stock price and operating performance of a control portfolio of utilities that did not engage in merger activity.      

Combinatorial auctions with decreasing marginal utilities

In most of microeconomic theory, consumers are assumed to exhibit decreasing marginal utilities. This paper considers combinatorial auctions among such submodular buyers. The valuations of such buyers are placed within a hierarchy of valuations that exhibit no complementarities, a hierarchy that includes also OR and XOR combinations of singleton valuations, and valuations satisfying the gross substitutes property. Those last valuations are shown to form a zero-measure subset of the submodular valuations that have positive measure. While we show that the allocation problem among submodular valuations is NP-hard, we present an efficient greedy 2-approximation algorithm for this case and generalize it to the case of limited complementarities. No such approximation algorithm exists in a setting allowing for arbitrary complementarities. Some results about strategic aspects of combinatorial auctions among players with decreasing marginal utilities are also presented.