Biological conservation in dynamic agricultural landscapes: Effectiveness of public policies and trade-offs with agricultural production

Land use change and land management intensification are major drivers of biodiversity loss, especially in agricultural landscapes, that cover a large and increasing share of the world's surface. Incentive-based agri-environmental policies are designed to influence farmers' land-use decisions in order to mitigate environmental degradation. This paper evaluates the effectiveness of agri-environmental schemes for biological conservation in a dynamic agricultural landscape under economic uncertainty. We develop a dynamic ecological economic model of agricultural land-use and spatially explicit population dynamics. We then relate policies (subsidies to grassland, taxation of agricultural intensity) to the ecological outcome (probability of persistence of a species of interest). We also analyze the associated trade-offs between agricultural production (in value) and biological conservation (in probability of persistence) at the landscape scale.     

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 assessment of pharmaceuticals for government subsidy in Australia: recent developments

SUMMARY

Australia has a well-developed system for the appraisal of pharmaceuticals and other health technologies. In January 1993, Australia was the world leader with mandatory economic evaluations for the government to consider subsidising pharmaceuticals on the Pharmaceutical Benefits Scheme. At the end of 2006, the Guidelines to sponsors underwent substantial revisions. In addition, other fundamental changes have recently occurred that present new challenges to the Pharmaceutical Benefits Advisory Committee (PBAC); these include the requirement for greater transparency of the PBAC process and appraisals following the Australia-United States Free Trade Agreement, and the appraisal of vaccines by the PBAC.

This editorial describes some recent developments and their key features in the appraisal of pharmaceuticals in Australia. The PBAC standards and technical requirements seem to have lost ground on the world stage. For example, the lack of a reference case and absence of probabilistic sensitivity analysis requirements have hindered the ability to make judgements on the relative value for money of new pharmaceuticals. Thus, the guidelines do not go far enough to advance standards for best practice. A better approach may have been to specify an objective list of criteria for judging the quality of submissions. Nevertheless, this latest (2006) revision to the PBAC guidelines is a highly useful and comprehensive guide on health technology assessment.     

Factors associated with increased hospital costs in patients treated with lipid-based amphotericin B for empirical therapy

Summary

Lipid-based amphotericin B agents have been studied in a number of clinical settings and patient populations, most notably as empirical therapy for patients at-risk for systemic fungal infection and for patients with documented invasive disease. In clinical practice, lipid-based therapies have been considered second- or even third-line therapy due to concerns about costs. However, few analyses have been conducted to determine those factors associated with empirical antifungal therapy and lipid-based agents that are most likely to influence hospital costs and length of stay.

The purpose of this analysis is to determine which demographic, treatment, and clinical outcome factors contribute to increased hospital costs and length of stay in patients treated empirically with a lipid-based amphotericin B agent.

A retrospective analysis of 89 patients enrolled in the clinical study was performed to assess hospital costs and length of stay following the start of empirical antifungal therapy. Bivariate and multivariate regressions were performed to identify variables most likely to affect hospital costs and length of stay.

Allogeneic bone marrow transplant (BMT) status, days of treatment, doubling of baseline creatinine, and dialysis were found to be predictive both of increased hospital costs and length of stay. Length of stay and number of concomitant nephrotoxic agents also were found to affect hospital costs.

Overall, risk factors and clinical outcomes associated with nephrotoxicity increased hospital costs and length of stay in patients treated empirically with lipid-based antifungal agents. Renal dialysis also increased hospital cost significantly. For empirical antifungal therapy, providers should consider both patient-specific risk factors and product-specific outcomes in selecting an appropriate agent.     

Evaluation of the long-term cost-effectiveness of liraglutide therapy for patients with type 2 diabetes in France

Objectives:

The present study aimed to compare the projected long-term clinical and cost implications associated with liraglutide, sitagliptin and glimepiride in patients with type 2 diabetes mellitus failing to achieve glycemic control on metformin monotherapy in France.

Methods:

Clinical input data for the modeling analysis were taken from two randomized, controlled trials (LIRA-DPP4 and LEAD-2). Long-term (patient lifetime) projections of clinical outcomes and direct costs (2013 Euros; €) were made using a validated computer simulation model of type 2 diabetes. Costs were taken from published France-specific sources. Future costs and clinical benefits were discounted at 3% annually. Sensitivity analyses were performed.

Results:

Liraglutide was associated with an increase in quality-adjusted life expectancy of 0.25 quality-adjusted life years (QALYs) and an increase in mean direct healthcare costs of €2558 per patient compared with sitagliptin. In the comparison with glimepiride, liraglutide was associated with an increase in quality-adjusted life expectancy of 0.23 QALYs and an increase in direct costs of €4695. Based on these estimates, liraglutide was associated with an incremental cost-effectiveness ratio (ICER) of €10,275 per QALY gained vs sitagliptin and €20,709 per QALY gained vs glimepiride in France.

Conclusion:

Calculated ICERs for both comparisons fell below the commonly quoted willingness-to-pay threshold of €30,000 per QALY gained. Therefore, liraglutide is likely to be cost-effective vs sitagliptin and glimepiride from a healthcare payer perspective in France.     

Pharmacoeconomic analysis for pemetrexed as a maintenance therapy for NSCLC patients with patient assistance program in China

Objective: This study is to evaluate the costs, clinical efficacy, and social benefits of a patient assistance program (PAP) implemented by the China Primary Healthcare Foundation for the use of pemetrexed as a first-line non-squamous non-small cell lung cancer (NSCLC) maintenance therapy in China.

Methods: A survival analysis was conducted on the clinical data of 1,366 patients who participated in the PAP. The progression-free survival (PFS) and median maintenance treatment cycle of pemetrexed were analyzed. A 36-month Markov model from a payer’s perspective was constructed to analyze the cost and effectiveness associated with the PAP for pemetrexed. The inputs of the model were sourced from the PAP clinical database and published literature. The study estimated the incremental quality adjusted life-years (QALYs) (pemetrexed plus best supportive care [BSC] vs BSC only), the cost saving of the PAP, the impact on the percentage of catastrophic health expenditures (CHE), and poverty headcount ratio (HCR).

Results: The median of PFS and maintenance treatment cycles were 187 days and five cycles (total nine cycles, which included four cycles of induction therapy), respectively. The pemetrexed plus BSC treatment with PAP resulted in an additional 0.12 QALYs over BSC only. The total cost was $48,034.46 and $96,191.57 for the patients who had or had not joined the PAP in 3 years, respectively. Compared to the patients without PAP, the percentage of CHE and HCR with PAP was reduced from 98.39% to 19.91% and 66.98% to 4.89%, respectively, indicating that the PAP substantially decreased the number of patients who had CHE and fallen into poverty.

Conclusion: The study concluded that the pemetrexed PAP generated noticeable clinical and economic benefits to society and to patients. The program also increased patients’ compliance with chemotherapy by allowing patients, for whom the pemetrexed treatment was unaffordable, to continue to receive it.     

认知疗法在骨科慢性疼痛性疾病患者护理中的应用价值

目的：探讨认知疗法在骨科慢性疼痛性疾病患者护理中的应用价值。方法选取广东省揭阳市惠来县人民医院骨科诊断为慢性疼痛性疾病的患者资料200例,将其采用随机数字表法分为两组,各100例,对照组患者给予骨科常规护理,观察组患者在其基础上加以认知疗法护理。比较两组患者治疗后的疼痛程度。结果观察组患者护理后疼痛率明显低于对照组;且观察组 SDS、SAS 评分下降水平也明显优于对照组,差异均有统计学意义（均 P＜0.05）。结论对骨科慢性疼痛性疾病患者的护理中施以认知疗法,能有效缓解患者的疼痛和焦虑。     

Effectiveness of sequences of One-Euro-Jobs for welfare recipients in Germany

Empirical evidence reveals that German welfare recipients often participate in multiple active labour market programmes (ALMPs). However, evidence on the effectiveness of ALMPs exists mostly for single ALMP participations so far. This article evaluates the sequential participation in ALMPs for welfare recipients in Germany based on comprehensive administrative data to control for dynamic selection that arises in the evaluation of sequences. Using a dynamic causal model and an inflow sample of welfare recipients, the article analyses the effects of sequences of a public employment programme called One-Euro-Jobs on labour market outcomes. For female participants in One-Euro-Jobs in the first period, especially in West Germany, the results imply that participating in two consecutive One-Euro-Jobs compared with receiving only welfare benefits for two consecutive periods better facilitates integration into regular employment. Moreover, taking part in a One-Euro-Job directly after entry into welfare receipt is also more effective for participants in One-Euro-Jobs in the first period than taking part in a One-Euro-Job in a later period, especially for East German men (although not for West German women). However, I also find evidence of so-called programme careers and stepwise integration into regular employment.     

Strategic prospective for the implementation of employment policies in the Azores

This article explains how a far-off autonomous region of Portugal lying 2700 km from Brussels decided to approach its future, notably labor. The government in the Azores applied strategic prospective, and two of its methods, MICMAC and MACTOR,¹ at three key moments in the implementation of employment policies. While providing background on Azorean public policy and the broader European context, the author describes three cases, which deal primarily with education, qualifications and mobility. Interestingly, the results of decisions made on the basis of the prospective exercises can already be measured. This underscores the real efficiency of the policies adopted and the importance of the European policies of mobility, notably within the scope of Eurodyssey, a program of professional mobility of the Assembly of European Regions, that is now led by the Azores.     

促进我国文化产业发展的政策研究

加快发展文化产业是提高国家文化软实力、增强中华文化竞争力的重要举措。党的十七届六中全会提出了加快推动文化产业成为国民经济支柱性产业的战略目标。目前我国文化产业发展进程中存在一些普遍性的问题,针对造成这些问题的原因,可以采取相应的政策建议来解决,以达到加快我国从"文化大国"转变为"文化强国"的目的。     

浅析高职院校市场营销专业《基础会计》教材的建设思路

根据高职教育的特点,从教材的内容和编写形式两个方面提出高职院校市场营销专业<基础会计>教材的建设思路.     

Cost-effectiveness achieved through changing the composition of renal replacement therapy in Japan

Abstract

Objective:

The cost-effectiveness of renal replacement therapy (RRT) is affected by the composition of treatment. This study aimed to estimate the costs and outcomes associated with changing the composition of RRT modality over time.

Methods:

By using clinical and cost data from a systematic review, a Markov model was developed to assess the costs and benefits of the four main treatments available for RRT in Japan. The model included direct health service costs and quality-adjusted life years (QALY). Sensitivity analyses were performed to assess the robustness of the results.

Results:

Over the 15-year period of the model, the current composition of RRT (i.e., the base composition of RRT) was $84,008/QALY. The most cost-effective treatment was when the likelihood of a living donor transplant was increased by 2.4-times ($70,581/QALY). Compared with the base composition of RRT, dominant treatments with respect to cost-effectiveness were when the likelihood of a deceased donor transplant was increased by 22-times and when the likelihood of a pre-emptive living donor transplant was increased by 2.4-times. Little difference was found between these two treatments. One-way sensitivity analysis did not change the cost effectiveness except for costs of chronic hemodialysis and a living donor transplant in subsequent years.

Limitations:

It is difficult to increase the rate of transplant overall in the shorter term nationally and internationally.

Conclusions:

Appropriate distribution of all transplant options and hemodialysis is necessary to achieve the most cost-effective solution.     

Research and development and trade policies for product innovation in the presence of foreign competition

This paper examines two policy instruments — a matching grant and import tariffs — for encouraging research and development (R&D) in product innovation by a domestic firm when it faces foreign competition. We do so by developing a theoretical model of product innovation where R&D effort is endogenous and its outcome uncertain. We examine the effects of a reduction in import tariffs on private expenditure on R&D, on public support for such R&D, and on total R&D expenditure. We find that in response to a reduction in import tariffs, the domestic firm always reduces its private R&D investments, but the total level of R&D expenditure (i.e., including public support) might go up depending on the level of tariffs. In particular, we find that it will go up if the initial level of tariff is higher than a critical level. When tariff is endogenous, we find that the socially optimal level of tariffs is positive. One finding that is of particular interest is that supporting private attempts to product innovate in the form of a matching grant program leads to a socially optimal level of product R&D.     

A Model for Evaluating the Effectiveness of Economic Education in Primary Grades

Understandably, many economists have grave doubts about the possibility of teaching basic economic concepts to primary level children. Davison and Kilgore report on the development and use of their Primary Test of Economic Understanding. Some 500 second-grade pupils and 24 teachers were involved in their experiment. A control group made up of children who received regular social studies instruction was compared with experimental groups using primary level economics materials. Differences in the pupils' general academic ability, socioeconomic environment and teacher preparation were taken into account. The authors found that children in early elementary grades can learn certain basic economic concepts.     

Time-driven activity-based cost analysis for outpatient anticoagulation therapy: direct costs in a primary care setting with optimal performance

Objectives: To determine how overall cost of anticoagulation therapy for warfarin compares with that of Novel Oral Anticoagulants (NOACs). Also, to demonstrate a scientific, comprehensive, and an analytical approach to estimate direct costs involved in monitoring and management of anticoagulation therapy for outpatients in an academic primary care clinic setting, post-initiation of therapy.

Methods: A population-based cross-sectional study was conducted in conjunction with observations of patient care processes between August 2014 and January 2015. The study was conducted in an academic primary care outpatient setting at Mayo Clinic’s warfarin anticoagulation clinic, Rochester, MN. The anticoagulation clinic serves patients 18?years of age or older in Warfarin therapy management, for any indication, after referral from the patient’s primary care provider. The study included anticoagulation clinic enrollment data on a population of 5,526 patients. Time-Driven Activity-Based Costing (TDABC) technique was applied. Detailed process flow maps which showed process steps for all the anticoagulation program components and care continuum phases were created. Staff roles associated with each of the process steps were identified and displayed on the maps. Process times and costs were captured and analyzed. The main outcome was direct cost of monitoring and management of anticoagulation therapy, post-initiation of therapy.

Results: The cost of warfarin management for patients who display unstable International Normalized Ratio (INR) is more than three times those who display stable INR over time. (Comparator to distinguish stability: Frequency of point-of-care visits needed by patients.) For complex anticoagulation patients, total cost of medication and monitoring for warfarin anticoagulation therapy is similar to that for NOACs.

Conclusion: Despite warfarin being significantly less expensive to purchase than NOACs, overall warfarin management incurs higher costs due to laboratory monitoring and provider time than NOACs. NOAC treatment, therefore, may not be more expensive than warfarin therapy management for complex anticoagulation patients.     

Cost-effectiveness of ceftolozane/tazobactam plus metronidazole compared with piperacillin/tazobactam as empiric therapy for the treatment of complicated intra-abdominal infections based on the in-vitro surveillance of bacterial isolates in the UK

Aims: An increase in the prevalence of antimicrobial resistance among gram-negative pathogens has been noted recently. A challenge in empiric treatment of complicated intra-abdominal infection (cIAI) is identifying initial appropriate antibiotic therapy, which is associated with reduced length of stay and mortality compared with inappropriate therapy. The objective of this study was to assess the cost-effectiveness of ceftolozane/tazobactam?+?metronidazole compared with piperacillin/tazobactam (commonly used in this indication) in the treatment of patients with cIAI in UK hospitals.

Methods: A decision-analytic Monte Carlo simulation model was used to compare costs (antibiotic and hospitalization costs) and quality-adjusted life years (QALYs) of patients infected with gram-negative cIAI and treated empirically with either ceftolozane/tazobactam?+?metronidazole or piperacillin/tazobactam. Bacterial isolates were randomly drawn from the Program to Assess Ceftolozane/Tazobactam Susceptibility (PACTS) database, a surveillance database of non-duplicate bacterial isolates collected from patients in the UK infected with gram-negative pathogens. Susceptibility to initial empiric therapy was based on the measured susceptibilities reported in the PACTS database.

Results: Ceftolozane/tazobactam?+?metronidazole was cost-effective when compared with piperacillin/tazobactam, with an incremental cost-effectiveness ratio (ICER) of £4,350/QALY and 0.36 hospitalization days/patient saved. Costs in the ceftolozane/tazobactam?+?metronidazole arm were £2,576/patient, compared with £2,168/patient in the piperacillin/tazobactam arm. The ceftolozane/tazobactam?+?metronidazole arm experienced a greater number of QALYs than the piperacillin/tazobactam arm (14.31/patient vs 14.21/patient, respectively). Ceftolozane/tazobactam?+?metronidazole remained cost-effective in one-way sensitivity and probabilistic sensitivity analyses.

Conclusions: Economic models can help to identify the appropriate choice of empiric therapy for the treatment of cIAI. Results indicated that empiric use of ceftolozane/tazobactam?+?metronidazole is cost-effective vs piperacillin/tazobactam in UK patients with cIAI at risk of resistant infection. This will be valuable to commissioners and clinicians to aid decision-making on the targeting of resources for appropriate antibiotic therapy under the premise of antimicrobial stewardship.     

Simulation of the impact of economic policies on poverty and inequality: GEM in micro-simulation for the Algerian economy

This paper presents an illustration of the importance of computable general equilibrium modelling micro-simulation for simulating the impact of economic policies on living levels of households. The CGEM, as built, was used to simulate the effects of some economic policies on the economy and living levels of all households including the classes of modest, middle and wealthy households. In this context, pro-active economic policies are simulated in order to understand their effects on the macroeconomic plan and on the living level of some household categories defined according to statistical criteria. The first on the analysis of two arbitrarily selected tax policy cases, and the other on three investment policy simulations. Different illustrated simulations show improvements in economic growth and upward social mobility, particularly in the case of increasing the overall investment and improving productive capacity. In all simulations, that inequality would have remained rigid downward and would sometimes even accentuate. Overall, it appears that the increase in investment would boost economic growth through demand effect. However, this increase in demand would be met by more imports, which would damage our trade balance. The national productive system, however, could reverse this trend by making profitable investments by strengthening its productive capacity.     

The impact of persistence with therapy on inpatient admissions and emergency room visits in the US among patients with multiple sclerosis

Objective:

Disease-modifying therapy (DMT) for multiple sclerosis (MS) can reduce relapses and delay progression; however, poor adherence and persistence with DMT can result in sub-optimal outcomes. The associations between DMT adherence and persistence and inpatient admissions and emergency room (ER) visits were investigated.

Methods:

Patients with MS who initiated a DMT in a US administrative claims database were followed for 1 year. Persistence to initiated DMT was measured as the time from DMT initiation to discontinuation (a gap of >60 days without drug ‘on hand’) or end of 1-year follow-up. Adherence to initiated DMT was measured during the persistent period and was operationalized as the medication possession ratio (MPR). Patients with an MPR <0.80 were considered non-adherent. Claims during the 1-year follow-up period were evaluated for the presence of an all-cause inpatient admission or an ER visit. Adjusted odds ratios (AORs) for inpatient admission or ER visit comparing persistent vs non-persistent and adherent vs non-adherent patients were estimated using logistic regression models adjusted for patient characteristics.

Results:

The final sample included 16,218 patients. During the 1-year follow-up period, 35.3% of patients discontinued their initiated DMT and 13.9% were not adherent while on therapy. During that same period, 10.0% of patients had an inpatient admission and 24.9% had an ER visit. The likelihoods of inpatient admission and ER visit were significantly decreased in persistent patients (AOR [95% CI]?=?0.50 [0.45, 0.56] and 0.65 [0.60, 0.69], respectively) and in adherent patients (AOR [95% CI]?=?0.83 [0.71, 0.97] and 0.86 [0.77, 0.95], respectively).

Conclusions:

Persistence and adherence with initiated DMT are associated with decreased likelihoods of inpatient admission or ER visit, which may translate to improved clinical outcomes.