Health-related quality-of-life,work productivity,and economic burden among patients with Parkinson’s disease in Japan

Abstract

Aims: This study aimed to characterize the burden of Parkinson’s disease (PD) by examining health-related quality-of-life (HRQoL), impairments to work productivity and daily activities, healthcare resource use, and associated costs among Japanese patients with PD.

Materials and methods: This retrospective cross-sectional study used data from the 2009–2014 Japan National Health and Wellness Survey (NHWS) (n?=?144,692). HRQoL (Short Form 36-Item Health Survey version 2), impairments to work productivity and daily activities (Work Productivity and Activity Impairment Questionnaire), healthcare resource utilization, and annual costs were compared between respondents with PD (n?=?133) and controls without PD (n?=?144,559). The effect of PD on outcomes was estimated using propensity score weighting and multivariable regression models.

Results: HRQoL was lower in patients with PD compared to the control group, with reduced physical (41.3 vs 51.3) and mental (35.7 vs 45.4) component summary scores and health state utility scores (0.62 vs 0.77; p?<?.001 for all). Patients with PD also reported higher levels of absenteeism (19.3% vs 3.3%), presenteeism (45.2% vs 18.5%), overall work impairment (52.8% vs 20.3%), and activity impairment (49.6% vs 20.8%) than controls without PD (p?<?.001 for all). In addition, patients with PD had higher healthcare resource utilization, direct (¥3,856,921/$37,994 vs ¥715,289/$7,046), and indirect (¥2,573,938/$25,356 vs ¥902,534/$8,891) costs compared with controls without PD (p?<?.001 for both).

Limitations: Data were cross-sectional and did not allow for causal inferences. Although the NHWS demographically represents the Japanese adult population, it is unclear whether it adequately represents the adult population with PD in Japan.

Conclusions: PD was associated with poorer HRQoL, greater work productivity loss, and higher direct and indirect costs. The findings suggest that an unmet need exists among patients with PD in Japan. Improving PD treatment and management could benefit both patients and society.     

The economic burden of advanced Parkinson’s disease: an analysis of a UK patient dataset

Abstract

Background:

To evaluate the cost burden of patients with advanced Parkinson’s disease (PD) according to the waking hours per day spent in OFF state. An analysis of resource use comprising medical services, professional care and informal care data from an observational, cross-sectional study was conducted.

Methods:

A total of 60 physicians comprising 40 neurologists and 20 geriatricians across the UK participating in the Adelphi PD Disease Specific Programme took part. There were 302 PD patients at H&Y stages 3–5. Patients were characterised according to the percentage of time per day spent in OFF state (<25%, 26–50%, 51–75%, >75%).

Results:

Average 12-monthly total costs increased according to the time spent in OFF state from £25,630 in patients spending less than 25% of their waking hours in OFF to £62,147 for patients spending more than 75% of their time in OFF. Overall, 7% of costs were attributed to direct medical care, while 93% were split between direct non-medical professional care (50%) and indirect informal care (43%).

Limitations:

Low patient numbers in the more advanced disease stages of PD led to very little or no data to directly inform some of the severe health states of the analysis. Data gaps were filled in with data derived from a regression analysis which may affect the robustness of the analysis.

Conclusion:

This study illustrates the increasing costs of advancing PD, in particular related to the time spent in OFF state, and identifies that the foremost cost burden is associated with the care needs of the patient rather than medical services.     

Medical management,costs, and consequences of Alzheimer’s disease in Germany: an analysis of health claims data

Abstract

Objective:

The main objective of this analysis was to assess the medical and economic differences between patients with and without diagnosed Alzheimer’s Disease (AD). Analysis included co-morbidities, patterns of drug use, and clinical course, as well as the magnitude of these differences attributable to AD.     

Amino acid formula as a new strategy for diagnosing cow’s milk allergy in infants: is it cost-effective?

Aims: To estimate the cost-effectiveness of a new strategy that uses an amino acid formula in the elimination diet of infants with suspected cow’s milk allergy (CMA).

Materials and methods: This pharmacoeconomic study was developed from the perspective of the Brazilian Public Healthcare System. The new strategy proposes using an amino acid formula in the diagnostic elimination diet of infants (≤24 months) with suspected CMA. The rationale is that infants who do not respond to the amino acid formula do not suffer from CMA. Patients with a positive oral challenge test receive a therapeutic elimination diet based on Brazilian Food Allergy Guidelines. This approach was compared to the current recommendations of the Brazilian Food Allergy Guidelines. A decision model was constructed using TreeAge Pro 2012 software. Model inputs were based on a literature review and the opinions of a panel of experts. A univariate sensitivity analysis of incremental cost-effectiveness ratios was performed.

Results: The mean cost per patient of the new amino acid formula strategy was R$3,341.57, while the cost of the current Brazilian guidelines strategy was R$3,641.08. The mean number of symptom-free days per patient, which was used as an indicator of effectiveness, was 900.6 and 875.7 days, respectively. The new strategy is, therefore, dominant. In the sensitivity analysis, the dominance was maintained with parameter variation.

Limitations: In the absence of information in the literature, some premises were defined by a panel of specialists.

Conclusions: The new strategy, which uses an amino acid formula in the elimination diagnostic diet followed by an oral food challenge, is a dominant pharmacoeconomic approach that has a lower cost and results in an increased number of symptom-free days.     

On the optimality and sustainability of Turkey’s current account

We analyze Turkey’s current account optimality and sustainability between 1992 and 2004. Using the intertemporal benchmark model for Turkey’s current account we test for its intertemporal solvency. Based on traditional and alternative tests (which account for persistence in the current account), we conclude that Turkey breached the intertemporal solvency condition in the sample period. In addition, stationarity tests of the deviation between actual and optimal net external liabilities series confirm that Turkey’s current account deficit was unsustainable for that period. However, further econometric investigation and analysis of reforms causes us to question our conclusions of non-optimality and unsustainability of the Turkish current account for the latter part of the period. We are indebted to two anonymous referees for insightful comments and suggestions. We would also like to thank seminar participants at Middle Eastern Technical University, Ankara, Turkey, for comments on an earlier version of this paper. Responsibility for all errors remains with the authors.     

Cost-effectiveness of continuous subcutaneous apomorphine in the treatment of Parkinson’s disease in the UK and Germany

Abstract

Background:

Parkinson’s disease (PD) is the second most common neurodegenerative disease, affecting ～5.2 million people worldwide. Continuous subcutaneous apomorphine (CSAI) represents an alternative treatment option for advanced PD with motor fluctuation. The purpose of this analysis was to estimate the cost-effectiveness of CSAI compared with Levodopa/carbidopa intestinal gel (LCIG), Deep-Brain-Stimulation (DBS) and Standard-of-care (SOC).

Methods:

A multi-country Markov-Model to simulate the long-term consequences, disease progression (Hoehn & Yahr stages 3–5, percentage of waking-time in the OFF-state), complications, and adverse events was developed. Monte-Carlo simulation accounted for uncertainty. Probabilities were derived from RCT and open-label studies. Costs were estimated from the UK and German healthcare provider’s perspective. QALYs, life-years (LYs), and costs were projected over a life-time horizon.

Results:

UK lifetime costs associated with CSAI amounts to £78,251.49 and generates 2.85 QALYs and 6.28 LYs (€104,500.08, 2.92 QALYs and 6.49 LYs for Germany). Costs associated with LCIG are £130,011.34, achieves 3.06 QALYs and 6.93 LYs (€175,004.43, 3.18 QALYs and 7.18 LYs for Germany). The incremental-cost per QALY gained (ICER) was £244,684.69 (€272,914.58). Costs for DBS are £87,730.22, associated with 2.75 QALYs and 6.38 LYs (€105,737.08, 2.85 QALYs and 6.61 LYs for Germany). CSAI dominates DBS. SOC associated UK costs are £76,793.49; 2.62 QALYs and 5.76 LYs were reached (€90,011.91, 2.73 QALYs and 6 LYs for Germany).

Conclusions:

From a health economic perspective, CSAI is a cost-effective therapy and could be seen as an alternative treatment to LCIG or DBS for patients with advanced PD.     

Between the hammer and the anvil: The impact of economic sanctions and oil prices on Russia’s ruble

Exchange rate fluctuations strongly affect the Russian economy, given its heavy dependence on foreign trade and investment. In the aftermath of the conflict between Russia and Ukraine that broke out early 2014, the Russian ruble lost 50% of its value against the US dollar. The impact of the conflict on Russia may have been amplified by sanctions imposed by Western countries. However, as Russia is heavily dependent on natural resource exports, another factor behind the deterioration could be the sharp decline in oil prices starting in summer 2014. Using high-frequency data on nominal exchange and interest rates, oil prices, actual and unanticipated sanctions, we provide evidence on forces underlying the ruble exchange rate. The analysis is based on cointegrated VAR models, where fundamental long-run relationships are implicitly embedded. The results indicate that the bulk of the depreciation can be related to the decline of oil prices. In addition, unanticipated sanctions matter for the conditional volatility of the variables involved.     

Adolph Wagner’s economic thought in Brazil: money and public finance in the turn of the 20th century

This paper addresses the dissemination of German economist Adolph Wagner’s ideas in Brazil. It shows that his monetary thinking, inspired by Thomas Tooke and the Banking School, as well as his ideas on public finance, particularly the law of increasing state spending, were assimilated by two Brazilian economic thinkers: Rui Barbosa and Vieira Souto. The way these policymakers incorporated Wagner’s ideas into their texts and the arguments with which they chose to engage show the kind of economic discourse they were shaping in Brazil. This analysis reveals the different functions that the original ideas could perform in another national context.     

The macroeconomics of the quiet revolution: Understanding the implications of the rise in women’s participation for economic growth and inequality

We study the impact of the rise in female labor supply on the economic performance of the United States over the period 1967–2002 through the lens of a calibrated structural model. The model features all the key forces behind the increase in female participation (the “Quiet Revolution”): (1) the decline in marriage rates, (2) the narrowing gender wage gap, (3) the preference (or cultural) shift towards market work, and (4) the change in women’s bargaining power within the household. We find that preference shifts and the rise in relative wages of women were the most important driving forces behind rising women’s participation, while changes in marriage patterns have also had a sizeable effect. We conclude that half of the growth in US earnings per capita over this period can be traced to growth in female labor supply. We also find that the rise in female labor supply has had offsetting effects on income inequality and, therefore, its overall role has been negligible relative to skill-biased demand shifts and rising residual wage volatility.     

An economic analysis of the Cattlemen’s Beef Promotion and Research Board demand-enhancing programmes

The research reported here addressed two objectives. The first objective was to measure the overall impact of the Cattlemen’s Beef Board as well as eight-specific advertising, promotion and research activities on US beef demand. The second objective was to compute marginal benefit–cost ratios (BCRs) for the eight individual checkoff activities and for the overall programme. The results indicated that Cattlemen’s Beef Board’s Promotion activities increased total domestic beef demand by 15.7 billion pounds in total, or 2.1 billion pounds per year between 2006 and 2014. Collectively, the overall marginal BCR for all Cattlemen’s Beef Board activities was $11.20.     

Changes in cyclical patterns of the USA labor market: from the perspective of nonlinear Okun’s law

The validity of Okun’s law has been debated because of the increase in cyclicality in aggregate hours after 1985. To investigate this, I measure Okun’s coefficients in three phases of the business cycle – recession, early, and late expansions. I found that an increased coefficient for aggregate hours is due to the increased responsiveness of the employment rate during late expansions and to the increased responsiveness of hours per employee during early expansions. These findings question the flexible labor market hypothesis focusing on firms’ firing behaviors during recessions. Rather, working hours’ flexibility represents a more prominent feature of the post-1985 USA labor market.     

Research on China’s export structure to the US: Analysis based on the US economic growth and exchange rate

Due to the rapid appreciation of RMB, the consistent declining of the US economy and other uncertain factors, China’s export volume to the United States has declined. The paper first chooses six industries to divide them into three groups based on per capita possession of capital, then employs the monthly data from 2001 to 2008 to carry out EG two-step cointegration test, and finally analyzes the impacts of the US economic growth and the exchange rate variability on different export industries. Empirical results show that the labor-intensive industries are most susceptible to fluctuations brought by economic growth and real exchange rate, while those industries with higher per capita possession of capital are less susceptible to external factors. In the short run, the export of labor-intensive products gives an advantage to China’s foreign trade development, but in the long-run, these industries will be affected greatly by various uncertain factors and the advantages of China’s labor-intensive export industries will disappear with the shift of the international division. Therefore, the only way to guarantee the dominant position of China’s foreign trade is to develop capital and technology intensive export industries and upgrade export structure.     

Political economy and the ‘modern view’ as reflected in the history of economic thought

This paper focuses on the transition from classical political economy to ‘modern’ economics, a central aspect of which is the ascent of the conception of ‘theory’ as a mere instrument of research. We analyse how this transitional phase was perceived and interpreted in representative, more or less contemporaneous histories of economic thought: those by Luigi Cossa in 1880, by John Kells Ingram in 1915 (originally published in 1888), and by Charles Gide and Charles Rist in 1915. Despite their differences, all authors share the same conception of the structure of scientific laws, as well as the view that economics must be separated from liberalism.     

Empirical exercises in estimating the effects of different types of financial institutions’ functioning on economic growth

While recent studies of the finance-growth nexus have focused on the use of proxies which more accurately capture the theorized functioning of the financial sector, they have tended to focus either on the functioning of the financial sector as a whole, or on the dominant institutions within the sector. Little attention has been paid to a comparison of the relative effects of different types of financial institutions on economic growth. This article attempts to get a deeper understanding of the finance-growth process by disaggregating the total financial sector impact and examining the individual and relative effects of each type of institution in the financial sector. We explore the empirical properties of alternative specifications of models of the impact of financial institutions’ functioning on economic growth, by conducting a number of exercises. These exercises experiment with various model specifications to represent the long- and short-run impacts of the financial institutions’ functioning on economic growth, using cointegration and error correction methodologies.     

On the assessment of the performance in earnings management for the banking industry: the case of China’s banks

Earnings management is popular in the banking industry. Earnings can be manipulated by discretionary loan loss provisions (DLLP). Analysing the trajectories of banks’ DLLP (i.e. their change in DLLP over time) is an effective way to assess the performance in earnings management for the banking industry, but seems not to have been addressed in the earnings management literature. In this study, we analyse the trajectories of DLLP with the yearly data from 2007 through 2012 for four types of banks in China. The results have indicated that state-owned banks, policy banks and city commercial banks seem to manage earnings well. Cautionary notes about bank risks are provided.     

Macroeconomic Effects of Serbia’s Integration in the EU and the Euro Area

International Advances in Economic Research - In 2009, Serbia officially applied for European Union (EU) membership. In 2014, membership negotiations began. After joining the EU, Serbia will have...     

Women’s investment in career and the household division of labour

This paper examines how partners in a couple share domestic work according to the woman’s investment in career. Investment is measured relatively to other women or to the partner. While previous studies mainly focused on the influence of wages and earnings, we extend them by considering more dimensions describing the intensity of the woman’s attachment to the labour market. We use the 2010 French Time Use survey to estimate a model of household division of labour in dual earner couples. We find that the more women are invested in career, the less domestic work they perform during weekdays, which is partly substituted by their partners but only on weekend days. The sharing of tasks is thus less unequal in those couples. However, women still spend more time than their partners on average performing domestic work, even when the woman outperforms him in career, implying no role reversal in the division of labour.