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.     

碳足迹的概念和核算方法研究进展

碳足迹提供了分析人类活动对气候变化影响的新视角.从概念和核算方法两个方面对有关碳足迹的研究进行了分析:(1)概念上,碳足迹目前无统一的定义.在分析度量单位、温室气体种类及系统边界的基础上,文章提出了碳足迹的建议定义.(2)方法上,碳足迹目前无统一的核算方法.投入产出分析、生命周期评价及混合生命周期评价是三种主要的核算方法.文章对这三种方法的原理、适用范围、优缺点及应用情况进行了分析.最后,从方法、应用和不确定性三个方面对碳足迹研究作了展望.     

Thermodynamics and process analysis for future economic scenarios

Economists are increasingly interested in forecasting future costs and benefits of policies for dealing with materials/energy fluxes, polluting emissions and environmental impacts on various scales, from sectoral to global. Computable general equilibrium (CGE) models are currently popular because they project demand and industrial structure into the future, along an equilibrium path. But they are applicable only to the extent that structural changes occur in or near equilibrium, independent of radical technological (or social) change. The alternative tool for analyzing economic implications of scenario assumptions is to use Leontief-type Input-Output (I-O) models. I-O models are unable to endogenize structural shifts (changing I-O coefficients). However, this can be a virtue when considering radical rather than incremental shifts. Postulated I-O tables can be used independently to check the internal consistency of scenarios. Or I-O models can be used to generate scenarios by linking them to econometric macro-drivers (which can, in principle, be CGE models). Explicit process analysis can be integrated, in principle, with I-O models. This hybrid scheme provides a natural means of satisfying physical constraints, especially the first and second laws of thermodynamics. This is important, to avoid constructing scenarios based on physically impossible processes. Process analysis is really the only available tool for constructing physically plausible alternative future I-O tables, and generating materials/energy and waste emissions coefficients. Explicit process analysis also helps avoid several problems characteristic of pure CGE or I-O models, viz. (1) aggregation errors (2) inability to handle arbitrary combinations of co-product and co-input relationships and (3) inability to reflect certain non-linearities such as internal feedback loops.     

Economic Valuation of Health for Environmental Policy: Comparing Alternative Approaches. Introduction and Overview

Protecting human health is a primary goal of environmental policy and economic evaluation of health can help policy-makers judge the relative worth of alternative actions. Economists use two distinct approaches in normatively evaluating health. Whereas environmental economists use benefit-cost analysis supported by monetary valuation in terms of willingness-to-pay, health economists evaluate interventions based on cost-effectiveness or cost-utility analysis (CEA), using quality-adjusted life-years (QALY) or similar indexes. This paper provides background on the controversy about the relative merits of these approaches and introduces the remaining papers in the special issue. These papers (with one exception) were presented at a conference sponsored by the Department of Economics at the University of Central Florida with support from the US Environmental Protection Agency. Although CEA might not lead to substantially different implications for environmental policy than benefit-cost analysis, and QALY may provide a benefit transfer tool to fill gaps in the morbidity valuation literature, the papers in this issue raise serious concerns about the suitability of QALY-based CEA for environmental regulatory analysis. QALY does not in general appropriately represent individual preferences for health and CEA is neither independent of income distribution nor adequate to assess efficiency.     

我国寿险业的效率研究

在寿险业市场全面对外开放以及全球金融危机的双重压力下,我国寿险业正面临着如何提升效率、维持竞争力的严峻考验。研究表明,提高财务杠杆率、扩张市场占有率是提升寿险企业经营效率的重要途径。由于股权属性在不同资源投入效率上各具优势,且企业成立年数对企业效率没有显著影响,使国内寿险企业在对外竞争中并不处劣势。     

Valuing Environmental Health Effects – An Economic Perspective

This paper provides an overview of some of the issues involved in comparing benefit-cost analysis and cost-effectiveness analysis based on quality-adjusted life-years as alternative approaches to assessing environmental policies that affect human health. It concludes that: (i) although QALYs have the advantage of reflecting policy impacts on both health status and longevity in a single scalar measure, they are not consistent with utility theory unless individuals’ preferences satisfy some restrictive conditions; (ii) they do not capture other important aspects of the valuation of changes in mortality and morbidity; (iii) cost-effectiveness analysis based on QALYs as a measure of effectiveness omits non-health related effects of environmental policy; and (iv) it leaves unanswered the important question of what level of environmental regulation is appropriate.     

沈阳市再生水源热泵供暖技术的节能减排潜力

利用生命周期评价方法分析对比再生水源热泵和燃煤锅炉在原材料生产、机组生产、运输、热量生产及废弃物处理整生命周期过程的能源消耗及SO2、总悬浮颗粒物(TSP)排放。结果表明在生产1GJ热能的情况下,再生水源热泵比燃煤锅炉节能约1GJ,减排SO20.7kg,减排大气TSP 7.2kg。热量生产阶段是耗能及污染物排放的关键环节,超过99%的能源消耗和污染排放在这一环节产生。在供暖季节,如果沈阳市现有和规划污水处理厂的再生水应用再生水源热泵替代燃煤锅炉供暖,在每年的供暖期里可为沈阳市节能11×106GJ(折合标煤37.5×104t),减排SO275.9t,减排TSP 775.4t。     

A cost-effectiveness analysis of levodopa/carbidopa intestinal gel compared to standard care in late stage Parkinson’s disease in the UK

Abstract

Objective:

Evaluation of cost-effectiveness of levodopa/carbidopa intestinal gel (LCIG), compared to standard care (SC) in patients with advanced Parkinson’s disease (aPD) in the UK.

Design:

Markov model to quantify costs and outcomes associated with LCIG versus SC in aPD patients at Hoehn and Yahr (H&Y) stages 3, 4 or 5 experiencing >50% OFF time per day. Time horizon was lifetime, LCIG treatment was assumed to last maximal 5 years after which patients revert to SC. Model comprised 12 aPD health states according to H&Y status and daily time spent in OFF state. Cost analyses are reported from a UK NHS and Personal Social Services perspective. Uncertainties were assessed through one-way sensitivity analyses.

Comparators:

LCIG, providing patients with continuous dopaminergic stimulation to maximise functional ON time during the day and SC, defined as medically determined best available oral medication.

Main outcome measures:

Cost-effectiveness, based on quality adjusted life years gained, presented as an incremental cost-effectiveness ratio.

Results:

Lifetime analysis yields an incremental cost per QALY of £36,024 for LCIG compared to SC (incremental cost £39,644, QALY gain 1.1). Results were sensitive to time on treatment, health state on treatment initiation, and estimates of long term benefit (OWSA results from £32,127 to £66,421 per QALY). Findings must be considered in the context of the study limitations which were mainly due to data availability constraints.

Conclusions:

LCIG is an effective treatment, reducing OFF time and improving quality of life in advanced PD. It provides value for money in levodopa-responsive aPD patients with severe motor fluctuations when no other treatment options are effective or suitable. Given LCIG is an orphan drug, it is reasonable to suggest that it may be considered cost-effective in the UK setting. However, further research is needed to complete current data gaps and increase robustness of the model.     

基于价值评价的外包决策模型研究

业务外包已经成为企业适应复杂的竞争环境的必然选择,基于价值评价的外包决策模型通过经济增加值和战略价值评价形成四种可能的结果,根据不同的评价结果企业可以进行是否外包的战略决策。     

Healthcare resource utilization and direct medical costs associated with index and recurrent Clostridioides difficile infection: a real-world data analysis

Abstract

Aims: This study aimed to evaluate all-cause economic outcomes, healthcare resource utilization (HRU), and costs in patients with Clostridioides difficile infection (CDI) and recurrent CDI (rCDI) using commercial claims from a large database representing various healthcare settings.

Materials and methods: A retrospective analysis of commercial claims data from the IQVIA PharMetrics Plus database was conducted for patients aged 18–64 years with CDI episodes requiring inpatient stay with CDI diagnosis code or an outpatient medical claim for CDI plus a CDI treatment. Index CDI episodes occurred between 1 January 2010 and 30 June 2017, including only those where patients were observable 6 months before and 12 months after the index episode. Each CDI episode was followed by a 14-d claim-free period. rCDI was defined as another CDI episode within an 8-week window following the claim-free period. HRU, all-cause direct medical costs and time to rCDI were calculated over 12 months and stratified by number of rCDI episodes.

Results: A total of 46,571 patients with index CDI were included. Mean time from one CDI episode to the next was approximately 1 month. In the 12-month follow-up period, those with no recurrence had 1.4 inpatient visits per person and those with 3 or more recurrences had 5.8. Most patients with 3 or more recurrences had 2 or more hospital admissions. The mean annual, total all-cause direct medical costs per patient were $71,980 for those with no recurrence and $207,733 for those with 3 or more recurrences.

Limitations: The study included individuals 18–64 years only. A stringent definition of rCDI was used, which may have underestimated the incidence of rCDI.

Conclusions: CDI and rCDI are associated with substantial healthcare resource utilization and direct medical costs. Timing of recurrences can be predictable, providing a window of opportunity for interventions. Prevention of multiple rCDI appears essential to reduce healthcare costs.     

Beyond the Stern Review: Lessons from a risky venture at the limits of the cost-benefit analysis

This paper argues that debates amongst economists triggered by the Stern Review are partly relevant, focusing on key parameters translating real ethical issues, and partly misplaced in that they do not consider enough other determinants of climate change damages: i) the specifications of the utility function used for the assessments (preference for the environment, preference for smooth growth paths), ii) the interplay between uncertainty and the sequentiality of the decision, and iii) whether the growth engines behind the integrated assessment models can account for transient disequilibrium and sub-optimality. We derive some suggestions for any future research agenda in integrated assessment modelling, whatever the position of the analysts about the relevance of the intertemporal optimisation framework and the Bayesian approach to uncertainty in the climate affair.     

电子废弃物回收处理系统环境绩效评估方法及应用

基于生命周期工具,从物质代谢效率和生态环境效益两方面建立了电子废弃物回收处理系统的环境绩效评估指标与方法,并以废弃手机为研究对象,分析现阶段我国回收处理系统的环境绩效水平及其改进潜力。结果显示,废弃手机回收处理系统在物质代谢效率指标方面表现出较好的绩效水平,但在生态环境效益方面尚存进一步优化的空间。通过情景设置开展优化分析结果表明:生产者主导回收情景在各项环境绩效指标上均略有改进;区域产业链配套情景下运输距离的减少仅对人体健康改善指标起到优化效果;鼓励部件再使用情景和先进资源化技术情景可显著提升废弃手机回收处理系统的环境绩效,前者优化效果主要表现在生态环境效益指标上,后者优化效果更均衡。     

我国废纸循环利用的适度水平研究

废弃物循环利用的适度水平是构建循环经济的一个重要问题。以废纸的再利用为例,在界定废纸循环利用的社会效益与社会成本的基础上,综合运用生命周期分析方法与环境影响经济评估方法识别并货币化度量废纸循环利用的边际社会效益,构建了我国废纸循环利用的边际成本函数,进而分析我国废纸循环利用的适度水平。研究结果表明,2008年我国用废纸替代木材生产1吨纸浆的社会效益为14 037元,社会福利最大化下的废纸循环利用适度水平为60.1%,高于同期国内废纸循环利用的实际水平39.5%,适当提高现阶段我国废纸循环利用的水平可以增加整个社会的福利。