Estimating local average treatment effects in aggregate data

In some contexts, the effect of a treatment can be estimated with easily accessible aggregate rather than individual data, using difference-in-difference estimation. However, under imperfect assignment within groups, this produces intent-to-treat estimates, which may not be the treatment effect of interest. This article provides a method for estimating local average treatment effects using aggregate data. I also suggest a data source that allows the method to be applied when treatment rates are not recorded.     

The impact of software piracy on inclusive human development: evidence from Africa

The study examines the effect of software piracy on inclusive human development in 11 African countries for which software piracy data is available for the period 2000–2010. The empirical evidence is based on instrumental variable panel Fixed Effects (FE) and Tobit models in order to control for the unobserved heterogeneity and limited range in the dependent variable. The modeling exercise is based on the inequality adjusted human development (IHDI) and its constituents. The following main findings are established. First, from the FE regressions, software piracy consistently improves the IHDI and its constituents. Within this framework, the positive relationship between inclusive human development and software piracy is driven by all its constituents. Second, for Tobit regressions, the positive relationship between software piracy and inclusive human development is confirmed exclusively in IHDI and literacy specifications. Within the latter framework, the positive relationship between software piracy and inclusive human is driven fundamentally by the literacy rate. Policy implications are discussed.     

Intergenerational Transmission of Education and Mediating Channels: Evidence from a Compulsory Schooling Reform in Germany

In this paper, I estimate the causal effect that an additional year of schooling for parents has on their children's education, by exploiting a compulsory schooling reform that was implemented in all West German states between 1946 and 1969. Although previous research indicates that the reform had no effect on earnings, I find that an additional year of schooling for women strongly affects the education of their sons. There is no effect for the other parent–child gender pairs. I investigate numerous channels that might mediate the positive effect of the education of mothers. Most importantly, I find that individuals with more schooling value their children's educational success as more important.     

Cost effectiveness of palivizumab in children with congenital heart disease in Germany

Abstract

Objectives: To assess the cost effectiveness of palivizumab, a humanised monoclonal antibody, used as prevention against severe respiratory syncytial virus (RSV) infection requiring hospitalisation, in infants with haemodynamically significant congenital heart disease (CHD) in the German healthcare setting.

Study design: A decision-tree model was used to estimate the cost effectiveness of palivizumab for a hypothetical cohort of patients. The analysis was based on a lifetime follow-up period in order to capture the impact of palivizumab on long-term morbidity and mortality resulting from an RSV infection. Data sources included published literature, the palivizumab pivotal trials, official price/tariff lists and national population statistics. The study was conducted from the perspective of society (primary analysis) and the healthcare purchaser (secondary analysis).

Results: From the societal perspective, use of palivizumab results in an incremental cost-effectiveness ratio (ICER) of €2,615 per quality-adjusted life-year (QALY) without discounting, which increases to €9,529/QALY after discounting. From the perspective of the German healthcare purchaser, use of palivizumab results in an ICER of €4,576/QALY without discounting, which increases to €16,673/QALY after discounting. Probabilistic sensitivity analyses confirmed the robustness of the model. The study is limited by a number of conservative assumptions. It was assumed that palivizumab only affects the occurrence of RSV hospitalisation and does not influence the severity of the RSV infection. Another assumption was that international clinical trial data and data on utilities could be applied to the German healthcare setting.

Conclusion: This analysis showed that palivizumab represents a cost-effective means of prophylaxis against severe RSV infection requiring hospitalisation in infants with haemodynamically significant CHD.     

Schooling and Citizenship in a Young Democracy: Evidence from Postwar Germany

This paper examines whether schooling has a causal impact on individuals' political behavior. Between 1949 and 1969, the number of compulsory years of schooling in the Federal Republic of Germany was gradually increased across all federal states. These legislative changes provide an opportunity to investigate the causal impact of schooling on political behavior. Years of schooling are found to be positively correlated with several political outcomes. However, there is little evidence of a causal effect. This study conjectures that there is ample historical evidence to support the hypothesis that the fundamentals of democracy were already learned earlier in school, potentially outweighing the political returns of schooling in Germany.     

The effect of childhood measles vaccination on school enrolment in Matlab,Bangladesh

There is increasing evidence that early childhood health interventions have long-term effects on cognitive development, educational achievement and adult productivity. We examine the effect of measles vaccination on the school enrolment of children in Matlab, Bangladesh. An intensive measles vaccination programme was introduced in one area in 1982, and extended to another in 1985, while a third area acted as a control. Using this staggered roll-out as an instrument, we find that age-appropriate vaccination raises the probability that a boy has enrolled in school by 7.4 percentage points but appears to have no effect on girls’ enrolment.     

The effect of female representation on political budget cycle and public expenditure: Evidence from Italian municipalities

This study analyzes the impact of the gender composition of political institutions on the political budget cycle (PBC) and on the size and structure of public expenditure. An instrumental variable approach is implemented to evaluate the influence of female politicians in municipal councils. The introduction of gender quotas for Italian municipalities is used as an exogenous variation in female participation in politics. The results show that: (i) fluctuations in local public spending are only slightly affected by the presence of a wider female representation; (ii) an increase in the number of elected women reduces the overall amount of public expenditure; (iii) this reduction involves fields typically affected by PBC (e.g., roads' maintenance) except those related to females' needs (e.g., kindergarten, primary education, and social care).     

L-carnitine in the management of patients after acute myocardial infarction: a cost effectiveness analysis in Italy

Summary

The prevalence of acute myocardial infarction (AMI) is estimated at 500,000 individuals in the Italian population; the annual incidence can be crudely estimated at 100,000 events. This represents a major healthcare problem and generates questions about the rational allocation of public resources devoted to healthcare, since in Italy there is a National Health Service. We focused on modelling the possible economic consequences of adding L-carnitine administration to the standard care of AMI patients in Italy, by extrapolating the results obtained in the SAVE trial and matching entry criteria from the CEDIM and SAVE studies. The cost-effectiveness ratios were explored using different assumptions of the effectiveness and cost of the intervention under analysis. In our base case, administering L-carnitine had an Incremental Cost/Effectiveness Ratio of 28.2 and 22.2 million Lira per life year saved (LYS), respectively, depending on whether discounted or non-discounted benefits were used in this model. The results were sensitive to both the cost and effectiveness of L-carnitine.     

瑞舒伐他汀联合环磷腺苷葡胺治疗急性心肌梗死对患者血清血管内皮生长因子-B和生长分化因子15水平的影响

目的探讨瑞舒伐他汀联合环磷腺苷葡胺治疗急性心肌梗死对患者血清血管内皮生长因子-B(VEFG-B)和生长分化因子15(GDF-15)水平的影响。方法选取2018年1月至2019年7月沈阳医学院附属中心医院收治的93例急性心肌梗死患者为研究对象,按照用药方案不同分为两组,对照组予以环磷腺苷葡胺注射液治疗,观察组在对照组基础上采用瑞舒伐他汀钙片治疗。比较两组患者治疗前后血清指标、心功能指标。结果两组患者治疗前各项血清指标比较差异无统计学意义(P>0.05);治疗后,两组肌酸激酶同工酶(CK-MB)、C反应蛋白(CRP)、肌红蛋白(Mb)、GDF-15、N-末端脑钠肽前体(NT-proBNP)、髓过氧化物酶(MPO)、肌钙蛋白Ⅰ(cTnⅠ)、同型半胱氨酸(Hcy)较治疗前明显下降,VEFG-B明显升高,且观察组改善幅度优于对照组,差异有统计学意义(P<0.05)。两组患者治疗前心功能指标比较差异无统计学意义(P>0.05);治疗后,两组每搏量、心输出量、左室射血分数较治疗前明显升高,且观察组高于对照组,差异有统计学意义(P<0.05)。结论采用瑞舒伐他汀联合环磷腺苷葡胺治疗急性心肌梗死,能改善患者心功能,对患者预后具有重要意义。     

The impact of health on wages: Evidence from the British Household Panel Survey

While income is generally considered an important determinant of health, little evidence has been offered on the reverse relationship, particularly for developed economies. This paper considers the effect of self-assessed general and psychological health on hourly wages using longitudinal data from six waves of the British Household Panel Survey. We employ single equation fixed effects and random effects instrumental variable estimators suggested by Hausman and Taylor (1981), Amemiya and MaCurdy (1986), and Breusch, Mizon and Schmidt (1989). Our results show that reduced psychological health reduces the hourly wage for males, while excellent self-assessed health increases the hourly wage for females. We also find the health variables to be positively correlated with the time-invariant individual effect. Further, we confirm the findings of previous work which suggested that the majority of the efficiency gains from the use of the instrumental variables estimators fall on the time-invariant endogenous variables, in our case academic attainment, and add further support to the hypothesis of a negative correlation between educational attainment and individual characteristics which affect wages. First version received: January 2000/Final version received: October 2000     

Hospital patients with severe wounds: early evidence on the impact of Medicare payment changes on treatment patterns and outcomes

Aims: This study examines the effects of recent changes in Medicare long-term care hospital (LTCH) payments on treatment patterns and outcomes for severe wound patients discharged from short-term acute care hospitals (STACHs).

Materials and methods: The rolling implementation of a new Medicare payment policy was used to develop a difference-in-difference model. The study population consisted of Medicare beneficiaries subjected to the payment policy changes and hospitalized for stage 3, 4, or unstageable wounds; non-healing surgical wounds; and fistula. Using 2015-Q1-2017 Medicare claims data, changes in outcomes were examined for severe wound patients exposed to the new policy (treatment) and those that were not (comparison). All outcomes were modeled using linear regressions and adjusted for patient clinical characteristics. Analysis was conducted in a full sample and a sample with high-LTCH-use propensity.

Results: Severe wound patients exposed to the new policy experienced 4.1 and 7.5 percentage point (pp) reductions in LTCH use relative to the comparison group in the full sample and high-LTCH-propensity sample, respectively (p?p?=?.039). No statistically significant change was found in 60-day mortality or Medicare spending after the policy change in the treatment group as compared to the comparison group (p?>?.10). However, among severe wound patients who are exposed to the new policy in the high-LTCH-propensity sample, readmission and post-discharge sepsis rates increased after the policy change relative to the comparison group (readmission rate = 8.1 pp, p?=?.075; sepsis rate = 7.0 pp, p?=?.033).

Limitations: The findings are based on data from a limited timeframe around the policy change and, thus, provide only early evidence on the effects of the new policy.

Conclusion: The new LTCH payment policy is associated with no changes in Medicare spending and mortality, but higher readmissions and post-discharge sepsis rates among severe wound patients with a high likelihood to use an LTCH.     

Exploring the causal effect of religious piety on dividend policy: evidence from historical religious identification

Theory suggests that religious piety is associated with greater risk aversion and more conservative financial policies. Returns to shareholders through dividends are much more certain than returns through capital gains expected to be realized far into the future. We hypothesize that religious piety leads to a higher likelihood of dividend payments. We exploit the variation in religious piety across the US counties and estimate the effect of religion on dividend policy. To draw a causal inference, we use historical religious piety in 1971 as the instrument. Our two-stage least squares results confirm that religious piety induces firms to pay larger dividends.     

The role of birth order in child labour and schooling

Does when a child was born relative to his or her siblings affect whether the child attends school or participates in child labour? We investigate this question by estimating the causal effect of birth order on the probabilities of school attendance and child labour participation. To address the potential endogeneity of family size, we use instrumental variable approach where the proportion of boys in the family is used to instrument family size. Using a longitudinal household survey data from Ethiopia, we estimate unobserved effects bivariate probit instrumental variable model of school attendance and child labour choices. The results suggest that the probability of child labour participation decreases with birth order, but we find no evidence that suggests birth order affects the probability of school attendance. However, among children who are going to school, hours spent studying increases with birth order. Results from complementary time-use analysis reveal that there is no birth order effect on hours spent on household chore. However, hours spent on school increases with birth order, where the increase in hours spent on school seems to come from a decrease in hours spent on market work.     

Intra-good trade in Germany: a first look at the evidence

This article contributes to the literature by using newly released comprehensive transaction-level data on all exports and imports to document facts about the amount of intra-good trade – the simultaneous export and import of identical goods by one firm – in Germany. Combined data for trade transactions and for characteristics of a representative large sample of trading firms are then used to report differences between firms that export and import different goods only (inter-good traders) and firms that engage in the simultaneous export and import of identical goods (intra-good traders). We find that the share of intra-good trade in total trade was some 17% in Germany in 2012. Intra-good trade matters. This share differs widely between broadly defined groups of goods and between industries. Controlling for detailed industry affiliation, intra-good traders differ significantly from inter-good traders – they are larger, more human capital intensive, more productive, have a higher R&D intensity and are more profitable. The data, however, are not rich enough to reveal the direction of causality between intra-good trade and firm performance and to investigate empirically the reasons why some firms engage in intra-good trade.     

Effects of a holiday trip on health and quality of life: evidence from a natural experiment in South Korea

We examine whether having a holiday trip affects an individual’s well-being, namely quality of life, health status, stress level and health behaviours. We use the two-stage estimation method to control for endogeneity of a travel experience, exploiting a natural experiment of distributing Travel Vouchers at random among qualified applicants in South Korea in 2012. We find that, for applicants whose decision to travel is influenced by receiving a voucher, a travel experience has no significant effects on the traveller’s well-being measured 3–12 months later. We also find that the OLS estimates overstate benefits of a travel.     

The effectiveness of quantitative easing: new evidence on private investment

This paper examines the effect of Federal Reserve’s large-scale purchases of securities on private investment. We find tentative evidence that quantitative easing (QE) stimulated the level of aggregate investment through the interest rate channel by narrowing corporate bond spread. In particular, the Fed’s purchases of mortgage-backed securities were found to have a statistically significant effect on aggregate private investment. Moreover, using a GARCH model, we find that QE has led to a reduction in the volatility of private investment. This finding remains robust with a QE dummy variable as an alternative measure of the unconventional monetary policy. The study also indicates how different aspects of QE influence private investment and its volatility.     

比伐卢定联合挽救性经皮冠状动脉介入治疗急性心肌梗死溶栓失败患者的疗效及安全性

目的探讨比伐卢定联合挽救性经皮冠状动脉介入治疗(PCI)治疗急性心肌梗死(ACI)溶栓失败患者的疗效及安全性。方法选取2017年9月至2020年6月辽宁省人民医院收治的98例ACI患者作为研究对象,按随机数字表法分为对照组与观察组,各49例。对照组接受肝素+挽救性PCI治疗,观察组采用比伐卢定+挽救性PCI治疗。比较两组血管再通率、血清心肌损伤标志物肌酸激酶同工酶(CK-MB)、肌钙蛋白T(cTnT)、肌钙蛋白Ⅰ(cTnⅠ)、超声心动图心功能参数左室射血分数(LVEF)、每搏输出量(SV)、左室舒张功能比值(E/A),随访并记录主要不良心血管事件发生情况。结果治疗后,两组患者的血管再通率差异无统计学意义(χ²=1.010,P=0.315);PCI术后,两组血清CK-MB、cTn T、cTnⅠ水平及超声LVEF、SV、E/A水平差异无统计学意义(t=1.283、1.163、0.795、0.351、0.309、0.471,P=0.101、0.124、0.214、0.363、0.379、0.319)。随访期间,观察组主要不良心血管事件发生率低于对照组患者(χ²=4.009,P=0.045)。结论伐卢定联合挽救性PCI用于急性心肌梗死溶栓失败患者的治疗,疗效与普通肝素相当,但在治疗安全性方面具有一定优势。     

Cost effectiveness analysis of immunotherapy in patients with grass pollen allergic rhinoconjunctivitis in Germany

Abstract

Objectives:

An economic evaluation was conducted to assess the outcomes and costs as well as cost-effectiveness of the following grass-pollen immunotherapies: OA (Oralair; Stallergenes S.A., Antony, France) vs GRZ (Grazax; ALK-Abelló, Hørsholm, Denmark), and ALD (Alk Depot SQ; ALK-Abelló) (immunotherapy agents alongside symptomatic medication) and symptomatic treatment alone for grass pollen allergic rhinoconjunctivitis.

Methods:

The costs and outcomes of 3-year treatment were assessed for a period of 9 years using a Markov model. Treatment efficacy was estimated using an indirect comparison of available clinical trials with placebo as a common comparator. Estimates for immunotherapy discontinuation, occurrence of asthma, health state utilities, drug costs, resource use, and healthcare costs were derived from published sources. The analysis was conducted from the insurant’s perspective including public and private health insurance payments and co-payments by insurants. Outcomes were reported as quality-adjusted life years (QALYs) and symptom-free days. The uncertainty around incremental model results was tested by means of extensive deterministic univariate and probabilistic multivariate sensitivity analyses.

Results:

In the base case analysis the model predicted a cost-utility ratio of OA vs symptomatic treatment of €14,728 per QALY; incremental costs were €1356 (95%CI: €1230; €1484) and incremental QALYs 0.092 (95%CI: 0.052; 0.140). OA was the dominant strategy compared to GRZ and ALD, with estimated incremental costs of ?€1142 (95%CI: ?€1255; ?€1038) and ?€54 (95%CI: ?€188; €85) and incremental QALYs of 0.015 (95%CI: ?0.025; 0.056) and 0.027 (95%CI: ?0.022; 0.075), respectively. At a willingness-to-pay threshold of €20,000, the probability of OA being the most cost-effective treatment was predicted to be 79%. Univariate sensitivity analyses show that incremental outcomes were moderately sensitive to changes in efficacy estimates. The main study limitation was the requirement of an indirect comparison involving several steps to assess relative treatment effects.

Conclusion:

The analysis suggests OA to be cost-effective compared to GRZ and ALD, and a symptomatic treatment. Sensitivity analyses showed that uncertainty surrounding treatment efficacy estimates affected the model outcomes.     

尿激酶静脉溶栓联合中药银杏二萜内酯葡胺治疗急性脑梗死患者的临床疗效

目的 探讨尿激酶静脉溶栓联合银杏二萜内酯葡胺治疗急性脑梗死患者的临床疗效.方法 按照不同的治疗方法将2019年6月至2020年6月鞍山市长大医院收治的97例急性脑梗死患者分为对照组和观察组,对照组(n=46)给予尿激酶静脉溶栓治疗,观察组(n=51)给予尿激酶静脉溶栓+银杏二萜内酯葡胺联合治疗.比较两组患者治疗效果、美...     

Research on effectiveness of technology transfer in technology alliances: evidence from Turkish SMEs

Many SMEs homed in newly industrialised countries are successful international players despite limited technological infrastructure and R&D resources. This study bridges a gap in the extant literature by examining the relationships between characteristics of partnership relationships, knowledge sharing and the effectiveness of technology transfer in partnerships between SMEs in developing countries and firms from developed countries. By studying data from Turkish SMEs and using partial least squares structural equation modelling, we find that explicit knowledge sharing forms the basis of technology transfer. Moreover, our findings demonstrate that explicit knowledge sharing is strongly contingent upon formalised technical support while trust and technical support seemed to be important antecedents of tacit knowledge sharing.