Cost-effectiveness analysis of quadrivalent influenza vaccination in at-risk adults and the elderly: an updated analysis in the UK

Abstract

Objective:

To update an earlier evaluation estimating the cost-effectiveness of quadrivalent influenza vaccination (QIV) compared with trivalent influenza vaccination (TIV) in the adult population currently recommended for influenza vaccination in the UK (all people aged ≥65 years and people aged 18–64 years with clinical risk conditions).     

The political economy of preferential trade arrangements: The case of Japan

ABSTRACT

Support for open trade regimes varies. We analyze Japanese survey data on individuals' preferences for TPP, unilateral import liberalization, and East Asian economic integration, and compare factors influencing policy preferences. First, despite the massive negative campaigns against TPP, 42.8% of individuals support Japan’s participation in TPP, vs. 21.1% against. Second, economic factors do matter for an individual in determining his/her policy preference over TPP. Third, noneconomic factors such as gender, age, access to accurate information, and attachment to hometown also feature as determinants. Fourth, although preferences over TPP and other policy options are positively correlated, some factors decrease TPP support but do not undermine support for two other less-politicized policy options: lack of access to accurate information and some industry and regional TPP-specific factors. Criticism impacts negatively on FTA policy preferences. Finally, we discuss economic policy implications for relationships between China, Japan, and Korea.

Abbreviations: FTA: Free trade agreement; JA: Japan agricultural cooperative; TPP: Trans-Pacific partnership agreement.     

China–US trade: implications on conflicts

ABSTRACT

In this study, we examine various aspects of China’s trade, the U.S.’ trade, and the bilateral trade between the two countries. The analysis of each aspect has direct and indirect implications on trade conflicts between the two countries. We focus on important factors, such as the growth of trade, import penetration, increased competitiveness of Chinese firms, comparative advantages of Chinese goods, China’s WTO entry and its compliance, and bilateral trade imbalance. While each of the factors can lead to trade frictions, individual factors will not have led to a large-scale trade war. These factors converge within a brief period and thus can be considered the China shock, thereby making other countries’ adjustments to their economic structures difficult. Therefore, trade frictions are inevitable.     

Management of vaccinations in Italy: a national survey after healthcare regionalization

Abstract

Objectives:

The main aim of this study was to describe the effects of regional organization and performance in managing vaccinations, in the light of the institutional devolution recently introduced in Italy.

Methods:

We analysed (1) the general organization of regions for vaccination programmes, (2) the management of four vaccination programmes (combined measles-rubella-parotitis, varicella for children, influenza, and pneumococcal 23-valent for adults).

First, we conducted preliminary face-to-face interviews with 16 regional managers of the infective disease prevention departments. Subsequently, we sent them a standardized questionnaire to obtain comparable information on general organization and on the four specific vaccination programmes considered. In all, 14 regions were eventually included.

Results:

The survey showed a widespread lack of regional staff involved in the management of vaccinations and a geographical variation in the availability of computerized data collection. We recorded poor coverage for varicella and pneumococcal 23-valent vaccinations compared to MRP and influenza. Prices of the four vaccines varied widely among regions, with only a weak correlation between prices and volumes.

Limitations and conclusions:

The major limitation of the survey was the lack of information available at regional level. The piecemeal diffusion of computerized systems and the widespread lack of sufficient staff should mainly explain this.

Economic incentives could be offered to regions that achieve national targets. Such incentives should encourage collaboration between central and regional authorities consistent with institutional trends in regional devolution.     

Social capital,knowledge sharing,and innovation capability: an empirical study of R&D teams in Iran

Effectively encouraging employees to share valuable knowledge can increase and sustain a firm's competitive advantages. This study adopted an integrated approach to understand casual relationships among knowledge sharing (KS) enablers (social capital factors), mechanism of forming KS behaviours (knowledge collecting and knowledge donating) through individuals’ KS intention, and KS outcome (innovation capability) within research and development teams. The research model was developed by reviewing literature and tested with survey data collected from 230 employees in multiple companies in Iran. Results of partial least squares analysis indicated that social interaction ties (as a structural capital factor), trust, reciprocity, and team identification (as relational capital factors) significantly associated with KS intention. KS intention, in turn, was significantly related to KS behaviours (knowledge colleting and knowledge donating). In addition, findings revealed that members’ willingness to collect and donate knowledge can affect team innovation capability. This study also discusses the implications for fostering social capital and KS behaviours to enhance team innovation capability.     

Perceived trade-off between education and sports career: evidence from professional football

To explore the attitudes towards risky career choices of young people in highly competitive environments, we surveyed almost 1000 football players in the youth academies of German professional clubs (Bundesliga), who must generally decide early in their careers whether or not to risk quitting school to focus solely on a professional football career. Based on the survey responses, we empirically analysed which factors influence these youths’ tendencies to choose a high-risk career option over a lower risk one. Our results seem to indicate that such risk taking in competitive environments can be explained by potential benefits expected from this decision, as well as judgments about the likelihood of achieving the desired career. Risk attitudes towards career choices vary by differences in individuals’ estimates of the potential benefits and in particular, in their own assessments of the likelihood of success, which is an important driver of risk acceptance. We also found that opportunity cost considerations influence risk acceptance: the better the low-risk option, the less willing the individual to give it up for a high-risk alternative. In addition, both national origin and level of cultural integration play a role in attitudes towards risky career choices, with reductions in the latter increasing the risk premium of quitting school.     

The role of corruption and risk aversion in entrepreneurial intentions

The literature on entrepreneurship has suggested that an individual’s entrepreneurial intention depends on three types of factor: personal characteristics, the individual’s expertise and professional background, and external factors. Our study investigates how corruption, an external factor, and risk aversion, a personal characteristic, may simultaneously affect individuals’ entrepreneurial intentions. With data on 76 203 individuals in 53 countries, our estimation results indicate that risk aversion decreases the individual’s probability of having an entrepreneurial intention by 6.67 percentage points. In addition, an increase in 1 SD in the perceived level of corruption in a country decreases the individual’s probability of having an entrepreneurial intention by 0.96 percentage points.     

Health economic evaluation of a vaccine for the prevention of herpes zoster (shingles) and post-herpetic neuralgia in adults in Belgium

Abstract

Objective:

To determine the cost-effectiveness of vaccination against herpes zoster (HZ) and post-herpetic neuralgia (PHN) in individuals aged 60 years and older in Belgium.

Methods:

A Markov model was developed to compare the cost-effectiveness of vaccination with that of a policy of no vaccination. The model estimated the lifetime incidence and consequences of HZ and PHN using inputs derived from Belgian data, literature sources, and expert opinion. Cost-effectiveness was measured by the incremental cost-effectiveness ratio (ICER), expressed as cost per quality-adjusted life-year (QALY) gained.

Results:

Vaccination in individuals aged 60 years and older resulted in ICERs of €6,799 (third party payer perspective), €7,168 (healthcare perspective), and €7,137 (societal perspective). The number needed to vaccinate to prevent one case was 12 for HZ, and 35 or 36 for PHN depending on the definition used. Univariate sensitivity analyses produced ICERs of €4,959–19,052/QALY; duration of vaccine efficacy had the greatest impact on cost-effectiveness. Probabilistic sensitivity analysis showed at least a 94% probability of ICERs remaining below the unofficial €30,000 threshold.

Discussion:

Key strengths of the model are the combination of efficacy data from a pivotal clinical trial with country-specific epidemiological data and complete sensitivity analysis performed. Main limitations are the use of non country-specific PHN proportion and non Belgian disease-specific utilities. Results are comparable with those recently published.

Conclusions:

HZ vaccination in individuals aged 60 years and older would represent a cost-effective strategy in Belgium.     

Higher-order risk preferences in social settings

We study prudence and temperance (next to risk aversion) in social settings. Previous experimental studies have shown that these higher-order risk preferences affect the choices of individuals deciding privately on lotteries that only affect their own payoff. Yet, many risky and financially relevant decisions are made in the social settings of households or organizations. We elicit higher-order risk preferences of individuals and systematically vary how an individual’s decision is made (alone or while communicating with a partner) and who is affected by the decision (only the individual or the partner as well). In doing so, we can isolate the effects of other-regarding concerns and communication on choices. Our results reveal that the majority of choices are risk averse, prudent, and temperate across social settings. We also observe that individuals are influenced significantly by the preferences of a partner when they are able to communicate and choices are payoff-relevant for both of them.     

Balancing market liquidity: Bank Structural Reform caught between growth and stability

Abstract

The European Commission’s proposal for a Bank Structural Reform (BSR) aimed at increasing banks’ resolvability through separating risky trading activities from deposit-taking institutions. In contrast to initial plans, the final proposal exempted market-making activities of banks. This exemption, we argue, was brought about by the Commission’s discursive framing of the BSR as a balancing act between stability and growth. Coupled with the incapacity to unambiguously measure the effects of the reform on market liquidity and on growth, this pushed the assessment of market-making from the technical to the political realm, leading to a reproduction of the prevalent market-based banking system.     

Impact on health outcome and costs of influenza treatment with oseltamivir in elderly and high-risk patients

Summary

The main objective of this study was to evaluate health outcomes and costs to the healthcare payer of treating influenza with oseltamivir in a high-risk population. Data from published literature, clinical trials and public sources were used to develop a decision-analytic model simulating a high-risk population in the UK. The underlying clinical pathway predicts morbidity and mortality due to influenza, and its specified complications for the two influenza treatment strategies—oseltamivir and usual care. Health outcomes (quality-adjusted life years [QALYs], days to return to normal activity) and costs were estimated for events in the model. Robustness of the results was tested by probabilistic, univariate and multivariate sensitivity analyses.

Treatment with oseltamivir within 48 hours results in reduced morbidity, which translates into faster recovery and return to normal activity. Economic evaluation showed that treatment with oseltamivir in a high-risk population in the UK is a cost-effective strategy in all analysed scenarios with cost-utility ratios between £225 and £17,900 per QALY gained.

Treatment with oseltamivir is effective in terms of health outcome and cost for high-risk patients from the perspectives of the individual patient and healthcare payer.     

Cost effectiveness of oseltamivir treatment of influenza: a critique of published methods and outcomes

Objective: The objective of this review was to determine, from a systematic assessment of published data, the cost effectiveness of the neuraminidase inhibitor antiviral medication oseltamivir in comparison with usual care (i.e. over-the-counter medication such as analgesics and antipyretics for symptomatic relief) for the treatment of influenza. How the findings of each of the studies considered related to the methods used for each analysis and the assumptions made were specifically reviewed.

Results: The online search found 80 individual articles, 66 of which did not meet the pre-defined screening criteria. The 14 studies remaining reported cost, cost-effectiveness and cost-utility analyses for oseltamivir treatment in various groups: healthy adults and adolescents, children, elderly, and individuals at increased risk.

Conclusion: Despite the range of values assumed for key probabilities such as the diagnostic certainty of influenza among people presenting with influenza-like illness, and how much work time is lost due to illness in healthy adults, base-case analyses consistently showed oseltamivir treatment to be cost effective or even cost saving for the four population groups studied, a conclusion that is in-line with previous reviews on this topic. However, clarity was frequently lacking in the published data in terms of various model assumptions and results, particularly with regards to the exact distributions of the constituting elements of savings and of quality-adjusted life years gained.     

The impact of behavioural risk-reduction interventions on willingness to pay to avoid sexually transmitted infections: a stated preference study of justice-involved youth

Risky health behaviours, such as smoking, drinking and risky sex, are substantial contributors to the U.S. morbidity rates and healthcare costs. While economic models typically regard preferences as stable, a growing literature suggests that information, including how it interacts with intentions and attitudes, plays an important role in unhealthy behaviours. Relatedly, a large health literature demonstrates that theory-based behavioural interventions can successfully change risky behaviour. This study uses the contingent valuation (CV) survey method to investigate the impact of behavioural interventions on a novel outcome measure: the willingness to pay (WTP) to avoid the consequences associated with risky behaviour. Using novel pre- and post-intervention data from Project MARS (Motivating Adolescents to Reduce Sexual Risk), this study estimates the impact of the intervention on elicited WTP to avoid sexually transmitted infections (STIs). It is found that after the intervention, participants’ elicited WTP to avoid STIs were significantly higher, and more sensitive to differences in infection severity. These results suggest that the intervention may affect risky sexual behaviour by changing the perceived value of avoiding the consequences of risky sexual behaviour. Additionally, these findings contribute to an ongoing debate regarding the construct validity of CV studies in health economics.     

Who participates in tax avoidance? Evidence from Swedish microdata

This article empirically examines why not all individuals participate in tax avoidance. We use rich Swedish administrative panel data on all taxpayers, with a link between corporate and individual tax returns and document that few individuals utilize legal and observable tax avoidance opportunities. Our results show that there are several frictions in tax avoidance participation. In addition to monetary benefits from tax avoidance (incentives), the opportunity to participate in tax avoidance (access), as well as information and knowledge about these opportunities (awareness), are important factors for the individual’s tax avoidance decision. We further show that tax avoidance spreads within communities. The impact of the local network is stronger for non-commuters who live and work in the same municipality.     

Intertemporal substitution in import demand and the role of habit formation: an application of Euler equation approach for Pakistan

Introduction

The study examines the importance of intertemporal substitution in import demand considering the role of habit formation. A two-goods version of the permanent income model is used in which time-non-separability in consumers’s preferences is assumed. The model is estimated using annual data for Pakistan at disaggregated level covering the period from 1977 to 2017.

Objectives

The objective of the study is to estimate elasticities of substitution along with parameters of habit formation for consumption goods at a disaggregated level.

Method

The study employs co-integration for the estimation of parameters of elasticities of substitution and generalized method of moments (GMM) for the estimation of the parameters of habit formation from Euler equations.

Findings

The estimates of intertempral elasticity of substitution suggest that the nature of commodity group (necessity/luxury) plays an important role when consumers are making intertemporal choices. Moreover, the study finds that intratemporal elasticity of substitution is larger than intertempral elasticity of substitution in almost all cases in Pakistan, suggesting that imported and domestic goods are best described as substitutes in Edgeworth-Pareto sense. In addition, the inclusion of habit formation delivers results with plausible signs and the habit formation process seems significant for certain commodity groups including tea, beverages, tobacco products and drugs.

Conclusion

The study concludes that there is a possibility of crowding out effect on domestic consumption and the depreciation of local currency may improve Pakistan’s balance of trade.

     

Misery loves company: Social regret and social interaction effects in choices under risk and uncertainty

Extensive field evidence shows individuals? decisions in settings involving uncertainty depend on their peers? decisions. One hypothesized cause of peer group effects is social interaction effects: an individual?s utility from an action is enhanced by others taking the same action. We employ a series of controlled laboratory experiments to study the causes of peer effects in choice under uncertainty. We find strong peer group effects in the laboratory. Our design allows us to rule out social learning, social norms, group affiliation, and complementarities as possible causes for the observed peer group effects, leaving social interaction effects as the likely cause. We use a combination of theory and empirical analysis to show that preferences including “social regret” are more consistent with the data than preferences including a taste for conformity. We observe spillover effects, as observing another?s choice of one risky gamble makes all risky gambles more likely to be chosen.     

Optimal Controls for a Large Insurance Under a CEV Model: Based on the Legendre Transform-Dual Method

The purpose of this paper is to consider the optimal proportional reinsurance and investment strategies for an insurance company. The insurer’s surplus process is approximated by a Brownian motion with drift. The insurance company can purchase proportional reinsurance and invest the surplus in a financial market which includes one risk-free asset and one risky asset whose price is modeled by a CEV model. The primary problem is changed to the dual problem by implying Legendre transform. When the objective of the insurance company is to maximize the expected logarithmic utility from terminal wealth, the closed-form expressions for the optimal reinsurance-investment policy which is different to the Merton case to the primal optimal problem are obtained and numerical simulations are provided to demonstrate our results. Moreover, we find an interesting result that risk exposure is non-monotonic in the cost of reinsurance.

     

On the origin of money,or Menger’s one-sided reading of Genovesi’s Lezioni

Abstract

By examining Menger’s interpretation of Genovesi’s arguments on the origin of money, this note shows that Genovesi is a subtle theorist managing to blend the Cartalist with the Mengerian approaches to the origins of money. Far from resting exclusively on the Mengerian unattended consequences of the uncoordinated behaviours of rational agents trying to minimise their transaction costs, Genovesi shows how governments can and do create fiat money with a positive value in connexion with their ability to raise taxes. For Genvesi both trust (à la Menger) and authority (à la Cartalist) are necessary to explain the positive value of money.     

Heterogeneous Firms in Importing: Theory and Evidence from China

In this study, I explore the effects of the financial status of firms on its decisions to import. The import decision is reflected in various aspects, such as whether to import or buy from home market; what types of goods to import, etc. A novelty of this analysis is that I distinguish between ordinary trade and processing trade, which involves importing inputs to be assembled and re-exported. Several novel patterns emerge. Firstly, a firm’s financial status, especially its liquidity, significantly influences its decisions to import. Secondly, regional financial development also has a significantly affect importing decisions. However, a firm’s creditworthiness and regional factors work independently (i.e., regional financial development does not alleviate a firm’s credit constraints). The findings yield implications for developing economies which demand technological spillovers from advanced markets and those which maintain large trade surpluses with the developed economies.     

Quantifying South Africa's crude oil import risk: A multi-criteria portfolio model

A major consequence of South Africa's strong economic growth since the democratic dispensation of 1994 is the rapid increase in domestic demand for oil energy. With small amounts of proven oil reserves, the rise in oil demand as an energy source has resulted in South Africa's growing dependence on external sources for its domestic crude oil needs. High oil prices, instability in major oil producing regions and the rise in ‘oil-nationalism’ are major concerns for the security of South Africa's oil supplies. Accordingly, a comprehensive understanding of oil import security risks can serve as a vital guide in formulating any energy policy framework(s) aimed at alleviating the impact of such risks. This study utilises portfolio theory and develops an empirical framework to provide quantitative measures of systematic and specific risks of South Africa's crude oil imports over the period 1994 to 2007. The paper examines the relationship between supply sources diversification and oil energy security risks, and provides an objective evaluation of different import adjustment strategies on South Africa's total crude oil import risks. The results show that a policy of having constant monthly imports from each supply region reduces the specific and systematic risks of the oil import portfolio by an average rate of 71% and 2.9% respectively. Significant reduction in specific risks of South Africa's oil imports is achieved if imports from risky regions (mainly the Middle East) can be diversified to relatively less risky regions of Europe and North America.