KIDNEY TRANSPLANTS AND THE SHORTAGE OF DONORS: IS A MARKET THE ANSWER?

This article examines the problem of kidney shortages for transplant in the United States. Following a study by Kaserman and Barnett, we reexamine the viability of allowing a market for cadaveric kidneys and estimate the implied equilibrium price based on our survey responses. In sharp contrast to the findings of Kaserman and Barnett, we estimate that a market equilibrium price for cadaveric kidneys may be prohibitively high. Consequently, we support other policy alternatives to increase supply, particularly presumed consent and mandated choice. Our findings also highlight the importance of obtaining data through experiments, rather than a survey, to estimate the impact of financial incentives. ( JEL I18, I12, I00)     

OBESITY AND NUTRIENT CONSUMPTION: A RATIONAL ADDICTION?

Recent research shows that the dramatic rise in obesity in the United States is due more to the overconsumption of unhealthy foods than underactivity. This study tests for an addiction to food nutrients as a potential explanation for the apparent excessive consumption. A random coefficients (mixed) logit model is used to test a multivariate rational addiction model. The results reveal a particularly strong addiction to carbohydrates. The implication of this finding is that price-based policies, sin taxes, or produce subsidies that change the expected future costs and benefits of consuming carbohydrate-intensive foods may be effective in controlling excessive nutrient intake. ( JEL D120, I120, C230)     

IMPLEMENTING A TRADE FACILITATION AGREEMENT IN THE WTO: WHAT MAKES SENSE?

Abstract.  In the Doha Round, trade facilitation is the negotiating issue in which the 'implementation issue' is most prominent. At the WTO (the Doha Development Agenda) the international community has approached the implementation problem as a challenge to restore mercantilist balance rather than as a need to build good economics into future agreements. The international community has taken on aggressively the development dimensions of trade facioitation through the development banks, bilateral aid agencies and other specialized institutions. Considerable funding has been provided. Though little progress has been made through WTO negotiations, the content of these development programs is supportive of development.     

Developing and applying a framework to evaluate participatory research for sustainability

The normative implications of participatory research imply ongoing social learning that ought to lead to personal and institutional transformation. Sustainability science also requires reflexive scientific practice in order to enable the co-generation of solutions that take account of uncertainty and multiple forms of knowledge. However, there is little published peer-reviewed material on how to assess to what degree the rhetoric regarding the benefits of participatory research are achieved in practice, particularly with regard to participatory research for sustainability. This paper outlines how linking the rationales for participatory research and for sustainability science to the principles of evaluation can deliver a conceptually coherent evaluation framework for assessment. The approach for evaluating participatory research in this context consists of framing the evaluation, i.e., setting boundaries on the subject within its social, political, environmental and institutional context and selecting appropriate criteria, methods and data sources. The application of the framework, using a summative evaluation of participatory research for sustainability in north-east Australia, illustrates its strengths and weaknesses, concluding with a consideration of its applicability to further participatory sustainability science.     

Regional and Sector-specific Determinants of Industry Dynamics and the Displacement–replacement Effects

In this paper, we empirically assess the importance of regional and sector-specific determinants of industry dynamics. To this aim we test three hypotheses (originally proposed by Shapiro and Khemani (1987, Int J Indust Organ 5:15–26)) for the relationship between the entry and exit of firms: independence, symmetry and simultaneity. Estimates from a panel data system of equations seem to confirm the simultaneity hypothesis for Spain, i.e. we find evidence of a displacement (replacement) effect between the gross rate of entry (exit) and the gross rate of exit (entry). Also, our results show that, irrespective of the hypothesis we use, both sectorial and regional variables affect entry and exit.

The macroeconomics of the labor market: three fundamental views

We distinguish and assess three fundamental views of the labor market regarding the movements in unemployment: (1) the frictionless equilibrium view; (2) the chain reaction theory, or prolonged adjustment view; and (3) the hysteresis view. While the frictionless view implies a clear compartmentalization between the short- and long-run, the hysteresis view implies that all the short-run fluctuations automatically turn into long-run changes in the unemployment rate. We assert the problems faced by these conceptions in explaining the diversity of labor market experiences across the OECD labor markets. We argue that the prolonged adjustment view can overcome these problems since it implies that the short, medium, and long-runs are interrelated, merging with one another along an intertemporal continuum.

Worth waiting for: increasing satisfaction by making consumers wait

A truism in the marketing literature, and among many marketing practitioners, is that requiring consumers to wait negatively impacts quality evaluations, purchase intentions and a range of other important outcomes. However, it is also true that consumer waiting or queuing has historically been considered from an operations perspective. The present research takes a different approach and examines waits in the context of their ability to function as a signal of quality. Four experiments demonstrate a required wait can indeed signal quality to consumers and increase, rather than decrease, both purchase intentions and actual experienced satisfaction. Three moderators of this effect are examined: preexisting knowledge, consumption motivations, and the extent to which quality is difficult to objectively determine. The results suggest in situations where quality is important, unknown or ambiguous, managers may increase consumer satisfaction by making consumers wait.     

The cost-effectiveness of solifenacin vs. trospium in the treatment of patients with overactive bladder in the German National Health Service

Objective:

To carry out a cost–utility analysis comparing initial treatment of patients with overactive bladder (OAB) with solifenacin 5?mg/day versus either trospium 20?mg twice a day or trospium 60?mg/day from the perspective of the German National Health Service.

Methods:

A decision analytic model with a 3 month cycle was developed to follow a cohort of OAB patients treated with either solifenacin or trospium during a 1 year period. Costs and utilities were accumulated as patients transitioned through the four cycles in the model. Some of the solifenacin patients were titrated from 5?mg to 10?mg/day at 3 months. Utility values were obtained from the published literature and pad use was based on a US resource utilization study. Adherence rates for individual treatments were derived from a United Kingdom general practitioner database review. The change in the mean number of urgency urinary incontinence episodes/day from after 12 weeks was the main outcome measure. Baseline effectiveness values for solifenacin and trospium were calculated using the Poisson distribution. Patients who failed second-line therapy were referred to a specialist visit. Results were expressed in terms of incremental cost–utility ratios.

Results:

Total annual costs for solifenacin, trospium 20?mg and trospium 60?mg were €970.01, €860.05 and €875.05 respectively. Drug use represented 43%, 28% and 29% of total costs and pad use varied between 45% and 57%. Differences between cumulative utilities were small but favored solifenacin (0.6857 vs. 0.6802 to 0.6800). The baseline incremental cost–effectiveness ratio ranged from €16,657 to €19,893 per QALY.

Limitations:

The difference in cumulative utility favoring solifenacin was small (0.0055–0.0057 QALYs). A small absolute change in the cumulative utilities can have a marked impact on the overall incremental cost-effectiveness ratios (ICERs) and care should be taken when interpreting the results.

Conclusion:

Solifenacin would appear to be cost-effective with an ICER of no more than €20,000/QALY. However, small differences in utility between the alternatives means that the results are sensitive to adjustments in the values of the assigned utilities, effectiveness and discontinuation rates.